bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparing for Bundled Payments in Cervical Spine Surgery
Authors: Kalakoti Piyush , Gao Yubo , Hendrickson Nathan R. , Pugely Andrew J. 
Published: August 2018

Study Design.
Retrospective, observational study.

Objective.
To examine the influence of patient, hospital, and procedural characteristics on hospital costs and length hospital of stay (LOS).

Summary of Background Data.
Successful bundled payment agreements require management of financial risk. Participating institutions must understand potential cost input before entering into these episodes-of-care payment contracts. Elective anterior cervical discectomy and fusion (ACDF) has become a popular target for early bundles given its frequency and predictability.

Methods.
A national discharge database was queried to identify adult patients undergoing elective ACDF. Using generalized linear models, the impact of each patient, hospital, and procedures characteristic on hospitalization costs and the LOS was estimated.

Results.
In 2011, 134,088 patients underwent ACDF in the United States. Of these 31.6% had no comorbidities, whereas 18.7% had three or more. The most common conditions included hypertension (44.4%), renal disease (15.9%), and depression (14.7%). Mean hospital costs after ACDF was $18,622 and mean hospital LOS was 1.7 days. With incremental comorbidities, both hospital costs and LOS increased. Both marginal costs and LOS rose with inpatient death (+$17,181, +2.0 days), patients with recent weight loss (+$8351, +1.24 days), metastatic cancer (+$6129 +0.80 days), electrolyte disturbances (+$4175 +0.8 days), pulmonary-circulatory disorders (+$4065, +0.6 days), and coagulopathies (+$3467, +0.58 days). Costs and LOS were highest with the following procedures: addition of a posterior fusion/instrumentation ($+11,189, +0.9 days), revision anterior surgery (+$3465, +0.3 days), and fusion of more than three levels (+$3251, +0.2 days). Patients treated in the West had the highest costs (+$9300, +0.3 days). All P values were less than 0.05.

Conclusion.
Hospital costs and LOS after ACDF rise with increasing patient comorbidities. Stakeholders entering into bundled payments should be aware of that certain patient, hospital, and procedure characteristics will consume greater resources.

Level of Evidence: 3
Continued Inpatient Care After Elective 1- to 2-level Posterior Lumbar Fusions Increases 30-day Postdischarge Readmissions and Complications
Authors: Malik Azeem T. , Jain Nikhil , Kim Jeffery , Yu Elizabeth , Khan Safdar N. 
Published: August 2018

Study Design:
This was a retrospective cohort study.

Objective:
The main objective of this article was to investigate the impact of discharge destination on postdischarge outcomes following an elective 1- to 2-level posterior lumbar fusion (PLF) for degenerative pathology.

Background Data:
Discharge to an inpatient care facility may be associated with adverse outcomes as compared with home discharge.

Materials and Methods:
The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was used to query for patients undergoing PLFs using Current Procedural Terminology (CPT) codes (22612, 22630, and 22633). Additional levels were identified using CPT-22614, CPT-22632, and CPT-22634. Records were filtered to include patients undergoing surgery for degenerative spine pathologies. Only patients undergoing a single-level or 2-level PLF were included in the study. A total of 23,481 patients were included in the final cohort.

Results:
A total of 3938 (16.8%) patients were discharged to a skilled care or rehabilitation facility following the primary procedure. Following adjustment for preoperative, intraoperative, and predischarge clinical characteristics, discharge to a skilled care or rehabilitation facility was associated with higher odds of any complication [odds ratio (OR), 1.70; 95% confidence interval (CI), 1.43–2.02], wound complications (OR, 1.73; 95% CI, 1.36–2.20), sepsis-related complications (OR, 1.64; 95% CI, 1.08–2.48), deep venous thrombosis/pulmonary embolism complications (OR, 1.72; 95% CI, 1.10–2.69), urinary tract infections (OR, 1.96; 95% CI, 1.45–2.64), unplanned reoperations (OR, 1.49; 95% CI, 1.23–1.80), and readmissions (OR, 1.29; 95% CI, 1.10–1.49) following discharge.

Conclusions:
After controlling for predischarge characteristics, discharge to skilled care or rehabilitation facilities versus home following 1- to 2-level PLF is associated with higher odds of complications, reoperations, and readmissions. These results stress the importance of careful patient selection before discharge to inpatient care facilities to minimize the risk of complications. Furthermore, the results further support the need for uniform and standardized care pathways to promote home discharge following hospitalization for elective PLFs.

Level of Evidence:
Level III.
Arthroscopy-assisted Treatment of Displaced Distal Clavicle Fractures Utilizing Curved Buttons and Suture Tape With a Single Coracoclavicular Tunnel
Authors: Rose Mark T. , Noyes Matthew P. , Denard Patrick J. 
Published: August 2018

Background:
Distal third clavicle fractures are associated with high rates of nonunion. Acceptable healing rates have been reported; however, complications and the need for additional procedures are a concern. The purpose of this study was to evaluate the functional outcomes and healing rates of an arthroscopy-assisted technique for fixation of unstable distal third clavicle fractures.

Methods:
Seven patients presenting to a single surgeon with displaced distal clavicle fractures were included. A curved suspensory button and suture tape construct with a single coracoclavicular tunnel was used. Visual Analog Scale, American Shoulder and Elbow Surgeons scores, Simple Shoulder Test, and Subjective Shoulder Value scores were analyzed preoperatively and at final follow-up. Radiographic evidence of union, maintenance of reduction and complications were recorded. All patients were available for 1-year follow-up.

Results:
Mean Visual Analog Scale pain score improved from 6.1±1.1 to 1.1±1.0 (P=0.022). American Shoulder and Elbow Surgeons scores increased from 40.3±17.2 to 86.7±13.7 (P≤0.001). The mean Simple Shoulder Test score increased from 2.7±1.1 to 11.0±1.8 (P≤0.001). The Subjective Shoulder Value improved from 41.6±19.1 to 91.4±7.6 (P=0.210). Fracture united in 6 of 7 patients and reduction was maintained in all patients. Six patients were satisfied and returned to previous activity level.

Conclusions:
Arthroscopy-assisted fixation of unstable displaced distal clavicle fractures demonstrates improved functional outcomes and high patient satisfaction. This construct avoids many of the previously reported complications associated with other methods of fixation, while minimizing the amount of soft tissue dissection.
Ewing-Like Sarcoma: A Case of a Primary Cutaneous Primitive Neuroectodermal Tumor With Atypical Immunohistochemistry and Lack of Fusion Oncogene Detection
Authors: Labadie Jessica G. , Florek Aleksandra G. , VandenBoom Timothy , Yazdan Pedram , Krunic Aleksandar L. 
Published: August 2018

Abstract:
We present a 25-year-old male patient with a primary cutaneous primitive neuroectodermal tumor (cPNET) with unusual immunohistochemistry and lack of fusion oncogene generation. The lesion expressed CD99 and WT-1, and the histological features were consistent with cPNET. Differential diagnoses such as rhabdomyosarcoma, desmoplastic small round blue cell tumor, hematolymphoid neoplasm, neuroblastoma, and CIC-DUX round cell sarcoma were ruled out based on immunohistochemistry, genetic studies, and histology. Previous cPNET cases have been published detailing abnormal immunochemistry and genetic expression. However, to our knowledge, fusion oncogene negativity in cPNET tumors has only been reported in one other published case series. These reports, including this study, reinforce the fact that a high index of suspicion should be used when diagnosing these tumors, regardless of immunohistochemical and genetic variability. This case highlights that the typical genetic and immunohistochemical features of cPNET may be more variable than previously thought. Future studies are needed to better understand these variations of cPNET.
Mental Health of Children of Deployed and Nondeployed US Military Service Members: The Millennium Cohort Family Study
Authors: Fairbank John A. , Briggs Ernestine C. , Lee Robert C. , Corry Nida H. , Pflieger Jacqueline C. , Gerrity Ellen T. , Amaya-Jackson Lisa M. , Stander Valerie A. , Murphy Robert A. 
Published: August 2018

Abstract

Objective:
Families experience multiple stressors as a result of military service. The purpose of this study was to investigate the associations among service member deployment experiences, family and military factors, and children's mental health using baseline data from the Millennium Cohort Family Study, a study designed to evaluate the health and mental health effects of military service on families, including children.

Method:
This study examined administrative data on deployment status (combat, noncombat, and no deployments), as well as service member– and spouse-reported data on deployment experiences and family functioning in relation to the mental health of children in the family who were aged 9 to 17 years.

Results:
Most children were not reported to have mental health, emotional, or behavioral difficulties regardless of parental deployment status. For an important minority of children, however, parental deployments with combat, compared with those with no deployment, were associated with a parental report of attention-deficit disorder/attention-deficit hyperactivity disorder and depression as diagnosed by a clinical provider, after accounting for demographics, psychosocial context, and military factors. Children's odds of a parental report of depression were significantly higher in both the combat and the noncombat deployment groups than in the no deployment group.

Conclusion:
These findings extend our understanding of the association between parental deployments and children's mental health, with implications for services and training mental health providers serving military families.
Critical Care Nurses’ Qualitative Reports of Experiences With Family Behaviors as Obstacles in End-of-Life Care
Authors: Beckstrand Renea L. , Mallory Caitlin , Macintosh Janelle L.B. , Luthy Karlen E. 
Published: August 2018

Background
Critical care nurses (CCNs) frequently provide end-of-life (EOL) care for critically ill patients. Critical care nurses may face many obstacles while trying to provide quality EOL care. Some research focusing on obstacles CCNs face while trying to provide quality EOL care has been published; however, research focusing on family behavior obstacles is limited. Research focusing on family behavior as an EOL care obstacle may provide additional insight and improvement in care.

Objectives
We wanted to gather firsthand experiences of CCNs regarding working with families of dying patients. We then wanted to determine the predominant obstacle themes noted when CCNs share these rich experiences in EOL care.

Methods
A random geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Responses from a qualitative question on the questionnaire were analyzed.

Results
Sixty-seven EOL obstacle experiences surrounding issues with families’ behavior were analyzed for this study. Experiences were categorized into 8 themes. Top 3 common obstacle experiences included families in denial, families going against patient wishes and advanced directives, and families directing care that negatively impacted patients.

Conclusions
In overcoming EOL obstacles, it may be beneficial to have proactive family meetings to align treatment goals and to involve palliative care earlier in the ICU stay.
Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women
Authors: Rao Angela , Newton Phillip J. , DiGiacomo Michelle , Hickman Louise D. , Hwang Christine , Davidson Patricia M. 
Published: August 2018

Background:
There is a paucity of evidence on gender-specific, individually tailored secondary prevention (cardiac rehabilitation [CR]) services for women with heart disease. Women participate less in CR programs, thus increasing their risk of further cardiac events. This review aims to (1) determine the effectiveness of gender-specific interventions specifically designed for women with heart disease, delivered in outpatient CR settings; and (2) classify key elements of effective CR strategies/models for women with heart disease.

Methods:
Using the PRISMA guidelines, this is a systematic review of CR models tailored to women to improve cardiovascular risk. Four databases were searched for randomized controlled trials (RCTs) between January 1974 and July 2017 published in peer-reviewed English language journals.

Results:
Three RCTs comprising 725 women of gender-specific CR strategies were identified. Significant improvements were found in one-third (1 study) of the included multicomponent CR strategies for outcomes including general health, social functioning, vitality, mental health, depression, and quality of life.

Conclusion:
Further large-scale RCTs are required to replicate positive findings and accurately assess the capacity for gender-specific multicomponent CR programs that incorporate participant-driven collaborative models to moderate psychological risk and improve functional capacity and quality of life for women with heart disease.
MACULAR CHOROIDAL THICKNESS IN UNILATERAL COMMOTIO RETINAE
Authors: Burke Marie , Lieu Philip , Abrams Gary , Boss Joseph 
Published: August 2018

Purpose:
To investigate the choroidal thickness (CT) and choroidal area (CA) in patients with unilateral commotio retinae of the macula using spectral domain optical coherence tomography with enhanced-depth imaging.

Methods:
This is a retrospective review of 16 eyes of 8 consecutive patients with unilateral macular commotio retinae within 7 days of blunt ocular trauma that underwent optical coherence tomography with enhanced-depth imaging seen at our institution. The contralateral, nontraumatized eye served as the control group. All patients underwent spectral domain optical coherence tomography imaging with enhanced-depth imaging protocol. Using the electronic caliper within the Zeiss optical coherence tomography review software, CT was measured from the outer portion of the retinal pigment epithelium band to the inner surface of the sclera. The central horizontal and vertical rasters were averaged to calculate the final CT measurement of each eye. The final CA reading of each eye was obtained by averaging the central 1,500 μm2 of subfoveal CA using the same rasters. The researchers compared the CT, CA, and best-corrected visual acuity in traumatized eyes with macular commotio with their fellow nontraumatized control eyes.

Results:
Traumatized eyes with macular commotio retinae had greater subfoveal CT and CA (P = 0.0027, P = 0.0279) compared with the normal fellow eye. An increase in CT and CA in the subfoveal area in the presence of commotio retinae was associated with worse visual acuity (P = 0.0180).

Conclusion:
Subfoveal CT and CA were greater in eyes with commotio retinae when compared with normal fellow eyes. Increased CT and CA in macular commotio retinae were associated with decreased visual acuity.
Novel Technique for Improving Graft Unfolding in Vitrectomized Eyes Using a Temporary Diaphragm in Descemet Membrane Endothelial Keratoplasty
Authors: Yoeruek Efdal , Bartz-Schmidt Karl U. 
Published: August 2018

Purpose:
To describe a new surgical technique for performing Descemet membrane endothelial keratoplasty (DMEK) using a temporary hydrophilic methacrylate sheet in the anterior chamber in cases of previous vitrectomy with complete removal of the vitreous body.

Methods:
Medical records were reviewed for baseline and follow-up best spectacle-corrected visual acuity, endothelial cell count, and indication for DMEK using a temporary hydrophilic methacrylate sheet. Operative notes were analyzed in all cases to identify any specific intraoperative event.

Results:
Seven eyes of 7 patients were included in this analysis. Mean age was 65.7 ± 18.2 years, and the mean follow-up duration was 11.5 months. All 7 patients had previously received pars plana vitrectomy with complete vitreous removal. All patients were pseudophakic. For 5 patients, it was their first DMEK surgery and 2 patients had DMEK surgery for a second time, due to a failed outcome in previous surgery. Best spectacle-corrected visual acuity improved from 1.5 ± 0.5 logMAR before surgery to 0.76 ± 0.37 logMAR after surgery during follow-up (P < 0.001). The mean endothelial cell count was 2442 ± 304 cells/mm2 and decreased to 1484 ± 279 cells/mm2 during follow-up (P < 0.001). No complications were observed in any of the cases at the unfolding stage using this method. All grafts remained clear at the last follow-up visit.

Conclusions:
This modified approach of DMEK surgery, using a temporary hydrophilic methacrylate sheet for flattening the anterior chamber and facilitating graft unfolding, could help overcome possible complications of DMEK in completely vitrectomized eyes.
Population-based Incidence of Childhood Pneumonia Associated With Viral Infections in Bangladesh
Authors: Havers Fiona P. , Fry Alicia M. , Goswami Doli , Nahar Kamrun , Sharmin Amina Tahia , Rahman Mustafizur , Brooks W. Abdullah 
Published: August 2018

Background:
The contribution of respiratory viruses to childhood pneumonia in tropical low- and middle-income countries is poorly understood. We used population-based respiratory illness surveillance in children 5 years of age or younger in Dhaka, Bangladesh, to characterize these illnesses.

Methods:
We conducted weekly home visits to children who were referred to clinic for fever or respiratory symptoms. Standardized clinical data were collected. Nasopharyngeal washes were collected for one fifth of children diagnosed with a febrile or respiratory syndrome, with virus isolation testing for influenza and reverse transcription polymerase chain reaction testing for other viruses. Pneumonia was defined as age-specific tachypnea and crepitations on chest auscultation by study physicians.

Results:
From April 2004 to February 2008, 17,584 children were followed for 17,644 child-years; 6335 children had 12,499 clinic visits with eligible illnesses, including 6345 pneumonia episodes (incidence of 36 episodes/100 child-years). Annual incidence of pneumonia/100 child-years ranged from 88.3 for children 0–6 months of age to 13.1 for those 36–60 months of age. Of 1248 pneumonia visits with laboratory testing, 803 (64%) had detection of viral pathogens, including 274 respiratory syncytial virus (22% of pneumonia visits with laboratory testing; incidence 7.9/100 child-years), 244 adenovirus (19%; 7.0/100 child-years), 198 human metapneumovirus (16%; 5.7/100 child-years), 174 parainfluenza (14.0%; 5.0/100 child-years), and 81 influenza (6.5%; 2.3/100 child years).

Conclusions:
Viral pathogens contribute to a majority of childhood pneumonia episodes in Bangladesh, a setting with high pneumonia rates, especially in children 2 years of age or younger. Developing effective prevention strategies targeting these children is a high priority. Given less sensitive laboratory method used for influenza detection, influenza rates may be underestimated.
Of Sound Heart and Mind
Authors: Greenman Paul S. , Viau Pascale , Morin Francis , Lapointe-Campagna Marie-Ève , Grenier Jean , Chomienne Marie-Hélène , Jbilou Jalila 
Published: August 2018

Background:
Heart disease is related to the etiology of mental health problems such as depression, anxiety, and posttraumatic stress.

Objective:
The goal of this scoping review was to determine which factors pose a significant risk for the onset of symptoms of depression, anxiety, and posttraumatic stress in patients with heart disease, as well as to identify what might protect them from these afflictions.

Method:
We conducted a thorough search of relevant medical and psychological databases (Scopus, PsycARTICLES, Psychology and Behavioral Sciences Collection, Sage Journals, and MEDLINE) and identified 41 studies that met inclusion criteria, which included all types of heart disease.

Results:
The results of our review indicate that mental health history, the tendency to stifle negative emotional experiences (known as “type D personality”), and social support in patients with heart disease are related to the onset of or protection from depression, anxiety, and posttraumatic stress. These factors, along with gender and younger age, seem to be relatively consistent predictors of mental health problems in this population.

Conclusions:
As per our results, it is important for clinicians to attend to the mental health history, type D personality, and presence and quality of social support in patients with heart disease. More research into prevention and gender differences is necessary to hone the detection and treatment of these problems in people with heart disease.

Clinical Implications:
Attention to their mental health history, their ability to express and regulate affect, their age, and their gender will most likely assist in identifying symptoms of depression, anxiety, and posttraumatic stress in people with cardiac disease. Gender differences, particularly in the manifestation of depression, ought to be taken into account.
Activation in Children and Adolescents Treated With Selective Serotonin Reuptake Inhibitors
Authors: Garcia-Delgar Blanca , Morer Astrid , Varela Eva , Romero Soledad , García Marta , Coffey Barbara J. , Lázaro Luisa 
Published: August 2018

Abstract

Background
Activation is a behavioral adverse event related to the use of psychotropic medication. Its high incidence in pediatrics and in childhood-onset neuropsychiatric disorders suggests it may be linked to neurodevelopment. However, previous studies have scarcely examined the role that factors relevant to developmental pharmacokinetics, such as body weight, may play in the onset of activation in children and adolescents.

Methods
We conducted a retrospective analysis of hospitalized patients to identify the risk factors for activation in children and adolescents treated with selective serotonin reuptake inhibitors. Our focus was on factors related to development, including body weight, to explore the relationship between activation and neurodevelopmental processes.

Results
Among the 139 participants (mean age, 14 ± 2.3 years), activation appeared in 29 (20.9%). Age 12 years or younger and comorbid diagnosis of autism spectrum disorder were associated with statistically significant increases in the risk of activation, but no association was found regarding body weight.

Conclusions
Our findings support the hypothesis that activation is closely linked to brain development processes. Longitudinal studies are needed to explore this line of research further.