bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Oral Antibiotics Following Discharge on Organ Space Infections in Children With Complicated Appendicitis
Authors: Anandalwar Seema P. , Graham Dionne A. , Kashtan Mark A. , Hills-Dunlap Jonathan L. , Rangel Shawn J. 
Published: July 2019

Objective:
To compare postdischarge rates of organ space infections (OSI) in children with complicated appendicitis between those receiving and not receiving oral antibiotics (OA) following discharge.

Summary Background Data:
Existing data regarding the clinical utility of extending antibiotic treatment following discharge in children with complicated appendicitis are limited.

Methods:
Retrospective cohort study of children ages 3 to 18 years undergoing appendectomy for complicated appendicitis from January 2013 to June 2015 across 17 hospitals participating in the NSQIP-Pediatric Appendectomy Pilot Collaborative (n = 711). Multivariable mixed-effects regression was used to compare postdischarge OSI rates between patients discharged with and without OA after propensity matching on demographic characteristics and disease severity. A subgroup analysis was performed for high-severity patients (multiple intraoperative findings of complicated disease or length of stay≥6 d).

Results:
The overall rates of OA utilization and OSI following discharge were 57.0% (hospital range: 3–100%) and 5.2% (range: 0–16.7%), respectively. In the propensity-matched analysis of the entire cohort, use of OA was associated with a 38% reduction in the odds of OSI following discharge compared with children not discharged on OA (4.2% vs. 6.6%, OR 0.62 [0.29, 1.31], P = 0.21). In the high-severity matched cohort (n = 324, 46%), use of OA was associated with a 61% reduction in the odds of OSI following discharge (4.3% vs 10.5%; OR 0.39 [0.15, 0.96], P = 0.04).

Conclusions:
Use of oral antibiotics following discharge may decrease organ space infections in children with complicated appendicitis, and those presenting with high-severity disease may be most likely to benefit.
Resection of Cavity Shave Margins in Stage 0–III Breast Cancer Patients Undergoing Breast Conserving Surgery
Authors: Dupont Elisabeth , Tsangaris Theodore , Garcia-Cantu Carlos , Howard-McNatt Marissa , Chiba Akiko , Berger Adam C. , Levine Edward A. , Gass Jennifer S. , Gallagher Kristalyn , Lum Sharon S. , Martinez Ricardo D. , Willis Alliric I. , Pandya Sonali V. , Brown Eric A. , Fenton Andrew , Mendiola Amanda , Murray Mary , Solomon Naveenraj L. , Senthil Maheswari , Ollila David W. , Edmonson David , Lazar Melissa , Namm Jukes P. , Li Fangyong , Butler Meghan , McGowan Noreen E. , Herrera Maria E. , Avitan Yoana P. , Yoder Brian , Walters Laura L. , McPartland Tara , Chagpar Anees B. 
Published: July 2019

Objective:
Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings.

Methods:
In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0–III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM (“shave” group) or not (“no shave” group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates.

Results:
Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the “shave” group and 200 to the “no shave” group. Median patient age was 65 years (range; 29–94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001).

Conclusion:
Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.
A Clinical Nomogram for Predicting Node-positive Disease in Esophageal Cancer
Authors: Semenkovich Tara R. , Yan Yan , Subramanian Melanie , Meyers Bryan F. , Kozower Benjamin D. , Nava Ruben , Patterson G. Alexander , Kreisel Daniel , Puri Varun 
Published: July 2019

Objective:
We developed and validated a nomogram predicting the likelihood of occult lymph node metastases in surgically resectable esophageal cancers.

Background:
Patients with esophageal cancer with positive lymph nodes benefit from neoadjuvant therapy, but limitations in current clinical staging techniques mean nodal metastases often go undetected preoperatively.

Methods:
The National Cancer Database was queried for patients with clinical T1-3N0M0 cancer undergoing upfront esophagectomy from 2004 to 2014. Multivariable logistic regression was used to develop the risk model using both statistical significance and clinical importance criteria for variable selection. Predictive accuracy was assessed and bootstrapping was used for validation. A nomogram was constructed for presentation of the final model.

Results:
Of 3186 patients, 688 (22%) had pathologic lymph node involvement (pN+) and 2498 (78%) had pN0 status. Variables associated with pN+ status included histology [adenocarcinoma vs squamous: odds ratio (OR) 1.75], tumor stage (T1: reference, T2: OR 1.90, T3: OR 2.17), tumor size (<1 cm: reference, 1–2 cm: OR 2.25, 2–3 cm: OR 3.82, 3–4 cm: OR 5.40, 4–5 cm: OR 5.66, ≥5 cm: OR 6.02), grade (1: reference, 2: OR 2.62, 3: OR 4.39, 4: OR 4.15, X: OR 1.87), and presence of lymphovascular invasion (absent: reference, present: OR 4.70, missing: OR 1.87), all P < 0.001. A nomogram with these variables had good predictive accuracy (Brier score: 0.14, calibration slope: 0.97, c-index: 0.77).

Conclusions:
We created a nomogram predicting the likelihood of pathologic lymph node involvement in patients with esophageal cancer who are clinically node negative using a generalizable dataset. Risk stratification with this nomogram could improve delivery of appropriate perioperative care.
Clinical Evaluation of Intraoperative Near Misses in Laparoscopic Rectal Cancer Surgery
Authors: Curtis Nathan J. , Dennison Godwin , Brown Chris S. B. , Hewett Peter J. , Hanna George B. , Stevenson Andrew R. L. , Francis Nader K. 
Published: July 2019

Objective:
To investigate the frequency, nature, and severity of intraoperative adverse near miss events within advanced laparoscopic surgery and report any associated clinical impact.

Background:
Despite implementation of surgical safety initiatives, the intraoperative period is poorly documented with evidence of underreporting. Near miss analyses are undertaken in high-risk industries but not in surgical practice.

Methods:
Case video and data from 2 laparoscopic total mesorectal excision randomized controlled trials were analyzed (ALaCaRT ACTRN12609000663257, 2D3D ISRCTN59485808). Intraoperative adverse events were identified and categorized using the observational clinical human reliability analysis technique. The EAES classification was applied by 2 blinded assessors. EAES grade 1 events (nonconsequential error, no damage, or need for correction) were considered near misses. Associated clinical impact was assessed with early morbidity and histopathology outcomes.

Results:
One hundred seventy-five cases contained 1113 error events. Six hundred ninety-eight (62.7%) were near misses (median 3, IQR 2–5, range 0–15) with excellent inter-rater and test–retest reliability (κ=0.86, 95% CI 0.83–0.89, P < 0.001 and κ=0.88, 95% CI 0.85–0.9, P < 0.001 respectively). Significantly more near misses were seen in patients who developed early complications (4 (3–6) vs. 3 (2–4), P < 0.001). Higher numbers of near misses were seen in patients with more numerous (P = 0.002) and more serious early complications (P = 0.003). Cases containing major intraoperative adverse events contained significantly more near misses (5 (3–7) vs. 3 (2–5), P < 0.001) with a major event observed for every 19.4 near misses.

Conclusion:
Intraoperative adverse events and near misses can be reliably and objectively captured in advanced laparoscopic surgery. Near misses are commonplace and closely associated with morbidity outcomes.
Immunity to Vaccine-preventable Viral Infections in Australians Being Evaluated for Liver Transplantation
Authors: Gardiner Astrid , Liu Ken , Bonnichsen Mark , Joshi Vikram , Davis Rebecca J. , Strasser Simone I. 
Published: July 2019

Background.
Vaccine-preventable viral infections are associated with increased risk of morbidity and mortality in immunocompromised patients. Current guidelines recommend routine screening and vaccination of all patients before solid organ transplantation. We studied rates of immunity against vaccine-preventable viruses in liver transplantation (LT) recipients.

Methods.
We retrospectively studied consecutive adult patients who underwent first deceased donor LT at a single center between August 2008 and October 2017. Viruses studied were hepatitis A (HAV), hepatitis B (HBV), varicella zoster virus (VZV), measles, and mumps. Hepatitis B surface antibody (anti-HBs) <10 IU/mL in HBV surface antigen-negative patients and negative IgG to other viruses was regarded as absent immunity.

Results.
Five hundred and fifty-five patients underwent LT (72.4% male; median age, 55.0 y). Percentages of patients who lacked immunity to vaccine-preventable infections were HAV (31.8%), HBV (63.8%), measles (1.4%), mumps (6.6%), and VZV (3.8%). Age was positively associated with immunity (from either past exposure or vaccination) against most viruses, including HAV, measles, mumps, and VZV (P < 0.05 for all). In contrast, older age was marginally associated with anti-HBs <10 IU/mL (P = 0.046). No significant changes in immunity rates were observed during the study period.

Conclusions.
A substantial number of patients undergoing LT are not immune to vaccine-preventable viruses at the time of assessment. This presents an opportunity for pre-LT vaccination and in particular younger patients may need to be targeted.
Comparing Pretransplant and Posttransplant Outcomes When Choosing a Transplant Center: Focus Groups and a Randomized Survey
Authors: Schaffhausen Cory R. , Bruin Marilyn J. , Chu Sauman , Wey Andrew , McKinney Warren T. , Snyder Jon J. , Lake Jack R. , Matas Arthur J. , Kasiske Bertram L. , Israni Ajay K. 
Published: July 2019

Background.
In response to calls for an increased focus on pretransplant outcomes and other patient-centered metrics in public reports of center outcomes, a mixed methods study evaluated how the content and presentation style of new information influences decision-making. The mixed methods design utilized qualitative and quantitative phases where the strengths of one method help address limitations of the other, and multiple methods facilitate comparing results.

Methods.
First, a series of organ-specific focus groups of kidney, liver, heart, and lung patients helped to develop and refine potential displays of center outcomes and understand patient perceptions. A subsequent randomized survey included adult internet users who viewed a single, randomly-selected variation of 6 potential online information displays. Multinomial regression evaluated the effects of graphical presentations of information on decision-making.

Results.
One hundred twenty-seven candidates and recipients joined 23 focus groups. Survey responses were analyzed from 975 adults. Qualitative feedback identified patient perceptions of uncertainty in outcome metrics, in particular pretransplant metrics, and suggested a need for clear guidance to interpret the most important metric for organ-specific patient mortality. In the randomized survey, only respondents who viewed a note indicating that transplant rate had the largest impact on survival chose the hospital with the best transplant rate over the hospital with the best posttransplant outcomes (marginal relative risk and 95% confidence interval, 1.161.501.95).

Conclusions.
The presentation of public reports influenced decision-making behavior. The combination of qualitative and quantitative research helped to guide and enhance understanding of the impacts of proposed changes in reported metrics.
Safety and Risk Factors of Pure Laparoscopic Living Donor Right Hepatectomy: Comparison to Open Technique in Propensity Score–matched Analysis
Authors: Park Jungchan , Kwon David Choon Hyuck , Choi Gyu-Seong , Kim Sung Joo , Lee Suk-Koo , Kim Jong Man , Lee Kyo Won , Chung Young Jae , Kim Kyeong Sik , Lee Ji Soo , Rhu Jinsoo , Kim Gaab Soo , Gwak Mi Sook , Ko Justin Sangwook , Lee Ja Eun , Lee SeungHwan , Joh Jae-Won 
Published: July 2019

Background.
The innovative pure laparoscopic living donor right hepatectomy (LLDRH) procedure for liver transplantation has never been fully compared to open living donor right hepatectomy (OLDRH). We aimed to compare the donor safety and graft results of pure LLDRH to those of OLDRH.

Methods.
From May 2013 to July 2017, 288 consecutive donors underwent either OLDRH (n = 197) or pure LLDRH (n = 91). After propensity score matching, 72 donors were included in each group. The primary outcome was postoperative complications during a 90-day follow-up period. Comprehensive complication index, duration of hospital stay, need for additional pain control, readmission, and donor outcomes were also compared.

Results.
The incidence of major complication during the 90-day follow-up was higher in the LLDRH group than the OLDRH group (6.6% vs 15.4%, P = 0.017) but was not statistically significant in propensity-matched analysis (11.1% vs 13.9%, odds ratio [OR], 1.29; 95% confidence interval [CI], 0.47-3.51; P = 0.62). A right hepatic duct <1 cm was independently associated with complication in the pure LLDRH group (odds ratio, 4.01; 95% confidence interval, 1.08-14.99; P = 0.04).

Conclusions.
In the initial 91 pure LLDRH cases, incidence of major complication was higher than in the OLDRH group, but the difference was not significant in propensity-matched analysis. A right hepatic duct verified as <1 cm may be related to increased frequency of complications in pure LLDRH donors. Further analysis is needed.
Safe Use of Right Lobe Live Donor Livers With up to 20% Macrovesicular Steatosis Without Compromising Donor Safety and Recipient Outcome
Authors: Bhangui Prashant , Sah Jayant , Choudhary Narendra , Gautam Dheeraj , Gupta Vikas , Srinivasan Thiagrajan , Rastogi Amit , Piplani Tarun , Saraf Neeraj , Saigal Sanjiv , Soin Avi 
Published: July 2019

Background.The principle in right lobe living donor liver transplantation is to use “near-perfect” grafts to maximize recipient benefit with minimal donor risk. Whether and what degree of graft macrovesicular steatosis is safe for both recipient and donor is debatable.Methods.We compared donor and recipient outcomes in 623 primary right lobe living donor liver transplantations, using grafts with (Group A; 10%–20% steatosis, n = 92) and without (Group B; <10%, n = 531) significant macrovesicular steatosis, on pre- or intraoperative biopsy.Results.Group A donors had higher body mass index, transaminases, fasting blood sugar, triglyceride, low density lipoprotein level, and lower high density lipoprotein, and liver attenuation index on CT scan, and similar future liver remnant. Mean postoperative day (POD) 7, aspartate aminotransferase (61.13 + 24.77 vs 73.17 + 53.71 IU/L;P= 0.04), and prothrombin time-international normalized ratio (1.16 + 0.36 vs 1.28 + 0.24;P= 0.0001) were lower in Group A donors. POD3 of 7 total bilirubin and alanine aminotransferase; POD3 aspartate aminotransferase and prothrombin time-international normalized ratio; postoperative morbidity (Dindo-Clavien >3b), hospital stay were similar in both groups. Recipients in both groups had similar age, model for end-stage liver disease score. Right lobe graft weight (764.8 + 145.46 vs 703.24 + 125.53 grams;P< 0.0001) and GRWR (1.09 + 0.29 vs 1.00 + 0.21;P= 0.0004) were higher in Group A. All biochemical parameters at POD 3 of 7, as well as hospital stay, 30-day mortality were similar in recipients of both groups, even after matching both groups for age, model for end-stage liver disease, and GRWR.Conclusions.Use of well-selected right lobe grafts (adequate future liver remnant in donor, GRWR in recipient), with up to 20% macrovesicular steatosis, does not compromise graft function and outcomes and is safe for the donor.
Stoma Bridge Types and Their Impact on Patient Outcomes
Authors: McTigue Toni , Lei Jason , Kowalski Mildred Ortu , Prestera Susan , Chiu Stephanie , Shehebar Josef A. 
Published: July 2019

PURPOSE:
The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist.

DESIGN:
Retrospective chart review and cross-sectional survey.

SAMPLE AND SETTING:
The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS).

METHODS:
In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist.

RESULTS:
Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ2 test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team.

CONCLUSIONS:
Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.
Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey
Authors: Kayser Susan A. , Phipps LeeAnn , VanGilder Catherine A. , Lachenbruch Charlie 
Published: July 2019

PURPOSE:
To evaluate prevalence and risk factors of incontinence-associated dermatitis (IAD).

DESIGN:
Retrospective analysis of 2016 International Pressure Ulcer Prevalence survey data.

SUBJECTS AND SETTING:
Adult patients who were in acute care, long-term acute care, long-term care, and rehabilitation facilities in the United States and Canada.

METHODS:
IAD prevalence was calculated among all patients surveyed, among the incontinent patients only, across multiple care settings, and by incontinence type. A logistic regression examined risk factors for IAD in the incontinent population.

RESULTS:
Nearly 1 in 5 incontinent patients had IAD documented. Incontinence-associated dermatitis prevalence in the entire patient population was 4.3% while incontinence prevalence was 18%. Of incontinent patients, prevalence of IAD ranged from 8.4% in long-term care facilities to 19% in acute care facilities. Facilities with higher rates of incontinence did not necessarily have higher prevalence of IAD. Incontinence-associated dermatitis prevalence by incontinence type ranged from 12% for patients with urinary incontinence to 26% for patients with fecal management systems. Regression results support the association of the following factors with an increased likelihood of IAD documented: all types of incontinence, fecal management systems, higher body weight, diminished mobility, additional linen layers, longer length of stay, and lower Braden Scale scores.

CONCLUSIONS:
Incontinence-associated dermatitis remains a concern in acute care settings. Risk factors associated with IAD were similar to risk factors previously reported for hospital-acquired pressure injuries, such as limited mobility, longer lengths of stay, and additional linen layers. By consistently documenting IAD as well as pressure injury prevalence, facilities may benchmark overall skin prevention models.
Plasma Itaconate elevation following successful cDMARD treatment in early rheumatoid arthritis patients elucidates disease activity associated macrophage activation
Authors: Daly Rónán , Blackburn Gavin , Mudaliar Manikhandan , Burgess Karl , Stirling Anne , Porter Duncan , McInnes Iain , Barrett Michael P. , Dale James 
Published: July 2019

AbstractObjectiveTo characterize changes in the plasma metabolic profile in newly diagnosed rheumatoid arthritis (RA) patients upon commencement of conventional disease modifying anti-rheumatic drug (cDMARD) therapy.MethodsPlasma samples collected in an early RA randomized strategy study (NCT00920478) that compared clinical (DAS) disease activity assessment with musculoskeletal ultrasound assessment (MSUS) to drive treatment decisions were subjected to untargeted metabolomic analysis. Metabolic profiles were collected at pre- and 3 months post commencement of non-biologic cDMARD. Metabolites that changed in association with changes in the DAS44 score were identified at the 3 month timepoint.ResultsA total of ten metabolites exhibited a clear correlation with reduction in DAS44 score following cDMARD commencement, particularly itaconate, its derived anhydride and a derivative of itaconate coA. Increasing itaconate correlated with improved DAS44 score and decreasing levels of CRP.ConclusioncDMARD treatment effects invoke consistent changes in plasma detectable metabolites, that in turn implicate clinical disease activity with macrophages. Such changes inform RA pathogenesis and reveal for the first time a link between itaconate production and resolution of an inflammatory disease in humans. Quantitative metabolic biomarker based tests of clinical change in state are feasible and should be developed around the itaconate pathway.Key MessagesWhat is already known about this subject?Rheumatoid arthritis is associated with perturbations in metabolic activity, which have also been associated with response to certain treatments. In vitro work on immunometabolism has recently revealed itaconate as a key metabolite controlling macrophage activation.What does this study add?In newly diagnosed RA, commencement of csDMARD therapy is associated with changes in the levels of ten metabolites (especially itaconate and its derivatives) that correlate to a corresponding fall in disease activity Pathway analyses suggest these metabolites are associated with macrophage activation.How might this impact on clinical practice?Changes in metabolite levels in response to treatment provide additional new insights into RA pathogenesis that suggest a focus on macrophage activation state. The association of increased itaconate with decreased inflammation point to possible routes of intervention in RA.