bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Staff Knowledge and Attitudes Toward Providing Psychosocial Support to NICU Parents Through an Online Education Course
Authors: Hall Sue L. , Famuyide Mobolaji E. , Saxton Sage N. , Moore Tiffany A. , Mosher Sara , Sorrells Keira , Milford Cheryl A. , Craig Jenene 
Published: July 2019

Background:
Provider–parent communication is a critical determinant of how neonatal intensive care unit (NICU) parents cope, yet staff feel inadequately trained in communication techniques; many parents are not satisfied with the support they receive from hospital providers.

Purpose:
This study evaluated whether NICU staff would demonstrate improved knowledge and attitudes about providing psychosocial support to parents after taking an online course.

Methods:
After providing demographic information, staff at 2 NICUs took a 33-item survey both before and after taking a 7-module online course “Caring for Babies and Their Families,” and again at 6-month follow-up. Scores (means ± standard deviation) from all time periods were compared and effect sizes calculated for each of the course modules.

Results:
NICU staff participants (n = 114) included nurses (88%), social workers (7%), physicians (4%), and occupational therapists (1%). NICU staff showed significant improvement in both knowledge and attitudes in all modules after taking the course, and improvements in all module subscores remained significant at the 6-month follow-up mark. Night staff and staff with less experience had lower pretest scores on several items, which improved on posttest.

Implications for Practice:
This course, developed by an interprofessional group that included graduate NICU parents, was highly effective in improving staff knowledge and attitudes regarding the provision of psychosocial support to NICU parents, and in eliminating differences related to shift worked and duration of work experience in the NICU.

Implications for Research:
Future research should evaluate course efficacy across NICU disciplines beyond nursing, impact on staff performance, and whether parent satisfaction with care is improved.
Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures
Authors: Trabuco Emanuel C. , Carranza Daniel , El Nashar Sherif A. , Weaver Amy L. , McGree Michaela E. , Elliott Daniel S. , Linder Brian J. , Occhino John , Gebhart John B. , Klingele Christopher J. 
Published: July 2019

OBJECTIVE:
To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.

METHODS:
We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis. The primary outcome was defined as reoperation for recurrent SUI. Secondary outcomes included intraoperative complications and mesh-related complications requiring reoperation after the index sling procedure.

RESULTS:
We identified 1,881 women who underwent a sling procedure for primary SUI—1,551 retropubic and 330 transobturator. There was no difference between groups in any of the evaluated baseline variables in the covariate-matched cohort of 570 with retropubic slings and 317 with transobturator slings; results herein are based on the covariate-matched cohort. Women undergoing a transobturator sling procedure had an increased risk of reoperation for recurrent SUI compared with women undergoing a retropubic sling procedure (hazard ratio 2.42, 95% CI 1.37–4.29). The cumulative incidence of reoperation for recurrent SUI by 8 years was 5.2% (95% CI 3.0–7.4%) in the retropubic group and 11.2% (95% CI 6.4–15.8%) in the transobturator group. Women in the retropubic group had a significantly higher rate of intraoperative complications compared with women in the transobturator group (13.7% [78/570] vs 4.7% [15/317]; difference=9.0%, 95% CI for difference 5.3–12.6%); the majority of this difference was due to bladder perforation (7.0% [40/570] vs 0.6% [2/317]; difference=6.4%, 95% CI for difference 4.1–8.7%). The cumulative incidence of sling revision for urinary retention plateaued at 3.2% and 0.4% by 5 years in the two groups.

CONCLUSION:
Women with primary SUI treated with a retropubic sling procedure have significantly lower cumulative incidence of reoperation for recurrent SUI compared with women who were treated with a transobturator sling procedure. Retropubic slings were associated with a higher risk of sling revision for urinary retention.
Dermatomyositis Presenting as Vulvovaginitis
Authors: Dickison Shelby , Grither Whitney , Compton Leigh , Chibnall Rebecca , Jones Heather 
Published: July 2019

BACKGROUND:
Dermatomyositis is an inflammatory myopathy that has an increased risk of malignancy, warranting aggressive health maintenance screenings. Dermatomyositis can rarely present with vulvovaginitis, thus clinical suspicion is important in early diagnosis.

CASE:
We present the case of a 31-year-old woman with a 10-year history of vulvovaginitis as her presenting symptom of dermatomyositis. On further investigation, she had a history of joint pain, muscle pain, fatigue, and leukopenia. On examination, she was found to have a rash and mucopurulent vulvovaginitis. Biopsies from the chest, axilla, and vulva were compatible with dermatomyositis. Evaluation for malignancy was negative, and her symptoms resolved with treatment of the dermatomyositis.

CONCLUSION:
Dermatomyositis is an inflammatory disease that can be associated with malignancy. This particular patient presented with vulvovaginitis. This case is important because the diagnosis was delayed. Early recognition is important to evaluate for malignancy.
Neonatal and Maternal Adverse Outcomes Among Low-Risk Parous Women at 39–41 Weeks of Gestation
Authors: Chen Han-Yang , Grobman William A. , Blackwell Sean C. , Chauhan Suneet P. 
Published: July 2019

OBJECTIVE:
To compare the composite neonatal or maternal adverse outcome among low-risk, parous women at 39–41 weeks of gestation.

METHODS:
This was a retrospective cohort study using the U.S. vital statistics data sets (2012–2016). We evaluated low-risk parous women with nonanomalous singleton gestations who delivered at 39, 40, or 41 weeks of gestation (as reported in completed weeks, eg, 39 weeks includes 39 0/7–39 6/7 weeks of gestation). The primary outcome, the composite neonatal adverse outcome, included any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for longer than 6 hours, neonatal seizure, or neonatal mortality. The secondary outcome, the composite maternal adverse outcome, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. We used multivariable Poisson regression analyses to estimate the association between gestational age and adverse outcome (using adjusted relative risks [aRR] and 95% CI).

RESULTS:
Of 19.9 million live births during the study period, 5.4 million (27.1%) met inclusion criteria. Among them, 54.4% delivered at 39 weeks of gestation, 35.7% at 40 weeks, and 9.9% at 41 weeks. The overall rate of the composite neonatal adverse outcome was 4.86 per 1,000 live births. The risk of the composite neonatal adverse outcome was higher for those delivered at 40 (aRR 1.18; 95% CI 1.15–1.22) and 41 (aRR 1.59; 95% CI 1.53–1.65) weeks of gestation when compared with 39 weeks. The overall rate of the composite maternal adverse outcome was 2.31 per 1,000 live births. The risk of the composite maternal adverse outcome was also significantly higher with delivery at 40 (aRR 1.15; 95% CI 1.11–1.19) and 41 weeks of gestation (aRR 1.50; 95% CI 1.42–1.58) than at 39 weeks.

CONCLUSION:
Though only modestly, the rates of the composite neonatal and maternal adverse outcomes increase, from 39 through 41 weeks of gestation, among low-risk parous women.
Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy
Authors: Pacquée Stefaan , Nawapun Katika , Claerhout Filip , Werbrouck Erika , Veldman Joan , D'hoore André , Wyndaele Jan , Verguts Jasper , De Ridder Dirk , Deprest Jan 
Published: July 2019

OBJECTIVE:
To report long-term outcomes after laparoscopic sacrocolpopexy.

METHODS:
We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management.

RESULTS:
The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse.

CONCLUSION:
More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Femoral Neck Fracture Pearls and Pitfalls
Authors: Sankar Wudbhav N. , Mehlman Charles T. 
Published: July 2019

Summary:
Pediatric hip fractures are uncommon injuries but are associated with a high complication rate including avascular necrosis, coxa vara, nonunion, and premature physeal arrest. This is due in part to the unique anatomy of the proximal femur. Management principles are aimed at minimizing the risk of complications and emphasize the importance of early treatment with anatomic reduction and stable internal fixation with a low threshold for supplementing fixation with a spica cast. The age of the patient and Delbet fracture type dictate the optimal type of fixation for a given case. This article will offer evidence and experience-based tips intended to benefit on-call surgeons caring for these injuries.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Foot Fracture Pearls and Pitfalls
Authors: Denning Jaime R. , Mehlman Charles T. 
Published: July 2019

Summary:
Although foot fractures are relatively rare in children, they deserve respect and attention because they may be associated with troublesome long-term consequences. These injuries are more common in adolescents and teenagers. In an epidemiological study in Britain (Cooper et al 2004), the incidence of pediatric foot fractures was 10.5 per 10,000 children occurring equally in boys and girls and peaking around 13 years of age. This article focuses on 5 fracture types which are at higher risk of complications in the pediatric and adolescent age group.
Danhong Injection Attenuates High-Fat–Induced Atherosclerosis and Macrophage Lipid Accumulation by Regulating the PI3K/AKT Insulin Pathway
Authors: Zhou Mingxue , Ren Pan , Li Sinai , Kang Qunfu , Zhang Ying , Liu Weihong , Shang Juju , Gong Yanbing , Liu Hongxu 
Published: July 2019

Background and Aims:
High-fat diet (HFD) is reported to induce atherosclerosis and insulin resistance. Macrophage lipid accumulation has been implicated as key mediators during the development of HFD-induced atherosclerosis. Traditional Chinese formula, which has long been used to improve disorder of glucose and lipid metabolism of patients, is now gradually being used as complementary therapy. This study aimed to investigate the effect of Danhong injection (DHI), a Chinese medicine used for the treatment of coronary artery disease, on atherosclerosis and its underlying mechanisms.

Methods and Results:
We observed the effects of DHI on HFD-induced atherosclerosis in a mice model, macrophage lipid accumulation in an ox-LDL–stimulated macrophage model, and the role of PI3K/AKT insulin pathway in the process of DHI ameliorating atherosclerosis. The data demonstrated that DHI attenuated atherosclerosis by ameliorating blood lipids, reducing the atherosclerotic index and atherosclerotic plaque area in HFD-induced atherosclerotic mice, and inhibiting TC levels in an ox-LDL–induced macrophage model. By estimating the levels of serum insulin resistance–related indexes and protein expression of GLUT-4, DHI treatment dramatically inhibited the levels of fasting serum NEFA and fasting serum insulin and promoted the protein expression of GLUT-4 in aortas of the HFD-induced atherosclerotic mice. Moreover, according to the hints provided by microarray-based transcriptional profiling, the results demonstrated that DHI treatment also promoted the activation of PI3K/AKT insulin signaling pathway induced by IRS-1 in aortas of HFD-induced atherosclerotic mice. Furthermore, in an ox-LDL–induced macrophage model, the activation of PI3k/AKT signaling pathway also effectively functioned in the process of DHI inhibiting macrophage lipid accumulation.

Conclusions:
These results highlight that DHI treatment attenuates atherosclerosis and macrophage lipid accumulation by promoting the activation of PI3K/AKT insulin signaling pathway. It provides new insights into the molecular mechanism of DHI and its therapeutic potential in the treatment of atherosclerosis.
The Pharmacodynamic Effects of a Dopamine–Somatostatin Chimera Agonist on the Cardiovascular System
Authors: van Esdonk Michiel Joost , Stevens Jasper , Stuurman Frederik E. , de Boon Wadim M. I. , Dehez Marion , van der Graaf Piet Hein , Burggraaf Jacobus 
Published: July 2019

Abstract:
The quantification of the effect of pharmacological treatment on the cardiovascular system is complicated because of the high level of interindividual and circadian variability. Recently, a dopamine–somatostatin chimera, BIM23B065, was under investigation to concurrently target the somatostatin and dopamine D2 receptors for the treatment of neuroendocrine tumors. However, both dopamine and somatostatin interact with different components of the cardiovascular system. This study established the response of the heart rate and the systolic blood pressure after administration of BIM23B065 in healthy male volunteers by analysis of the rate-pressure product (RPP), in a model-informed analysis. The RPP in the supine position of placebo-treated subjects showed a clear circadian component, best described by 2 cosine functions. The pharmacokinetics of BIM23B065 and its metabolite were best described using 2-compartment models with different forms of elimination kinetics. The administration of BIM23B065 gave a statistically significant reduction in the RPP, after which the effect diminished because of the tolerance to the cardiovascular effects after prolonged exposure to BIM23B065. This model provided insight in the circadian rhythm of the RPP in the supine position and the level of interindividual variability in healthy male volunteers. The developed population pharmacokinetic/pharmacodynamic model quantified the interaction between BIM23B065 and the RPP, informing on the clinical pharmacological properties of BIM23B065.
Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants
Authors: Yoshida Ruka , Ishii Hideki , Morishima Itsuro , Tanaka Akihito , Morita Yasuhiro , Takagi Kensuke , Yoshioka Naoki , Hirayama Kenshi , Iwakawa Naoki , Tashiro Hiroshi , Kojima Hiroki , Mitsuda Takayuki , Hitora Yusuke , Furusawa Kenji , Tsuboi Hideyuki , Murohara Toyoaki 
Published: July 2019

Abstract:
Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score–matched pairs (hazard ratio 6.21, 95% confidence interval 3.29–11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68–14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.
Correlation of Inhaled Long-Acting Bronchodilators With Adverse Cardiovascular Outcomes in Patients With Stable COPD: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
Authors: Wu Jinchun , Ye Yi , Li Chenxi , Zhou Wenqin , Chang Rong 
Published: July 2019

Abstract:
A majority of existing studies have focused on the efficacy of inhaled long-acting bronchodilators (ILABs), such as long-acting muscarinic antagonists (LAMAs) and long-acting β2–agonists (LABAs), and LABAs combined with LAMAs in treating chronic obstructive pulmonary disease (COPD). The current meta-analysis aimed to investigate the correlation of ILABs with specific cardiovascular adverse events (CAEs). Five electronic databases, including PubMed, Embase, Cochrane Library, Scopus, and Web of Science were systematically retrieved. Finally, 16 randomized controlled trials were enrolled into the current meta-analysis. Typically, the efficacy of 3 major classes of drugs (LABAs, LAMAs, and LABAs combined with LAMAs), and 7 specific drugs (including formoterol, glycopyrrolate, indacaterol, olodaterol, Salmeterol, tiotropium, and vilanterol) for 4 CAEs, including myocardial infarction, cardiac failure (CF), ischemic heart disease (IHD), and stroke in stable COPD patients, was examined. All the pooled results were analyzed through the odds ratios (ORs) with the corresponding 95% confidence intervals (CIs). The direct meta-analysis results suggested that LABAs could increase the risk of CF in patients with stable COPD compared with placebo controls (OR 1.70, 95% CI, 1.00–2.90). In addition, network meta-analysis results indicated that LAMAs combined with LABAs would result in an increased risk of CF in patients with stable COPD (OR 2.31, 95% CI, 1.10–5.09). According to the ILABs specific drug analysis, formoterol may potentially have protective effects on IHD compared with placebo controls (OR 0.45, 95% CI, 0.18–1.00). In conclusion, among these 3 kinds of ILABs, including LAMAs, LABAs, and LABAs/LAMAs, for stable COPD patients, LAMAs and LABAs are associated with the least possibility to induce myocardial infarction and stroke, respectively. However, the application of LABAs will probably increase the risk of CF; they should be used with caution for stable COPD patients with CF. In addition, in specific-drug analysis, the use of formoterol can reduce the risk of treatment-related IHD. Nevertheless, more studies on different drug doses are needed in the future to further validate this conclusion.
Selective Serotonin Reuptake Inhibitors and Fertility: Considerations for Couples Trying to Conceive
Authors: Sylvester Christie , Menke Marie , Gopalan Priya 
Published: July 2019

Background
Depression and anxiety are prevalent disorders and are often treated with selective serotonin reuptake inhibitors (SSRIs). Infertility is also common among couples, and rates of depression and anxiety are elevated in this population, but the impact of SSRIs on fertility has received modest attention. This review explores the literature available on SSRIs, fertility, and infertility-treatment outcomes to assist clinicians in better counseling their patients.

Methods
A literature search was performed using the search terms infertility, fertility, antidepressants, and SSRIs to identify studies that investigated the relationship between SSRI use and fertility or infertility-treatment outcomes.

Results
Twenty relevant articles were identified, 16 of which were original research studies. The studies varied in design, quality, and outcome measures, limiting meta-analysis. The prevalence of antidepressant use ranged from 3.5%–10% in reproductive-age women, with infertile populations reporting less use. The two studies examining the impact of SSRIs in fertile women had conflicting results. Six of the seven studies in infertility patients found no significant association between SSRIs and treatment outcomes; three observed a trend, however, toward reduced fecundability or negatively influenced fertility biomarkers. One study found treatment increased pregnancy rates. In males, most studies were of relatively poor quality, though six of the seven studies found SSRIs to have an adverse effect on semen parameters.

Conclusions
There is insufficient evidence at present to propose that SSRIs reduce fertility or influence infertility-treatment outcomes. SSRIs may have an adverse impact on sperm quality, but further research is warranted.