bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient
Authors: Jeong Hee Joon , Sim Woo Seog , Park Hue Jung , Lee Seung Hwan , Oh Min Seok , Cho Min Kyoung , Seon Heui Jin , Lee Jin Young 
Published: August 2019

Abstract

Introduction:
Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy.

Patient concerns:
Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy.

Diagnosis:
Enhanced lumbar magnetic resonance imaging revealed left sided L1–L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation.

Interventions:
A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day.

Outcomes:
The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction.

Conclusion:
An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.
Primary epiploic appendagitis as an unusual cause of acute abdominal pain in a middle-aged male
Authors: Yang Lan , Jia Min , Han Ping 
Published: August 2019

Abstract

Rationale:
Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction.

Patient concerns:
In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening.

Diagnoses:
He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan.

Interventions:
He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use.

Outcomes:
The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up.

Lessons:
In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.
Behavior of self-inflicted violence in patients with bipolar disorder
Authors: de Cássia Hoffmann Leão Rita , Filho Frederik L. , Fiamoncini Carolina M. , Sousa Renata Alves de , Vasconcelos Selene Cordeiro , Sougey Everton Botelho , Silva Tatiana de Paula Santana da 
Published: August 2019

Abstract

Background:
Studies aimed at understanding the higher risk profiles for self-inflicted violence in individuals with BD become essential as a possible predictive risk measure for the presence of suicidal behavior, corroborating the expressive reduction of suicide deaths in young people who are in psychic suffering.

Methods:
The protocol was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA-P) and the research question was constructed using guidelines from the Population Intervention Comparator Outcome Setting (PICOS) strategy. A third reviewer will be contacted, and two studies will be included in the selection, analysis and inclusion phases of the articles, in case of divergence, a third reviewer will be contacted. (1) methodological design studies of cohorts, case-control and cross-sectional; (2) Diagnosis of Bipolar disorder according to Diagnostic and statistical Manual of mental disorders V; (3) Studies with adult population and (4) Studies that consider at least one type of self-inflicted violence as a variable. The articles considered eligible will be analyzed by New Castle - Ottawa quality assessment scale/cross section studies (NOS) to evaluate the quality of the studies.

Results:
The identification of the characteristics of self-harm may subsidize professionals who work in the treatment of bipolar disorder with greater attention to these practices and monitoring of possible suicidal behaviors.

Conclusion:
This study may represent one of the initial measures of evaluation on these correlations, which will allow to protocol the guidelines in the field of practice and contribute to improvements in public health indexes.
Effect of extracorporeal shockwave therapy on carpal tunnel syndrome
Authors: Kim Ju Chan , Jung Se Hee , Lee Shi-Uk , Lee Sang Yoon 
Published: August 2019

Abstract

Background:
Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS.

Methods:
Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models.

Results:
ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439–2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, −0.131 to 0.968; P = .135). A publication bias was not evident in this study.

Conclusion:
Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.
Predictors of quality of care and survival in a three-state cohort of locally advanced cervical cancer patients and development of a predictive model to identify women at risk of incomplete treatment
Authors: Schad Michael D. , Moore Joanna , Camacho Fabian , Anderson Roger T. , Cantrell Leigh A. , Showalter Timothy N. 
Published: August 2019

Abstract
To expand our prior statewide analysis of care distribution for locally advanced cervical cancer in Virginia to include 2 more states and to develop a tool for predicting quality of care. Complete treatment was defined as receiving chemotherapy (CT), brachytherapy (BT), and external beam radiotherapy.
State cancer registry databases yielded a three-state cohort of 3197 women diagnosed with locally advanced cervical cancer from 2000 to 2013. A logistic regression evaluated predictors for receipt of BT, CT, and high (2–3 modalities received) versus low (0–1 modalities received) quality care. A Cox proportional hazards models determined predictors of survival. Finally, a predictive model was developed and preliminarily validated using our cohort.
Only 35.3% of the cohort received complete treatment and only 57.3% received BT. Significant predictors of lower odds of receiving high quality care varied by state but included: 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; public insurance with supplement as compared to private; treatment at a low volume facility; and closer distance quintiles to a high volume treatment center as compared to the furthest quintile. Significant predictors of worse survival varied by state but included: low quality score (0–1 modalities received); 2000 to 2004 or 2005 to 2009 year of diagnosis as compared to 2010 to 2013; 66+ age at diagnosis as compared to 18 to 42, 42 to 53, or 53 to 66; cancer stage IVA as compared to IIIx, IIx, or IB2; treatment at a low volume facility; and unmarried/unknown marital status as compared to married. Our treatment quality prediction tool included age, age2, treatment at high volume facility, and cancer stage and demonstrated 78.2% sensitivity and a 62.9% specificity.
Only 35.3% of patients received complete guidelines-concordant treatment. Additionally, in 2/3 states it appeared that BT usage may have decreased during the study period. Our predictive model may help identify patients/regions at risk of receiving low quality care to target interventions aimed at improving cervical cancer treatment quality and survival.
Add-on effect of Guizhi Fuling formula to mifepristone for endometriosis
Authors: Meng Wenbin , Ta Na , Wang Fei 
Published: August 2019

Abstract

Background:
Guizhi Fuling pill, a famous traditional Chinese herbal formula, has been widely used for treatment of gynecological diseases. This meta-analysis sought to evaluate the add-on effect of Guizhi Fuling capsule (GZFL) to mifepristone in women with endometriosis.

Methods:
A comprehensively literature search was conducted using Pubed, Embase, Cochrane Library, Wanfang, CNKI, VIP databases from their inceptions to January 25, 2019. Randomized controlled trials that compared GZFL plus mifepristone to mifepristone alone for treatment of endometriosis were eligible. Main outcomes were pregnancy, reduction of the recurrence, and serum level of follicle-stimulating hormone, luteinizing hormone, estradiol or progesterone.

Results:
A total of 1052 women with endometriosis from 10 trials were identified and analyzed. Meta-analyses showed that GZFL plus mifepristone was superior to mifepristone in reducing the recurrence of endometriosis (RR 0.40; 95% CI 0.27–0.59) and improving the pregnancy (risk ratio [RR] 1.74; 95% confidence intervals [CI] 1.40–2.17). Moreover, adjuvant treatment with GZFL also significantly reduced serum level of estradiol (mean difference [MD] −20.83 pmol/L; 95% CI −34.01 to −7.65) and progesterone (MD −0.18 mmol/L; 95% CI −0.23 to −0.12). However, there were no significant differences in serum level of follicle-stimulating hormone (MD −0.42 U/L; 95% CI −1.16 to 0.31) and luteinizing hormone (MD −0.04 U/L; 95% CI −0.43 to 0.34).

Conclusion:
GZFL as adjuvant therapy to mifepristone appears to have additional benefits in preventing recurrence of endometriosis and improving pregnancy among women with endometriosis. However, these conclusions should be interpreted with caution due to the methodological flaws of the included trials.
Traditional Chinese medicine for mild-to-moderate ulcerative colitis
Authors: Shen Zhaofeng , Zhou Qing , Ni Yingjun , He Weiming , Shen Hong , Zhu Lei 
Published: August 2019

Abstract

Background:
Ulcerative colitis (UC) is a universal chronic nonspecific intestinal inflammatory disease of unknown etiology. Although 5-aminosalicylic acid (5-ASA) is used as a first-line treatment for mild-to-moderate UC, some patients do not react well to it. Traditional Chinese medicine (TCM) plays a complementary role in the management of UC. A large number of randomized controlled trials (RCTs) have shown that TCM has a significant effect in the treatment of mild-to-moderate UC. However, due to the diversity of TCM treatments, its relative effectiveness and safety remains unclear. Therefore, we aim to compare the effectiveness and safety of TCM for mild-to-moderate UC by implementing a Bayesian network meta-analysis (NMA) and provide a reference for clinical treatment.

Methods:
According to the Cochrane Handbook, PubMed, MEDLINE, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CHKD-CNKI), Chinese Biomedical Literature database (CBM), and WANFANG database will be searched. Related randomized controlled trials (RCTs) that compared one TCM intervention with another or with 5-ASA (placebo) for mild-to-moderate UC from inceptions to February 2019 will be included. Two authors will screen the literature and extract data independently based on predesigned rules, and evaluate the risk of bias of included studies using the Cochrane Risk of Bias Tool. Both classical pair-wise meta-analysis and Bayesian NMA will be conducted using R-3.4.4 and WinBUGS-1.4.3 software. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarized as surface under the cumulative ranking curve. The consistency within network will be evaluated with Cochrane Q statistic and net-heat plot. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Results:
The study results will be disseminated through a peer-reviewed journal publication or conference presentation.

Conclusions:
The findings will provide a systematic evidence-based medical evidence of TCM interventions in the treatment of UC and help clinical practitioners, UC patients, and policy-makers make more informed choices in the decision-making.

Ethics and dissemination:
Ethical approval and informed consent are not required since this is a protocol for a network meta-analysis based on published studies. The findings will be disseminated through a peer-reviewed journal publication or conference presentation.

Registration:
PROSPERO CRD42019133962.
Assessing the Relative Contribution of Resident Versus Facility Characteristics Associated With Antipsychotic Medication Receipt Among Nursing Facility Residents
Authors: Busch Susan H. , Cohen Michael S. , Konetzka R. Tamara 
Published: August 2019

Objective:In 2012 Centers for Medicare and Medicaid Services (CMS) launched a multifaceted initiative aimed at reducing the unnecessary use of antipsychotic medications in nursing facilities due to evidence these medications are associated with little or uncertain benefit and substantial risk. Yet, little is known about whether efforts to reduce antipsychotic medication should be focused on residents with targeted characteristics, or on nursing facility regulation (eg, staffing levels). Our objective was to identify the relative contribution of resident and facility characteristics to potentially inappropriate antipsychotic use.Methods:We examined 1,156,875 long stay residents in 14,699 US nursing facilities in 2014 and predicted resident antipsychotic use controlling sequentially for resident and facility characteristics and calculated the incremental variation explained.Results:We found significant variability in unadjusted rates of potentially inappropriate antipsychotic use among nursing facilities (mean=18.0%; interquartile range: 11.3%–23.7%; SD: 11.1). Regression results indicated that 93% of the explained variation in antipsychotic use was attributed to resident characteristics and 7% was attributed to facility-level factors. At the facility level, worker hours per resident day was not significantly associated with antipsychotic use. Simulations indicated that applying the effect sizes achieved by the best performing facilities to the existing case mix across all nursing facilities would result in no more than a 1 percentage point change in population-level antipsychotic use.Conclusions:Efforts to reduce antipsychotic use may have greater impact by developing new clinical strategies to address specific diagnoses rather than regulations related to facility-level attributes.
Comparative Responsiveness and Minimally Important Difference of Common Anxiety Measures
Authors: Kroenke Kurt , Baye Fitsum , Lourens Spencer G. 
Published: August 2019

Background:
Anxiety is one of the most prevalent mental disorders and accounts for substantial disability as well as increased health care costs. This study examines the minimally important difference (MID) and responsiveness of 6 commonly used anxiety scales.

Methods:
The sample comprised 294 patients from 6 primary care clinics in a single VA medical center who were enrolled in a telecare trial for treatment of chronic musculoskeletal pain and comorbid depression and/or anxiety. The measures assessed were the Patient Reported Outcomes Measurement Information System (PROMIS) 4-item, 6-item, and 8-item anxiety scales; the Generalized Anxiety Disorder 7-item scale (GAD-7); the Symptom Checklist anxiety subscale (SCL); the Posttraumatic Stress Disorder Checklist (PCL); the Short Form (SF)-36 Mental Health subscale; and the SF-12 Mental Component Summary (MCS). Validity was assessed with correlations of these measures with one another and with measures of quality of life and disability. MID was estimated by triangulating several methods. Responsiveness was evaluated by comparing: (a) the standardized response means for patients who reported their mood as being better, the same, or worse at 3 months; (b) the area under the curve for patients who had improved (better) versus those who had not (same/worse).

Results:
Convergent and construct validity was supported by strong correlations of the anxiety measures with one another and moderate correlations with quality of life and disability measures, respectively. All measures differentiated patients who reported global improvement at 3 months from those who were unchanged, but were less able to distinguish worsening from no change. The area under the curves showed comparable responsiveness of the scales. The estimated MID was 4 for the PROMIS scales; 3 for the GAD-7; 6 for the PCL; 9 for the SF-36 mental health subscale; 5 for the MCS score, and 0.3 for the SCL anxiety scale.

Conclusions:
Six commonly used anxiety scales demonstrate similar responsiveness, and estimated MIDs can be used to gauge anxiety change in clinical research and practice.
Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration
Authors: May Folasade P. , Yano Elizabeth M. , Provenzale Dawn , Steers William N. , Washington Donna L. 
Published: August 2019

Introduction:
Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50–75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer.

Methods:
We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA.

Results:
The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65–0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61–0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72–0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10–1.31 for quintiles 2–5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake.

Conclusions:
Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.
Using Ancillary Sociodemographic Data to Identify Sexual Minority Adults Among Those Responding “Something Else” or “Don’t Know” to Sexual Orientation Questions
Authors: Elliott Marc N. , Dahlhamer James M. , MacCarthy Sarah , Beckett Megan K. , Orr Nate , Guerino Paul , Agniel Denis , Saunders Catherine L. , Schuster Mark A. , Ng Judy H. , Martino Steven C. 
Published: August 2019

Background:
General population surveys are increasingly offering broader response options for questions on sexual orientation—for example, not only gay or lesbian, but also “something else” (SE) and “don’t know” (DK). However, these additional response options are potentially confusing for those who may not know what the terms mean. Researchers studying sexual orientation-based disparities face difficult methodological trade-offs regarding how best to classify respondents identifying with the SE and DK categories.

Objectives:
Develop respondent-level probabilities of sexual minority orientation without excluding or misclassifying the potentially ambiguous SE and DK responses. Compare 3 increasingly inclusive analytic approaches for estimating health disparities using a single item: (a) omitting SE and DK respondents; (b) classifying SE as sexual minority and omitting DK; and (c) a new approach classifying only SE and DK respondents with >50% predicted probabilities of being sexual minorities as sexual minority.

Materials and Methods:
We used the sociodemographic information and follow-up questions for SE and DK respondents in the 2013–2014 National Health Interview Survey to generate predicted probabilities of identifying as a sexual minority adult.

Results:
About 94% of the 144 SE respondents and 20% of the 310 DK respondents were predicted to identify as a sexual minority adult, with higher probabilities for younger, wealthier, non-Hispanic white, and urban-dwelling respondents. Using a more specific definition of sexual minority orientation improved the precision of health and health care disparity estimates.

Conclusions:
Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult.
Pneumonia Readmissions in Older Adults With Dementia
Authors: Knox Sara 
Published: August 2019

Background/Objectives:
Pneumonia readmissions have significant quality of care and policy implications for patients and health care providers. Research indicates that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia have an increased risk of pneumonia and subsequent hospitalizations, suggesting that they may be at high-risk of pneumonia readmissions. The purpose of this study was to determine if associations between patient factors and readmission rates differ for older adults with and without dementia who were hospitalized for pneumonia.

Design:
This was a retrospective study of secondary data.

Participants:
A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database.

Measures:
Differences between groups were analyzed using χ2 and t tests. A generalized linear model was utilized to examine associations between patient factors and pneumonia readmissions.

Results:
Significant differences were found (P<0.001) when comparing patient characteristics of older adults with and without dementia who were readmitted. Older adults with dementia had a readmission rate of 23.5% and were 2.9 times more likely to be readmitted (odds ratio; 95% confidence interval, 1.93, 4.40) than older adults without dementia. Associations were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified (P<0.05) the relationship between pneumonia readmissions and 4 factors; (a) discharge disposition, (b) chronic conditions, (c) risk of mortality, and (d) median household income.

Conclusions:
Classifying older adults with dementia as a high-risk subgroup for pneumonia readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.