bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of quantitative sensory testing in the prediction of chronic pain
Authors: Treede Rolf-Detlef 
Published: April 2019

Abstract
Quantitative sensory testing (QST) is a formal variant of a time-honoured clinical examination technique in neurology, the sensory examination. Prototypical QST profiles have been found in human surrogate models of peripheral sensitization, central sensitization, and deafferentation. Probabilistic sorting of individual patients to any combination of these profiles has been developed, and there is emerging evidence for the predictive value of such sensory profiles for treatment efficacy. This way, QST aids in diagnostics of individual patients and may help guide their care in the future. Deficits in “dynamic” QST have been proposed as predictors of chronic pain (impaired descending inhibition and delayed recovery from central sensitization). Several psychological factors had previously been found to be predictors of pain chronicity (catastrophizing, self-efficacy, and neuroticism). The relative importance of psychological vs sensory testing predictors has not been evaluated. It is likely that both will have differential roles in clinical practice.
The ED-PACT Tool Initiative: Communicating Veterans' Care Needs After Emergency Department Visits
Authors: Cordasco Kristina M. , Saifu Hemen N. , Song Hyun-Sung , Hsiao Jonie J. , Khafaf Mana , Doyle Brian , Rubenstein Lisa V. , Chrystal Joya G. , Bharath Purnima , Ganz David A. 
Published: April 2019

ABSTRACT

Background:
Communication failures between providers threaten patient safety.

Purpose:
We developed, implemented, and formatively evaluated the ED-PACT Tool, which uses the Veterans Health Administration's (VA) electronic health record to send messages from emergency department (ED) providers to primary care patient-aligned care team (PACT) registered nurses (RNs) for Veterans discharged home from the ED with urgent or specific follow-up needs.

Methods:
We used Plan-Do-Study-Act quality improvement methodology.

Results:
Between November 1, 2015, and November 30, 2017, the tool was used to send 4,899 messages in one local VA healthcare system (ED and associated primary care clinics). Formative evaluation revealed that providers and RNs perceive the tool as providing substantial benefit for coordinating post-ED care. Patient-aligned care team leaders reported that RN training and “buy-in” facilitated tool implementation, while insufficient staffing posed a barrier. Emergency department providers noted the advantage of having a standardized and reliable system for communicating with PACTs.

Conclusions/Implications:
The ED-PACT Tool encapsulates several best practices (standardized processes, “closed-loop” communication, embedding into workflow) to facilitate communication between VA ED and follow-up care providers. Our development process illustrates key lessons in quality improvement and innovation implementation including the value of using rapid-cycle improvement methodology, with interprofessional collaboration and representatives from intended spread sites.
Circulating tumor cells in pancreatic cancer: a review
Authors: Habib Joseph R. , Yu Jun 
Published: April 2019

Abstract
Pancreatic cancer remains one of the deadliest types of cancer with little or no recent evidence of significant improvement in survival. This is, in large part, due to the current unavailability of effective screening or even early detection methods. Circulating tumor cells (CTCs), particularly with the rapidly improving methods for isolation, enrichment, and characterization methods, have emerged as the next best hope to overcome these challenges. This paper reviews the current state-of-the-art of CTC technologies with particular focus on the various isolation and enrichment methods based on liquid biopsy, the current limitations of these technologies and, consequently, the areas of further research and improvements in CTC methods that are needed to translate it to the clinical setting of routine diagnosis, treatment, and management of pancreatic cancer.
Incidence and Risk Factors Associated With 30-Day Readmission for Alcoholic Hepatitis
Authors: Garg Sushil K. , Sarvepalli Shashank , Singh Dupinder , Obaitan Itegbemie , Peeraphatdit Thoetchai , Jophlin Loretta , Asrani Sumeet K. , Shah Vijay H. , Leise Michael D. 
Published: April 2019

Background:
Alcohol abuse and liver disease are associated with high rates of 30-day hospital readmission, but factors linking alcoholic hepatitis (AH) to readmission are not well understood. We aimed to determine the incidence rate of 30-day readmission for patients with AH and to evaluate potential predictors of readmission.

Methods:
We used the Nationwide Readmissions Database to determine the 30-day readmission rate for recurrent AH between 2010 and 2014 and examined trends in readmissions during the study period. We also identified the 20 most frequent reasons for readmission. Multivariate survey logistic regression analysis was used to identify factors associated with 30-day readmission.

Results:
Of the 61,750 index admissions for AH, 23.9% were readmitted within 30-days. The rate of readmission did not change significantly during the study period. AH, alcoholic cirrhosis, and hepatic encephalopathy were the most frequent reasons for readmission. In multivariate analysis female sex, leaving against medical advice, higher Charlson comorbidity index, ascites, and history of bariatric surgery were associated with earlier readmissions, whereas older age, payer type (private or self-pay/other), and discharge to skilled nursing-facility reduced this risk.

Conclusions:
The 30-day readmission rate in patients with AH was high and stable during the study period. Factors associated with readmission may be helpful for development of consensus-based expert guidelines, treatment algorithms, and policy changes to help decrease readmission in AH.
Older Adult Perspectives Toward Surveillance Colonoscopy
Authors: Calderwood Audrey H. , Cazares Kathy , O’Connor Sharon 
Published: April 2019

Goals and Background:
Surveillance colonoscopy is the most common indication for colonoscopy in older adults, yet factors involved in patient decision-making are poorly defined. We sought to understand general perspectives of older adults toward surveillance colonoscopy.

Study:
We conducted 2 in-person, 90-minute semistructured focus groups at a rural, tertiary care, academic facility with a total of 20 English-speaking participants with a history of colon polyps. We also obtained baseline characteristics including information to calculate life expectancy using the Schonberg Index, a validated measure of 5-year and 9-year mortality.

Results:
Participant ages ranged from 75 to 89, 67% were female, and 61% had a life expectancy of ≤9 years. Major common themes included reasons for and against getting a surveillance colonoscopy, and preferences and opinions surrounding discontinuing surveillance. Fear of cancer, trust in the colonoscopy procedure, and provider advice played prominent roles in patient decisions to return for surveillance. Most felt they should make screening decisions with input from providers, and that providers should engage them in these decisions and base recommendations on their patients’ personal history and health, not on how old they are or on actuarial data.

Conclusions:
This small, qualitative study suggests that older adults familiar with surveillance colonoscopy prefer patient-centered decision-making on when to discontinue testing and want support and information from providers when making choices. The evidence also suggests that participants value provider communication and trust their advice. Future work will use this information to create a larger patient survey on attitudes and beliefs toward surveillance colonoscopy.
Impact of Automated Time-released Reminders on Patient Preparedness for Colonoscopy
Authors: Nayor Jennifer , Feng Aiden , Qazi Taha , Hurwitz Shelley , Saltzman John R. 
Published: April 2019

Goals:
To evaluate the effect of an automated time-released colonoscopy reminder program on preparation quality and the rates of canceled procedures.

Background:
Patients missing colonoscopy appointments or arriving with inadequate bowel preparations result in delays in care and increase in health care costs.

Study:
We initiated a quality improvement program which included switching to a split-dose preparation and delivering preparation instructions and appointment reminders via text messages and emails sent with an automated time-released HIPAA-compliant software platform. All patients scheduled for a colonoscopy from March through June 2017 were enrolled unless mobile phone, email, or preparation type data was missing (nonintervention cohort). Primary outcome metrics were the rate of adequate bowel preparation and the rate of canceled procedures. Outcomes of the intervention group were compared with outcomes from colonoscopies performed from March through June 2016 (baseline cohort).

Results:
There were 1497 patients (40.7% male, mean age 56.4 y) enrolled in the automated reminder program. Compared with the baseline cohort, the rate of adequate bowel preparation increased from 88.5% to 96.2% (P<0.0001). The rate of canceled procedures decreased from 6.1% to 4.3% (P=0.02). On multivariable analysis, the automated reminder program improved adequate preparation quality 2.85-fold (95% confidence interval, 2.03-3.99; P<0.0001). Sensitivity analysis comparing the intervention to nonintervention cohorts showed that improvement in preparation quality was attributable to the automated reminder program.

Conclusions:
Implementation of automated time-released colonoscopy preparation reminders via text messages and emails improved patient preparedness for colonoscopy, with significantly improved bowel preparation quality and fewer canceled procedures.
Thromboelastography-guided Blood Product Transfusion in Cirrhosis Patients With Variceal Bleeding
Authors: Rout Gyanranjan , Shalimar  , Gunjan Deepak , Mahapatra Soumya J. , Kedia Saurabh , Garg Pramod K. , Nayak Baibaswata 
Published: April 2019

Goals:
The aim of this study was to assess the use of thromboelastography (TEG)-directed blood product transfusion in cirrhotic patients with acute variceal bleeding compared with conventional transfusion for correction of coagulopathy.

Background:
Coagulopathy is common in patients with cirrhosis. Recommendations for correction of conventional parameters of coagulation—platelets and the international normalized ratio before endoscopy in patients with acute variceal bleeding—need more validation.

Study:
In this randomized controlled trial, cirrhotic patients with severe coagulopathy and acute variceal bleeding were randomized to either TEG-guided blood product transfusion or conventional transfusion from March 2017 to December 2017. The primary outcome was the difference in the amount of fresh frozen plasma and platelet units transfused between the groups. Secondary outcomes were rebleeding at 5 days and 42 days, and 6-week mortality.

Results:
Of the 60 recruited patients, 30 each were randomized to the TEG and conventional transfusion groups. There were no differences in baseline characteristic and endoscopic findings between the 2 groups. Four subjects in the TEG group received blood product transfusions versus all in the conventional transfusion group (13.3% vs. 100%; P<0.001). The control of bleeding on initial endoscopy was similar in the 2 groups. Rebleeding in the TEG and conventional transfusion groups at 5 days was similar [1 (3.3%) vs. 4 (13.3%), P=0.167], whereas it was significantly less in the TEG group at 42 days [3 (10%) vs. 11 (36.7%), P=0.012]. Mortality at 6 weeks was seen in 4 (13.3%) in the TEG group and in 8 (26.7%) patients in the conventional transfusion group (P=0.176).

Conclusions:
TEG-guided strategy was associated with reduced blood product transfusion to correct coagulopathy without compromising hemostasis in cirrhotic patients (Clinical trial ID: CTRI/2017/02/007864).
Risk factors of malignant fluorodeoxyglucose-avid lymph node on preablation positron emission tomography in patients with papillary thyroid cancer undergoing radioiodine ablation therapy
Authors: Cho Sang-Geon , Kwon Seong Young , Kim Jahae , Cho Dong-Hyeok , Na Myung Hwan , Kang Sae-Ryung , Yoo Su Woong , Song Ho-Chun 
Published: April 2019

Abstract
F-18 fluorodeoxyglucose (FDG)-avid metastatic lesions are associated with a poor response to radioiodine ablation therapy (RIT) in papillary thyroid cancer (PTC). This study evaluated the significance of preablative FDG positron emission tomography (PET) for the assessment of risk factors and frequency of malignant FDG-avid lymph nodes in patients with PTC undergoing RIT.
The study included 339 consecutive patients (mean age 46.3 ± 12.5 y; 260 females) with PTC referred for the first RIT and who underwent routine preablative FDG PET between April 2011 and February 2013. FDG-avid lymph nodes (FALNs) were identified using retrospective image reviews. The frequency of malignant FALN (mFALN), its contribution to persistent or recurrent PTC, and its risk factors were analyzed.
Among the patients, 112 had FALNs (33.0%): 11 mFALNs (3.2%) and 101 benign FALNs (bFALNs, 29.8%). mFALN contributed to 55% of persistent or recurrent PTC after RIT, which was observed in 20 of 339 patients (5.9%) during the post-RIT follow-up. Among preoperative risk factors, suspicious extrathyroidal extension and lateral neck lymph node metastasis on imaging studies were associated with mFALN. Among postoperative risk factors, T3/T4 and N1b stages, higher stimulated thyroglobulin, and higher numbers of metastatic lymph nodes and dissected lymph nodes, were associated with mFALN.
mFALNs were observed in a small number of patients with PTC undergoing RIT, but it contributed 55% of total recurrent or persistent disease. Increased frequency of mFALNs is associated with more advanced PTC. Preablative FDG PET has value in evaluation of patients with RIT-resistant lesions and may help determine further treatment strategies.
Cardiac implantable electronic device infections
Authors: Refaat Marwan , Zakka Patrick , Khoury Maurice , Chami Hassan , Mansour Shareef , Harbieh Bernard , Abi-Saleh Bernard , Bizri Abdul Rahman 
Published: April 2019

AbstractWith increasing rates of device implantation, there is an increased recognition of device infection. We conducted a retrospective observational study in a tertiary care center in Lebanon, with data collected from medical records of patients presenting with cardiac implantable electronic device (CIED) infection from 2000 to 2017 with the purpose of identifying etiologies, risk factors and other parameters, and comparing them to available data from the rest of the world. We identified a total of 22 CIED infections. The most common microbial etiologies, including involvement in polymicrobial infection, were coagulase-negative staphylococci (45.5%) andStaphylococcus aureus(22.7%). Rare cases ofBrucella melitensis,Sphingomonas paucimobilis, andKytococcus schroeteridevice infection were seen. Heart failure was seen in 77.3% of patients, hypertension in 68.2%, and chronic kidney disease in 50%. Skin changes were the most common presenting symptoms (86.4%). Antibiotics were given to all patients and all had their devices removed, with 36.4% undergoing new device implantation. This is the first study of CIED infections in Lebanon and the Middle East. Local epidemiology and occupational exposure must be considered while contemplating the microbial etiology of infection. Close monitoring after device implantation is important in preventing device infection that carries high risk of morbidity and mortality.
General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty
Authors: Pu Xiang , Sun Jian-ming 
Published: April 2019

Abstract

Background:
The optimal anesthetic technique remains debated in patients undergoing total-hip arthroplasty (THA). The purpose of this meta-analysis was to test the efficacy of general and spinal anesthesia for patients undergoing THA.

Methods:
In January 2018, we searched PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) that compared the use of general and spinal anesthesia for patients undergoing THA were retrieved. The primary outcome was to compare the total blood loss. The secondary outcomes were the occurrence of deep venous thrombosis (DVT), the occurrence of nausea, and the length of hospital stay. Software Stata 12.0 was used for meta-analysis.

Results:
Five RCTs with 487 THAs were finally included for meta-analysis. There was no significant difference between the general anesthesia and spinal anesthesia in terms of the total blood loss (weighted mean difference [WMD] = −20.72, 95% confidence interval [CI] −84.50 to 43.05, P = .524; I
2 = 87.8%) and the occurrence of DVT (risk ratio (RR) = 0.85, 95% CI 0.24–3.01, P = .805; I
2 = 70.5%). Compared with general anesthesia, spinal anesthesia was a significant reduction in the occurrence of nausea (RR = 3.04, 95% CI 1.69–5.50, P = .000; I
2 = 0.0%) and the length of hospital stay (WMD = 1.00, 95% CI 0.59–1.41, P = .000; I
2 = 94.7%).

Conclusion:
Spinal anesthesia was superior than general anesthesia in terms of the occurrence of nausea and shorten the length of hospital stay. The quality and number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of spinal anesthesia on reducing the blood loss after THA.
Metabolic characteristics of obese children with fatty liver
Authors: Zhao Kanglu , Ju Hongzhen , Wang Haili 
Published: April 2019

Abstract
To investigate metabolic differences between simple obese children and those comorbid with fatty liver disease.
Obese children hospitalized in our center from 2014 to 2016 were included and divided into simple obese group and obese with fatty liver group by ultrasound-based diagnosis of fatty liver. Epidemiology data and serum biochemical studies were recorded. Body Mass Index (BMI) and homeostasis model insulin resistance index (HOMA-IR) were calculated accordingly.
A total of 186 obese children were enrolled in this study, including 93 cases of obese children and 93 obese patients’ comorbid with fatty liver. The proportion of male, age, waist circumference (WC), BMI, fasting blood-glucose (FBG), glycosylated hemoglobin A1c (HbA1c), fasting insulin (FINS), and HOMA-IR were significantly higher in obese patients with fatty liver (P <.05). Age and BMI were found to be independent risk factors for fatty liver disease (OR >1, P <.05).
Among obese children, male and elder patients and individuals with higher uric acid are more susceptible to fatty liver.
Clinical course and risk factors of recurrent corneal erosion
Authors: Nanba Hisataka , Mimura Tatsuya , Mizuno Yoshinobu , Matsumoto Koichi , Hamano Shigeki , Ubukata Shoko , Yamamoto Megumi , Watanabe Emiko , Mizota Atsushi 
Published: April 2019

Abstract
Recurrent corneal erosion (RCE) is a common disorder causing ocular pain, tearing, photophobia, and visual impairments. Various factors such as ocular trauma, ocular surgery, corneal dystrophy, contact lens wear, and diabetes mellitus (DM) can cause RCE. The purpose of this study was to determine the causative factors and clinical course of RCE.
We retrospectively examined 21 eyes of 21 patients with RCE and investigated the patients’ background, type of treatments, and clinical course after the treatments. All patients were treated with eye drops, ocular lubrication, or contact lens bandage for the RCE.
Among the 21 patients with RCE, 9 were caused by trauma (Trauma group), 8 by DM (DM group), 1 by bacterial corneal ulcer, 1 by lagophthalmus and bacterial corneal ulcer, 1 by bandkeratopathy, and 1 by eyelid tumor (one eye). The mean age of the patients was 57.8 years with a range 34–91 years. The mean duration from the trauma to the onset of RCE was 5.2 ± 5.0 months (mean ± SD). The time required for a complete recovery of RCE was longer in the DM group (10.3 ± 3.1 weeks) than in the Trauma group (2.7 ± 1.1 weeks, P < .01). The presence of DM was significantly associated with the recovery duration of RCE (r = 0.72; P
< .01). Multivariate analyses showed that the recovery duration of RCE was associated with the presence of DM (odds ratio = 139.8, P = .04). On the other hand, the type of treatments had no effect on the recovery duration of RCE.
These findings suggest that trauma and DM are important causes of RCE. Wound recovery after RCE may be delayed in patients with DM.
Effect of beraprost on pulmonary hypertension due to left ventricular systolic dysfunction
Authors: Wang Li , Zhu Xinyi , Zhao Liang-Ping , Wang Maosong , Liu Xiang , Chen Yuqi , Chen JianChang , Xu WeiTing 
Published: April 2019

Abstract
Beraprost is used to treat peripheral chronic arterial occlusive disease. However, the efficacy and safety of beraprost in patients with pulmonary hypertension (PH) due to left ventricular systolic dysfunction (PH-HFrEF) remains unknown. The primary objective of this study was to determine the effects of beraprost on PH-HFrEF.
We prospectively recruited patients with PH-HFrEF as determined by echocardiography and right cardiac catheterization. Beraprost sodium was given orally (1 μg/kg/d) added to the usual treatment, and patients were evaluated at 1-year follow-up.
Twenty-five patients were recruited with baseline systolic pulmonary artery pressure (PAP) of 49.5 ± 10.8 mm Hg. Systolic PAP results at 3, 6, 9, and 12 months were 39.1 ± 8.1, 30.4 ± 5.2, 27.7 ± 3.0, and 27.0 ± 4.7 mm Hg, respectively, which were all significantly lower than systolic PAP at baseline (P < .05). Left ventricular ejection fraction results at 6 months (43.5 ± 7.0%), 9 months (47.0 ± 5.5%), and 12 months (48.2 ± 4.8%) were significantly higher than at baseline (34.7 ± 9.2%) (P < .05). Six-minute walking distance at 3 months (282.8 ± 80.6 m), 6 months (367.1 ± 81.2 m), 9 months (389.8 ± 87.1 m), and 12 months (395.7 ± 83.4 m) increased with time, and all were significantly higher than baseline (190.1 ± 75.5 m) (P < .05). One patient developed atrial fibrillation and recovered to sinus rhythm after intravenous administration of amiodarone. There were no instances of cardiac-related death, severe bleeding, or severe impairment of liver function.
Routine oral administration of beraprost sodium added to the usual treatment may improve cardiopulmonary hemodynamics and exercise capacityin patients with PH-HFrEF.