bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic Health Record Use Among American Neurotology Society Members
Authors: Kamil Rebecca J. , Giddings Neil , Hoffer Michael , Ying Yu-Lan Mary , Kwartler Jed , Brookler Kenneth , Arriaga Moises , Agrawal Yuri 
Published: August 2018

Objective:
To describe the use of electronic health records (EHR) among members of the American Neurotology Society (ANS).

Study Design:
Cross-sectional.

Setting:
Active ANS members in November 2017.

Intervention:
Internet-based survey.

Main Outcome Measure:
Survey that assessed the use of EHR in practice, types of EHR programs, different elements of EHR employed, and respondents’ satisfaction and efficiency with EHR.

Results:
One hundred twenty-seven ANS members responded to the survey with 67 (52.8%) respondents working in academic practice and 60 (47.2%) respondents working in private practice. Epic was the most commonly used EHR with 89 (70.1%) respondents using this system. Among all respondents, 84 (66.1%) respondents reported their efficiency was reduced by EHR use, and there was an even split between respondents who reported they were satisfied versus dissatisfied with their EHR (∼40% each). We found that younger members were more likely to feel EHR increased their efficiency compared with the older members (p = 0.04). In all other analyses, we found no significant difference in efficiency and satisfaction between age groups, practice settings, presence of residents or fellows, or specific EHR used. The main challenges reported by ANS members related to the EHR were increased time burden, poor user interface, lack of customizability, and the focus away from patients.

Conclusions:
The majority of ANS members felt their efficiency decreased as a result of EHR. These findings provide specific changes to the EHR that would improve efficiency and satisfaction among neurotologists.
Evaluation of Outcome Variability Associated With Lateral Wall, Mid-scalar, and Perimodiolar Electrode Arrays When Controlling for Preoperative Patient Characteristics
Authors: Fabie Joshua E. , Keller Robert G. , Hatch Jonathan L. , Holcomb Meredith A. , Camposeo Elizabeth L. , Lambert Paul R. , Meyer Ted A. , McRackan Theodore R. 
Published: August 2018

Objective:
Determine the impact of electrode array selection on audiometric performance when controlling for baseline patient characteristics.

Study Design:
Retrospective evaluation of a prospective cochlear implant (CI) database (January 1, 2012–May 31, 2017).

Setting:
Tertiary Care University Hospital.

Patients:
Three hundred twenty-eight adult CI recipients.

Interventions/Main Outcomes Measured:
Hearing outcomes were measured through unaided/aided pure tone thresholds and speech recognition testing before and after cochlear implantation. All reported postoperative results were performed at least 6 months after CI activation. All device manufacturers were represented.

Results:
Of the 328 patients, 234 received lateral wall (LW) arrays, 46 received perimodiolar (PM) arrays, and 48 received mid-scalar (MS) arrays. Patients receiving PM arrays had significantly poorer preoperative earphone and aided PTAs and SRTs, and aided Consonant-Nucleus-Consonant(CNC) word and AzBio +10 SNR scores compared with patients receiving LW arrays (all p ≤ 0.04), and poorer PTAs and AzBio +10 SNR scores compared with MS recipients (all p ≤ 0.02). No preoperative audiological variables were found to significantly differ between MS and LW patients. After controlling for preoperative residual hearing and speech recognition ability in a hierarchical multiple regression analysis, no statistically significant difference in audiological outcomes was detected (CNC words, AzBio quiet, or AzBio +10 SNR) among the three electrode array types (all p > 0.05).

Conclusion:
While previous studies have demonstrated superior postoperative speech recognition scores in LW electrode array recipients, these differences lose significance when controlling for baseline hearing and speech recognition ability. These data demonstrate the proclivity for implanting individuals with greater residual hearing with LW electrodes and its impact on postoperative results.
Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics
Authors: Govil Nandini , DeMayo William M. , Hirsch Barry E. , McCall Andrew A. 
Published: August 2018

Objective:
The purpose of this study was to evaluate the impact of patient positioning on physician ergonomics during in-office otologic procedures. A previous simulation study suggested that placing patients supine during in-office otology procedures is ergonomically favorable. This study aims to substantiate these findings during the routine care of patients in an otolaryngology practice setting.

Study Design:
Observational study.

Setting:
Outpatient otology clinic within tertiary care facility.

Study Subjects:
Two neurotology attending physicians.

Interventions:
Physicians performed cerumen removal procedures in the office with patients either in the seated position (n = 24) or supine position (n = 24).

Main Outcome Measures:
The rapid upper limb assessment (RULA), a validated instrument that measures body positioning with a focus on the upper arm, was used to measure ergonomic positioning. RULA scores correlate occupational body positioning with a numeric representation of musculoskeletal injury risk ranging from 1 (minimal risk) to 7 (very high risk).

Results:
Overall median RULA scores were 4.5 (medium risk) with patients in the seated position, and 2 (low risk) with patients in the supine position (p < 0.0001). Similarly, RULA scores were significantly lower with patients in the supine position when each physician was evaluated independently (p < 0.0001, for both).

Conclusions:
Placing patients in a supine position for cerumen removal results in more favorable ergonomic positioning for the physician, thus reducing risk for work-related musculoskeletal disorders. This suggests that physicians should consider placing patients in the supine position for in-office otologic procedures. Further study is needed to investigate optimal ergonomic positioning for other common otolaryngology procedures.
Spontaneous Vestibular Schwannoma Regression: A Case-Control Study
Authors: Tikka Theofano , Yiannakis Constantina P. , Stapleton Emma , Locke Richard , Crowther John A. , Taylor William A. S. , Kontorinis Georgios 
Published: August 2018

Objective:
To explore the nature of spontaneously regressing vestibular schwannomas (VS) and identify possible predictive factors for such behavior.

Study Design:
Retrospective case control study.

Setting:
Tertiary referral center, university teaching hospital.

Patients:
Patients with sporadic VS demonstrating spontaneous regression compared with a control group of patients with growing VS.

Interventions:
Review of serial magnetic resonance imaging of the internal auditory meatus (MRI IAM) and case notes and direct comparison of possible related factors between the two groups using univariate analysis.

Main Outcome Measures:
Presenting symptoms, VS size and consistency, patients’ age and sex, tumor laterality and location, and the neutrophil-to-lymphocyte ratio between the two groups.

Results:
Of the 540 patients on the database 28 (5.2%) showed spontaneous regression with a mean follow-up of 122 months. Mean absolute and relative regression was 3.9 mm and 25.7%, respectively. 60% of tumors showed gradual regression while 25% showed growth followed by regression. Regressing VS had a significantly larger size than the control group; while the regressing tumors were located further from the fundus than the control group. The remaining examined factors did not reach a statistical level of significance.

Conclusion:
This is, to our knowledge, the first study comparing a cohort of regressing tumors with a control group of growing VS. The finding that the location of tumors around the porous, is more common in regressing VS has implications for patients’ counselling.
Resource Utilization and Outcomes of Medicare Recipients With Chronic Hepatitis B in the United States
Authors: Kim Min , Paik James , Golabi Pegah , Jeffers Thomas , Mishra Alita , Younossi Zobair M. 
Published: August 2018

Goals:
To assess the outcomes and resource utilization of chronic hepatitis B (CH-B) among Medicare beneficiaries.

Background:
CH-B is highly prevalent among immigrants from endemic areas. Although incidence of CH-B is stable in the United States, CH-B patients have become Medicare eligible.

Study:
We used the inpatient and outpatient Medicare database (2005 to 2014). Adult patients with CH-B diagnosis were included. One-year mortality and resource utilization were assessed. Independent associations with resource utilization and mortality were determined using multivariate analysis.

Results:
Study cohort included 18,603 Medicare recipients with CH-B. Between 2005 and 2014, number of Medicare beneficiaries with CH-B increased by 4.4% annually. The proportion of beneficiaries with CH-B who were whites decreased while those who were Asians increased (P<0.05). Furthermore, 7.4% of CH-B Medicare cohort experienced decompensated cirrhosis, 2.9% hepatocellular carcinoma (HCC) and 11.9% 1-year mortality. Although the number of inpatients with CH-B remained stable, the number of outpatient encounters increased. Annual total inpatient charges increased from $66,610 to $94,221 while these charges for outpatient increased from $9257 to $47,863. In multivariate analysis, age [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.04-1.05], male gender [OR, 1.24 (95% CI, 1.12-1.38)], decompensated cirrhosis [OR, 3.02 (95% CI, 2.63-3.48)], HCC [OR, 2.64 (95% CI, 2.10-3.32)], and higher Charlson comorbidity index [OR, 1.24 (95% CI, 1.21-1.27)] were independently associated with increased 1-year mortality. HCC and higher Charlson comorbidity index were also associated with higher inpatient and outpatient charges, and inpatient length of stay (all P<0.001).

Conclusions:
CH-B infection has been rising in Medicare population and is responsible for significant mortality and resource utilization.
Alternatively spliced tissue factor levels are elevated in the plasma of patients with chronic liver diseases
Authors: Caversaccio Nathalie I. , Reina Caro Maria D. , Prince Raja , Müller Martin , Lewis Clayton S. , Bogdanov Vladimir Y. , Dufour Jean-François , Angelillo-Scherrer Anne 
Published: August 2018

Objectives
In patients with chronic liver diseases, hypercoagulability can contribute to the progression of fibrosis and complications of cirrhosis. Tissue factor (TF) is a transmembrane glycoprotein that initiates the extrinsic pathway of blood coagulation. Recent investigations have established that TF is elevated in patients with pancreatic cancer, blood disorders, diabetes, and cardiovascular disease. Alternatively spliced tissue factor (asTF), a secreted form of TF, induces angiogenesis and exhibits low-level procoagulant activity. The aim of this study was to investigate whether the circulating levels of asTF are elevated in the plasma of patients with liver disease.

Materials and methods
In a single-center study, we retrospectively analyzed asTF plasma levels in healthy participants and patients having stage F0–F3 liver fibrosis, liver cirrhosis, as well as hepatocellular carcinoma (HCC). AsTF plasma levels were measured using a sandwich enzyme-linked immunosorbent assay. Values were expressed as median with interquartile range (IQR).

Results
The lowest median plasma asTF concentration (94 pg/ml, IQR: 33–275) was found in the healthy control group. The patients with low-grade liver fibrosis (F0–F1 group) displayed the highest median asTF concentration (404 pg/ml, IQR: 277–789). Significant differences between the asTF levels in the plasma of healthy participants and those in patients with grade F0–F1 fibrosis (P<0.001), patients with grade F2–F3 fibrosis (P=0.019), patients with cirrhosis (P=0.004), and patients with HCC (P<0.001) were found using a Wilcoxon rank-sum test. Treatment-naive patients with HCC had significantly higher asTF levels (P=0.018) than those receiving treatment. AsTF levels were found to increase with worsening Child–Pugh scores and heightened liver disease activity.

Conclusion
AsTF levels are elevated in patients with chronic liver diseases, which increase with worsening Child–Pugh scores and decrease following HCC therapy.
Clinical and pathological profile of eosinophilic gastroenteritis
Authors: Sato Hiroki , Honma Terasu , Owaki Takashi , Tominaga Kentaro , Yokoyama Junji , Terai Shuji 
Published: August 2018

Background
Eosinophilic gastroenteritis (EoGE) can be diagnosed on the basis of histologic criteria; however, the pathology is considered to be heterogeneous. There is no consensus on the management of this enigmatic disorder with an unknown etiology.

Patients and methods
Data for patients diagnosed with EoGE and followed up over a 1-year period were analyzed. Their symptoms, patterns of flares, and type of treatment were documented. The shift in peripheral blood eosinophil levels was also examined.

Results
A total of 10 (mean age, 44 years; range: 31–70 years; women, 5) patients were diagnosed with EoGE. The most frequent presenting symptom was abdominal pain, and eight patients were classified with mucosal type of EoGE. Chronic disease or multiple flares were observed in seven out of 10 (70.0%) patients, and all of them had a history of allergy. Four were corticosteroid dependent (three relapsed during corticosteroid tapering and one following corticosteroid withdrawal). One of them received anti-IL5 monoclonal antibody that enabled corticosteroid dose tapering. In four patients with highly elevated initial eosinophil levels at diagnosis, the peripheral eosinophil level correlated with the amelioration and deterioration of their symptoms. The remaining three patients had a single flare without relapse. Two had no history of allergy.

Conclusion
EoGE is a unique disorder with a variable clinical course. Although further studies are required to confirm our observations, the presence of other allergic disorders is associated with chronicity or multiple flares. Peripheral eosinophil level may be an effective biomarker for recurrence in patients with severe systemic disorders at diagnosis.
Assessing Trends in Hospital System Structures From 2008 to 2015
Authors: Walker Daniel M. , Mora Arthur M. , Hogan Tory H. , Diana Mark L. , McAlearney Ann Scheck 
Published: August 2018

Background:
The Affordable Care Act introduced a major systematic change aimed to promote coordination across the care continuum. Yet, it remains unknown the extent to which hospital system structures have changed following the Affordable Care Act. The structure of hospital systems has important implications for the cost, quality, and accessibility of health services.

Objectives:
To assess trends in the structures of hospital systems.

Research Design:
We aggregated data from the American Hospital Association (AHA) Annual Survey to the system level. Using a panel of hospital systems from 2008 to 2015, we assessed trends in the number of hospital systems, their size, ownership characteristics, geospatial arrangements, and integration with outpatient services.

Results:
In the period 2008–2015, there was an increasing percentage of hospitals that were system affiliated as well as growth in the number of hospital systems. A greater percentage of hospital systems that were organized as moderately centralized systems transitioned to centralized systems than to decentralized systems (19.8% vs. 4.7%; P<0.001). In terms of geospatial arrangement, a greater percentage of hub-and-spoke systems moved to a regional design than to national systems (20.0% vs. 8.2%; P<0.05). An increasing trend over time toward greater integration with outpatient services was found in a measure of total system level integration with outpatient services.

Conclusions:
Our findings suggest that hospital systems may be moving toward more regional designs. In addition, the trend of increasing integration offered across hospital systems overall, and as portion of total integration, suggests that systems may be increasing their services along the continuum of care.
Predictors of Severe Clinical Course in Children With Carbon Monoxide Poisoning
Authors: Akcan Yildiz Leman , Gultekingil Ayse , Kesici Selman , Bayrakci Benan , Teksam Ozlem 
Published: August 2018

Objective
Carbon monoxide (CO) is a gas, which is produced by incomplete combustion of hydrocarbon-containing substances, and causes significant tissue and organ damage in the common event of CO poisoning. This study aims to evaluate the demographic, clinical, and laboratory characteristics of patients diagnosed with CO poisoning in the emergency department and to determine the factors associated with severe course in the acute phase of poisoning.

Methods
A total of 331 patients diagnosed with CO poisoning in Hacettepe University Children's Hospital, Pediatric Emergency Unit, between January 2004 and March 2014 were included in the study. Their demographic characteristics, presenting complaints, physical examination findings, Glasgow Coma Scale scores, carboxyhemoglobin, leukocyte, hemoglobin, troponin T, pH and lactate levels, type of treatment (normobaric or hyperbaric oxygen), intensive care unit admissions, and outcome of poisoning were investigated.

Results
Ninety-three patients were given hyperbaric oxygen. Fifty-one patients were admitted to the pediatric intensive care unit, 18 patients have had a severe clinical course, and 6 patients have died. The risk factors associated with severe disease course were determined to be low Glasgow Coma Scale score, high leukocyte count, and high troponin T levels at presentation.

Conclusions
Glasgow Coma Scale score, leukocyte count, and troponin T level may be beneficial in predicting clinical outcomes and tailoring therapy in children with CO poisoning.
A Randomized Single-Blinded Simulation-Based Trial of a Novel Method for Fluid Administration to a Septic Infant
Authors: Kline Matthew , Crispino Lauren , Bhatnagar Ambika , Panchal Rajavee A. , Auerbach Marc 
Published: August 2018

Objectives
For children presenting in shock, American College of Critical Care Medicine guidelines recommend 3 boluses of intravenous fluids during initial resuscitation, but these are often not met. This study aims to compare a novel device LifeFlow, to established manual methods for rapid fluid delivery in a simulated environment.

Method
This single-blinded randomized trial was conducted in a level 1 pediatric trauma center emergency department. Fifty-four participants were paired and randomized to one of the following methods: push/pull, pressure bag, or LifeFlow. The teams were presented with a standardized simulation-based case and asked to resuscitate a 10-kg patient in decompensated shock. We used a demographic survey to study provider variables, recordings of the simulation and fluid delivery to independently establish rate and accuracy, and the National Aeronautical and Space Administration Task Load Index to assess workload.

Result
All 54 participants completed the assigned tasks, and no significant differences were found among the demographics of participants. The primary outcome (mean rate of fluid administration) differed significantly between the 3 techniques, LifeFlow being the fastest (65.29 mL/min). The composite National Aeronautical and Space Administration Task Load Index score (30; P = 0.184) was lowest for the LifeFlow. Significant differences were seen among the correlation coefficient comparing the estimated to the actual volume of fluid for each method, pressure bag being the highest (0.66), followed by push-pull (0.54) and LifeFlow (0.31).

Conclusions
LifeFlow allowed for faster fluid administration rate and thus could be the preferred technique for rapid fluid resuscitation in pediatrics patients. Further investigations should explore the reproducibility of these results using this device in real patients in multiple centers.
Veterinary-Prescribed Buprenorphine Ingestion in a 2-Year-Old Girl
Authors: Roberts Kristin J. , Tomasi Suzanne , Stull VMD Jason W. , McKenzie Lara B. , Spiller Henry A. 
Published: August 2018

Introduction
Ingestion of buprenorphine by young children is on the rise and can lead to life-threatening consequences and death. Exposure most often occurs when a child acquires the medication intended for adult use. However, buprenorphine is also prescribed by veterinarians and may be sent home, typically in non–child-resistant packaging, to be administered to the family pet.

Case
A previously healthy 2-year-old girl weighing 11.36 kg was found with a 1-mL syringe containing 0.6 mg/mL of buprenorphine in her mouth. The syringe had been in a plastic bag provided to the family by their veterinarian for the family dog. She was hospitalized for 24 hours but remained asymptomatic and was discharged healthy. This type of exposure to buprenorphine has not previously been described in the literature.

Conclusions
Having this unsecured medication in the home increases the potential risk of exposure for young children and associated health consequences. Pediatricians should be aware of the potential dangers that veterinary pharmaceuticals can pose and educate parents about proper storage of medications. In addition, veterinarians should take extra precautions when dispensing these medications to pet owners with children.
Demonstration of Tubercular “Abdominal Cocoon” (Sclerosing Encapsulating Peritonitis) in 18F-FDG PET/CT
Authors: Vadi Shelvin Kumar , Mittal Bhagwant Rai , Parihar Ashwin Singh , Kumar Rajender , Sharma Vishal , Mandavdhare Harshal S. 
Published: August 2018

Abstract
Sclerosing encapsulating peritonitis also called as abdominal cocoon is a less understood condition mostly due to idiopathic causes and sometimes secondary to tuberculosis or peritoneal dialysis. This report describes the typical features of “abdominal cocoon” on 18F-FDG PET/CT in a young woman, which was later diagnosed to be secondary to tuberculosis. Because the early features of this unusual entity are often nonspecific, high clinical suspicion along with understanding of the typical radiological/PET/CT features of this intriguing entity may guide the physician in ruling out the secondary treatable causes like tuberculosis, as noted in the index case.
Prevention of Earlobe Keloid Recurrence After Excision: Assessment of the Value of Presurgical Injection of Triamcinolone
Authors: Aluko-Olokun Bayo , Olaitan Ademola A. , Morgan Regina E. , Adediran Olanrewaju Moses 
Published: August 2018

Abstract
The ear is commonly involved in keloid formation, being often pierced. This study estimates the value of pre-excision triamcinolone injection of earlobe keloid, by comparing recurrence rates in patients who only received postexcision triamcinolone injection to those who had it administered before and after excision.
The prospective intervention study involved 18 keloid lesions in as many consenting patients who presented with pedunculated earlobe keloid from January 2005 to January 2007.
Triamcinolone doses were administered 10 mg/cm of lesion or sutured excision site. Each patient was followed-up for 10 years. Aggregate length of keloid lesions at presentation was 24.4 cm in Group A and 26.5 cm in Group B. Aggregate length of postexcision sutured wound in Group A was 16.1 cm, and 14.8 cm in Group B. Group A patients received a total of 1610 mg of triamcinolone, while a total of 4660 mg of same drug was administered to Group B patients, among whom 3180 mg was delivered presurgically. Total number of clinic visits during the course of treatment in Group A was 10, while that of Group B was 22. No patient with recurrent keloid was recorded in both groups.
The authors concluded that there is no advantage to presurgical injection of triamcinolone when excision is considered as part of treatment protocol of a keloid lesion. This study helps to eliminate an ostensibly needless part of a commonly used treatment protocol.