bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and associated factors of mortality after percutaneous coronary intervention for adult patients with ST elevation myocardial infarction
Authors: Yan Fanghong , Liu Huan , Jiang Wenhui 
Published: June 2019

Abstract

Background:
The percutaneous coronary intervention (PCI) has been one of the fastest growing therapeutic interventions for patients with ST elevation myocardial infarction (STEMI). However, the mortality of patients with STEMI after PCI is uncertain currently. There is a paucity of systematic review on the associated factors of mortality among patients with STEMI after PCI. Therefore, this meta-analysis was designed to synthesize available evidence on the prevalence and associated factors of mortality after PCI for adult patients with STEMI.

Methods:
Both case–control and cohort studies reporting on mortality after PCI for patients with STEMI, published in Chinese and English will be eligible for inclusion. Studies from 12 databases covering the period from 2008 to present will be considered for systematic searches. Two reviewers will independently screen and select studies, extract data, and assess methodologic quality. When available, meta-analysis will be performed. Pooled proportions of mortality, and proportions in the exposed and unexposed groups, and population attributable fraction of each factor will be calculated by a suitable transformation of proportions. If necessary, meta-regression models, subgroup analysis, sensitivity analysis, funnel plot, and Egger test will be performed. Narrative synthesis will be done where meta-analysis cannot be performed. Reporting of this protocol will comply with the preferred reporting items for systematic review and meta-analyses (PRISMA-P) guidelines.

Results:
This systematic review will be developed according to the meta-analysis of observational studies in epidemiology (MOOSE) guidelines.

Conclusion:
This study will provide a comprehensive review on the available evidence regarding the prevalence and associated factors of mortality for patients with STEMI following PCI. This review will be constrained by the divergence of definition and assessment of specific factors between studies. However, the development of a qualitative description of definition and assessment tools will also provide an overview of the current practice. Formal ethical approval is not required since the secondary data will be collected for systematic review. The findings will be disseminated in a relevant peer-reviewed journal and academic presentations.

Systematic review registration:
PROSPERO CRD42017070969
Evaluation of different antibiotic prophylaxis strategies for hepatectomy
Authors: Guo Tao , Ding Ruiwen , Yang Jian , Wu Ping , Liu Pengpeng , Liu Zhisu , Li Zhen 
Published: June 2019

Abstract

Background:
The application of antibiotic prophylaxis for hepatectomy remains uncertain. This research aims to evaluate different antibiotic prophylaxis strategies for hepatectomy based on network meta-analysis.

Methods:
Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating antibiotic prophylaxis strategies for hepatectomy. Relative parametric data, including surgical site infection (SSI), remote site infection (RSI) and total infection (TI), were quantitatively pooled and estimated based on the Bayesian theorem. The values of surface under the cumulative ranking curve (SUCRA) probabilities regarding each parameter were calculated and ranked. Node-splitting analysis was performed to test the inconsistency of the main results, and publication bias was assessed by examining the funnel plot symmetry. Additional pairwise meta-analyses were performed to validate the differences between respective strategies at the statistical level.

Results:
After a detailed review, a total of 5 RCTs containing 4 different strategies were included for the network meta-analysis. The results indicated that the application of no antibiotics possessed the highest possibility of having the best clinical effects on SSI (SUCRA, 0.56), RSI (SUCRA, 0.46) and TI (SUCRA, 0.61). Moreover, node-splitting analysis and funnel plot symmetries illustrated no inconsistencies in the current study. Additional pairwise meta-analyses determined that additional and long-duration applications had no clinical benefit.

Conclusion:
Based on current evidence, we concluded that antibiotic prophylaxis did not reveal clinical benefit in hepatectomy. However, more relative trials and statistical evidence are still needed.
Effect of pressure therapy for treatment of hypertrophic scar
Authors: Zhang Hao , Wang Hao-yan , Wang Da-li , Zhang Xiao-dong 
Published: June 2019

Abstract

Background:
Pressure therapy (PST) has been reported for the treatment of hypertrophic scar (HS) effectively. However, no study has assessed its effect and safety systematically. Therefore, this study will investigate its effect and safety for patients with HS.

Methods:
A comprehensive literature search will be performed from the electronic databases and grey literatures. The electronic databases include MEDILINE, EMBASE, Cochrane Library, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All of them will be searched from inception to the present without language restrictions. Any randomized controlled trials on assessing the effect and safety of PST on HS will be considered for inclusion. In addition, we will also search grey literature to avoid missing any potential studies. RevMan V.5.3 software will be utilized for statistical analysis.

Results:
This study will provide the most recent evidence of PST on HS by evaluating primary outcomes of scar pruritus and improvement of scar; and secondary outcomes of scar blood flow, elasticity, volume, pain and burning. In addition, we will also evaluate adverse events.

Conclusion:
This study will provide up-to-date evidence of PST in patients with HS.
Systematic review registration: PROSPERO CRD42019136627.
Combination of endoscopic incision and balloon dilation for treatment of a completely obstructed anastomotic stenosis following colorectal resection
Authors: Yuan Xianglei , Liu Wei , Ye Liansong , Wu Mengjuan , Hu Bing 
Published: June 2019

Abstract

Rationale:
The management of complete obstruction of anastomosis following colorectal surgery is challenging. Some modified minimally invasive methods have been reported to be successfully implemented in some cases. In this case report, we present a case to share our experience.

Patient concerns:
A 64-year-old man underwent low anterior resection and single barrel ileostomy for rectal cancer 5 months ago. Completely obstructed anastomotic stenosis was found during colonoscopy.

Diagnosis:
Colonoscopy showed the anastomosis at 8 cm from the anal verge was completely obstructed.

Interventions:
A small incision was made by a needle knife, and then the stenosis was sequentially dilated by using a wire-guided balloon dilator.

Outcomes:
The luminal continuity was reestablished. The patient underwent successful ileostomy closure 2 months later. At 18-months follow-up, no restenosis of the anastomosis was observed during colonoscopy.

Lessons:
Endoscopic small incision with a needle knife along with balloon dilation could be an alternative method for patients with complete obstruction of anastomosis after colorectal resection. But this procedure should be performed with great caution in selected patients and performed only by highly experienced endoscopists.
Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease
Authors: Patel Perseus V. , Pantell Matthew S. , Heyman Melvin B. , Verstraete Sofia 
Published: June 2019

ABSTRACTObjective:Few studies report the impact of depression on inflammatory bowel disease (IBD)‐related hospitalizations. We evaluated the association between depression and pediatric IBD‐related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures.Methods:Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all‐payer pediatric inpatient cross‐sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD‐9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient‐ and hospital‐level variables and for potential disease confounders.Results:For primary IBD‐related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19–1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04–2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72–1.30), endoscopy (OR 0.91; 95% CI 0.74–1.14), blood transfusion (OR 0.85; 95% CI 0.58–1.23), or abdominal imaging (OR 1.15; 95% CI 0.53–2.53).Conclusions:Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.
Multicenter Evaluation of Clinical Efficacy and Safety of Per‐oral Endoscopic Myotomy in Children
Authors: Choné Adrien , Familiari Pietro , von Rahden Burkhard , Desai Pankaj , Inoue Haruhiro , Shimamura Yuto , Eleftheriadis Nikos , Yamashita Kanefumi , Khashab Mouen A. , Shiwaku Hinorari , Seewald Stefan , Draganov Peter V. , Alvarez Lybil B. Mendoza , Chaussade Stanislas , Tantau Marcel , Abraham Mathew , Marks Jeffrey , Arevalo Gabriel , Albéniz Eduardo , Mion Francois , Roman Sabine , Rivory Jérôme , Dubois Rémi , Lachaux Alain , Benech Nicolas , Subtil Fabien , Ponchon Thierry , Barret Maximilien , Pioche Mathieu 
Published: June 2019

ABSTRACTObjectives:Per‐oral endoscopic myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children.Methods:International multicenter retrospective study conducted in 14 tertiary centers that included consecutive children who underwent POEM between January 2012 and August 2018. Outcomes, such as clinical response were assessed whenever available. Adverse events and factors associated with clinical failure were also investigated.Results:A total of 117 patients (mean ± SD age: 14.2 ± 3.7 years) underwent POEM for achalasia (type I, n = 36; type II n=66; type III, n=8). Among these, 30 (26%) were pretreated (botulinum injection and/or pneumatic dilatation). Mean ± SD baseline Eckardt score was 7.5 ± 2.0. Clinical success was achieved in 90.6% of cases (95%CI [83.8%;95.2%]) in the intention‐to‐treat analysis. The mean ± SD Eckardt score post‐POEM was 0.9 ± 1.2 (P < 0.001). The mean duration of follow‐up time 545 days (range: 100–1612). A total of 7 adverse events occurred (4 mucosotomies, 2 subcutaneous emphysema, 1 esopleural fistula). Gastroesophageal reflux symptoms were seen in 17 patients (15%); missing data for 10 patients (9%). There was a trend towards more frequent clinical failure in achalasia associated with genetic disorders (40% vs 8%, P = 0.069).Conclusions:POEM in pediatric patients appears to be effective and safe, although there was a trend towards more frequent clinical failure achalasia associated with genetic disorders. Further studies are needed to assess the long‐term outcomes, especially the consequences of GERD.
Clinicians' Perspectives on Admission of Pregnant Women
Authors: Breman Rachel Blankstein , Iobst Stacey , Paul Julie , Low Lisa Kane 
Published: June 2019

Abstract

Purpose:
Reducing primary cesarean births is a national priority in the United States. Recommendations include delaying admission of low-risk pregnant women to the hospital until they are in active labor, considered to be 6 cm cervical dilatation. How this recommendation affects decision-making during triage requires further exploration. The purpose of this study was to explore the clinician's perspective on the triage process and deferral of hospital admission for low-risk pregnant women who were not yet in active labor.

Methods:
A qualitative descriptive approach was used via semistructured interviews with physicians, midwives, and nurses. Data analysis used an inductive approach and identified codes, a theme and subthemes.

Results:
Twenty-five clinicians participated. A triad of decision-making occurred between three main stakeholders: the low-risk pregnant woman, the triage nurse, and the physician or midwife. One theme and four subthemes related to this triad were identified. The theme Admission of Low-Risk Pregnant Women Depends on Many Factors provides context to the maternity care triage process. There are many factors clinicians consider prior to admitting women, including situational and clinical factors. Subthemes related to the woman are her expectation and knowledge about birth and her ability to cope with labor. Subthemes associated with the provider and triage nurse are care variation and concern for maternal and fetal safety.

Clinical Implications:
From the clinician's perspective, triage is a complex, dynamic process, even for low-risk pregnant women. There is an interplay of different factors affecting clinical decision-making, thus the decision-making triad provides a possible framework for shared decision-making.
Perspectives on Barriers and Facilitators in Caring for Women with Gestational Diabetes in Rural Appalachia
Authors: Chertok Ilana R. Azulay , Silk Jennifer J. , Kulasa Kathryn A. 
Published: June 2019

Abstract

Purpose:
The purpose of this study was to explore perspectives of healthcare providers in rural Appalachia who care for pregnant women with gestational diabetes, including management facilitators and barriers.

Study Design and Methods:
Qualitative study with interviews and thematic analysis. Thematic analysis was conducted using the sort and sift method after inductive content analysis with open coding, identifying categories, and abstraction.

Results:
Twenty-one advanced practice nurses and 10 physicians participated in the study. Three themes were identified: rural healthcare challenges including limited resources and lack of adherence to recommendations, cultural influences including normalization of diabetes and food culture, and collaborative care including accessible resources and patient motivation.

Clinical Implications:
The themes provide insight into the perceived barriers and facilitators of healthcare providers caring for women with gestational diabetes in rural Appalachia. Consistent, evidence-based communication with cultural consideration supports effective education and care of women with gestational diabetes. Healthcare providers' knowledge of local resources, accessible electronic medical records, and communication among the various team members enhance collaboration in diabetic management in the rural setting.
Treating Posttraumatic Stress Disorder in the Presence of Acute Suicide Risk in Veterans and Active Duty Service Members
Authors: Holliday Ryan , Holder Nicholas , Olson-Madden Jennifer H. , Monteith Lindsey L. 
Published: June 2019

Abstract
Posttraumatic stress disorder (PTSD) is associated with increased risk for suicide, and clinicians often encounter acute suicide risk during the process of intervening upon PTSD. Although the Department of Veterans Affairs (VA) and the Department of Defense (DoD) have disseminated evidence-based treatments for PTSD, prior clinical trials have used inconsistent definitions and unclear assessment methods of suicide risk. Consequently, translating findings from PTSD treatment research to clinical practice remains challenging. This article describes challenges inherent to the current PTSD interventional research literature related to concurrent acute suicide risk among veterans and active duty service members. We reviewed prior trials and how their assessment methods and nomenclature compare with strategies and definitions mandated within the VA/DoD. Furthermore, we describe methodological recommendations for future research, including consistent use of mandated universal suicide nomenclature, standardization for classifying suicide risk, transparency in reporting assessment means and measures, and examination of current models of PTSD treatment in the context of acute suicide risk.
Truncal blocks and teenager postoperative pain perception after laparoscopic surgical procedures
Authors: Visoiu Mihaela , Chelly Jacques , Kenkre Tanya 
Published: June 2019

Abstract

Introduction:
The prevalence of moderate to severe pain is high in hospitalized teenage patients admitted to surgical services.

Objectives:
The aims of this study were to determine (1) the preoperative and postoperative factors influencing teenager postoperative pain perception; and (2) suffering, defined as the patient's anxiety, pain catastrophizing thoughts, and mood.

Methods:
Data were collected from medical records and from 2 medical interviews at the time of enrollment and postoperative day 1. Stepwise linear regression was conducted to assess variables that predicted teenagers' pain scores and suffering.

Results:
Two hundred two patients (mean age = 13.8 years, SD = 1.9), 56.4% females, scheduled for laparoscopic surgical procedures completed the study. The variables found to be significant predictors of pain response in teenagers were pain on the day of surgery (6.81, 95% confidence interval [CI] = 0.08–13.55, P = 0.05) and use of regional anesthesia (single-injection rectus sheath, transversus abdominis plane, and paravertebral nerve blocks) (−6.58, 95% CI = −12.87 to −0.30, P = 0.04). The use of regional anesthesia was found to predict mood responses (all patients: 2.60, 95% CI = 0.68–4.52, P = 0.01; girls: 3.45, 95% CI = 0.96–5.93, P = 0.01; 14–17-year-old teens: 2.77, 95% CI = 0.44–5.10, P = 0.02) and to negatively predict catastrophic thoughts among all patients as a group (−4.35, 95% CI = −7.51 to −1.19, P = 0.01) and among 14- to 17-year-old teens (−5.17, 95% CI = −9.44 to −0.90, P = 0.02).

Conclusion:
A comprehensive pain approach that includes truncal blocks may improve teenagers' postoperative pain control after laparoscopic surgeries.
Removal of Nasal Silicone Implant and the Impact of Subsequent Capsulectomy
Authors: Kook Won S. , Yang Chae E. , Lew Dae H. 
Published: June 2019

Background:
Little is known about contributory factors of unremoved periimplant capsule causing nasal deformities after postrhinoplasty silicone implant extraction. This study investigated the impact of retained capsule causing contracture deformity and effect of subsequent capsulectomy in preventing and correcting the deformity.

Methods:
A total of 103 patients underwent secondary surgery for silicone implant removal and grafted cartilage between May of 2015 and June of 2017. Among them, 67 patients without septal extension graft or open wound and with 8-week or more follow-up were analyzed retrospectively. All operations were approached with an intranasal incision. Three procedures were performed: (1) removal of implant plus tip graft only (n = 12), (2) removal of implant plus tip graft plus subtotal capsulectomy (n = 47), and (3) removal of implant plus tip graft plus subtotal capsulectomy in patients with contraction and thick capsule (n = 8). Preremoval/postremoval of nasal bridge length index and nasolabial angle were measured with the lateral view.

Results:
In group 1, nasal bridge length index decreased by 6.2 percent and nasolabial angle increased by 5.7 percent. In group 2, nasal bridge length index increased by 2.5 percent and nasolabial angle decreased by 2.2 percent. In group 3, nasal bridge length index increased by 8.6 percent and nasolabial angle decreased by 7.9 percent.

Conclusions:
For patients undergoing surgical removal of a nasal silicone implant with or without cartilage, a concomitant capsulectomy is required to prevent potential contractures and to minimize tip deformity. Capsulectomy can release and lengthen the contracted nose without septal extension or derotation grafting. Dorsal skin irregularity did not occur regardless of whether capsulectomy was performed.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient
Authors: DeWane Michael P. , Sukumar Nitin , Stolar Marilyn J. , Gill Thomas M. , Maung Adrian A. , Schuster Kevin M. , Davis Kimberly A. , Becher Robert D. 
Published: June 2019

BACKGROUND
As the geriatric population grows, the need for hospitals performing high quality emergency general surgery (EGS) on older patients will increase. Identifying clusters of high-performing geriatric emergency general surgery hospitals would substantiate the need for in-depth analyses of hospital-specific structures and practices that benefit older EGS patients. The objectives of this study were therefore to identify clusters of hospitals based on mortality performance for geriatric patients undergoing common EGS operations and to determine if hospital performance was similar for all operation types.

METHODS
Hospitals in the California State Inpatient Database were included if they performed a range of eight common EGS operations in patients 65 years or older, with a minimum requirement of three of each operation performed over 2 years. Multivariable beta regression models were created to define hospital-level risk-adjusted mortality. Centroid cluster analysis was used to identify groups of hospitals based on mortality and to determine if mortality-performance differed by operation.

RESULTS
One hundred seven hospitals were included, performing a total of 24,279 operations in older patients. Hospitals separated into three distinct clusters: high, average, and low performers. The high-performing hospitals had survival rates 1 to 2 standard deviations better than the low-performers (p < 0.001). For each cluster, high performance in any one EGS operation consistently translated into high performance across all EGS operations.

CONCLUSION
Hospitals conducting EGS operations in the geriatric patient population cluster into three distinct groups based on their survival performance. High-performing hospitals significantly outperform the average and low performers across every operation. The high-performers achieve reliable, high-quality results regardless of operation type. Further qualitative research is needed to investigate the perioperative drivers of hospital performance in the geriatric EGS population.

LEVEL OF EVIDENCE
Study Type Prognostic, level III.