bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diffuse Idiopathic Skeletal Hyperostosis Extended to the Lumbar Segment Is a Risk Factor of Reoperation in Patients Treated Surgically for Lumbar Stenosis
Authors: Yamada Kentaro , Satoh Shigenobu , Abe Yuichiro , Yanagibashi Yasushi , Hyakumachi Takahiko , Masuda Takeshi 
Published: February 2018

Study Design.
Retrospective longitudinal cohort study.

Objective.
To investigate the association between diffuse idiopathic skeletal hyperostosis (DISH) and reoperation in patients treated surgically for lumbar spinal stenosis (LSS) in long-term results.

Summary of Background Data.
Few studies have evaluated DISH as a potential risk factor of poor surgical results for LSS.

Methods.
This study included 1063 responders to a postoperative postal survey out of 2363 consecutive patients who underwent surgery for LSS between 2002 and 2010. The survey included questions about reoperations performed at another hospital and the patient-reported outcomes. DISH was evaluated by preoperative standing whole-spine radiographs. We investigated DISH as a predictor of reoperation and characteristics of poor outcomes in patients with DISH. We also assessed selection bias by examining the differences between responders and nonresponders to a postal survey.

Results.
Reoperations were performed in a total of 115 patients (10.8%) within an average of 8.6 years after the initial surgeries. Patients who only had DISH were not associated with reoperation; however, reoperations were performed significantly more often in patients with DISH extended to the lumbar segment (L-DISH) than in patients without (22% and 7.3%, respectively; P < 0.001). Cox analysis showed that L-DISH was one of the significant independent predictors for reoperation (hazard ratio 2.05, P = 0.009). Surgery-free survival was significantly shorter in patients with L-DISH than in those without (P = 0.005). The cause of reoperation did not differ between the patients with and without L-DISH. Several factors, but not L-DISH, were significantly associated with responders to the survey.

Conclusion.
L-DISH was independently associated with reoperation for LSS. The decreased number of lumbar mobile segments due to L-DISH might lead to unfavorable outcomes. Careful follow-up of patients is needed after surgery for LSS with L-DISH.

Level of Evidence: 3
The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying
Authors: Vranas Kelly C. , Jopling Jeffrey K. , Scott Jennifer Y. , Badawi Omar , Harhay Michael O. , Slatore Christopher G. , Ramsey Meghan C. , Breslow Michael J. , Milstein Arnold S. , Kerlin Meeta Prasad 
Published: February 2018

Objective:
Many ICU patients do not require critical care interventions. Whether aggressive care environments increase risks to low-acuity patients is unknown. We evaluated whether ICU acuity was associated with outcomes of low mortality-risk patients. We hypothesized that admission to high-acuity ICUs would be associated with worse outcomes. This hypothesis was based on two possibilities: 1) high-acuity ICUs may have a culture of aggressive therapy that could lead to potentially avoidable complications and 2) high-acuity ICUs may focus attention toward the many sicker patients and away from the fewer low-risk patients.

Design:
Retrospective cohort study.

Setting:
Three hundred twenty-two ICUs in 199 hospitals in the Philips eICU database between 2010 and 2015.

Patients:
Adult ICU patients at low risk of dying, defined as an Acute Physiology and Chronic Health Evaluation-IVa–predicted mortality of 3% or less.

Exposure:
ICU acuity, defined as the mean Acute Physiology and Chronic Health Evaluation IVa score of all admitted patients in a calendar year, stratified into quartiles.

Measurements and Main Results:
We used generalized estimating equations to test whether ICU acuity is independently associated with a primary outcome of ICU length of stay and secondary outcomes of hospital length of stay, hospital mortality, and discharge destination. The study included 381,997 low-risk patients. Mean ICU and hospital length of stay were 1.8 ± 2.1 and 5.2 ± 5.0 days, respectively. Mean Acute Physiology and Chronic Health Evaluation IVa–predicted hospital mortality was 1.6% ± 0.8%; actual hospital mortality was 0.7%. In adjusted analyses, admission to low-acuity ICUs was associated with worse outcomes compared with higher-acuity ICUs. Specifically, compared with the highest-acuity quartile, ICU length of stay in low-acuity ICUs was increased by 0.24 days; in medium-acuity ICUs by 0.16 days; and in high-acuity ICUs by 0.09 days (all p < 0.001). Similar patterns existed for hospital length of stay. Patients in lower-acuity ICUs had significantly higher hospital mortality (odds ratio, 1.28 [95% CI, 1.10–1.49] for low-; 1.24 [95% CI, 1.07–1.42] for medium-, and 1.14 [95% CI, 0.99–1.31] for high-acuity ICUs) and lower likelihood of discharge home (odds ratio, 0.86 [95% CI, 0.82–0.90] for low-, 0.88 [95% CI, 0.85–0.92] for medium-, and 0.95 [95% CI, 0.92–0.99] for high-acuity ICUs).

Conclusions:
Admission to high-acuity ICUs is associated with better outcomes among low mortality-risk patients. Future research should aim to understand factors that confer benefit to patients with different risk profiles.
Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis
Authors: Meyer Nathaniel , Harhay Michael O. , Small Dylan S. , Prescott Hallie C. , Bowles Kathryn H. , Gaieski David F. , Mikkelsen Mark E. 
Published: February 2018

Objectives:
A growing number of patients survive sepsis hospitalizations each year and are at high risk for readmission. However, little is known about temporal trends in hospital-based acute care (emergency department treat-and-release visits and hospital readmission) after sepsis. Our primary objective was to measure temporal trends in sepsis survivorship and hospital-based acute care use in sepsis survivors. In addition, because readmissions after pneumonia are subject to penalty under the national readmission reduction program, we examined whether readmission rates declined after sepsis hospitalizations related to pneumonia.

Design and Setting:
Retrospective, observational cohort study conducted within an academic healthcare system from 2010 to 2015.

Patients:
We used three validated, claims-based approaches to identify 17,256 sepsis or severe sepsis hospitalizations to examine trends in hospital-based acute care after sepsis.

Interventions:
None.

Measurements and Main Results:
From 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased from 3.9% to 9.4%, whereas in-hospital mortality rate for sepsis hospitalizations declined from 24.1% to 14.8%. As a result, the proportion of medical and surgical discharges at-risk for hospital readmission after sepsis increased from 2.7% to 7.8%. Over 6 years, 30-day hospital readmission rates declined modestly, from 26.4% in 2010 to 23.1% in 2015, driven largely by a decline in readmission rates among survivors of nonsevere sepsis, and nonpneumonia sepsis specifically, as the readmission rate of severe sepsis survivors was stable. The modest decline in 30-day readmission rates was offset by an increase in emergency department treat-and-release visits, from 2.8% in 2010 to a peak of 5.4% in 2014.

Conclusions:
Owing to increasing incidence and declining mortality, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. The 30-day hospital readmission rates for sepsis declined modestly but were offset by a rise in emergency department treat-and-release visits.
Transport Time and Preoperating Room Hemostatic Interventions Are Important: Improving Outcomes After Severe Truncal Injury
Authors: Holcomb John B. 
Published: February 2018

Objectives:
Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room.

Data Sources:
Limited literature review.

Data Synthesis:
The peak time to death after severe truncal injury is within 30 minutes of injury. However, when adding prehospital transport time, time spent in the emergency department, followed by the time in the operating room, it currently takes 2.1 hours to achieve definitive truncal hemorrhage control. This disparity in uncontrolled truncal bleeding and time to hemorrhage control needs to be reconciled. Prehospital and emergency department whole blood transfusion and temporary truncal hemorrhage control are now possible.

Conclusions:
The importance of rapid transport, early truncal hemorrhage control and whole blood transfusion is now widely recognized. Prehospital temporary truncal hemorrhage control and whole blood transfusion should offer the best possibility of improving patient outcomes after severe truncal injury.
Endothelial Cell-Specific Molecule-1 in Critically Ill Patients With Hematologic Malignancy
Authors: Zafrani Lara , Resche-Rigon Matthieu , De Freitas Caires Nathalie , Gaudet Alexandre , Mathieu Daniel , Parmentier-decrucq Erika , Lemiale Virginie , Mokart Djamel , Pène Frédéric , Kouatchet Achille , Mayaux Julien , Vincent François , N’yunga Martine , Bruneel Fabrice , Rabbat Antoine , Lebert Christine , Perez Pierre , Meert Anne-Pascale , Benoit Dominique , Darmon Michael , Azoulay Elie 
Published: February 2018

Objectives:
To assess whether serum concentration of endothelial cell-specific molecule-1 (Endocan) at ICU admission is associated with the use of ICU resources and outcomes in critically ill hematology patients.

Design:
Prospective multicenter cohort study.

Setting:
Seventeen ICUs in France and Belgium.

Patients:
Seven hundred forty-four consecutive critically ill hematology patients; 72 critically ill septic patients without hematologic malignancy; 276 healthy subjects.

Intervention:
None.

Measurements and Main Results:
Median total endocan concentrations were 4.46 (2.7–7.8) ng/mL. Endocan concentrations were higher in patients who had received chemotherapy before ICU admission (4.7 [2.8–8.1] ng/mL vs. 3.7 [2.5–6.3] ng/mL [p = 0.002]). In patients with acute respiratory failure, endocan levels were increased in patients with drug-induced pulmonary toxicity compared with other etiologies (p = 0.038). Total endocan levels higher than 4.46 ng/mL were associated with a higher cumulative probability of renal replacement therapy requirement (p = 0.006), a higher requirement of mechanical ventilation (p = 0.01) and a higher requirement of vasopressors throughout ICU stay (p < 0.0001). By multivariate analysis, total endocan levels at admission were independently associated with ICU mortality (odds ratios, 1.39; 95% CI, 1.06–1.83; p = 0.018). The predictive value of endocan peptide fragments of 14 kDa in terms of mortality and life-sustaining therapies requirement was inferior to that of total endocan. Endocan levels were higher in critically ill hematology patients compared with healthy subjects (p < 0.0001) but lower than endocan values in critically ill septic patients without hematologic malignancy (p = 0.005)

Conclusions:
Serum concentrations of endocan at admission are associated with the use of ICU resources and mortality in critically ill hematology patients. Studies to risk-stratify patients in the emergency department or in the hematology wards based on endocan concentrations to identify those likely to benefit from early ICU management are warranted.
Prognostic Value of Secretoneurin in Patients With Severe Sepsis and Septic Shock: Data From the Albumin Italian Outcome Sepsis Study
Authors: Røsjø Helge , Masson Serge , Caironi Pietro , Stridsberg Mats , Magnoli Michela , Christensen Geir , Moise Gabriella , Urbano Maria Cristina , Gattinoni Luciano , Pesenti Antonio , Latini Roberto , Omland Torbjørn 
Published: February 2018

Objectives:
Secretoneurin directly influences cardiomyocyte calcium handling, and circulating secretoneurin levels seem to improve risk prediction in patients with myocardial dysfunction by integrating information on systemic stress, myocardial function, and renal function. Accordingly, in this study, we hypothesized that secretoneurin would improve risk prediction in patients with sepsis and especially in patients with septic shock as these patients are more hemodynamically unstable.

Design:
Multicenter, interventional randomized clinical trial.

Setting:
Multicenter, pragmatic, open-label, randomized, prospective clinical trial testing fluid administration with either 20% human albumin and crystalloids or crystalloid solutions alone in patients with severe sepsis or septic shock (The Albumin Italian Outcome Sepsis).

Patients or Subjects:
In total, 540 patients with septic shock and 418 patients with severe sepsis.

Interventions:
Either 20% human albumin and crystalloids or crystalloid solutions alone.

Measurements and Main Results:
We measured secretoneurin on days 1, 2, and 7 after randomization and compared the prognostic value of secretoneurin for ICU and 90-day mortality with established risk indices and cardiac biomarkers in septic shock and severe sepsis. High secretoneurin levels on day 1 were associated with age and serum concentrations of lactate, bilirubin, creatinine, and N-terminal pro-B-type natriuretic peptide. Adjusting for established risk factors and cardiovascular biomarkers, secretoneurin levels on day 1 were associated with ICU (odds ratio, 2.27 [95% CI, 1.05–4.93]; p = 0.04) and 90-day mortality (2.04 [1.02–4.10]; p = 0.04) in patients with septic shock, but not severe sepsis without shock. Secretoneurin levels on day 2 were also associated with ICU (3.11 [1.34–7.20]; p = 0.008) and 90-day mortality (2.69 [1.26–5.78]; p = 0.01) in multivariate regression analyses and improved reclassification in patients with septic shock, as assessed by the net reclassification index. Randomized albumin administration did not influence the associations between secretoneurin and outcomes.

Conclusions:
Secretoneurin provides early and potent prognostic information in septic patients with cardiovascular instability.
Anal and Cervical High-Risk Human Papillomavirus Genotyping in Women With and Without Genital Neoplasia
Authors: Bregar Amy J. , Cronin Beth , Luis Christine , DiSilvestro Paul , Schechter Steven , Pisharodi Latha , Raker Christina , Clark Melissa , Robison Katina 
Published: February 2018

Objective
The aim of the study was to compare the prevalence, genotypes, and rates of concomitant anal and cervical high-risk human papillomavirus (HR-HPV) in women with and without a history of HPV-related genital neoplasia.

Materials and Methods
This was a prospective cohort study conducted from December 2012 to February 2014. Women with a history of neoplasia were considered the high-risk group. Women without a history of neoplasia were considered the low-risk group. Cervical and anal cytology and HPV genotyping were performed. All women with abnormal anal cytology were referred for anoscopy.

Results
One hundred eighty-four women met inclusion criteria. High-risk HPV was detected in the anal canal of 17.4% of the high-risk group and 1.5% of the low-risk group (p = .003). High-risk HPV was detected in the cervix of 30.5% of the high-risk group and 7.6% of the low-risk group (p < .001). Concomitant anal and cervical high-risk HPV was detected in 4.4% of the high-risk group and was not detected in the low-risk group (p = .2). Among women with anal intraepithelial neoplasia 2 or greater (n = 5), 60% had HR-HPV detected in the anal canal while none had HR-HPV detected in the cervix.

Conclusions
Women with a history of genital neoplasia are more likely to be positive for anal and cervical HR-HPV compared with women without a history of genital neoplasia. Although there was no significant difference in rates of concomitant HR-HPV between low- and high-risk groups, HR-HPV can be found concomitantly in the anus and the cervix and may be associated with anal intraepithelial neoplasia or carcinoma.
Serum Methylarginines and Hearing Loss in a Population-based Cohort of Older Adults
Authors: McEvoy Mark , Harris David C. , Mangoni Arduino A. , Sarant Julia Z. 
Published: February 2018

Objective:
Age-related hearing loss is associated with endothelial dysfunction and increased cardiovascular risk, suggesting a vascular etiology. Methylarginines are endogenous nitric oxide synthase inhibitors that cause endothelial dysfunction and increase cardiovascular disease risk. This study is the first to examine the hypothesis that higher serum concentrations of methylarginines are associated with greater hearing loss prevalence.

Study Design/Patients:
Cross-sectional audiometric data on hearing levels, and serum methylarginines were collected from a population-based sample of 630 older community-dwelling adults.

Results:
Linear regression analysis showed a statistically significant association between higher serum concentrations of asymmetric dimethylarginine (ADMA) and L-arginine and greater degrees of hearing loss for males, particularly over 75 years. Higher body mass index and previous history of stroke were also associated with hearing loss. For females, ADMA concentration was not associated with hearing loss, but higher serum L-arginine concentrations were associated with reduced hearing loss prevalence in older females. Antihypertensive medication use was also associated with reduced hearing loss prevalence. LDL cholesterol and previous myocardial infarction were associated with greater hearing loss.

Conclusion:
This study showed a significant association between serum concentrations of ADMA and hearing loss for males, consistent with the association between endothelial dysfunction and hearing loss. The opposite effect of L-arginine on hearing loss in males versus females might reflect a different role of this precursor toward nitric oxide versus methylated arginines synthesis. These findings are potentially clinically significant if the association between ADMA and hearing loss is causal, as serum methylarginine levels are modifiable through pharmacotherapeutic/lifestyle interventions.
Changes in Sugary Beverage Consumption and Public Perceptions in Upstate New York After Implementation of a Community Awareness Campaign and Healthier Vending Strategies
Authors: Durant Danielle J. , Lowenfels Ann , Ren Jia , Brissette Ian , Martin Erika G. 
Published: February 2018

Objective:
We evaluated the impact of a community-based healthy beverage procurement and serving practices program, and educational media campaign, on residents' behaviors and beliefs regarding sugary beverages.

Design:
Repeated cross-sectional population surveys in 2013 and 2014 were conducted, as well as semistructured interviews with key informants. We employed multivariate differences-in-differences regression analysis, adjusting for demographics and weight status, using the survey data. Key informant interviews were reviewed for common themes.

Setting:
Three rural counties in upstate New York with high prevalence of children living in poverty and childhood obesity.

Participants:
Residents of Broome, Cattaraugus, and Chautauqua, with Chemung as a control, reached through cross-sectional random-digit-dial landline and cellular telephones, and practitioners involved in intervention implementation.

Intervention:
Community organizations were encouraged through presentations to leadership to adopt healthier vending policies, providing more low- and no-sugar options, and were provided assistance with implementation. In addition, a media campaign supported by presentations to the public aimed to educate residents regarding the health consequences of sugary beverage consumption.

Outcome Measures:
The survey measured population demographics and sugary beverage consumption frequency, availability, beliefs about harmfulness, and support for regulation, pre- and postintervention. Key informant interviews elicited perceived program challenges and successes.

Results:
Compared with temporal trends in the control county, availability of regular soda in the intervention counties decreased (differences-in-differences estimator: β = −.341, P = .04) and support for regulation increased (differences-in-differences estimator: β = .162, P = .02). However, there were no differences regarding beliefs about harmfulness or consumption. Practitioners confirmed that the intervention increased awareness but was insufficient to spur action.

Conclusion:
Although public education on the harmfulness of sugary beverages and provision of healthier options in some vending machines successfully impacted soda availability and support for regulation, it did not reduce consumption. This intervention seems promising but should be paired with other community-based interventions for a more comprehensive approach.
Media Flight Schedules and Seasonality in Relation to Quitline Call Volume
Authors: Murphy-Hoefer Rebecca , Madden Patrick A. , Dufresne Ruth M. 
Published: February 2018

Context:Given the high profile, cost, and vulnerability to budget cuts of mass-reach health education campaigns, researchers have cited the need for media buying strategies.Objective:The objective of the current study is to fill a gap in the literature by comparing the impact of media flight schedule types in relation to tobacco quitline call volume.Design:The retrospective study was designed to determine whether type of media flight schedule (eg, flighting, continuous, pulsing) impacted number of calls to the Maine Tobacco Helpline, while accounting for number of gross rating points (GRPs), seasonality, holidays, and other factors.Setting:Maine has 3 designated market areas (DMAs): Portland/Auburn, Bangor, and Presque Isle.Main Outcome Measures:Daily call volume was matched with weekly GRPs.Methods:A negative binomial regression model was created to examine the relationship among media flight schedules, number of GRPs, and call volume. Gross rating points reflect national networks and local cable TV media buys. A second model examined the association between GRP dose levels and call volume.Results:The number of GRPs was a significant predictor of call volume (P< .001). Weekly number of GRPs within a media flight schedule was the most important indicator for potential effectiveness. Weekly low-dose GRPs were not effective in increasing calls, indicating a minimum threshold. For every 250 GRPs, 29% (or 73) more calls per week were attributed to the media campaigns (P< .001). Weekly quitline call volume was 21% (or 53 calls) lower during the weeks of Christmas, US Thanksgiving, and US Independence Day.Conclusion:Type of media flight schedule should be considered in the context of purchasing sufficient weekly, as well as quarterly, rating points to increase tobacco quitline call volume. In addition, our study is the first to quantify and report on lower tobacco quitline call volume during several US holidays.