bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of First Milk Expression to Maximize Breastfeeding Continuation Among Mothers of Very Low-Birth-Weight Infants
Authors: Parker Margaret G. , Melvin Patrice , Graham Dionne A. , Gupta Munish , Burnham Laura A. , Lopera Adriana M. , Zera Chloe A. , Belfort Mandy B. 
Published: May 2019

OBJECTIVE:
To estimate the time of first milk expression among mothers of very low-birth-weight (VLBW, 1,500 g or less) infants that predicts the maximal duration of mother's milk provision during hospitalization in the neonatal intensive care unit (NICU).

METHODS:
We performed a secondary analysis and studied 1,157 mother–VLBW infant pairs in nine Massachusetts hospitals born from January 2015 until December 2017. We determined the cut-point for timing of first milk expression after delivery that was associated with the highest probability of any and exclusive provision of mother's milk for the infant at NICU discharge or transfer using recursive partitioning. We estimated hazard ratios (HRs) comparing the probability of continued provision of mother's milk during the hospitalization between mothers who initiated milk expression before compared with after the cut-point (within 8 hours after delivery [referent] vs 9–24 hours), adjusting for gestational age, birth weight, maternal race and ethnicity, and clustering by hospital and plurality in Cox proportional hazards models.

RESULTS:
Sixty-eight percent of mothers first expressed milk within 8 hours after delivery. First milk expression at 9–24 hours was associated with lower odds of any mother's milk provided to the infant on day 7 (adjusted odds ratio [aOR] 0.39 [0.24–0.60]) and discharge or transfer (aOR 0.45 [0.33–0.62]), compared with expression within 8 hours. Findings were similar for exclusive mother's milk. Mothers who first expressed 9–24 hours stopped providing milk earlier in the neonatal hospitalization (adjusted HR 1.64 [1.33–2.01]) compared with mothers who first expressed within 8 hours.

CONCLUSION:
Using a data-driven approach, we identified that first milk expression within 8 hours was superior to 9–24 hours with respect to maximal duration of provision of mother's milk for hospitalized VLBW infants. Randomized control trials are needed to further establish the causal relationship between timing of first milk expression and long-term lactation success among mothers of VLBW infants.
Laparoscopic Compared With Open Surgery for Severe Pelvic Inflammatory Disease and Tubo-Ovarian Abscess
Authors: Shigemi Daisuke , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo 
Published: May 2019

OBJECTIVE:
To compare operative outcomes of laparoscopic surgery compared with laparotomy in patients with moderate to severe pelvic inflammatory disease (PID).

METHODS:
Using the Diagnosis Procedure Combination database, a national inpatient database for acute-care inpatients in Japan, we performed a large, nationwide retrospective cohort study. We identified all patients aged 18 years or older who were diagnosed with PID with or without tubo-ovarian abscess and were admitted to a participating hospital from July 2010 to March 2016. We excluded patients who were pregnant, had cancer, or for whom data were missing. We compared outcomes between patients who underwent laparoscopic surgery compared with laparotomy. Propensity score–matched analyses were performed to compare operative outcomes including postoperative length of stay, surgical complications, in-hospital deaths, and revision surgery.

RESULTS:
Of 27,841 patients with PID, 4,419 (15.9%) underwent surgical intervention. From among 749 women undergoing laparoscopy and 3,670 women undergoing laparotomy for PID, 740 pairs were created for propensity score matching. The laparoscopic group had shorter operation duration (125 vs 166 min), fewer blood transfusions (4.7% vs 10.0%), and shorter length of hospital stay (median 5 days vs 7 days; all P<.001) compared with the laparotomy group. There were no significant differences between groups for in-hospital deaths, surgical complications, and revision surgery.

CONCLUSION:
Laparoscopic surgery may have clinical advantages over laparotomy in patients diagnosed with severe PID.
Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs
Authors: Rodriguez Maria I. , Hersh Alyssa , Anderson Lorinda B. , Hartung Daniel M. , Edelman Alison B. 
Published: May 2019

OBJECTIVE:
To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception.

METHODS:
A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed.

RESULTS:
Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies.

CONCLUSION:
Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed.
Evaluation of the Effect of Surgeon's Operative Volume and Specialty on Likelihood of Revision After Mesh Midurethral Sling Placement
Authors: Brennand Erin A. , Quan Hude 
Published: May 2019

OBJECTIVE:
To estimate rates of revision surgery after insertion of mesh midurethral slings and explore whether physician specialty, annual operative volume, or hospital type are associated with this outcome.

METHODS:
A population-based retrospective cohort of women undergoing midurethral sling procedures over a 13-year interval (2004–2017) in Alberta, Canada was created using administrative health data. The primary outcome was subsequent surgery for revision of midurethral sling, defined by a composite of surgical procedures. Exposures included annual number of midurethral sling procedures performed by the surgeon, surgeon specialty, facility type, patient age, and concomitant prolapse repair. Mixed effects logistic regression using linear spines was used to test a-priori hypothesis that annual surgical volume would be inversely related in a nonlinear fashion to risk of revision.

RESULTS:
In the cohort of 19,511 women, cumulative rates of revision surgery were 3.84% (95% CI 3.54–4.17) at 5 years and 5.26% (95% CI 4.82–5.74) at 10 years. The first year after midurethral sling placement was the most vulnerable window, with 0.40% (95% CI 0.31–0.49) undergoing revision within 30 days and 2.15% (95% CI 1.95–3.52) within 1 year. Concomitant prolapse repairs (odds ratio [OR] 1.24, 95% CI 1.04–1.48) and surgeon's annual volume were associated with revision. After 50 cases per year, odds of revision declined with each additional case (OR 0.99/case, 95% CI 0.98–0.99, OR 0.91/10 cases, 95% CI 0.84–0.98) and plateaued at 110 cases per year. Surgeon specialty, hospital type, and patient age were not associated with outcome.

CONCLUSION:
One in 20 women undergo revision surgery within 10 years after midurethral sling placement. Higher physician surgical volume is associated with decreased risk, with the decline occurring at a threshold of 50 cases annually. Minimum caseload parameters for surgeons performing midurethral sling procedures may improve quality of these procedures.
Shoulder Shrug Maneuver to Facilitate Delivery During Shoulder Dystocia
Authors: Sancetta Ronald , Khanzada Hiba , Leante Ricardo 
Published: May 2019

BACKGROUND:
Shoulder dystocia is a potential complication of vaginal delivery that increases the chances of injury to the neonate and the mother. The incidence of dystocia can be up to 3%, and sudden presentation and the lack of reliable predictors make shoulder dystocia a challenge for obstetricians.

TECHNIQUE:
The shoulder shrug technique involves shrugging the posterior shoulder and rotating the head–shoulder unit 180 degrees to resolve the shoulder dystocia.

EXPERIENCE:
We describe successful delivery in three cases of persistent shoulder dystocia using the shoulder shrug technique after the dystocia could not be resolved with McRoberts maneuver.

CONCLUSION:
When successful, the shoulder shrug maneuver may decrease the likelihood of morbidity for the neonate. The technique has resolved dystocia in three cases in which the posterior shoulder could be shrugged. Because it does not take much time to perform the shoulder shrug maneuver, it is worth considering this technique during management of unresolved shoulder dystocia.
Association of Radical Hysterectomy Surgical Volume and Survival for Early-Stage Cervical Cancer
Authors: Matsuo Koji , Shimada Muneaki , Yamaguchi Satoshi , Matoda Maki , Nakanishi Toru , Kikkawa Fumitaka , Ohmichi Masahide , Okamoto Aikou , Sugiyama Toru , Mikami Mikio 
Published: May 2019

OBJECTIVE:
To examine the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy.

METHODS:
This is a nationwide multicenter retrospective study examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy from 2004 to 2008 (N=5,964). The surgical volume per site over the 5-year period was defined as low-volume (fewer than 32 surgeries, 46 [39.7%] institutions, n=649 [10.9%]), mid-volume (32–104 surgeries, 60 [51.7%] institutions, n=3,662 [61.4%]), and high-volume (105 surgeries or more, 10 [8.6%] institutions, n=1,653 [27.7%]). Surgical volume-specific survival was examined with multivariable analysis and propensity score matching.

RESULTS:
The median number of surgeries per site was 44 (interquartile range, 17–65). The 5-year disease-free survival rates among stage IB1-IIB disease were 77.2%, 79.9%, and 84.5% for low-, mid-, and high-volume groups, respectively. On multivariable analysis, women in high-volume centers had a decreased risk of recurrence (adjusted hazard ratio [HR] 0.69, 95% CI 0.58–0.82, P<.001) and all-cause mortality (adjusted HR 0.73, 95% CI 0.59–0.90, P=.003) compared with those in mid-volume centers. Specifically, women in high-volume centers had a decreased risk of local recurrence (adjusted HR 0.62, 95% CI 0.49–0.78, P<.001) but not distant recurrence (adjusted HR 0.85, 95% CI 0.67–1.06, P=.142) compared with those in mid-volume centers. Among 1,700 women with clinical stage IB1 disease treated with surgery alone, surgery at high-volume centers was associated with a decreased risk of recurrence (adjusted HR 0.45, 95% CI 0.25–0.79, P=.006) and all-cause mortality (adjusted HR 0.29, 95% CI 0.11–0.76, P=.013) compared with surgery at mid-volume centers on multivariable analysis. After propensity score matching, surgery at high-volume centers remained an independent prognostic factor for decreased recurrence (adjusted HR 0.69, 95% CI 0.57–0.84, P<.001) and all-cause mortality (adjusted HR 0.75, 95% CI 0.59–0.95, P=.016) compared with surgery at mid- and low-volume centers on multivariable analysis.

CONCLUSION:
Hospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer. Surgery at high-volume centers is associated with decreased local recurrence risk and improved survival.
The evolving role of anabolic therapy in the treatment of osteoporosis
Authors: Cosman Felicia 
Published: May 2019

Purpose of review
Many physicians have long considered anabolic osteoporosis medication to be the last resort for patients after multiple fractures have already occurred. Thinking is evolving toward the view that anabolic agents should be used more proactively earlier in patients who are at high risk for fracture.

Recent findings
Recent data suggest that the three anabolic agents, teriparatide, abaloparatide and romosozumab, reduce nonvertebral and vertebral fractures faster and to a greater extent than the best antiresorptive treatments.

Summary
This review will summarize the evolving role of anabolic therapy in the management of the postmenopausal woman at high risk for fracture. Pivotal clinical trial data for the three anabolic agents are overviewed and studies comparing anabolic and antiresorptive medications are described. Studies comparing treatment sequences with anabolic and antiresorptive treatments are also summarized. High-risk patients who should be considered for initial treatment with anabolic medication are defined.
Is Tissue Engineering Helping Orthopaedic Care in Trauma?
Authors: Crist Brett D. , Leach J. Kent , Lee Mark A. 
Published: May 2019

Summary:
Tissue engineering in orthopaedic trauma is needed. Progress has been made in all areas including regenerating bone, cartilage, soft tissue, and making up for bone defects with scaffolds. Bone regeneration and managing bone defects with scaffolds continue to be successful in the basic science realm with promising results, but currently, these successes are mostly limited to small animal models. Cartilage defects have more clinically available treatment options, but the benefits of “off-the-shelf” allograft options, and scaffolds, have little clinical evidence in the acute fracture setting. Most of the true chondrocyte replacement therapies such as matrix-induced autologous chondrocyte implantation and osteochondral allografts require delayed treatment while cell growth or graft matching occurs. Soft-tissue defects can be managed with tissue engineering for the skin with success, but muscle and nerve defects are still limited to the basic science arena. Although significant gains have been made in all areas for tissue engineering in basic science, and is very promising, this success currently comes with limited translation into clinical availability for the orthopaedic trauma patient.
Reliability and Validity of A-Mode Ultrasound to Quantify Body Composition
Authors: Hendrickson Nathan , Davison John , Schiller Luke , Willey Michael 
Published: May 2019

Objective:
Immobilization and inadequate nutrition after high-energy trauma result in loss of lean muscle mass. Body composition [percent body fat (%BF), fat mass (FM), fat-free mass (FFM)] is traditionally quantified with techniques that require expensive equipment and/or ionizing radiation. The purpose of this study was to assess reliability and validity of amplitude-mode (A-mode) ultrasound (US) to quantify body composition for use in a randomized clinical trial assessing interventions to prevent muscle loss in young individuals after high-energy musculoskeletal trauma.

Methods:
Thirty-one volunteer subjects underwent body composition assessments using A-mode US and air displacement plethysmography (ADP). Independent raters performed 2 serial US measures. The same raters performed body composition assessment in 12 consecutive subjects that sustained acute musculoskeletal trauma indicated for surgery. Test–retest and inter-rater reliability were assessed using intraclass correlation coefficient (ICC). Agreement between US and ADP was assessed with Bland–Altman analysis.

Results:
Test–retest and inter-rater reliability was excellent for volunteer subjects, with ICC values (%BF, FM, and FFM) of 0.87, 0.90, and 0.99 (rater 1); 0.80, 0.82, and 0.98 (rater 2). FFM measured by US was strongly correlated with ADP measures (r = 0.9635, P < 0.05). Bland–Altman analysis demonstrated no systematic bias between US and ADP measures of body composition. In trauma subjects, the inter-rater reliability was excellent, with ICCs of 0.96, 0.98, and 0.99 for %BF, FM, and FFM, respectively.

Conclusions:
A-mode US is a relatively low-cost tool that provides reliable estimates of body composition and is a viable alternative for monitoring body composition in young, healthy patients.
Prevalence of sarcopenia and associated factors in climacteric women of the Colombian Caribbean
Authors: Monterrosa-Castro Alvaro , Ortiz-Banquéz Mauricio , Mercado-Lara María 
Published: May 2019

Abstract

Objective:
The aim of the study was to determine the prevalence of sarcopenia and associated factors in climacteric middle-aged women.

Methods:
This was a cross-sectional study carried out in Colombian Caribbean women (40-59 y, n = 403), who were surveyed with a form that included sociodemographic information and two validated tools (the Menopause Rating Scale and the SF-36 Health questionnaire). Calf circumference, handgrip, and gait speed were measured. Low muscle mass (calf circumference <31 cm), reduced muscle strength (<20 kg in handgrip), and lower physical performance (<0.8 m/s gait speed) were estimated. Criteria of the European Working Group on Sarcopenia in Older People were used to identify sarcopenia. Association between sarcopenia (dependent variable) and menopausal symptoms and health perception (independent variables) was estimated.

Results:
Median age of surveyed women was 48 years, with 44.5% being postmenopausal. 9.6% had low muscle mass, 18.1% had reduced muscle strength, and 6.9% had lower physical performance. Presarcopenia was identified in 9.6% and sarcopenia in 7.9% (nonsevere sarcopenia 7.1% and severe sarcopenia 0.8%). Most important factors associated with sarcopenia were feeling full of life only sometimes, feeling a lot of energy only sometimes, having joint/muscular discomfort, history of hysterectomy, hot flashes, mestizo ethnic group, age 50 or more, being postmenopausal, and sleep problems.

Conclusions:
Sarcopenia was present in this middle-aged female Colombian Caribbean sample and associated with various factors such as ethnicity, age, and menopausal symptoms and status.
Transdiagnostic Approach to Olfactory Reference Syndrome: Neurobiological Considerations
Authors: Skimming Kathryn A. , Miller Christopher W. T. 
Published: May 2019

Abstract
Olfactory reference syndrome (ORS) describes a constellation of emotional and behavioral symptoms that cause clinically significant distress or impairment arising from the false belief that one is emitting an offensive odor. Despite cases of ORS reported throughout the world over the last century, our knowledge and understanding of ORS remain relatively poor because of the limited literature—mostly case studies and series, but no clinical trials. ORS continues to pose significant diagnostic challenges within our current frameworks of categorizing mental disorders, including the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases. We review the ORS literature and discuss diagnostic parallels and challenges of placing ORS within specific categories. We also review the current research on the neurocircuitry of olfaction and of disorders with potential clinical relevance to patients presenting with ORS. While no primary neuroscientific research has specifically investigated ORS, an overlapping circuitry has been implicated in the neurobiology of obsessive-compulsive, trauma and stressor, and psychotic spectrum disorders, suggesting that the phenomenology of ORS can best be understood through a dimensional, rather than categorical, approach.
Results From the First Teleglaucoma Pilot Project in Addis Ababa, Ethiopia
Authors: Giorgis Abeba T. , Alemu Abiye M. , Arora Sourabh , Gessesse Girum W. , Melka Fikru , Woldeyes Alemayehu , Amin Samreen , Kassam Faazil , Kurji Ayaz K. , Damji Karim F. 
Published: May 2019

Precis:
A teleglaucoma case-finding model was utilized in Ethiopia using a high-risk case identification approach. An overall 7.9% of patients had definite glaucoma, and 13.8% were glaucoma suspects. Most cases could be managed medically.

Background:
This study was carried out to analyze disease prevalence and clinical referral pathways for high-risk patients assessed through a hospital-based teleglaucoma case-finding program.

Methods:
Patients over the age of 35 years were referred from outpatient diabetic and hypertensive clinics. Through a teleglaucoma consultation, a glaucoma specialist provided remote diagnosis and management recommendations. Patient referral pathways were analyzed. Part way through the program, frontline ophthalmic nurses and optometrists were empowered to refer patients to be seen by general ophthalmologists within a week if patients met high-risk criteria. Qualitative stakeholder feedback was also obtained.

Results:
A total of 1002 patients (53% female) were assessed with a mean age of 51.0±11.7 years. The prevalence of glaucoma and glaucoma suspects was 7.9% (79 cases) and 13.8% (138 cases), respectively. Retinopathy was found in 9.1%, with hypertensive retinopathy (2.7%) and diabetic retinopathy (2.5%) representing the majority of cases. Age-related macular degeneration was present in 1.5% and cataract in 16%. An overall 63% of cases were without organic eye disease. 35% of patients were referred to a general ophthalmologist, 0.7% to a glaucoma specialist (for surgery), 1.5% to a retina specialist, and 17.7% to an optometrist for further care. Qualitative analysis revealed that stakeholders felt the value of teleglaucoma would be in triaging patients requiring more urgent management and in identifying disease at an earlier stage.

Conclusions:
There is a high prevalence of glaucoma in Ethiopian patients assessed through this teleglaucoma program. This model and study have also demonstrated various principles behind telemedicine, such as the development of an intelligent triage system, case-finding for a variety of diseases, and consideration of optimal patient flow/referral pathways.
Thromboprophylaxis After Hospitalization for Joint Replacement Surgery
Authors: Giuliano Karen K. , Pozzar Rachel , Hatch Courtney 
Published: May 2019

ABSTRACT
Venous thromboembolism (VTE) is a leading cause of mortality during the perioperative period, with individuals who have undergone hip and knee arthroplasty at the highest risk for VTE. The American College of Chest Physicians recommends 35 days of postoperative thromboprophylaxis and the use of intermittent pneumatic compression (IPC) therapy for mechanical compression after major orthopedic surgery. However, little research has described adherence to these recommendations during recovery at home. The purpose of this cross-sectional descriptive study was to describe thromboprophylaxis prescription, use, and education among patients discharged home after major orthopedic surgery. We surveyed patients within 2 years of major orthopedic surgery. A total of 388 subjects completed the survey. More than three-quarters of respondents reported a thromboprophylaxis duration <35 days. Most (93.8%) respondents were prescribed a pharmacologic agent, while 55.9% were prescribed mechanical compression therapy. Of the respondents who were prescribed mechanical compression therapy, 13.4% were prescribed IPC. Adherence to mechanical compression therapy was moderate, with 63% of respondents wearing mechanical compression therapy ≥75% of the time. The results of this study suggest a need for increased duration of thromboprophylaxis and increased use of IPC in the outpatient setting. Additional research describing prescribers' perceptions of thromboprophylaxis is also needed.