bluuebunny/crossref_metadata_2025_split huggingface dataset:
Somatotopically specific primary somatosensory connectivity to salience and default mode networks encodes clinical pain
Authors: Kim Jieun , Mawla Ishtiaq , Kong Jian , Lee Jeungchan , Gerber Jessica , Ortiz Ana , Kim Hyungjun , Chan Suk-Tak , Loggia Marco L. , Wasan Ajay D. , Edwards Robert R. , Gollub Randy L. , Rosen Bruce R. , Napadow Vitaly 
Published: March 2019

Abstract
Although several studies have found that chronic pain is characterized by increased cross-network connectivity between salience network, sensorimotor network, and default mode network (DMN), a large sample-size investigation allowing for a more reliable evaluation of somatotopic specificity and subgroup analyses with linkage to clinical pain intensity has been lacking. We enrolled healthy adults and a large cohort of patients (N = 181) suffering from chronic low back pain (cLBP). To specifically link brain connectivity with clinical pain intensity, patients were scanned at baseline and after performing physical maneuvers that exacerbated pain. Compared with healthy adults, patients with cLBP demonstrated increased connectivity between the functionally localized back representation in the primary somatosensory cortex (S1back) and both salience network and DMN. Pain exacerbation maneuvers increased S1back connectivity to salience network regions, but decreased connectivity to DMN, with greater pain intensity increase associated with greater shifts in these connectivity patterns. Furthermore, only in patients with cLBP reporting high pain catastrophizing, DMN connectivity was increased to a cardinal node of the salience network, anterior insula cortex, which was correlated with increased postmaneuver pain in this cLBP subgroup. Hence, increased information transfer between salience processing regions, particularly anterior insula, and DMN may be strongly influenced by pain catastrophizing. Increased information transfer between the salience network and S1 likely plays an important role in shifting nociceptive afference away from self-referential processing, reallocating attentional focus, and affective coding of nociceptive afference from specific body areas. These results demonstrate S1 somatotopic specificity for cross-network connectivity in encoding clinical back pain and moderating influence of catastrophizing for DMN/insula connectivity.
People in pain make poorer decisions
Authors: Attridge Nina , Pickering Jayne , Inglis Matthew , Keogh Edmund , Eccleston Christopher 
Published: March 2019

Abstract
Chronic pain affects 1 in 5 people and has been shown to disrupt attention. Here, we investigated whether pain disrupts everyday decision making. In study 1, 1322 participants completed 2 tasks online: a shopping-decisions task and a measure of decision outcomes over the previous 10 years. Participants who were in pain during the study made more errors on the shopping task than those who were pain-free. Participants with a recurrent pain condition reported more negative outcomes from their past decisions than those without recurrent pain. In study 2, 44 healthy participants completed the shopping-decisions task with and without experimentally induced pain. Participants made more errors while in pain than while pain-free. We suggest that the disruptive effect of pain on attending translates into poorer decisions in more complex and ecologically valid contexts, that the effect is causal, and that the consequences are not only attentional but also financial.
Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening
Authors: Cheng Caleb , Ganz David A. , Chang Evelyn T. , Huynh Alexis , De Peralta Shelly 
Published: March 2019

ABSTRACT

Background:
Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened.

Purpose:
To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017.

Methods:
Specimens were rejected for the following reasons: expired specimen, lack of recorded collection date/time, lack of physician orders, incomplete patient information, and illegible handwriting. Multidisciplinary teams devised the following interventions: FIT envelope reminder stickers, automated FIT patient reminder phone calls, a laboratory standard operating procedure, an accessioning process at satellite laboratories, revisions to a clinical reminder when offering FIT, and provision of FIT-compatible printers to clinics.

Results:
Total specimens received each month ranged from 647 to 970. Fecal immunochemical test rejection rates fell from 28.6% in June 2017 to 6.9% in December 2017 with a statistically significant decrease (p-value = .015) between the intervention period (May 2017–October 2017) and the postintervention period (November 2017–May 2018).

Conclusions:
Targeted interventions with stakeholder involvement are essential in reducing the rejection rate.

Implications:
The decreased rejection rate saves resources by decreasing the need to rescreen patients whose specimens were rejected, and may improve CRC screening rates.
Veterans Health Administration Primary Care Provider Adherence to Prescribing Guidelines for Systemic Hormone Therapy in Menopausal Women
Authors: Cordasco Kristina M. , Yuan Anita H. , Danz Marjorie J. , Jackson LaShawnta , Yee Ellen F. , Tcheung Lueng Sophia , Washington Donna L. 
Published: March 2019

ABSTRACT

Background:
Systemic hormone therapy (HT) is effective for treating menopausal symptoms but also confers risks. Therefore, experts have developed clinical guidelines for its use.

Purpose:
We assessed primary care guideline adherence in prescribing systemic HT, and associations between adherence and provider characteristics, in four Veterans Health Administration (VA) facilities.

Methods:
We abstracted medical records associated with new and renewal systemic HT prescriptions examining adherence to guidelines for documenting indications and contraindications; prescribing appropriate dosages; and prescribing progesterone.

Results:
Average guideline adherence was 58%. Among new prescriptions, 74% documented a guideline-adherent indication and 28% documented absence of contraindications. Among renewals, 39% documented a guideline-adherent indication. In prescribing an appropriate dose, 45% of new prescriptions were guideline-adherent. Among renewal prescriptions with conjugated equine estrogen doses ≥0.625 mg or equivalent, 16% documented the dosing rationale. Among 116 prescriptions for systemic estrogen in women with a uterus, progesterone was not prescribed in 8.

Conclusions:
Guideline adherence in prescribing systemic HT was low among VA primary care providers. Failures to coprescribe progesterone put women at increased risk for endometrial cancer.

Implications:
Intervention development is urgently needed to improve guideline adherence among primary care prescribers of systemic HT for menopause. Similar assessments should be conducted in community settings.
Hepatic steatosis and patients with inflammatory bowel disease: when transient elastography makes the difference
Authors: Arieira Cátia , Monteiro Sara , Xavier Sofia , Dias de Castro Francisca , Magalhães Joana , Moreira Maria J. , Marinho Carla , Cotter José 
Published: March 2019

Background
Recent studies suggest an increased prevalence of hepatic steatosis (HS) in patients with inflammatory bowel disease (IBD). Features such as chronic inflammation, previous surgeries, drug-induced hepatotoxicity, malnutrition, and intestinal dysbiosis seem to be involved in its pathogenesis.

Aims
The aim of this study was to assess the frequency of HS in patients with IBD quantified by controlled attenuation parameter (CAP) and by clinical–analytical scores: Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI). The secondary aim was to investigate risk factors associated with HS in patients with IBD.

Patients and methods
A cross-sectional study was carried out including consecutive outpatients observed in our department between January and March 2017. HS was defined as HSI of at least 36 or FLI of at least 60 or CAP of greater than 248.

Results
A total of 161 patients were included, with a mean age of 40.6±12.8 years. There were 86 (53.4%) female patients. Overall, 62.7% had Crohn’s disease and 37.1% had ulcerative colitis. Moreover, 73 (45.3%) patients had CAP greater than 248, 27 (16.8%) had FLI greater than 60, and 46 (28.6%) had HSI greater than 36.
We found that patients with CAP of greater than 248 were more frequently obese (28.8 vs. 0.0% P<0.001), male (57.5 vs. 37.5% P=0.011), and presented more frequently with metabolic syndrome (23.9 vs. 4.5% P <0.001). With regard to IBD factors, patients with HS had a higher frequency of previous surgeries (31.5 vs. 12.5% P=0.003). In multivariate analysis, only male sex [odds ratio: 5.7 (95% confidence interval: 2.0–15.9); P=0.001] and previous surgeries [odds ratio: 5.9 (95% confidence interval: 1.5–22.9); P=0.011] were independent risk factors of HS.

Conclusion
In our cohort, the frequency of HS varied between 16.8 and 45.3% defined by noninvasive methods. We found that male sex and previous history of surgery were the independent risk factors of HS when quantified by transient elastography.
Benefits and Risks of Anticoagulation in Acute Coronary Syndrome
Authors: Pop Calin , Matei Claudia 
Published: March 2019

Background:
Both antiplatelets and anticoagulants are necessary in the management of acute coronary syndrome (ACS), although the exact proportion of antithrombotic effect that each drug and class should ideally provide remains a matter of ongoing study.

Area of Uncertainty:
Defining the best combination between the antiplatelet agents and oral anticoagulants (OACs) can be challenging. The choice is particularly important for special categories of patients with ACS who have an indication of a long-term OAC.

Data Sources:
A literature search regarding benefits and risks of anticoagulation in ACS was conducted through MEDLINE and EMBASE (past 20 years until September 2018).

Therapeutic Advances:
Many patients with ACS have an indication for long-term OACs. Those receiving dual antiplatelet therapy and anticoagulants are considered to be at a high bleeding risk. The addition of a vitamin K antagonist (VKA) imposes a target international normalized ratio of 2.0–3.0. When non-VKA oral anticoagulants are used, the lowest effective tested dose for stroke prevention should be applied. For most patients, triple therapy in the form of an OAC plus dual antiplatelet therapy [aspirin and P2Y12 inhibitors (usually clopidogrel)] should be considered for 3–6 months. Later, dual therapy (OAC plus aspirin or clopidogrel) should be considered for an additional 6 months. After 1 year, it is recommended that only the OAC is maintained. In cases of very high bleeding risk, triple therapy can be reduced to 1 month after ACS, continuing on dual therapy up to 1 year, and thereafter only anticoagulation. In general, the bleeding risk seems to be lower with non-VKA oral anticoagulants than VKA plus antiplatelet combination.

Conclusions:
Many risk factors for ischemic events and bleeding overlap. The clinician's challenges include monitoring patients' adherence and global assessment of the antithrombotic effect that incorporates antiplatelet and anticoagulant effects.
Contemporary management of hepatoblastoma
Authors: Hafberg Einar , Borinstein Scott C. , Alexopoulos Sophoclis P. 
Published: March 2019

Purpose of review
Hepatoblastoma is the most common primary pediatric liver malignancy. The goal of treatment in hepatoblastoma is complete surgical resection. Recently published multinational collaborative studies are better defining risk factors for disease recurrence and guide optimal treatment strategy.

Recent findings
Successful margin-negative resection of hepatoblastoma is dependent on the location and extent of disease as defined by the PRETEXT classification. Liver transplantation is an appropriate treatment modality when complete oncological resection requires total hepatectomy. In general, advanced PRETEXT class as well as histologic features, age at presentation, tumoral production of α-feto protein and the presence of metastatic disease adversely affect outcome. Hepatoblastoma is chemosensitive and significant downstaging can occur with the use of neoadjuvant chemotherapy allowing for less extensive hepatectomy. In addition, patients at moderate-to-high risk of postresection recurrence should receive neoadjuvant chemotherapy. Cisplatin-based chemotherapy can allow for resection of transplantation of patients with metastatic disease when complete metasatectomy can be achieved albeit with inferior results.

Summary
Treatment of hepatoblastoma with surgical resection or liver transplantation is associated with excellent long-term results in the setting of modern chemotherapy.
Clinical Nurse Leader Knowledge Production to Quality Improvement in a Seamless Trajectory
Authors: Bender Miriam , Spiva LeeAnna , Patrick Sara , Meffert Sarah , Moton Lonnie , Clarke Sharee , Mathis Kendra , Leclerc Lucy , Knotts Kimberly , Mount April 
Published: March 2019

Background:
Health systems are actively implementing Clinical Nurse Leader (CNL)-integrated care delivery across the United States.

Problem:
However, the CNL model is a complex health care intervention, making it difficult to generate evidence of effectiveness using traditional research frameworks.

Approach:
Participatory research is a growing alternative to traditional research frameworks, emphasizing partnership with target community members in all phases of research activities. This article describes a system-based participatory study that leveraged academic and practice knowledge to conduct research that was feasible and relevant, and which produced findings that were easily translated into systematic action by the health system.

Outcomes:
Study data were used to produce improvements in the health system's CNL onboarding process, role differentiation, performance, recruitment, and growth plus development.

Conclusions:
A participatory approach can be used in future CNL studies, providing a framework for research efforts and potentially speeding up CNL evidence generation and utilization in practice.
Patient Satisfaction With Telephone Nursing
Authors: Gustafsson Silje , Wälivaara Britt-Marie , Gabrielsson Sebastian 
Published: March 2019

Background:
Studies of patient satisfaction with telephone nursing can provide a better understanding of callers' needs and inform the improvement of services.

Purpose:
This study described patients' experiences and perceptions of satisfaction with telephone nursing.

Methods:
The design was nonexperimental and descriptive, with an inductive approach. Data were collected using open-ended questions in a questionnaire that was dispatched to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden.

Results:
Patients' satisfaction with telephone nursing was related to calm, clarity, and competence. Calm referred to the nurse remaining calm and composed during the call. Clarity was described as distinct, concrete, and practical advice on how to act, what to observe, and where to seek further assistance. Competence referred to both health care knowledge and caring skills.

Conclusion:
These aspects of nursing are dependent on each other and on-call telephone nursing services, which value patient satisfaction need to target all 3.
Associations Between Hospital-Level Patient Satisfaction Scores and Hospital-Acquired Pressure Ulcer Occurrences Among Medicare Stroke Patients
Authors: Odom-Maryon Tamara , Hu Hsou Mei , Tzeng Huey-Ming 
Published: March 2019

Background:
Limited research has explored the associations between the US Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings data and hospital-acquired pressure ulcer (HAPU) occurrences.

Purpose:
We examined the associations between the hospital-level patient satisfaction HCAHPS scores with hospital care experience reported by Medicare patients 65 years or older and the occurrence of HAPUs among Medicare patients with stroke.

Methods:
A matched case-control design was used. Patients with a history of stroke were identified using the 2011 Medicare fee-for-service patient data. Medicare Beneficiary Summary and Medicare Provider Analysis and Review files processed by the Chronic Conditions Data Warehouse were analyzed. Conditional logistic regression was used.

Results:
HAPUs occur less frequently among Medicare patients with stroke who received inpatient care at hospitals with higher patient satisfaction HCAHPS scores for nurses' communication skills and quietness at night for the areas around patient rooms.

Conclusions:
Using hospital-level patient satisfaction HCAHPS scores to monitor and project HAPU occurrences is recommended.
Pain and quality of life in youth with inflammatory bowel disease: the role of parent and youth perspectives on family functioning
Authors: Caes Line , Chambers Christine T. , Otley Anthony , Stinson Jennifer 
Published: March 2019

Abstract

Introduction:
Daily pain experiences are a common feature of pediatric inflammatory bowel disease (IBD), which can negatively influence their health-related quality of life (HRQOL). A holistic, family systems approach is needed to further our understanding of daily pain experiences in youth with IBD and their influence on youth's HRQOL.

Objectives:
The study's objectives were to (1) provide a detailed description of daily pain experiences in youth with IBD, (2) investigate the relative contribution of family functioning and pain in explaining youth's HRQOL, and (3) explore differences in parental and youth perspectives.

Methods:
Sixty youth with IBD (8–17 years) and a parent completed questionnaires to assess family functioning, HRQOL, and pain experiences within the past week. A subsample of 16 youth completed an online diary (7 days) about their pain experiences.

Results:
When including any pain experiences, higher youth-reported family satisfaction and lower pain intensity were related to better HRQOL, whereas higher parent-reported family cohesion and satisfaction indirectly related to youth HRQOL through lower pain intensity. When only accounting for abdominal pain, pain intensity related negatively with HRQOL, and only parent-reported cohesion showed an indirect relation with HRQOL through pain intensity. Diary data revealed large heterogeneity: abdominal pain, described as cramping, sharp, and/or stinging was most frequent, but other pain symptoms (eg, back pain and headache) often co-occurred.

Conclusion:
The findings provide a rich picture of the daily pain experiences of youth with IBD and underscore the importance of a family systems approach to understand how family functioning and pain symptoms influence HRQOL.
When Global ART Budgets Cannot Cover All Patients, Who Should Be Eligible?
Authors: Zhang Yi , Bärnighausen Till , Eyal Nir 
Published: March 2019

Background:
Widely expected cuts to budgets for global HIV/AIDS response force hard prioritization choices.

Setting:
We examine policies for antiretroviral therapy (ART) eligibility through the lens of the most relevant ethical approaches.

Methods:
We compare earlier ART eligibility to later ART eligibility in terms of saving the most lives, life-years, and quality-adjusted life-years, special consideration for the sickest, special consideration for those who stand to benefit the most, special consideration for recipients' own health needs, and special consideration to avoid denying ART permanently.

Results:
We argue that, in most low- and middle-income countries with generalized HIV/AIDS epidemic, ethically, ART for sicker patients should come before ART eligibility for healthier ones immediately on diagnosis (namely, before “universal test and treat”). In particular, reserving all ART for sicker patients would usually save more life-years, prioritize the sickest, and display other properties that some central ethical approaches find important, and that concern none—so ethically, it is “cross-theoretically dominant,” as we put it.

Conclusions:
In most circumstances of depressed financing in low- and middle-income countries with generalized HIV/AIDS epidemic, reserving all ART for sicker patients is more ethical than the current international standard.
Maxillofacial Injuries Due to Traffic Accidents
Authors: Roccia Fabio , Sotong Jacqueline , Savoini Matteo , Ramieri Guglielmo , Zavattero Emanuele 
Published: March 2019

Purpose:
The purpose of this retrospective study was to analyze the epidemiology, patterns, and management of maxillofacial due to road traffic accidents over a 17-year period.

Methods:
Between January 2001 and December 2017, 2924 patients with maxillofacial fractures were admitted to the Division of Maxillofacial Surgery, Turin, Italy.
The following data were analyzed: age, gender, data of the trauma, alcohol and drug abuse, mechanism of injury, fracture site, facial injury severity scale, associated injuries, type of treatment, and length of hospital stay.

Results:
Of the 605 patients included in the study, 419 were male and 186 were female (ratio, 2.2:1). The most common mechanism of injury was car accidents (62.6%).
More than half of the patients had fractures of the middle third of the maxillofacial skeleton.
Associated injuries were detected in 172 (45.5%) patients. In total 5.3% of patients did not undergo surgery. The average hospital stay was 7.3 days.

Conclusions:
This study shows an important reduction in maxillofacial fractures following road traffic accidents since the turn of the new millennium. At least in north-western Italy, road safety policies implemented in the last 30 years seem to have affected the behavior of motorists and motorcyclists.
Review of the Pathways Involved in the Osteogenic Differentiation of Adipose-Derived Stem Cells
Authors: Asserson Derek B. , Orbay Hakan , Sahar David E. 
Published: March 2019

Abstract
Grafts and prosthetic materials used for the repair of bone defects are often accompanied by comorbidity and rejection. Therefore, there is an immense need for novel approaches to combating the issues surrounding such defects. Because of their accessibility, substantial proportion, and osteogenic differentiation potential, adipose-derived stem cells (ASCs) make for an ideal source of bone tissue in regenerative medicine. However, efficient induction of ASCs toward an osteoblastic lineage in vivo is met with challenges, and many signaling pathways must come together to secure osteoblastogenesis. Among them are bone morphogenic protein, wingless-related integration site protein, Notch, Hedgehog, fibroblast growth factor, vascular endothelial growth factor, and extracellular regulated-signal kinase. The goal of this literature review is to conglomerate the present research on these pathways to formulate a better understanding of how ASCs are most effectively transformed into bone in the context of tissue engineering.