bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II
Authors: Tumlin James A. , Murugan Raghavan , Deane Adam M. , Ostermann Marlies , Busse Laurence W. , Ham Kealy R. , Kashani Kianoush , Szerlip Harold M. , Prowle John R. , Bihorac Azra , Finkel Kevin W. , Zarbock Alexander , Forni Lui G. , Lynch Shannan J. , Jensen Jeff , Kroll Stew , Chawla Lakhmir S. , Tidmarsh George F. , Bellomo Rinaldo 
Published: March 2018

Objective:
Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy.

Design:
Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial.

Setting:
ICUs.

Patients:
Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively).

Interventions:
IV angiotensin II or placebo.

Measurements and Main Results:
Primary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%–67%) and 30% (95% CI, 19%–41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%–54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%–27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%–68%) and 22% (95% CI, 12%–34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively.

Conclusions:
In patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II.
Systematic Review of Standardized Patient Use in Continuing Medical Education
Authors: Wilbur Kerry , Elmubark Alaa , Shabana Sara 
Published: March 2018

Introduction:
The standardized patient (SP) has assumed a fundamental role in undergraduate medical education since first conceived over 50 years ago. While widely used in student training and assessment of communication and clinical examination across health disciplines, little is known how SPs enhance knowledge or skill development among professionals. We conducted a systematic review to determine the effectiveness of SPs in continuing medical education (CME) programs.

Methods:
Authors independently searched for studies published between 1966 and 2016, describing CME initiatives using SP encounters as practice for participants compared with those which did not. Studies assessing virtual patients or mannequins or employing SPs for assessment only were excluded. Learning outcomes were characterized according to the Kirkpatrick framework for determining the effectiveness of training programs.

Results:
Four hundred eighty-eight studies were identified, but only five were eligible for analysis. Most were conducted with small numbers of primary care physicians in North America. CME topics related to opioid prescribing, breast cancer examination and cancer screening, smoking cessation, and chronic asthma management. In the two studies testing knowledge, no difference was found between intervention and control groups (Kirkpatrick level 2). Improved behaviors were demonstrated in breast cancer patient examination and interview and decreased opioid-prescribing rates among selected participants in two studies (Kirkpatrick level 3). Only one study investigated patient outcomes and found reduced rates of uncontrolled asthma in practices of physicians who were assigned to SP practice encounters in the CME training (Kirkpatrick level 4).

Discussion:
There is little rigorous outcome study of CME programs incorporating SPs. Given the necessary human and fiscal resources associated with their use, our review highlights the need to reconsider the SP role in CME unless further purposeful evaluation to determine participant behavior change and related patient outcomes is pursued.
Assessment of Interprofessional Team Collaboration Scale (AITCS): Further Testing and Instrument Revision
Authors: Orchard Carole , Pederson Linda L. , Read Emily , Mahler Cornelia , Laschinger Heather 
Published: March 2018

Introduction:
The need to be able to assess collaborative practice in health care teams has been recognized in response to the direction for team-based care in a number of policy documents. The purpose of this study is to report on further refinement of such a measurement instrument, the Assessment of Interprofessional Team Collaboration Scale (AITCS) first published in 2012. To support this refinement, two objectives were set: Objective 1: to determine whether the items from the data collected in 2016 load on the same factors as found for the 2012 version of the 37-item AITCS. Objective 2: to determine whether the items in the subscales of the AITCS could be reduced while retaining psychometric properties similar to those from the earlier versions of the AITCS.

Methods:
Initially, the overall data sets of 1002 respondents from two hospitals and four community agencies were analyzed for demographics and scale and subscale mean values, SDs, and mean item scores. After deletion of respondents because of missing data, 967 respondents were available for the first analysis. An exploratory factor analysis was then conducted to determine the factor structure. All respondents with any random missing data were further removed to reduce the data set to 676 responses, followed by a confirmatory factor analysis to find a model fit resulting in an item reduction in the scale.

Results:
The result was a 23-item AITCS-II for practitioners that retained acceptable levels of reliability and validity within 3 subscales—partnership (8 items), cooperation (8 items), and coordination (7 items).

Discussion:
The shortened version of the AITCS-II is a valid and reliable instrument that can be used to assess collaboration in health care teams in practice settings.
Applications of Computer Technology in Complex Craniofacial Reconstruction
Authors: Day Kristopher M. , Gabrick Kyle S. , Sargent Larry A. 
Published: March 2018

Background:
To demonstrate our use of advanced 3-dimensional (3D) computer technology in the analysis, virtual surgical planning (VSP), 3D modeling (3DM), and treatment of complex congenital and acquired craniofacial deformities.

Methods:
We present a series of craniofacial defects treated at a tertiary craniofacial referral center utilizing state-of-the-art 3D computer technology. All patients treated at our center using computer-assisted VSP, prefabricated custom-designed 3DMs, and/or 3D printed custom implants (3DPCI) in the reconstruction of craniofacial defects were included in this analysis.

Results:
We describe the use of 3D computer technology to precisely analyze, plan, and reconstruct 31 craniofacial deformities/syndromes caused by: Pierre-Robin (7), Treacher Collins (5), Apert’s (2), Pfeiffer (2), Crouzon (1) Syndromes, craniosynostosis (6), hemifacial microsomia (2), micrognathia (2), multiple facial clefts (1), and trauma (3). In select cases where the available bone was insufficient for skeletal reconstruction, 3DPCIs were fabricated using 3D printing. We used VSP in 30, 3DMs in all 31, distraction osteogenesis in 16, and 3DPCIs in 13 cases. Utilizing these technologies, the above complex craniofacial defects were corrected without significant complications and with excellent aesthetic results.

Conclusion:
Modern 3D technology allows the surgeon to better analyze complex craniofacial deformities, precisely plan surgical correction with computer simulation of results, customize osteotomies, plan distractions, and print 3DPCI, as needed. The use of advanced 3D computer technology can be applied safely and potentially improve aesthetic and functional outcomes after complex craniofacial reconstruction. These techniques warrant further study and may be reproducible in various centers of care.
Living High and Feeling Low: Altitude, Suicide, and Depression
Authors: Kious Brent M. , Kondo Douglas G. , Renshaw Perry F. 
Published: March 2018

Learning objectivesAfter participating in this activity, learners should be better able to:• Assess epidemiologic evidence that increased altitude of residence is linked to increased risk of depression and suicide• Evaluate strategies to address hypoxia-related depression and suicidal ideationAbstractSuicide and major depressive disorder (MDD) are complex conditions that almost certainly arise from the influences of many interrelated factors. There are significant regional variations in the rates of MDD and suicide in the United States, suggesting that sociodemographic and environmental conditions contribute. Here, we review epidemiological evidence that increases in the altitude of residence are linked to the increased risk of depression and suicide. We consider the possibility that chronic hypobaric hypoxia (low blood oxygen related to low atmospheric pressure) contributes to suicide and depression, which is suggested by animal models, short-term studies in humans, and the effects of hypoxic medical conditions on suicide and depression. We argue that hypobaric hypoxia could promote suicide and depression by altering serotonin metabolism and brain bioenergetics; both of these pathways are implicated in depression, and both are affected by hypoxia. Finally, we briefly examine treatment strategies to address hypoxia-related depression and suicidal ideation that are suggested by these findings, including creatine monohydrate and the serotonin precursors tryptophan and 5-hydroxytryptophan.
Relationships Between Subcortical Shape Measures and Subjective Symptom Reporting in US Service Members With Mild Traumatic Brain Injury
Authors: Bolzenius Jacob D. , Wade Benjamin S. C. , Velez Carmen S. , Drennon Ann Marie , Cooper Douglas B. , Kennedy Jan E. , Reid Matthew W. , Bowles Amy O. , Thompson Paul M. , Gutman Boris , Lewis Jeffrey D. , Ritter John L. , York Gerald E. , Bigler Erin D. , Tate David F. 
Published: March 2018

Objective:
To assess interactions of subcortical structure with subjective symptom reporting associated with mild traumatic brain injury (mTBI), using advanced shape analysis derived from volumetric MRI.

Participants:
Seventy-six cognitively symptomatic individuals with mTBI and 59 service members sustaining only orthopedic injury.

Design:
Descriptive cross-sectional study.

Main Measures:
Self-report symptom measures included the PTSD Checklist-Military, Neurobehavioral Symptom Inventory, and Symptom Checklist-90-Revised. High-dimensional measures of shape characteristics were generated from volumetric MRI for 7 subcortical structures in addition to standard volume measures.

Results:
Several significant interactions between group status and symptom measures were observed across the various shape measures. These interactions were revealed in the right thalamus and globus pallidus for each of the shape measures, indicating differences in structure thickness and expansion/contraction for these regions. No relationships with volume were observed.

Conclusion:
Results provide evidence for the sensitivity of shape measures in differentiating symptomatic mTBI individuals from controls, while volumetric measures did not exhibit this same sensitivity. Disruptions to thalamic nuclei identified here highlight the role of the thalamus in the spectrum of symptoms associated with mTBI. Additional work is needed to prospectively, and longitudinally, assess these measures along with cognitive performance and advanced multimodal imaging methods to extend the utility of shape analysis in relation to functional outcomes in this population.
Should Routine Postoperative Clinic Visits Be Phased Out?
Authors: Litz Cristen N. , McGuire Margaret , Danielson Paul D. , Chandler Nicole M. 
Published: March 2018

Introduction
Postoperative clinic visits are often considered routine practice in pediatric surgery. The purpose of this study was to determine family preferences regarding routine clinic visits among those presenting for postoperative visits.

Methods
Patients aged 18–21 years or the parents/guardians of patients aged 0–17 years who underwent appendectomy, pyloromyotomy, umbilical/inguinal hernia repair, circumcision, or supernumerary digit removal between November 18, 2015, and October 28, 2016, were approached at the postoperative visit to complete a survey.

Results
The survey was completed by 151 participants. Clinic visits were preferred by 66% of respondents, and this did not differ by age, educational level, urgency of operation, work/school missed, or frequency of email use. Respondents with concerns that were addressed were more likely to prefer in-office follow-up (79%) compared with those whose concerns were not addressed (44%) or those without concerns (37%; p ≤ .01). There was a trend toward preference for in-office follow-up from respondents who traveled less than 15 minutes (<15 vs. 16–30 vs. >30 minutes: 81% vs. 60% vs. 62%, respectively; p = .09) and those evaluated by surgeons (surgeon vs. advanced practice provider: 71% vs. 58%, respectively; p = .06). Additional interventions were performed in eight patients (5%).

Discussion
Most families who present for postoperative clinic visits prefer follow-up in clinic despite the resources required to attend the visit.
Inflammatory Cytokine Profile in Crohn’s Disease Nonresponders to Optimal Antitumor Necrosis Factor Therapy
Authors: Yarur Andres J. , Jain Anjali , Quintero Maria A. , Czul Frank , Deshpande Amar R. , Kerman David H. , Abreu Maria T. 
Published: March 2018

Background:
A significant number of patients receiving therapy with antitumor necrosis factor (TNF) agents for Crohn’s disease experience primary or secondary nonresponse. The aim of this study was to assess whether patients with nonresponse to anti-TNF agents have increased expression of alternative cytokine pathways.

Methods:
We designed a prospective, cross-sectional study that included patients with Crohn’s disease receiving anti-TNF undergoing colonoscopy with adequate serum trough drug levels (≥8 µg/mL) and without anti-drug antibodies. Inflammatory cytokines and cell adhesions markers measured included intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1, interleukin (IL)-8, IL-1β, and IL-6. The primary outcome was the presence of active endoscopic inflammation defined as the presence of at least 1 ulceration ≥5 mm.

Results:
In total, 47 patients were included. Patients with active inflammation had significantly higher levels of ICAM-1 and IL-1β when compared with those without intestinal inflammation (45.9 vs. 35.8 ng/mL, P<0.0001 and 3.2 vs. 1.5 pg/mL, P=0.002, respectively). There were no significant differences in the other study variables. Using receiving operating curves, ICAM and IL-1β had a good correlation (receiver operating characteristic ≥0.8) with inflammation in this cohort of patients with “anti-TNF resistance.” The results were similar in the group of patients with previous anti-TNF exposure.

Conclusion:
Our study suggests that patients who have active inflammation with seemingly adequate serum anti-TNF levels have increased levels of specific inflammatory pathways that may serve as biomarkers of nonresponse as well as potential targets of therapy in anti-TNF nonresponders.
Esophageal Food Impaction
Authors: Melendez-Rosado Jose , Corral Juan E. , Patel Sheetal , Badillo Raul J. , Francis Dawn 
Published: March 2018

Goals:
The goal of this study is to examine the causes, type of adverse events (AE), and effects of elective intubation in outcomes associated with esophageal food impaction (EFI).

Background:
EFI is a gastrointestinal emergency requiring immediate medical attention.

Study:
Retrospective review of all EFI cases presenting at 3 large tertiary centers from October 1, 2011 to October 31, 2014 and all cases registered in the Clinical Outcome Research Initiative (CORI) database from January 1, 2000 to December 31, 2012. Statistical analysis compared health care utilization, AEs, and outcomes in patients with or without elective intubation.

Results:
A total of 214 cases presenting with EFI at our 3 referral hospitals and 4950 cases in the CORI database met inclusion criteria. Prevalence of structural disorders was similar in the Mayo Clinic and CORI datasets: 24.3% and 27.7% had strictures, and 3.8% and 2.5% had a tumor, respectively. AEs in the nonintubation group were 14.7% compared with 33.3% in the elective intubation group (P=0.003); however, 71.0% of these events were associated with EFI itself and not therapeutic procedure. Esophageal AEs were common (15.0%), followed by pulmonary and cardiovascular events with 3.0% and 1.4%, respectively. Severity of the AEs was influenced by the impaction-to-endoscopy time.

Conclusions:
Prevalence of structural esophageal disorders was similar to previous smaller studies. Elective intubation was associated with increased AEs; however, this is felt to be because of the nature of EFI itself and not by therapeutic endoscopy. Prolonged impaction-to-endoscopy time was associated with severe AEs.
The institutional development award states pediatric clinical trials network: building research capacity among the rural and medically underserved
Authors: Snowden Jessica , Darden Paul , Palumbo Paul , Saul Phil , Lee Jeannette 
Published: March 2018

Purpose of review
The institutional development award (IDeA) program was created to increase the competitiveness of investigators in states with historically low success rates for National Institutes of Health (NIH) research funding applications. IDeA states have high numbers of rural and medically underserved residents with disproportionately high rates of infant mortality, obesity, and poverty. This program supports the development and expansion of research infrastructure and research activities in these states. The IDeA States Pediatric Clinical Trials Network (ISPCTN) is part of the environmental influences on child health outcomes program. Its purpose is to build research capacity within IDeA states and provide opportunities for children in IDeA states to participate in clinical trials. This review describes the current and future activities of the network.

Recent findings
In its initial year, the ISPCTN created an online series on clinical trials, initiated participation in a study conducted by the pediatric trials network, and proposed two novel clinical trials for obese children. Capacity building and clinical trial implementation will continue in future years.

Summary
The ISPCTN is uniquely poised to establish and support new pediatric clinical research programs in underserved populations, producing both short and long-term gains in the understanding of child health.
TH1 and TH2 Cytokine Profiles as Predictors of Severity in Acute Pancreatitis
Authors: Rodriguez-Nicolas Antonio , Martínez-Chamorro Alba , Jiménez Pilar , Matas-Cobos Ana M. , Redondo-Cerezo Eduardo , Ruiz-Cabello Francisco 
Published: March 2018

Objectives
Acute pancreatitis (AP) is severe in up to 20% of patients, with a high mortality rate. Quantification of serum TH1 and TH2 cytokines may provide objective evidence to assess the severity of AP and predict its course.

Methods
One hundred seventeen patients were studied, measuring serum concentrations of interleukin (IL)1β, IL2, IL4, IL5, IL6, IL10, IL12p70, IL13, IL18, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN) γ, and tumor necrosis factor (TNF) α.

Results
Significant differences were found between patients with severe AP and those with mild or moderately severe AP in IFN-γ (P < 0.001), IL6 (P < 0.001), TNF-α (P = 0.002), GM-CSF (P < 0.001), IL4 (P = 0.002), IL1b (P = 0.017), and IL13 (P < 0.001) concentrations. Interferon-γ, IL6, and TNF-α were associated with severe AP, whereas GM-CSF, IL4, IL1b, and IL13 were associated with mild or moderately severe AP. The IL13/IFNγ ratio was significantly higher in patients with mild AP (P = 7.36 × 10−8).

Conclusions
A TH1 profile was associated with severe AP and a TH2 profile with mild or moderately severe AP. We report an IL13/IFNγ ratio of potential value to predict the prognosis in AP.
Weekend Effect in Acute Pancreatitis–Related Hospital Admissions in the United States
Authors: Sharma Prabin , Aguilar Rodrigo , Nader Mark Abi , Siddiqui Shaheryar , Baniya Ramkaji , Bhandari Sanjeeb Sudarshan , Cervantes Carmen Elena , Correa Ricardo , Masoud Amir 
Published: March 2018

Objective
This study aimed to assess the difference in overall outcomes between weekend admissions for acute pancreatitis (AP) and weekday admissions.

Methods
Between 2005 and 2012, data were extracted from the Nationwide Inpatient Sample on adult patients with AP. Exclusion criteria were applied for chronic pancreatitis and other pancreatic and biliary malignancies. In-hospital mortality, length of stay, hospitalization costs, comorbidities, complications, and intervention rates were compared between the weekend and weekday admissions.

Results
During the study period, there were a total of 432,303 weekday admissions and 147,435 weekend admissions for AP in the United States hospitals. Weekend AP admissions were more likely to develop alcohol withdrawal (5.9% vs 5.7%, P = 0.001) and ileus (4.1% vs 3.1%, P = 0.04). They were also more likely to develop acute respiratory distress syndrome (4.7% vs 4.4%, P < 0.001) and required more endotracheal intubation (3.9% vs 3.6%, P < 0.001). There was no significant in-hospital mortality difference between the weekend and weekday admissions on both univariate and multivariate analysis.

Conclusions
Weekend AP admissions develop more severe complications requiring intensive care. Despite this, there was no weekend effect for in-hospital mortality for AP-related admissions.
Establishment and Verification of a Scoring Model for the Differential Diagnosis of Pancreatic Cancer and Chronic Pancreatitis
Authors: Zhang Huimin , Han Wei , Jin Meng , Lai Yamin , Wang Xi , Wang Jian , Yao Yao , Wu Dong , Qian Jiaming , Yang Hong 
Published: March 2018

Objectives
The aims of this study were to establish a scoring model for the differential diagnosis of pancreatic cancer (PC) and chronic pancreatitis (CP) and to evaluate its diagnostic efficacy.

Methods
The data of 502 patients with PC and 210 patients with CP at the Peking Union Medical College Hospital from January 1999 to December 2013 were retrospectively analyzed. Binary logistic regression was applied to establish the prediction model for the differential diagnosis. The model was verified using the method of leave-one-out cross-validation.

Results
The scoring system was established with 5 variables including age, carbohydrate antigen 19-9 level, splenic vein invasion, irregular dilatation of the pancreatic duct, and nontruncated pancreatic duct stenosis. The score range was from −2 to 3. The area under the receiver operating characteristic curve of the objects was 0.779 (95% confidence interval, 0.744–0.814) (P < 0.01), indicating that the scoring system is good at differentiation of PC with CP. With a score of 1 as the diagnostic cut-off value, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate were 71.3%, 69.0%, 70.0%, 71.4%, and 70.2%, respectively.

Conclusions
The scoring model may improve the differential diagnosis of PC and CP and be useful in clinical practice.