bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dermatologic Surgeons Can Positively Impact the Opioid Epidemic: A Quality Improvement Study of Pain Management in Dermatology Surgery
Authors: Raji Kehinde , Yeung Howa , Bein Amanda Ashley , Lequeux-Nalovic Katarina G. 
Published: October 2019

BACKGROUND
The opioid epidemic is a national emergency, and it is imperative that all physicians are engaged in reducing exposure. Among dermatologists, dermatologic surgeons prescribe most opioids with the highest rates of prescription occurring in Southern states.

OBJECTIVE
Implement a quality improvement intervention to decrease opioids prescribed and filled to <10% of surgeries performed and have a 0% increase in the amount of patient complaints regarding postoperative pain.

MATERIALS AND METHODS
The number of opioids prescribed and filled in a single surgical facility in Georgia was obtained from the state's Prescription Drug Monitoring Program before, 1 month after, and 6 months after implementation of the quality improvement initiative. Telephone encounters regarding postoperative pain was also collected at the same specified periods.

RESULTS
Proportion of opioids prescribed and filled decreased from 58% to 5% at 1-month postintervention and remained low on 6-month follow-up at 4%. There was no increase in postoperative pain complaints. Rather, a decrease in complaints was noted from 8.6% to 3.1% at 1-month postintervention and sustained on 6-month follow-up at 4.9%.

CONCLUSION
Our data support the management of postoperative pain with nonopioid medications.
Validity and Reliability of the Korean Version of the Watson Caritas Patient Score
Authors: IM SookBin , CHO MiKyoung , HEO MyoungLyun 
Published: October 2019

ABSTRACT

Background
The increasing use of information technology in healthcare settings has reduced human contact with healthcare providers and is hampering human-centered intrinsic nursing work associated with patient discomfort, emotional distress, and desire. The caring attitude of nurses affects patient compliance with medication instructions as well as the promotion of health behaviors and patient satisfaction.

Purpose
This study was designed to develop a Korean version of the Watson Caritas Patient Score (WCPS) developed by Watson and then verify its reliability and validity.

Methods
This was a methodological study. Data were collected from 240 patients in wards of the departments of internal medicine and surgery of a general hospital with more than 500 beds in Kunsan City between May 1 and June 8, 2017. Exploratory factor analysis and confirmatory factor analysis were used to verify the construct validity and model fit. The Patient Perception of Hospital Experience with Nursing was used to confirm convergence validity. Data were analyzed using descriptive analysis, Cronbach's alpha, factor analysis, and Pearson's product–moment correlation analysis.

Results
The internal consistency of the Korean version of the WCPS assessed using Cronbach's alpha was .94. The content validity index for each of the five items was 1.0. The communality ranged from .75 to .87, and the overall model fit was good. In addition, the average variance extracted was .61, the composite reliability was .89, and the convergent validity was .72 (p < .001).

Conclusions/Implications for Practice
The original English version and the Korean version of the WCPS both address a single factor, which confirmed the reliability and good fit of the model and showed both convergent and criterion-related validity. The Korean version of the WCPS is expected to contribute to improving the quality of nursing care in Korea by providing a simple scale that assesses patient perceptions of nursing care easily and accurately.
Mesothelioma Associated With the Use of Cosmetic Talc
Authors: Moline Jacqueline , Bevilacqua Kristin , Alexandri Maya , Gordon Ronald E. 
Published: October 2019

Objective:To describe 33 cases of malignant mesothelioma among individuals with no known asbestos exposure other than cosmetic talcum powder.Methods:Cases were referred for medico-legal evaluation, and tissue digestions were performed in some cases. Tissue digestion for the six cases described was done according to standard methodology.Results:Asbestos of the type found in talcum powder was found in all six cases evaluated. Talcum powder usage was the only source of asbestos for all 33 cases.Conclusions:Exposure to asbestos-contaminated talcum powders can cause mesothelioma. Clinicians should elicit a history of talcum powder usage in all patients presenting with mesothelioma.
Clinical and angiographic factors predicting fractional flow reserve and explaining the visual–functional mismatch in patients with intermediate coronary artery stenosis
Authors: Watanabe Heitaro , Onishi Kyohei , Kakehi Kazuyoshi , Takase Toru , Yamaji Kenji , Ueno Masafumi , Kobuke Kazuhiro , Miyazaki Shunichi , Iwanaga Yoshitaka 
Published: October 2019

Background
Visual–functional mismatch between coronary angiography and fractional flow reserve (FFR) has been reported, and the underlying reason remains poorly understood. Therefore, the relationship between angiographic measurements and FFR was evaluated, and predictors for FFR in intermediate coronary artery stenosis were determined.

Methods
Consecutive 314 patients (405 lesions) with a lesion of 30–80% angiographic diameter stenosis who underwent invasive FFR were recruited. The myocardial area supplied by the coronary artery distal to the stenosis was evaluated using a modified version of the Bypass Angioplasty Revascularization Investigation (BARI) score. Participants underwent follow-up, and major cardiovascular events (MACE), including all-cause death, myocardial infarction (MI), and unplanned revascularization were recorded.

Results
Although % diameter stenosis was correlated with FFR (R = 0.279, P < 0.001), diameter stenosis-FFR mismatch was observed in 37.8% of the lesions. Although FFR values were not associated with clinical factors, such as age, sex, and comorbidities, it was correlated with minimal lumen diameter (MLD), diffuse lesion, presence of proximal lesion, and BARI score. In addition, the lesions in left anterior descending (LAD) coronary artery showed low FFR values compared with those in the left circumflex coronary artery or right coronary artery. In multivariate logistic analysis, MLD (β coefficient = 0.330), diffuse lesion (β coefficient = –0.266), proximal lesion (β coefficient = –0.144), BARI score (β coefficient = –0.219), and LAD lesion (β coefficient = –0.293) were all independent predictors for FFR value. The estimated FFR value based on these factors showed smaller mismatch and higher sensitivity. No difference was observed in the event rates for MACE and MI or revascularization between the FFR-guided and estimated FFR-guided strategies.

Conclusions
MLD, diffuse lesion, proximal lesion, BARI score, and lesion vessel were independent predictors for FFR in intermediate coronary stenosis. Not only the extent of local lesion stenosis but also the amount of myocardial supply and the lesion location may determine the physiological significance and explain the visual–functional mismatch. The estimation of FFR by these factors may be useful in clinical practice.
Combination therapies in the treatment of osteoporosis
Authors: Kelly Jennifer J. , Garapati Sree Susmitha 
Published: October 2019

Purpose of review
Osteoporotic fractures are common and can be devastating. Although multiple different medications with unique mechanisms of action are currently available in our arsenal to attempt to prevent fractures, an ideal opportunity in which to use these medications in combination remains elusive. New data has emerged over the past few years in regards to assessing which medication combinations may be productive and efficacious.

Recent findings
Previous studies performed using different medications to treat osteoporosis in combination proved either not overall beneficial or inconclusive. More recent studies suggest a potential additive and synergistic benefit of certain combination therapies, particularly with the use of denosumab and teriparatide in select situations.

Summary
The knowledge of modern data as to when the potential use of combination therapy in treating osteoporosis may be useful is critical to the acquisition of proficiency in the ideal management of our patients at highest risk for fracture. Although not recommended yet by current guidelines, the advancement of expertise in this field, both in research studies, and clinical practice, will help us discern how to best consider the use of combination treatment now and in the future.
Inpatient Maternal Mortality in the United States, 2002–2014
Authors: Mogos Mulubrhan F. , Liese Kylea L. , Thornton Patrick D. , Manuck Tracy A. , O'Brien William D. , McFarlin Barbara L. 
Published: October 2019

Background
Although prior studies of inpatient maternal mortality in the United States provide data on the overall rate and trend in inpatient maternal mortality, there are no published reports of maternal mortality data stratified by timing of its occurrence across the pregnancy continuum (antepartum, intrapartum, and postpartum).

Objective
The study objective was to determine whether the maternal mortality rate, trends over time, self-reported race/ethnicity, and associated factors vary based on the timing of the occurrence of death during pregnancy.

Methods
We conducted a cross-sectional analysis of the Nationwide Inpatient Sample database to identify pregnancy-related inpatient stays stratified by timing. Among women in the sample, we determined in-hospital mortality and used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify comorbidities and behavioral characteristics associated with mortality, including alcohol, drug, and tobacco use. Joinpoint regression was used to calculate rates and trends of in-hospital maternal mortality.

Results
During the study period, there were 7,411 inpatient maternal mortalities among an estimated 58,742,179 hospitalizations of women 15–49 years of age. In-hospital maternal mortality rate stratified by race showed that African Americans died at significantly higher rates during antepartum, intrapartum, and postpartum periods compared to hospitalizations for Whites or Hispanics during the same time period. Although the postpartum hospitalization represents only 2% of pregnancy-related hospitalizations among women aged 15–49 years, hospitalization during this time period accounted for 27.2% of all maternal deaths during pregnancy-related hospitalization.

Discussion
Most in-hospital maternal mortalities occur after hospital discharge from child birth (postpartum period). Yet, the postpartum period continues to be the time period with the least maternal healthcare surveillance in the pregnancy continuum. African American women experience three times more in-hospital mortality when compared to their White counterparts.
Characteristics and Practices Within Research Partnerships for Health and Social Equity
Authors: Dickson Elizabeth , Magarati Maya , Boursaw Blake , Oetzel John , Devia Carlos , Ortiz Kasim , Wallerstein Nina 
Published: October 2019

Background
As federal research funding focuses more on academic/community collaborations to address health inequities, it is important to understand characteristics of these partnerships and how they work to achieve health equity outcomes.

Objectives
This study built on previous National Institutes of Health-funded research to (a) describe partnership characteristics and processes of federally funded, community-based participatory research (CBPR) or community-engaged research projects; (b) explore characteristics of these projects by stage of funding; and (c) build on previous understanding of partnership promising practices.

Methods
Between fall 2016 and spring 2017, we completed a cross-sectional analysis and principal component analysis of online survey data from key informants of federally funded CBPR and community-engaged research projects. Respondents for 179 projects (53% response rate) described project characteristics (e.g., type of partner, stage of partnership, and population) and the use of promising practices (e.g., stewardship, advisory board roles, training topics) by stage of partnership.

Results
Projects involved community, healthcare, and government partners, with 49% of respondents reporting their project was in the early stage of funding. More projects focused on Black/African American populations, whereas principal investigators were mostly White. The more established a partnership (e.g., with multiple projects), the more likely it employed the promising practices of stewardship (i.e., community safeguards for approval), community advisory boards, and training on values and power.

Conclusions
Community engagement is a developmental process with differences between early-stage and established CBPR partnerships. Engaging in active reflection and adopting promising partnering practices are important for CBPR partnerships working to improve health equity. The data provided in this study provide key indicators for reflection.
Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury
Authors: Kim Taeyeon , Nam Kiyeun , Kwon Bum Sun 
Published: October 2019

Background
Isolated oculomotor nerve palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of oculomotor nerve palsy.

Methods
We performed a search for all clinical studies of isolated oculomotor nerve palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated oculomotor nerve palsy, mild head trauma, management, and prognosis.

Results
We identified 14 cases of isolated oculomotor nerve palsy after mild traumatic brain injury. In three cases, steroids were used to manage the oculomotor nerve palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5–18 mos.

Conclusions
This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies oculomotor nerve palsies, steroid therapy to reduce related brain edema, and oculomotor rehabilitation with training eye movement behavior.
Past-Year Racial Discrimination and Allostatic Load Among Indigenous Adults in Canada: The Role of Cultural Continuity
Authors: Currie Cheryl L. , Copeland Jennifer L. , Metz Gerlinde A. , Chief Moon-Riley Kat , Davies Colleen M. 
Published: October 2019

ABSTRACT

Objective
This study aimed to examine the association between racial discrimination and allostatic load (AL) and whether this association was moderated by cultural continuity among Indigenous adults.

Methods
Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (mean age = 27.8 years). The Experience of Discrimination Situation Score and the Vancouver Index Enculturation Subscale were used to assess racial discrimination and cultural continuity, respectively. AL was measured as a composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for confounders (n = 104; 72.5% women).

Results
Across the full sample, racial discrimination was associated with a linear, dose-response increase in AL score after adjustment for confounders. Among adults with low cultural continuity, past-year discrimination was associated with increased AL and explained 22% (adjusted R
2) of the variance in AL score. Taken together, the full model including age, sex, and income explained 38% of the variance in AL score in this subgroup. Among adults with high cultural continuity, racial discrimination was not associated with AL, whereas age remained significant and explained 13% of the variance in AL score.

Conclusions
Past-year racial discrimination was associated with early and more pronounced wear and tear on stress response systems among Indigenous adults relative to peers. Indigenous cultural continuity served as an important buffer that promoted biological resilience against the adverse effects of racial discrimination on physiologic regulation among Indigenous adults.
Brief Report: Zinc Supplementation and Inflammation in Treated HIV
Authors: Dirajlal-Fargo Sahera , Yu Jiao , Kulkarni Manjusha , Sattar Abdus , Funderburg Nicholas , Barkoukis Hope , Mccomsey Grace A. 
Published: October 2019

Objective:
In this study, we explored the effect of zinc supplementation on markers of inflammation and monocyte activation in antiretroviral therapy–treated HIV infection.

Methods:
This is a phase I open-labeled randomized double-arm study, exploring the efficacy and safety of zinc supplementation on inflammation in ≥18-year-old people living with HIV in the US, on stable antiretroviral therapy and with zinc levels ≤75 µg/dL in the last 60 days. Patients were randomized 1:1 to zinc gluconate capsules at a dose of 45 mg (low-dose), or 90 mg (high-dose) elemental zinc daily for 16 weeks. We assessed inflammatory and gut integrity biomarkers at baseline and 16 weeks.

Results:
Overall, a total of 52 participants were enrolled (25 participants in the low-dose arm and 27 participants in the high-dose arm). Median (Interquartile range) age was 49 (38, 60) years, 77% were men and 73% were African Americans. At baseline, median zinc levels were 73 (64, 86) µg/dL. Median circulating zinc levels increased to 91 µg/dL in the low-dose arm and to 100 µg/dL in the high-dose arm. Overall, 48%–60% of participants experienced a reduction in biomarkers levels. The margin of reduction ranged between 8% and 21%. This change was meaningful with large effect size (Cohen D ranging from 5 to 19).

Conclusions:
In this pilot study, we found that zinc supplementation is effective at increasing circulating zinc levels. In addition, our findings provide novel data suggesting that zinc can affect a biological signature in people living with HIV and modulate biomarkers associated with clinical comorbidities.
Switching to Fixed-Dose Bictegravir, Emtricitabine, and Tenofovir Alafenamide (B/F/TAF) in Virologically Suppressed HIV-1 Infected Women: A Randomized, Open-Label, Multicenter, Active-Controlled, Phase 3, Noninferiority Trial
Authors: Kityo Cissy , Hagins Debbie , Koenig Ellen , Avihingsanon Anchalee , Chetchotisakd Ploenchan , Supparatpinyo Khuanchai , Gankina Natalya , Pokrovsky Vadim , Voronin Evgeny , Stephens Jeffrey L. , DeJesus Edwin , Wang Hui , Acosta Rima K. , Cao Huyen , Quirk Erin , Martin Hal , Makadzange Tariro 
Published: October 2019

Background:
Bictegravir, coformulated with emtricitabine/tenofovir alafenamide as a fixed-dose combination (B/F/TAF), is recommended for treatment of HIV-1-infection. Multiple studies of B/F/TAF in treatment-naive and virologically suppressed cohorts have shown high efficacy and tolerability with no treatment-emergent resistance through 48 weeks. Participants in these studies have been predominantly men. We report 48-week results from a phase 3 study evaluating switching to B/F/TAF, specifically in a globally distributed trial population of women.

Methods:
In this multicenter, randomized, open-label, active-controlled, noninferiority trial (ClinicalTrials.gov NCT02652624), women living with HIV who were virologically suppressed (HIV-1 RNA levels <50 copies/mL) on a regimen containing either TAF or tenofovir disoproxil fumarate were randomly assigned (1:1) to switch to B/F/TAF (50/200/25 mg) or stay on baseline regimen (SBR) once daily for 48 weeks. Primary endpoint was proportion of participants with plasma HIV-1 RNA ≥50 copies/mL at week 48 (U.S. Food and Drug Administration snapshot algorithm); prespecified noninferiority margin was 4%.

Findings:
We randomized 472 participants and treated 470 (234 B/F/TAF, 236 SBR). Switching to B/F/TAF was noninferior to SBR for the primary outcome, as 1.7% (4/234) vs 1.7% (4/236) had HIV-1 RNA ≥50 copies/mL at week 48 (difference 0.0%, 95.001% confidence interval: −2.9% to 2.9%). No individual receiving B/F/TAF developed treatment-emergent resistance. Both treatments were well-tolerated; no participant discontinued treatment because of an adverse event.

Interpretation:
Fixed-dose combination B/F/TAF provides a safe and efficacious option for ongoing treatment of HIV in women. This study contributes important data on safety, tolerability, and outcomes of antiretroviral therapy among women living with HIV.
A Modification of the Posterior Perichondrio-Adipo-Dermal Flap for Protruding Ear Correction
Authors: Ersen Burak 
Published: October 2019

Abstract
Prominent ear deformity is a common congenital deformity of the external ear affecting 5% of the general population. Because of the deformity's displeasing nature, corrective prominent ear surgery is widely common and performed as a prophylactic surgery. More than 200 surgical techniques for the correction of prominent ear deformity have been described to improve the cosmetic outcome and decrease complication rates. The aim of the study was to present a modified post auricular flap technique that increases the control of reshaping the ear cartilages, decreases the operation time, and provides a symmetrical long-lasting cosmetic outcome.
One hundred sixty-two patients (141 male and 21 female) had ear correction surgeries performed by the same surgeon using the described technique between January 2015 and January 2018. One hundred sixty patients were gone through bilateral ear correction, whereas only 2 patients had unilateral ear correction procedures. A modified posterior perichondrio-adipo-dermal flap technique for protruding ear correction was applied to all patients.
The patients' ages ranged from 18 to 40 years, with a median of 28.3 years. The mean follow-up time was 22.5 months (6–36 months). Total operation time was 35 minutes on average (25–45 minutes). As more experience was gained in flap harvesting, operation time became shorter. The mean preoperative upper third ear proportion-scalp distance was 33.1 mm and the middle third ear proportion—scalp distance was 29.8 mm. At the sixth month of the surgery, the measurements were 9.8 and 11.6 mm.
Measuring and adjusting flap's width provided to achieve symmetry in initial technique. Locating the postoperative scar along the posterior surface of the helical groove also provides a natural view. Different from traditional posterior fascial flap, the width of the flap was narrowed to 8 to 10 mm. In the traditional technique, the flap was dissected along the incision margins. Narrowing the width of the flap decreased the operation time. The preserved skin between the helix and the mastoid bone has the same width with perichondrio-adipo-dermal flap. That increases the control over the helix-mastoid distance and posterior auricular fold not to mention provides permanent results. The previously mentioned method can be a simple, useful, and practical technique for protruding ear deformity.