bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of adductor canal block and femoral nerve block after total-knee arthroplasty regarding analgesic effect, effectiveness of early rehabilitation, and lateral knee pain relief in the early stage
Authors: Tan Zhen , Kang Pengde , Pei FuXing , Shen Bin , Zhou ZongKe , Yang Jing 
Published: November 2018

Abstract

Background:
The aim of this study was to compare the analgesic effect on the lateral and overall knee and early rehabilitation between adductor canal block (ACB) and femoral nerve block (FNB) after total-knee arthroplasty.

Method:
Two hundred patients randomly participated in the study and were divided into the ACB group and FNB group in a randomized manner. All patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included visual analog scale (VAS) scores at rest and during activity, quadriceps strength, range of motion (ROM), total opioid consumption and complication occurrence, sleep interruptions caused by pain, postoperative nausea and vomiting (PONV), and postoperative length of stay (PLOS) before discharge in all groups. In the 90-day postoperative follow-up, we also observed the acute deep periprosthetic joint infection, wound breakdown, readmission, reoperations, inpatient falls, ROM, and patient satisfaction score.

Results:
The lateral knee VAS scores are lower in the FNB group at rest and during activity (2–24 hours postoperatively) compared with those in the ACB group. However, the overall knee VAS score, total opioid consumption and complication occurrence, sleep interruptions caused by pain, and PONV are similar between the FNB and ACB groups. When evaluating early rehabilitation, the quadriceps strength in the ACB group is superior to that in the FNB group 24 hours postoperatively. At 24, 48, and 72 hours postoperatively, ROM in the ACB group is significantly better than that in the FNB group. Furthermore, the ACB group has a shorter PLOS (4.5 ± 0.60 days) than the FNB group (5.3 ± 0.7 days). However, patient satisfaction score, readmission rate, inpatient falls, acute deep periprosthetic joint infection, and wound breakdown are not statistically significantly different between the 2 groups.

Conclusion:
The ACB does not relieve lateral knee pain in the early stage but provides similar analgesic effect and better effectiveness of early rehabilitation compared with FNB in patients undergoing TKA.
Effects of rehabilitation on spontaneous intramedullary spinal cord hemorrhage (hematomyelia) patient without surgery
Authors: Oh Hyun-Min , Nam Tae-Woo , Kim Ju-Hyun , Jung Tae-Du 
Published: November 2018

Abstract

Rationale:
Spontaneous intramedullary spinal cord hemorrhage (hematomyelia) is a rare disease and most cases have specific etiologies such as cavernous malformations and tumor. Most reported cases are about surgical treatment of intramedullary spinal cord hemorrhage, but there are no reports of rehabilitation effectiveness reported. This case reports the first case with positive effect of rehabilitation on a patient with intramedullary spinal cord hemorrhage, who did not undergo surgery.

Patient concerns:
A 79-year old female visited the department of emergency complaining of sudden-onset back pain, weakness and sensory disturbance in both lower extremities and voiding difficulty. The symptoms started 2 weeks prior to her visit.

Diagnoses:
Whole spine magnetic resonance imaging revealed intramedullary spinal cord hemorrhage at the C7-T3 level and preoperative diagnosis was spinal cavernous malformation.

Interventions:
Since the benefit of surgery was presumed to be low on her, she performed rehabilitation, divided into 2 sessions per day and each session took 30 min.

Outcomes:
After 3 months of rehabilitation, numeric pain rating scale of back pain decreased, and Berg Balance Scale score, Korean version of modified Barthel index score improved. On discharge, she was able to walk independently under supervision and void without Foley catheter.

Lessons:
This case suggests that early rehabilitation such as physical therapy is an effective treatment for improving function in patients with intramedullary spinal cord hemorrhage with or without operation
Primary squamous cell carcinoma of the endometrium in a woman of perimenopausal age
Authors: Zhang Chao , Zhang Hongyan , Yang Linqing , Wang Yunfei , Li Xiaoyu , Guo Jinfeng , Xu Jing 
Published: November 2018

Abstract

Rationale:
Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare entity, and only sporadic cases have been reported in the literature since the 1st report in 1892. This report describes a case of a perimenopausal woman with PSCCE.

Patient concerns:
A 47-year-old, human papilloma virus type 16-positive, perimenopausal woman was admitted to our hospital with irregular vaginal bleeding for 6 months and secondary anemia.

Diagnoses:
The patient was diagnosed with stage IIIc primary and moderately differentiated endometrial squamous cell carcinoma.

Interventions:
The patient underwent diagnostic curettage twice and cold knife conization (CKC). Following this total abdominal hysterectomy combined with bilateral adnexectomy and pelvic lymph node, dissection was performed. After the surgery, the patient was treated with radiotherapy and chemotherapy. Tumor markers were followed up regularly after the operation to monitor tumor recurrence and therapeutic effect.

Outcomes:
Ninety-two days after the operation, there was tumor recurrence of the left pelvic cavity and the patient died after 11 months of follow-up.

Lessons:
Intrauterine pathology after the 1st diagnostic curettage suggests that high-grade squamous intraepithelial lesion should make the clinician vigilant and investigate the origin of the lesion. Magnetic resonance imaging scans and tumor markers can be used to confirm the diagnosis as soon as possible and avoid unnecessary interventions like CKC.
Validation of modified fibrosis-4 index for predicting hepatocellular carcinoma in patients with compensated alcoholic liver cirrhosis
Authors: Kim Ji Hyun , Lee Minjong , Park Seung Woo , Kang Myungho , Kim Minjeong , Lee Sang Hoon , Kim Tae Suk , Park Jin Myung , Choi Dae Hee 
Published: November 2018

Abstract
Recently, modified fibrosis-4 index (mFIB-4) and the easy liver fibrosis test (eLIFT) were developed for predicting liver fibrosis in chronic liver disease patients. We evaluated whether the 2 tests can predict hepatocellular carcinoma (HCC) risk in alcoholic liver cirrhosis (ALC) patients.
A retrospective cohort of 924 ALC patients was assessed for HCC development. Four non-invasive serum biomarkers, mFIB-4, the eLIFT score, fibrosis-4 index (FIB-4), and aspartate aminotransferase to platelet ratio index (APRI) were tested using time-dependent analysis of areas under receiver operating characteristic curve (AUROC), DeLong, and log-rank tests.
During a median 4.8 years of follow-up, HCC occurred in 83 patients (9.0%). For predicting HCC development at 3 years, the mFIB-4 showed a significantly higher AUROC than APRI and eLIFT scores (0.71 vs 0.61 and 0.56, respectively, all P < .05). The AUROCs of the mFIB-4 for HCC development were not significantly different from those of the FIB-4. According to the mFIB-4, the risk of HCC development was significantly stratified by low index (≤4)/high index (>4) (P < .001 by log-rank test).
The mFIB-4 showed better predictability of HCC development than APRI and eLIFT scores, and significantly stratified HCC risk in Asian ALC patients.
Quality of care indicators for a resuscitation unit
Authors: Yuguero Oriol , Vena Ana , Forné Carles , Lacasta Jose Daniel , Llobet Cecilia , Abadías Maria José 
Published: November 2018

Abstract
There are lack of indicators of quality of care in resuscitation units of emergency departments. With the aim of proposing a series of indicators to evaluate the quality of care delivered in hospital resuscitation areas, we conducted a descriptive study of 7579 admissions to the resuscitation unit of an emergency department at a Spanish hospital between 2012 and 2016. The proposed indicators were the percentage of patients attending to the emergency department admitted to the resuscitation area by level of triage, the length of stay, the percentage of patients moved to intensive care and surgery at disposition, the mortality in the area or in the emergency department within 24 hours of disposition, and the data completeness. A majority of the patients (62.6%) were men and the median age was 68 years. Over 99% of the required data were recorded. Median length of stay in the resuscitation unit was 0.87 hours (interquartile range, 0.5–1.5). Approximately 80% of patients categorized as an emergency on admission to the emergency department were admitted to the resuscitation unit, although the proportion of urgency patients was higher. The main disposition destination was a trauma cubicle (82.3% of cases). Mortality was 0.41%.
Specific indicators are needed to assess the quality of care delivery in resuscitation units. We believe that our findings will provide new insights into the work done to date in this field.
Effectiveness of intrahospital transportation of mechanically ventilated patients in medical intensive care unit by the rapid response team
Authors: Kwack Won Gun , Yun Miae , Lee Dong Seon , Min Hyunju , Choi Yun Young , Lim Sung Yoon , Kim Youlim , Lee Sang Hoon , Lee Yeon Joo , Park Jong Sun , Cho Young-Jae 
Published: November 2018

Abstract
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.
A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation. Patients who underwent out-of-ICU transportation supported by RRT members, including a portable ventilator, were categorized as the RRT group, whereas those transported by general members, such as residents or interns, were the general group. Propensity score matching (PSM) was conducted due to several significant differences in the baseline characteristics between the 2 groups. Adverse events were defined as any situation requiring cardiopulmonary resuscitation (CPR), any physiologic deteriorations requiring immediate intervention or equipment dysfunctions.
The median age of the 184 subjects included was 72 (inter quartile range, 62–75) years, and 114 (62.3%) of them were male. Thirty-six (19.6%) transports were supported by RRT, with significant higher APACHE II score than general groups (36.7 ± 6.0 vs 32.4 ± 7.7, P = .002). There was no critical event requiring CPR in both groups. However, adverse events were more frequently observed in the RRT than the general group (27.8% vs 8.1%, P = .001). PSM revealed insignificant difference in adverse events (26.7% vs 10.0%, P = .228).
In critically ill patients in the medical ICU, IHT supported by the RRT did not show a more preventative effect on adverse events than that by the general group.
Pseudohyponatremia in Hypertriglyceridemia-Induced Acute Pancreatitis
Authors: Wang Yuchen , Attar Bashar M. , Abu Omar Yazan , Agrawal Rohit , Demetria Melchor V. 
Published: November 2018

Objectives
The relative rarity of hypertriglyceridemia (HTG) as the etiology for acute pancreatitis (AP) delays the final diagnosis of hypertriglyceridemia-induced AP (HTG-AP). This study aimed to explore the diagnostic and prognostic value of pseudohyponatremia in this clinical entity.

Methods
We retrospectively compared 140 patients with HTG-AP and 266 patients of AP of other etiologies. The correlation of presenting hyponatremia and a final diagnosis of HTG-AP is evaluated.

Results
Presenting hyponatremia had an area under curve of 0.926 for predicting the diagnosis of HTG-AP. After dichotomization by the optimal cutoff value of 130 mEq/dL, patients with hyponatremia had a higher prevalence of acute kidney injury (61.9% vs 38.1%, P < 0.001), systemic inflammatory response syndrome (52.2% vs 47.8%, P < 0.001), a higher Ranson criteria (3.0 vs 1.4, P < 0.001), and a higher Bedside Index for Severity of Acute Pancreatitis score (0.69 vs 0.55, P = 0.011).

Conclusions
Presenting hyponatremia is highly efficient in differentiating hypertriglyceridemia from other etiologies of AP. It also demonstrated promising prognostic values in both AP and HTG-AP patients. Therefore, initial serum sodium could potentially provide the first clue of HTG-AP, as well as facilitate risk-stratifying patients to determine treatment allocation.
Burkitt Leukemia With Precursor B-Cell Immunophenotype and Dual Translocation of t(14;18) and t(8;14) in a Child: Case Report and Review of the Literature
Authors: Odaman Al Işik , Bayram Cengiz , Koç Başak , Ersoy Gizem , Pasli Uysalol Ezgi , Aki Hilal , Özdemir Gül Nihal 
Published: November 2018

Background:
Burkitt leukemia (BL) with the precursor B-cell immunophenotype is a rarely reported condition. The prognosis of such patients is similar to that of classic BL. However, the combination of chromosomal translocations associated with bcl-2 and c-myc rearrangement has a poor prognosis.

Observations:
An 11-year-old child presented with fever and weakness. Bone marrow aspiration showed morphologically L1 type blasts and flow cytometry analysis was compatible with precursor B-cell immunophenotype. Cytogenetic analysis revealed a combination of t(8;14) and t(14;l8).

Conclusions:
The combination of t(8;14) and t(14;l8) can exhibit different immunophenotypical and morphologic features in leukemias.
Population Health Management
Authors: Zander Karen 
Published: November 2018

Purpose:
Population health is finally catching up with itself. Before it was known as disease management, it began at New England Medical Center in Boston, MA (now Tufts Medical Center), more than 30 years ago.

Implications for Case Management Practice:
Take-away ideas: (1) population health management is about segmenting and targeting specific patient populations for interventions that are evidence based; (2) there are currently many examples of population health management; (3) population health management will not work without social workers and nurse navigators/care coordinators working side by side.

Primary Practice Setting:
All health care settings.
An Operational Exercise for Disaster Assessment and Emergency Preparedness in South of Iran
Authors: Sheikhbardsiri Hojjat , Yarmohammadian Mohammad H. , Khankeh Hamidreza , Khademipour Gholamreza , Moradian Mohammad Javad , Rastegarfar Behnaz , Rastegar Mohammad Reza 
Published: November 2018

Introduction:
Exercise is an important step in preparation and implementation of disaster risk programs. The aim of this research was the development and assessment of an operational exercise for disaster preparedness in southeast Iran.

Methods:
A descriptive cross-sectional study was used to evaluate a 2-day exercise for a level 4 (L-4) scale mock disaster conducted in southeastern Iran in 2017. Seven medical sciences universities participated in the mock disaster exercise: Kerman, Rafsanjan, Bam, Jiroft, Zahedan, Zabol, and Iranshahr medical sciences universities. In total, 990 personnel participated. The disaster preparedness was assessed using a tool designed by the exercise planning team.

Results:
The present research reveals that the universities of medical sciences in the southeastern hub of Iran are properly prepared for emergencies and disasters. This included the Disaster Medical Assistance Teams and the response operational comprehensive plan for emergencies and disasters. The research findings indicated a preparedness score of 79.8%. The mean arrival time at exercise area (Jiroft City) was 4 hours 35 minutes despite the wide area of Kerman and Sistan and Baluchistan provinces. Personnel safety and security, rapid assessment, communications, logistics, warnings, and news confirmation functions showed higher levels of preparedness.

Conclusion:
The Joint Commission on Accreditation of Healthcare Organizations reported that organizations must perform the performance preparedness exercises on different levels and areas twice a year to be properly prepared for responding to emergencies and disasters. This study can be considered a suitable standard guide for health care organizations to execute exercises for the maintenance and promotion of their preparedness for properly responding to emergencies and disasters at L-4.
State Laws and Nonprofit Hospital Community Benefit Spending
Authors: Johnson Emily K. , Hardy Rose , Santos Tatiane , Leider Jonathon P. , Lindrooth Richard C. , Tung Gregory J. 
Published: November 2018

Objective:
To determine the association of state laws on nonprofit hospital community benefit spending.

Design:
We used multivariate models to estimate the association between different types of state-level community benefit laws and nonprofit hospital community benefit spending from tax filings.

Setting:
All 50 US states.

Participants:
A total of 2421 nonprofit short-term acute care hospital organizations that filled an internal revenue service Form 990 and Schedule H for calendar during years 2009-2015.

Results:
Between 2009 and 2015, short-term acute care hospitals spent an average of $46 billion per year in total, or $20 million per hospital on community benefit activities. Exposure to a state-level community benefit law of any type was associated with an $8.42 (95% confidence interval: 1.20-15.64) per $1000 of total operating expense greater community benefit spending. Spending amounts and patterns varied on the basis of the type of community benefit law and hospital urbanicity.

Conclusions:
State laws are associated with nonprofit hospital community benefit spending. Policy makers can use community benefit laws to increase nonprofit hospital engagement with public health.
Modern Primary Breast Augmentation: Best Recommendations for Best Results
Authors: Wan Dinah , Rohrich Rod J. 
Published: November 2018

Learning Objectives:
After reading this article, the participant should be able to: 1. Develop a practical method for preoperative implant size selection. 2. List characteristics and examples of fourth- and fifth-generation silicone implants. 3. Recognize the differences in “profile” designations across implant manufacturers. 4. Recall updated statistics on breast implant–associated anaplastic large cell lymphoma and describe current guidelines on disease diagnosis and treatment. 5. Apply atraumatic and aseptic surgical techniques in primary breast augmentation.

Summary:
Modern primary breast augmentation requires an intimate knowledge of the expanding breast implant market, including characteristics of current generation silicone implants and “profile” types. Optimal implant size selection requires balancing patient desires with tissue qualities. Evidence and awareness of breast implant–associated anaplastic large cell lymphoma continue to grow, and patients and surgeons alike should be informed on the most updated facts of the disease entity. Atraumatic surgical technique and aseptic adjuncts are critical in reducing periprosthetic inflammation and contamination, both of which are known instigators of capsular contracture and potentially breast implant–associated anaplastic large cell lymphoma.
Cost-Effectiveness Analysis of Silicone versus Saline Implant-Based Breast Reconstruction Using the BREAST-Q
Authors: Siotos Charalampos , Sarmiento Samuel , McColl Michael , Sacks Justin M. , Manahan Michele A. , Rosson Gedge D. , Cooney Carisa M. 
Published: November 2018

Background:
The most common type of breast reconstruction is implant-based breast reconstruction. Implant-based reconstruction has been reported to impact quality-of-life outcomes. Therefore, the authors sought to evaluate the cost-effectiveness of saline versus silicone implants.

Methods:
The authors retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at their institution. This included type of procedure, acellular dermal matrix use, complications, and number of revisions. Costs were estimated using the Centers for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using BREAST-Q–adjusted life-years, a measure of years of perfect breast health, based on BREAST-Q data collected before mastectomy and reconstruction and at 12 months after final reconstruction. The incremental cost-effectiveness ratio was obtained for silicone and saline reconstruction.

Results:
The authors identified 134 women, among which 77 (57 percent) underwent silicone and 57 (43 percent) underwent saline breast reconstruction. The cost of saline reconstruction was $1288.23 less compared with silicone. BREAST-Q–adjusted life-years were 28.11 for saline and 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The incremental cost-effectiveness ratio for saline was −$283.48, or $283.48 less per year of perfect breast-related health postreconstruction than silicone.

Conclusions:
The authors’ results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months after final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used.
A Partially Structured Postoperative Handoff Protocol Improves Communication in 2 Mixed Surgical Intensive Care Units
Authors: Lane-Fall Meghan B. , Pascual Jose L. , Peifer Hannah G. , Di Taranti Laura J. , Collard Meredith L. , Jablonski Juliane , Gutsche Jacob T. , Halpern Scott D. , Barg Frances K. , Fleisher Lee A. 
Published: November 2018

Objective:
To assess the effectiveness of standardizing operating room (OR) to intensive care unit (ICU) handoffs in a mixed surgical population.

Summary of Background Data:
Standardizing OR to ICU handoffs improves information transfer after cardiac surgery, but there is limited evidence in other surgical contexts.

Methods:
This prospective interventional cohort study (NCT02267174) was conducted in 2 surgical ICUs in 2 affiliated hospitals. From 2014 to 2016, we developed, implemented, and assessed the effectiveness of a new standardized handoff protocol requiring bedside clinician communication using an information template. The primary study outcome was number of information omissions out of 13 possible topics, recorded by trained observers. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable regression.

Results:
We observed 165 patient transfers (68 pre-, 97 postintervention). Before standardization, observed handoffs had a mean 4.7 ± 2.9 information omissions each. After standardization, information omissions decreased 21.3% to 3.7 ± 1.9 (P = 0.023). In a pre-specified subanalysis, information omissions for new ICU patients decreased 36.2% from 4.7 ± 3.1 to 3.0 ± 1.6 (P = 0.008, interaction term P = 0.008). The decrement in information omissions was linearly associated with the number of protocol steps followed (P < 0.001). After controlling for patient stability, the intervention was still associated with reduced omissions. Handoff duration increased after standardization from 4.1 ± 3.3 to 8.0 ± 3.9 minutes (P < 0.001). ICU mortality and length of stay did not change postimplementation.

Conclusion:
Standardizing OR to ICU handoffs significantly improved information exchange in 2 mixed surgical ICUs, with a concomitant increase in handoff duration. Additional research is needed to identify barriers to and facilitators of handoff protocol adherence.