bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provision of and Barriers to Integrating Reproductive and Sexual Health Services for Reproductive-age Women in Opioid Treatment Programs
Authors: Klaman Stacey L. , Lorvick Jennifer , Jones Hendrée E. 
Published: March 2019

Objectives:
To identify the level of provision of reproductive and sexual health (RSH) services to reproductive-age women enrolled in opioid treatment programs (OTPs) in 2017, and to understand provider-perceived barriers to integration of services.

Methods:
A web-based survey was sent to medical or program directors at all OTPs (n = 48) in North Carolina (NC). Data were collected regarding program characteristics, demographic information about female patient populations, provision of RSH services, and provider-perceived barriers to service integration into OTPs. Survey results were aggregated for descriptive analysis.

Results:
The survey response rate was 79%, representing 38 out of the 48 OTPs. Among OTPs, 95% serve pregnant and parenting women, 21% have female-specific programs, and together they serve a total of about 5000 women annually. Medical and program directors reported that approximately 53% of women have 1 or more children, and 6.5% are, at present, pregnant. Nearly 90% of programs provide pregnancy testing, but only about 50% provide contraception. Although more than half offer hepatitis C virus (HCV) testing, less than half offer human immunodeficiency virus (HIV) testing and sexually transmitted infection (STI) testing. Half of the programs provide education about STI prevention and safer sex practices. Most medical and program directors (84%) perceive female patients could benefit from RSH education and more than two-thirds (68%) perceive female patients need increased access to RSH services. Provider-perceived barriers to service integration include lack of facility equipment and supplies, trained staff, and childcare.

Conclusions:
NC OTPs are a logical setting for integrating RSH services to meet the needs of reproductive-age women in treatment for OUD.
Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication
Authors: Adam Angéline , Faouzi Mohamed , McNeely Jennifer , Yersin Bertrand , Daeppen Jean-Bernard , Bertholet Nicolas 
Published: March 2019

Objectives:
To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions.

Methods:
In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records.

Measurements:
Proportion of subjects with at least 1 further ED admission, 1 further ED admission with AI, and any PD admission over the study period.
Associations between patients’ characteristics at index visit and readmissions were assessed using backward selection multivariate regression analyses.

Results:
Mean age was 24, 66% were male, 60% had any ED/PD admissions during the study period, 17.9% a PD admission, and 13.8% were re-admitted to ED with AI. Disruptive behavior at the index visit was associated with further ED (odds ratio [OR] 1.69 [1.13; 2.54]) and PD admissions (OR 2.41 [1.44; 4.05]). Psychiatric diagnosis was associated with any further ED admission (OR 2.07 [1.41; 3.05]), with further ED admission with AI (OR 4.56 [2.36; 8.81]) and with PD admission (OR 3.92 [2.40; 6.41]). Female sex predicted any further ED admission (OR 1.65 [1.14; 2.39]).

Conclusions:
Young adults presenting with alcohol intoxication have high rates of subsequent inpatient emergency and psychiatric admissions. Being female, presenting with disruptive behavior, and having a psychiatric diagnosis at the ED visit were predictors of further admissions.
Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Major Postoperative Morbidity
Authors: Kabon Barbara , Sessler Daniel I. , Kurz Andrea ,   on behalf of the Crystalloid–Colloid Study Team
Published: March 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Crystalloid solutions leave the circulation quickly, whereas colloids remain for hours, thus promoting hemodynamic stability. However, colloids are expensive and promote renal toxicity in critical care patients. This study tested the hypothesis that goal-directed colloid administration during elective abdominal surgery decreases 30-day major complications more than goal-directed crystalloid administration.

Methods
In this parallel-arm double-blinded multicenter randomized trial, adults having moderate- to high-risk open and laparoscopically assisted abdominal surgery with general anesthesia were randomly assigned to Doppler-guided intraoperative volume replacement with 6% hydroxyethyl starch 130/0.4 (n = 523) or lactated Ringer’s solution (n = 534). The primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications that were assessed with a generalized estimating equation multivariate model. The primary safety outcome was a change in serum creatinine concentration up to 6 months postoperatively, compared to baseline concentrations.

Results
A total of 1,057 patients were included in the analysis. Patients assigned to crystalloid received a median [quartile 1, quartile 3] amount of 3.2 l [2.3, 4.4] of crystalloid, and patients assigned to colloid received 1.0 l [0.5, 1.5] of colloid and 1.8 l [1.2, 2.4] of crystalloid. The estimated intention-to-treat common effect relative risk for the primary composite was 0.90 for colloids versus crystalloids (95% CI: 0.65 to 1.23, P = 0.51), and 18% (91 of 523) of colloid patients and 20% (103 of 534) of crystalloid patients incurred at least one component of the primary outcome composite. There was no evidence of renal toxicity at any time.

Conclusions
Doppler-guided intraoperative hydroxyethyl starch administration did not significantly reduce a composite of serious complications. However, there was also no indication of renal or other toxicity.
Evaluating Teamwork in the Neonatal Intensive Care Unit
Authors: Masten Marjorie , Sommerfeldt Susan , Gordan Suzanne , Greubel Elizabeth , Canning Caroline , Lioy Janet , Chuo John 
Published: March 2019

Background:
A unified vision of team mission, psychologically safe practice environment, effective communication, and respect among team members are key characteristics of an effective interdisciplinary neonatal intensive care unit (NICU) team.

Purpose:
A quality improvement team in a quaternary NICU surveyed parents, physicians, and nurses on perceptions of teamwork to identify opportunities for improvement.

Design/Methods:
Parents and healthcare staff (n = 113) completed an anonymous survey from May to July of 2014 to assess team roles and membership, team qualities, shared mission, psychological safety, hierarchy, communications, and conflict awareness. An expert panel assigned questions into one or more characteristics of team intelligence.

Results:
Physicians, nurses, and parents perceive their roles and the composition of the healthcare team differently. Most providers reported a shared mission and having a cooperative spirit as their teams' best attributes. While most nurses chose safety as most important, the majority of doctors chose treatment plan. Parents consider tenderness toward their infant, providing medical care and answers to their questions important. All expressed varying concerns about psychological safety, conflict resolution, and miscommunications.

Implications for Practice:
This survey identifies strengths and gaps of teamwork in our NICU and provides insight on necessary changes that need to be made to improve collaboration among the interdisciplinary care team including parents.

Implications for Research:
This quality improvement report identifies aspects of team care delivery in NICUs that require further study. The concept of team intelligence and its impact on team effectiveness invites in-depth exploration.
Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty
Authors: Ives Graham C. , Fein Lydia A. , Finch Lindsey , Sluiter Emily C. , Lane Megan , Kuzon William M. , Salgado Christopher J. 
Published: March 2019

Background:
Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV).

Methods:
This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample.

Results:
One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m2 (range 17.8–48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications.

Conclusions:
We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.
American Society of Plastic Surgeons Member Post-Operative Opioid Prescribing Patterns
Authors: Torabi Radbeh , Bourn Lynn , Mundinger Gerhard S. , Saeg Fouad , Patterson Charles , Gimenez Alejandro , Wisecarver Ian , St. Hilaire Hugo , Stalder Mark , Tessler Oren 
Published: March 2019

Introduction:
Despite the widespread use of opioids in pain management, there are currently no evidence-based guidelines for the treatment of postoperative pain with opioids. Although other surgical specialties have begun researching their pain prescribing patterns, there has yet to be an investigation to unravel opioid prescribing patterns among plastic surgeons.

Methods:
Survey Monkey was used to sample the American Society of Plastic Surgeons (ASPS) members regarding their opioid prescribing practice patterns. The survey was sent randomly to 50% of ASPS members. Respondents were randomized to 1 of 3 different common elective procedures in plastic surgery: breast augmentation, breast reduction, and abdominoplasty.

Results:
Of the 5,770 overall active ASPS members, 298 responses (12% response rate) were received with the following procedure randomization results: 106 for breast augmentation, 99 for breast reduction, and 95 for abdominoplasty. Overall, 80% (N = 240) of respondents used nonnarcotic adjuncts to manage postoperative pain, with 75.4% (N = 181) using nonnarcotics adjuncts >75% of the time. The most commonly prescribed narcotics were Hydrocodone with Acetaminophen (Lortab, Norco) and Oxycodone with Acetaminophen (Percocet, Oxycocet) at 42.5% (N = 116) and 38.1% (N = 104), respectively. The most common dosage was 5 mg (80.4%; N = 176), with 48.9% (N = 107) mostly dispensing 20–30 tablets, and the majority did not give refills (94.5%; N = 207).

Conclusions:
Overall, plastic surgeons seem to be in compliance with proposed American College of Surgeon’s opioid prescription guidelines. However, there remains a lack of evidence regarding appropriate opioid prescribing patterns for plastic surgeons.
Keystone Flap: Overcoming Paradigms
Authors: Gómez Oswaldo J. , Barón Oscar I. , Peñarredonda Martha L. 
Published: March 2019

Background:
The physiology and geometry of the keystone flap (KF) are the main factors that support its development. This study reports our experience using the KF and proposes the concept of pedicular area.

Methods:
A prospective cohort study was conducted from October 2014 to December 2016, in which 112 KF procedures were performed with an average follow-up time of 10 months. The conclusions drawn from clinical observations were compared with the findings of a literature review.

Results:
One hundred twelve flaps were performed in 89 patients (45 men and 44 women) with an average age of 64 years (range, 3–89 years). The flap survival rate was 100%. The term pedicular area (PA) was coined to describe a flap segment that remains attached to its bed without vascular detriment and whose location can be randomly selected. In this study, the PA could be reduced up to a 10%, which means that over 90% of each flap was dissected without any harm.

Conclusions:
The KF is a safe, cost-effective technique with better results when compared with other reconstructive procedures. Although research is still needed to better understand the physiological adaptations of KF, the clinical evidence supports its use in many reconstructive scenarios.
Z-plasty and Postoperative Radiotherapy for Anterior Chest Wall Keloids: An Analysis of 141 Patients
Authors: Arima Juri , Dohi Teruyuki , Kuribayashi Shigehiko , Akaishi Satoshi , Ogawa Rei 
Published: March 2019

Background:
The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids.

Methods:
All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013–2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy.

Results:
In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution.

Conclusions:
Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.
NCRP Report 181, Evaluation of the Relative Effectiveness of Low-energy Photons and Electrons in Inducing Cancer in Humans: A Critique and Alternative Analysis
Authors: Kocher David C. , Hoffman F. Owen 
Published: March 2019

Abstract
A recent report from the National Council on Radiation Protection and Measurements presents an evaluation of the effectiveness of low-energy photons and electrons, relative to higher-energy photons, in inducing cancer in humans. The objective of that evaluation was to develop subjective probability distributions of an uncertain quantity, denoted by ρ, to represent ranges of credible values of the effectiveness of five groups of low-energy radiations (L): photons at about 1.5 keV; 15 to 30 keV photons; 40 to 60 keV photons; >60 to 150 keV photons; and electrons from beta decay of tritium (3H). Probability distributions of ρ
L for all low-energy groups were derived based on an evaluation of uncertainties in data on biological effectiveness from five areas of research and use of an elicitation process and decomposition method to combine probability distributions to represent those uncertainties. In this paper, we argue that uncertainties in ρ
Ls for all low-energy groups are too small compared with uncertainties in biological effectiveness from the different areas of research, especially that upper confidence limits of all ρ
Ls are too low. These deflations of uncertainty in all ρ
Ls apparently are due, at least in part, to an invalid assumption in the decomposition method that probability distributions of biological effectiveness from the different areas of research are representations of random uncertainty that arises from repeated measurements of the same quantity under the same conditions using well-calibrated instruments. However, those distributions essentially are representations of systematic uncertainty in different estimates of biological effectiveness from each area of research, which means that a deflation of uncertainty in ρ
Ls is not a credible result. We then use the same probability distributions of biological effectiveness from the different areas of research in an alternative analysis to derive wider probability distributions of ρ
L that we believe provide a better representation of the state of knowledge of the effectiveness of low-energy photons and electrons in inducing cancer in humans. Our analysis is based on the notion that each probability distribution of biological effectiveness from an area of research represents a distinctly different model of a ρ
L and use of the concept of model averaging to combine those distributions.
Invasive Fungal Sinusitis: Risk Factors for Visual Acuity Outcomes and Mortality
Authors: Hirabayashi Kristin E. , Idowu Oluwatobi O. , Kalin-Hajdu Evan , Oldenburg Catherine E. , Brodie Frank L. , Kersten Robert C. , Vagefi M. Reza 
Published: March 2019

Endoscopic sinus debridement portends better visual acuity outcomes in patients with invasive fungal sinusitis, whereas exenteration yields no difference in survival benefit.

Purpose:
Invasive fungal sinusitis is a rare but potentially lethal disease that primarily affects immunocompromised patients. The purpose of this study was to review an academic medical center’s experience in the presentation, diagnosis, and treatment of invasive fungal sinusitis.

Methods:
A retrospective chart review was performed at a single institution over a 17-year period. Medical records, radiographic imaging, and operative reports were analyzed. Bivariate and multivariable analyses were performed to determine factors that affected visual acuity outcomes and mortality.

Results:
Fifty-five patients with histopathologically confirmed invasive fungal sinusitis were included. The average duration of follow up was 1.8 ± 2.6 years (range: 1 week to 10 years). The most common causes of immunosuppression were hematologic malignancy (45%), diabetes (31%), and organ transplantation (9%). At presentation, 35% of individuals were neutropenic (absolute neutrophil count < 500/μl). All patients received systemic antifungal treatment. A surgical intervention was performed on 50 patients (91%), and all but one had functional endoscopic sinus surgery. Nine (16%) patients underwent orbital exenteration. Multivariable analysis of visual acuity outcomes demonstrated that individuals infected with Zygomycota had 6–7 lines worse vision than those infected with Ascomycota (mean difference in logMAR 0.66, 95% confidence interval 0.27 to 1.06, p = 0.001). Patients who had functional endoscopic sinus surgery had 7–8 lines better visual acuity than those without functional endoscopic sinus surgery (mean difference in logMAR −0.76, 95% confidence interval −1.13 to −0.38, p < 0.001). The overall death rate due to infection was 24%. Bivariate models demonstrated no difference in mortality in patients receiving exenteration versus those who did not (p = 0.14). Multivariable analysis of mortality demonstrated that neutropenia increased mortality (adjusted odds ratio 10.05, 95% confidence interval 1.49 to 67.67, p = 0.02). Having a greater number of surgeries was associated with an increased rate of survival (adjusted odds ratio 0.39, 95% confidence interval 0.15 to 0.96, p = 0.04).

Conclusions:
Invasive fungal sinusitis is an aggressive disease with significant mortality. Patients with neutropenia had a lower rate of survival, and infection with Zygomycota was associated with worse visual acuity outcomes. Those having functional endoscopic sinus surgery had better final visual acuity, and an increased number of surgeries was associated with a decreased chance of death. Exenteration yielded no observed survival benefit.
A Study of Congenital Protein C Deficiency With Infancy Onset of CADASIL in a Chinese Baby
Authors: Yuan Xiuli , Li Changgang , Chen Xiaowen , Liu Liwei , Liu Guosheng , Wen Feiqiu 
Published: March 2019

Objective:
The main objectives of this article were to study a severe congenital protein C deficiency (PCD) in a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and analyze the cause of this case.

Materials and Methods:
We had recorded clinical manifestations of the patient, laboratory tests, imaging studies, and gene sequencing of the PROC gene and NOTCH3 gene to study the disease in this family. We checked the change of NOTCH3 protein by immunohistochemistry.

Results:
Laboratory studies of the patient had revealed that his PC activity was 3%. Magnetic resonance imaging results showed hyperintense lesions in the cerebral white matter of the patient. PROC gene and NOTCH3 gene sequencing was performed among the family members. The patient was confirmed as homozygous for the (A-G)-12 at the transcription initiation site in the promoter region of the PROC gene and heterozygous mutation of the NOTCH3 gene. Immunohistochemical results showed that NOTCH3 protein was positive in the skin vascular smooth muscle of the patient.

Conclusions:
We studied a rare case of an infat boy diagnosed with both congenital PCD and CADASIL; congenital PCD was attributable to a compound that was homozygous for (A-G)-12 at the transcription initiation site in the promoter region of the PROC gene, and CADASIL was caused by missense mutation in exon 24 of NOTCH3. He was a sporadic patient with congenital PCD and CADASIL; it maybe that the deficiency of protein C led to early onset of CADASIL. The gene sequencing of PROC gene and NOTCH3 gene may have important value for fertility guidance and prenatal diagnosis.