bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer
Authors: Hopkins Jessica J. , Reif Rebecca L. , Bigam David L. , Baracos Vickie E. , Eurich Dean T. , Sawyer Michael B. 
Published: February 2019

BACKGROUND:
Computed tomography-derived body composition parameters are emerging prognostic factors in colorectal cancer.

OBJECTIVE:
This study aimed to determine the roles of sarcopenia, myosteatosis, and obesity as independent and overlapping parameters in stage I to III colorectal cancer.

DESIGN:
This is a retrospective cohort study from a prospectively collected database. Multivariate Cox proportional hazards models were performed to assess the associations between body composition parameters and survival.

SETTINGS:
All patients were seen in a tertiary care cancer center.

PATIENTS:
Adult patients with stage I to III colorectal cancer, undergoing curative resection from 2007 to 2009, were included.

INTERVENTION:
Computed tomography-derived quantification of skeletal muscle and adipose tissues was used to determine population-specific cutoffs for sarcopenia, myosteatosis, and total adiposity.

MAIN OUTCOME MEASURES:
Primary outcome measures were overall, recurrence-free, and cancer-specific survival.

RESULTS:
In the 968 patients included, there were a total of 254 disease recurrences and 350 deaths. Body mass index and CT-derived measures of adiposity did not result in worse survival outcomes. Sarcopenia was independently predictive of worse overall (HR, 1.45; 95% CI, 1.16-1.84), recurrence-free (HR, 1.32; 95% CI, 1.00–1.75), and cancer-specific survival (HR, 1.46; 95% CI, 1.09–1.94) in a multivariate model. Myosteatosis was also independently predictive of overall survival (HR, 1.53; 95% CI, 1.19–1.97). In a model considering joint effects of sarcopenia and myosteatosis, the presence of both predicted the worst overall (HR, 2.23; 95% CI, 1.62–3.06), recurrence-free (HR, 1.53; 95% CI, 1.06–2.21), and cancer-specific survival (HR, 2.40; 95% CI, 1.69–3.42) in a multivariate model.

LIMITATIONS:
The limitations of this study are inherent in retrospective observational studies.

CONCLUSIONS:
Sarcopenia and myosteatosis are independent predictors of worse survival in stage I to III colorectal cancer, and their joint effect is highly predictive of reduced overall, recurrence-free, and cancer-specific survival. See Video Abstract at http://links.lww.com/DCR/A923.
Predictors of Readmission Following Proctectomy for Rectal Cancer
Authors: O’Connell Emer P. , Healy Vincent , Fitzpatrick Fidelma , Higgins Caitriona A. , Burke John P. , McNamara Deborah A. 
Published: February 2019

BACKGROUND:
Unplanned readmission after surgery negatively impacts surgical recovery. Few studies have sought to define predictors of readmission in a rectal cancer cohort alone. Readmission following rectal cancer surgery may be reduced by the identification and modification of factors associated with readmission.

OBJECTIVES:
This study seeks to characterize the predictors of 30-day readmission following proctectomy for rectal cancer.

DESIGN:
This study is a retrospective analysis of prospectively gathered cohort data. Outcomes were compared between readmitted and nonreadmitted patients. Multivariate analysis of factors association with readmission was performed by using binary logistic regression.

SETTINGS:
This study was conducted at Beaumont Hospital, a nationally designated, publicly funded cancer center.

PATIENTS:
Two hundred forty-six consecutive patients who underwent proctectomy for rectal cancer between January 2012 and December 2015 were selected.

MAIN OUTCOME MEASURES:
The primary outcomes measured were readmission within 30 days of discharge and the variables associated with readmission, categorized into patient factors, perioperative factors, and postoperative factors.

RESULTS:
Thirty-one (12.6%) patients were readmitted within 30 days of discharge following index rectal resection. The occurrence of anastomotic leaks, high-output stoma, and surgical site infections was significantly associated with readmission within 30 days (anastomotic leak OR 3.60, p = 0.02; high-output stoma OR 11.04, p = 0.003; surgical site infections OR 13.39, p = 0.01). Surgical site infections and high-output stoma maintained significant association on multivariate analysis (surgical site infections OR 10.02, p = 0.001; high-output stoma OR 9.40, p = 0.02). No significant difference was noted in the median length of stay or frequency of prolonged admissions (greater than 24 days) between readmitted and nonreadmitted patients.

LIMITATIONS:
The institutional database omits a number of socioeconomic factors and comorbidities that may influence readmission, limiting our capacity to analyze the relative contribution of these factors to our findings.

CONCLUSIONS:
An early postoperative care bundle to detect postoperative complications could prevent some unnecessary inpatient admissions following proctectomy. Key constituents should include early identification and management of stoma-related complications and surgical site infection. See Video Abstract at http://links.lww.com/DCR/A912.
Superior Mesenteric Artery Pseudoaneurysms in Patients With Familial Adenomatous Polyposis–Associated Intra-abdominal Desmoids: Case Series
Authors: Bolshinsky Vladimir , Xhaja Xhileta , Halleran David R. , Church James 
Published: February 2019

BACKGROUND:
Rupture of a superior mesenteric artery pseudoaneurysm is a rare but potentially lethal complication in patients with familial adenomatous polyposis and desmoid disease.

OBJECTIVE:
We report our experience in the management of such patients with a rare but significant and life-threatening condition.

DESIGN:
This is a descriptive study of a small series of patients.

SETTINGS:
Data were obtained from their medical charts and from the Cologene Database of the David G. Jagelman Polyposis Registry in the Sanford R. Weiss, M.D., Center for Hereditary Colorectal Cancer at the Cleveland Clinic Foundation.

PATIENTS:
Of 227 patients with mesenteric desmoid disease, there were 4 cases of superior mesenteric artery pseudoaneurysm rupture.

MAIN OUTCOMES MEASURES:
We reviewed the patients with mesenteric desmoid tumors in our desmoid registry. The registry is approved by the institutional review board of the Cleveland Clinic.

RESULTS:
The patients were young (aged from 22 to 28 y at presentation), with otherwise minimal comorbidities. Two patients had a previous proctocolectomy and J-pouch, and 2 had a total colectomy and ileorectal anastomosis. Two patients had preemptive endoluminal stenting and fared better than the 2 who had damage control embolization. One patient died and, in the others, recovery was prolonged and complicated. Two of the 4 patients have ended up with a reasonable quality of life.

LIMITATIONS:
We acknowledge that this is a rare complication of an uncommon disease and, as such, any case series will be limited by small numbers; therefore, a tailored approach is warranted when managing such complex patients.

CONCLUSIONS:
We advocate an increased awareness of the possibility of visceral pseudoaneurysms in patients with familial adenomatous polyposis who have desmoid disease encasing the superior mesenteric artery. See Video Abstract at http://links.lww.com/DCR/A914.
Dermatologic Surgical Care for Transgender Individuals
Authors: Marks Dustin H. , Awosika Olabola , Rengifo-Pardo Monica , Ehrlich Alison 
Published: February 2019

BACKGROUND
Transgender individuals experience common and unique dermatologic concerns from severe acne associated with testosterone therapy in transmen to complications due to illicit silicone injections in transwomen. Currently, 2 survey studies and 4 reviews have addressed the dermatologic care of transgender individuals. However, none of them provide a focus on the dermatologic surgeon.

OBJECTIVE
To assess the dermatologic considerations in transgender individuals and the role of dermatologic surgeon in their care.

METHODS
The PubMed and MEDLINE databases were reviewed in June 2018 using keywords, such as transgender, procedures, hair removal, laser, and hormone therapy.

RESULTS
In total, 48 relevant publications addressing dermatologic care in transgender patients were reviewed. According to the literature, there are several critical dermatologic considerations in transgender patients, including hair growth and removal, acne vulgaris, facial procedures to masculinize and feminize the face, scar removal, and sexually transmitted infections.

CONCLUSION
As dermatologic surgeons have the privilege to improve the health care of transgender patients, they must understand the common and unique concerns of transgender individuals. Given the considerable spectrum of physical goals expressed by transmen and transwomen, individual patient preference must ultimately guide his/her/their dermatologic care.
Intake of Antioxidants in Relation to Infertility Treatment Outcomes with Assisted Reproductive Technologies
Authors: Li Ming-Chieh , Nassan Feiby L. , Chiu Yu-Han , Mínguez-Alarcón Lidia , Williams Paige L. , Souter Irene , Hauser Russ , Chavarro Jorge E. 
Published: February 2019

Background:
Randomized trials of supplementation with antioxidant mixtures during infertility treatment show no benefit on pregnancy or live birth rate. However, the roles of individual antioxidants are poorly understood. We examined the association of baseline intake of vitamins A, C, E, and carotenoids with outcomes of assisted reproductive technologies (ARTs).

Methods:
We followed 349 women undergoing a total of 588 ART cycles for infertility treatment at the Massachusetts General Hospital. We assessed antioxidant intakes from food and supplements before treatment using a validated food frequency questionnaire. We used generalized linear mixed models to account for multiple ART cycles per woman while adjusting for confounding.

Results:
Mean (SD) age and body mass index were 35.1 years (4.0 years) and 24.1 kg/m2 (4.3 kg/m2), respectively. Total intake of vitamins A, C, and E was not associated with the probability of live birth. Women in the highest intake category of β-carotene from foods had a lower probability of live birth than women in the lowest intake quartile (50% vs. 22%; P trend = 0.03); for lutein and zeaxanthin, the probability for the highest intake group was 44% vs. 28% for the lowest. Intake of β-carotene from supplements and intakes of retinol and all other carotenoids were unrelated to live birth rates.

Conclusions:
We found unexpected inverse associations of β-carotene intake from foods and of lutein and zeaxanthin intake with live birth rates. Within the observed intake ranges, total consumption of vitamins A, C, and E before starting infertility treatment with ART was not associated with live birth rates.
The Impact of Unemployment on Antidepressant Purchasing
Authors: Bijlsma Maarten J. , Wilson Ben , Tarkiainen Lasse , Myrskylä Mikko , Martikainen Pekka 
Published: February 2019

Background:
The estimated effect of unemployment on depression may be biased by time-varying, intermediate, and time-constant confounding. One of the few methods that can account for these sources of bias is the parametric g-formula, but until now this method has required that all relevant confounders be measured.

Methods:
We combine the g-formula with methods to adjust for unmeasured time-constant confounding. We use this method to estimate how antidepressant purchasing is affected by a hypothetical intervention that provides employment to the unemployed. The analyses are based on an 11% random sample of the Finnish population who were 30–35 years of age in 1995 (n = 49,753) and followed until 2012. We compare estimates that adjust for measured baseline confounders and time-varying socioeconomic covariates (confounders and mediators) with estimates that also include individual-level fixed-effect intercepts.

Results:
In the empirical data, around 10% of person-years are unemployed. Setting these person-years to employed, the g-formula without individual intercepts found a 5% (95% confidence interval [CI] = 2.5%, 7.4%) reduction in antidepressant purchasing at the population level. However, when also adjusting for individual intercepts, we find no association (−0.1%; 95% CI = −1.8%, 1.5%).

Conclusions:
The results indicate that the relationship between unemployment and antidepressants is confounded by residual time-constant confounding (selection). However, restrictions on the effective sample when using individual intercepts can compromise the validity of the results. Overall our approach highlights the potential importance of adjusting for unobserved time-constant confounding in epidemiologic studies and demonstrates one way that this can be done.
How Transparency Efforts Helped One System’s Financial Turnaround
Authors: Purves Stephen A. 
Published: February 2019

SUMMARY
Healthcare consumerism, costs, and price transparency are garnering unprecedented attention from hospitals and health systems in the United States. To many observers of the US healthcare delivery system, the inability to provide accurate pricing information and the variability in prices for comparable services are utter failures of the administrative infrastructure that supports patient care processes.
Price transparency and the affordability of healthcare have also become top concerns for professional and trade organizations, which are devoting significant resources to assist member institutions in facing these issues. In many states, elected officials have passed legislation requiring pricing support for consumers. When the value equation (cost divided by quality) is considered, comparisons of healthcare providers can become even more confusing.
Price transparency and demonstration of cost-effective, high-quality service to patients have become strategic imperatives at Maricopa Integrated Health System (MIHS). A safety-net system and one of Arizona’s largest providers of graduate medical education and other teaching programs, MIHS faced an operating deficit of more than $74 million in fiscal year 2014. In 2015, financial concerns prompted the CEO and board to hold weekly meetings to appraise cash availability and management interventions. Over the next four years, MIHS achieved a cumulative improvement in net income of more than $150 million. Today, MIHS is reinventing itself through a major capital campaign made possible in part by a $935 million public bond referendum passed by the voters of Maricopa County. Ultimately, our ability to better serve the community involves connecting with our patients and addressing their need for price transparency.
Understanding Costs and Supporting Transparency—Keys to Quality Care
Authors: Decker Tina Freese 
Published: February 2019

SUMMARY
Demonstrating value is essential to the future success of healthcare organizations. Health systems that disrupt traditional delivery models and meet consumer demands will lead the way. However, value depends on understanding the true cost of care. Until now, determining the total cost of care has not been addressed for three primary reasons: (1) tackling such a herculean effort was not necessary; (2) a lack of effective coding, accounting, and billing tools connected to clinical systems made it next to impossible; and (3) consumers did not pay as much for their healthcare as they do now.
Diving headfirst into this challenge is Spectrum Health, a $6 billion system based in Grand Rapids, Michigan, with 14 hospitals, more than 225 service sites, a medical staff of 4,200 (about half of whom are members of its medical group), and a million-member health plan. Spectrum Health has transformed its care model and billing platform, transitioning to one electronic health record systemwide, because a high-performing, fully integrated approach ensures the highest-quality care and outcomes. At the same time, the cost of care directly correlates to what consumers pay through their insurance, and they want pricing information that can help lower their expenses. Spectrum Health’s insurance entity, Priority Health, is making significant strides in offering leading-edge price transparency tools.
This article outlines the challenges and opportunities in determining the total cost of care and ultimately reducing those costs. Equally important is translating this information into what consumers pay, as well as providing price transparency and other digital tools that engage consumers in their health and wellness.
Water Exposure and the Risk of Contact Lens–Related Disease
Authors: Arshad Memoona , Carnt Nicole , Tan Jacqueline , Ekkeshis Irenie , Stapleton Fiona 
Published: February 2019

Purpose:
To describe the association of water exposure with contact lens (CL)–related disease and explore the guidelines regarding water exposure to CL wearers, provided by CL manufacturing industry, global public health, and CL–related professional associations.

Methods:
A review of the literature was conducted by searching PubMed, MEDLINE, and Web of Science databases up to September 2017 for articles published or translated in English using keywords: contact lens* AND tap water OR swimming OR showering OR water exposure AND microbial keratitis OR Acanthamoeba keratitis OR corneal infiltrate* OR ocular adverse event*. References in all relevant publications were also reviewed.

Results:
Water exposure during CL wear is associated with complications ranging from sterile corneal infiltrative events to sight-threatening infections. Despite the documented risks due to water exposure, water-related habits are common among CL wearers. This suggests a lack of awareness and understanding regarding the risks among CL wearers and potentially CL practitioners. Discrepancies exist in guidelines for CL hygiene and compliance provided by the CL manufacturing industry, global public health, and CL–related professional associations. There is also widespread use of water imagery within CL marketing and packaging materials. These factors may give rise to confusion among wearers and may contribute toward risk-taking behaviors.

Conclusions:
Consensus among stakeholders about water and CL care is needed. Guidelines should unequivocally advocate for the avoidance of any water exposure including handling CLs with wet hands, rinsing CLs or storage cases in tap water, showering while wearing CLs and swimming with CLs without wearing goggles.
Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Intraocular Pressure Measurements Found in a Population at High Risk for Glaucoma
Authors: Hark Lisa A. , Myers Jonathan S. , Pasquale Louis R. , Razeghinejad M. Reza , Maity Alisha , Zhan Tingting , Hegarty Sarah E. , Leiby Benjamin E. , Waisbourd Michael , Burns Christine , Divers Meskerem , Molineaux Jeanne , Henderer Jeffrey D. , Haller Julia A. , Katz L. Jay 
Published: February 2019

Precis:
Intraocular pressure (IOP) measurements, when used during telemedicine eye screening alongside nonmydriatic fundus photography, were shown to improve the likelihood of accurate glaucoma and glaucoma-related diagnoses at the follow-up eye examination.

Purpose:
To determine if IOP measurements, used as an adjunct to nonmydriatic fundus photography, are useful in glaucoma telemedicine screening.

Materials and Methods:
A total of 902 high-risk individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening at visit 1 included fundus photography, assessing family history of glaucoma, and IOP measurements using a hand-held rebound tonometer. Participants with suspicious nerve findings for glaucoma, IOP>21 mm Hg or other ocular pathologies were invited for a follow-up appointment with an ophthalmologist (visit 2).

Results:
Of the 902 individuals screened at visit 1, 19.6% (n=177/902) had elevated IOP (>21 mm Hg). Fifteen participants were found to have an IOP>30 mm Hg at visit 1, including 2 with an IOP of >40 mm Hg. Among all who attended visit 2 (n=347), 10.9% had glaucoma and 7.2% had ocular hypertension. For participants having both suspicious nerve findings and IOP>21 mm Hg compared with those with neither, the odds ratio (OR) of being diagnosed with glaucoma was 4.48 (95% CI, 1.50-13.93; P=0.007), whereas for participants with suspicious discs and IOP≤21 mm Hg the OR was 2.04 (95% CI, 0.83-5.53; P=0.15).

Conclusions:
In this telemedicine vision screening setting, having a higher IOP at the screening visit increased the likelihood of receiving a final diagnosis of glaucoma. Therefore, this study supports incorporating IOP measurements, using a portable tonometer, into vision screening programs in high-risk populations.
Different Disc Characteristics Associated With High Myopia and the Location of Glaucomatous Damage in Primary Open-Angle Glaucoma and Normal-Tension Glaucoma
Authors: Lan Yu-Wen , Chang Shin-Yu , Sun Fang-Ju , Hsieh Jui-Wen 
Published: February 2019

Précis:Disc tilt is a characteristic of high myopia and related to lower wedge-shaped retinal nerve fiber layer (RNFL) defects in normal-tension glaucoma (NTG). In primary open-angle glaucoma (POAG), the direction of disc torsion corresponds to the location of wedge-shaped RNFL defects.Purpose:To evaluate the disc characteristics in high myopia and the relationships between disc tilt and torsion and the location of wedge-shaped RNFL defects in primary POAG and NTG.Materials and Methods:The differences in disc properties and clinical characteristics between POAG (n=53) and NTG (n=82), and between high myopic (<−6 D, n=77) and non–high myopic (≥−6 D, n=58) glaucoma, were investigated. The association between disc tilt and torsion and the location of wedge-shaped RNFL defects in POAG and NTG were assessed by univariate and multivariate logistic regression analyses.Results:In NTG, but not in POAG, high myopia eyes had significantly smaller discs, a lower tilt ratio (0.73±0.09), and more disc tilt (56.5%) than did non–high myopia eyes (0.80±0.09, 33.3%). In POAG, eyes with lower wedge-shaped RNFL defects had a significantly smaller torsion angle (−5.44±19.62 degrees, inferior disc torsion) than did eyes with upper defects (9.70±23.62 degrees, superior disc torsion;P=0.014). In NTG, a significantly decreased tilt ratio (0.74±0.93;P=0.001) and more disc tilt (55.9%,P=0.005) were found in eyes with lower wedge-shaped RNFL defects than in eyes with upper defects (0.81±0.09; 21.7%). The torsion degree and tilt ratio were the only factors associated with the location of wedge-shaped RNFL defects in POAG and NTG, respectively.Conclusions:In NTG, smaller and tilted discs were the characteristics of high myopia. Disc tilt was associated with lower wedge-shaped RNFL defects. In POAG, the direction of disc torsion corresponded to the location of the wedge-shaped RNFL defects.