bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Factors Affecting Emergency Department Utilization and Hospital Readmission Rates After Primary Anterior Cervical Discectomy and Fusion
Authors: Sheha Evan D. , Salzmann Stephan N. , Khormaee Sariah , Yang Jingyan , Girardi Federico P. , Cammisa Frank P. , Sama Andrew A. , Lyman Stephen , Hughes Alexander P. 
Published: April 2019

Study Design.
Retrospective database analysis.

Objective.
To identify preoperative risk factors for emergency department (ED) visit and unplanned hospital readmission after primary anterior cervical discectomy and fusion (ACDF) at 30 and 90 days.

Summary of Background Data.
Limited data exist to identify factors associated with ED visit or readmission after primary ACDF within the first 3 months following surgery.

Methods.
Patients undergoing ACDF from 2005 to 2012 were identified in the Statewide Planning and Research Cooperative System database. Multivariable regression models were created based on patient-level and surgical characteristics to identify independent risk factors for hospital revisit.

Results.
Of 41,813 patients identified, 2514 (6.0%) returned to the ED within 30 days of discharge. Risk factors included age < 35, black race (OR 1.19), Charlson Comorbidity index score > 1, length of stay (LOS) greater than 1 day (OR 1.23), and fusion of > 2 levels (OR 1.17). Four thousand six hundred nine (11.0%) patients returned to the ED within 90 days. Risk factors mirrored those at 30 days. Patients having private insurance or those discharged to rehab were less likely to present to the ED. One thousand three hundred ninety-four (3.3%) patients were readmitted by 30 days. Risk factors included male sex, Medicare, or Medicaid insurance (OR 1.71 and 1.79 respectively), Charlson comorbidity index > 1, discharge to a skilled nursing facility (OR 2.90), infectious/pathologic (OR 3.296), or traumatic (OR 1.409) surgical indication, LOS > 1 day (OR 1.66), or in-hospital complication. 2223 (5.3%) patients were readmitted by 90 days. Risk factors mirrored those at 30 days. No differences in readmission were seen based on race or number of levels fused. Patients aged 18 to 34 were less likely to be readmitted versus patients older than 35.

Conclusion.
Insurance status, comorbidities, and LOS consistently predicted an unplanned hospital visit at 30 and 90 days. Although nondegenerative surgical indications and in-hospital complications did not predict ED visits, these factors increased the risk for readmission.

Level of Evidence: 3
Epidemiology, Tumor Characteristics, and Survival in Patients With Primary Pancreatic Lymphoma
Authors: Mukhija Dhruvika , Nagpal Sajan Jiv Singh , Sohal Davendra P.S. 
Published: April 2019

Introduction:
Primary pancreatic lymphoma (PPL) is an extranodal manifestation of non-Hodgkin lymphoma originating in the pancreas, which constitutes <1% of all pancreatic neoplasms. Because of the rarity of the disease, most data on PPL are derived from case reports and small case series. To provide better insight into the epidemiology, treatment, and outcomes of these patients, we conducted an analysis of patients with PPL from the Surveillance, Epidemiology and End Results (SEER) database, which is presented in this study.

Methods:
Patients with PPL were identified using the International Classification of Disease for Oncology, third edition histology codes for lymphoma (9590/3-9734/3), with pancreas (C25.0-C25.9) listed as the primary disease site. We collected data on patient demographics, year of diagnosis, primary tumor site, histology, first line of treatment received, and survival until death or last follow-up for the period 1973-2014.

Results:
Overall, 835 patients were included. The median (range) age of the study population was 67 (2 to 98) years. The median (95% confidence interval) overall survival for the cohort was 53 (37 to 73) months. On univariable analyses, age, stage, and use of chemotherapy were statistically associated with improved overall survival. Besides these factors, white race was associated with improved cause-specific survival on multivariable analysis.

Conclusions:
This large population-based series describes PPL in detail. Younger age, white race, early stage, and initial treatment with chemotherapy are associated with improved survival in patients with PPL.
Extramedullary Hematopoiesis: An Unusual Finding in Angiolymphoid Hyperplasia With Eosinophilia
Authors: Johnson Nathan M. , Thomas Raj J. , Grider Douglas J. 
Published: April 2019

Abstract:
Extramedullary hematopoiesis is the process of blood cell synthesis occurring outside the medulla of the bone marrow. During fetal development, extramedullary hematopoiesis is considered physiological; however, it is considered pathologic when occurring outside the neonatal period. Angiolymphoid hyperplasia with eosinophilia (ALHE) describes a lesion characterized histologically by plump endothelial cells associated with a mixed inflammatory infiltrate of lymphocytes, plasma cells, mast cells, and eosinophils. This report describes an adolescent boy with an isolated preauricular facial lesion. After excision, histopathology confirmed a diagnosis of ALHE with the additional finding of trilineage extramedullary hematopoiesis. To the authors' knowledge, this is the first reported case of extramedullary hematopoiesis in ALHE.
Impact of Prenatal Selective Serotonin Reuptake Inhibitor Antidepressant Exposure and Maternal Mood on Physical Activity, Dietary Intake, and Markers of Adiposity at Age 6 Years
Authors: Hutchison Sarah M. , Mâsse Louise C. , Glier Melissa B. , Brain Ursula , Devlin Angela M. , Oberlander Tim F. 
Published: April 2019

ABSTRACT:

Objective:
This study assessed associations between maternal depressive symptoms, prenatal maternal antidepressant treatment, maternal estimates of child physical activity (PA), dietary total intake, and markers of adiposity.

Methods:
Mothers and their children (N = 116) were part of a longitudinal cohort study examining the effects of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression (SSRI exposed, n = 42; nonexposed, n = 74). Maternal depression symptoms were assessed prenatally and postnatally. At 6 years, PA was assessed using maternal report, 3-day dietary total intakes were obtained using objective records of intake, portion sizes, and product brand names, and birth weight, weight, height, and waist circumference (WC) at age 6 years were also collected. Body mass index (BMI) and WC z-scores standardized for sex and age were computed as markers of adiposity.

Results:
Children with SSRI exposure had lower levels of PA than children without SSRI exposure. Total dietary energy intakes did not vary between exposure groups. SSRI exposure was not associated with BMI or WC z-scores of the children. Importantly, although lower birth weight was observed in SSRI-exposed children, differences did not remain, accounting for gestational age.

Conclusion:
Although SSRI exposure was associated with lower estimates of PA, such exposure was not associated with markers of adiposity or total diet energy intake at age 6 years. The implications across subsequent measures in childhood remain to be determined.
Endothelin-1 Concentration in Aqueous Humor Predicts Postoperative Late Low Intraocular Pressure in Primary Open-angle Glaucoma After Trabeculectomy
Authors: Liu Yuejun , Han Bing , Li Fang , Liu Hui 
Published: April 2019

Background:
This study aimed to evaluate the potential risk factors for postoperative late low intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) after trabeculectomy.

Materials and Methods:
Adult patients who were diagnosed with POAG and scheduled to undergo primary unilateral trabeculectomy in our hospital were consecutively included. Blood samples before the surgery and aqueous humor samples during the surgery of each participant were collected. Patient demographics, preoperative assessments, and laboratory tests were compared in patients with or without late low IOP. The risk factors for late low IOP were evaluated using logistic regression modeling. The predictive value of endothelin-1 (ET-1) in aqueous humor for late low IOP was evaluated by receiver operating characteristic curve analysis.

Results:
Thirty-nine of 222 enrolled patients were cases of late low IOP with an incidence of 17.6% (39/222). The multivariate logistic regression analysis indicated that ET-1 concentration in aqueous humor was the only independent risk factor for late low IOP after trabeculectomy (odds ratio, 0.89; 95% confidence interval, 0.79-0.98; P=0.021). Receiver operating characteristic curve analysis showed that ET-1 concentration in aqueous humor was a predictor for late low IOP after trabeculectomy with an area under the curve of 0.639, a specificity of 84.62%, and a sensitivity of 39.89%, respectively (P=0.006).

Conclusions:
Our study indicated that ET-1 concentration in aqueous humor was an independent risk factor for late low IOP in patients with POAG after trabeculectomy.
The Outcomes of a Comprehensive Program for Maintenance of Goldmann Applanation Tonometer
Authors: Choudhari Nikhil S. , Richhariya Ashutosh , Wadke Vidya , Deshmukh Sanket P. , George Ronnie , Senthil Sirisha , Chandra Sekhar Garudadri 
Published: April 2019

Precis:
We checked 190 tonometers every month and repaired faulty ones. Calibration error (CE) frequency reduced from 23% to 0.6% at 1 year. Tonometers needing one or >1 CE repair differed in survival but not in age.

Purpose:
The purpose of this study was to report the outcomes of a comprehensive program to maintain calibration status of the Goldmann applanation tonometer.

Methods:
This prospective cohort study was carried out at 2 tertiary eye care referral centers. We included 190 slit-lamp mounted Goldmann applanation tonometers (Model AT 900 C/M). Health care providers (error checking and reporting) and clinical engineers (maintenance) participated. The team carried out CE check once a month, and repair of faulty tonometers, if any, within 24 hours. Failure of tonometer was defined as development of unacceptable CE beyond the third repair. The main outcome measures were the frequency of CE and survival function of the tonometer over 1 year.

Results:
The median age of the tonometers was 10.7 (range, 0.2 to 25.1) years. The total number of repairs was 86. The proportion (95% confidence interval) of faulty tonometers reduced from 23.1% (17.7, 29.6) in the first month to 0.6% (0.1, 3.3) at 1 year (P<0.01). The median age of the tonometer did not differ between those needing (n=63, 9.4 y) and not needing (n=127, 10.7 y; P=0.24) repair. All tonometers requiring 1 CE repair (n=49, 25.7%) survived until 1 year. The survival of tonometers requiring >1 CE repair (n=14, 7.3%) was 40% at 1 year.

Conclusions:
Our in-house program maintained 92.6% tonometers error free. Number of repairs rather than age determined the need for replacement/sending back the tonometer to the manufacturer. Our simple and easy to follow maintenance program has the potential for wide application.
Overuse and Underuse of Visual Field Testing Over 15 Years
Authors: Ben-Artsi Elad , Goldenfeld Modi , Zehavi-Dorin Tzukit , Cohen Asaf , Porath Avi , Levkovitch-Verbin Hani 
Published: April 2019

Précis:
A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established.

Purpose:
The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization.

Methods:
This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses. Study population: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated. Main outcome measures: VF performance rates.

Results:
A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, non–glaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95±6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95±0.37 annual tests) began.

Conclusion:
There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.
Patients' Intensive Telephone-Based Care Program Reduces Depression in Coronary Artery Disease Patients and May Contribute to Favorable Overall Survival by Decreasing Depression
Authors: Yang Lanju , Wang Xuemei , Cui Xiaoning 
Published: April 2019

Objective:
The aim of this study was to investigate the effectiveness of patients' intensive telephone-based care program (PITC) on depression and its correlation with overall survival in patients with coronary artery disease who have depression.

Methods:
A total of 224 patients with coronary artery disease who were complicated with depression were allocated randomly to the PITC group and control group in a 1:1 ratio. In the PITC group, PITC and usual care were performed, whereas in the control group, only usual care was given. Depression was assessed using Hospital Anxiety and Depression Scale–Depression (HADS-D) score and Zung Self-Rating Depression Scale (SDS) score.

Results:
No difference in baseline characteristics was found between the PITC and control groups (all P > .05). There were changes the HADS-D score (P = .002) and SDS score (P = .019) from baseline (M0) to month 12 (M12) in the PITC group. Those in the PITC group had a reduced depression rate (assessed by HADS-D score <8 at month 12) (P = .005). As for overall survival analysis, Kaplan-Meier curves revealed that overall survival was numerically longer in the PITC group compared with the control group but displayed no statistical significance (P = .061), whereas patients without depression at month 12 presented with better overall survival compared with patients with depression at month 12, as assessed by HADS-D (P = .041) or SDS (P = .014).

Conclusions:
A PITC could serve as an effective means to decrease depression, and it might contribute to favorable overall survival by decreasing depression in patients with coronary artery disease.
Medicaid Expansion at Title X Clinics
Authors: Boudreaux Michel , Choi Yoon Sun , Xie Liyang , Marthey Daniel 
Published: April 2019

Background:
Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act’s Medicaid expansion.

Objectives:
To examine the impact of the Affordable Care Act’s Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix.

Research Design:
A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states.

Subjects:
Administrative data from Family Planning Annual Reports that describe Title X clients who sought services.

Measures:
Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15–44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type.

Results:
We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification.

Conclusions:
Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.
Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone–Related Peptide–Secreting Renal Tumor
Authors: Keblawi Samir S. , Wright Jason N. , Otjen Jeffrey P. , Verma Arushi , Brown Emily C. , Ness Kate D. , Feldman Kenneth W. 
Published: April 2019

Background
When evaluating an infant with unexplained fractures for child abuse, it is important to evaluate for possible causes of underlying bone fragility.

Case
A 7-month-old infant was found to have a parathyroid hormone (PTH)–related peptide–secreting mesoblastic nephroma. In spite of having an elevated serum calcium, depressed serum phosphate, and high levels of PTH-related peptide, he had no demineralization or other hyper parathyroid–related bone changes. Instead, he had multiple classic metaphyseal lesions, fractures of differing ages including a proximal clavicle fracture, and current and past bruising. No fractures typical of bone insufficiency were present. These findings are highly indicative of abuse in addition to his hormone-secreting tumor.

Conclusions
In spite of this child's abuse findings, endogenous or tumor-related hyper PTH should be in the differential of underlying bone fragility. Children with disorders that could cause injury susceptibility can also be abused.
Screening Laboratory Testing in Asymptomatic Minor Pediatric Blunt Trauma Leads to Unnecessary Needle Sticks
Authors: Badru Faidah , Osei Hector , Munoz-Abraham Armando Salim , Saxena Saurabh , Breeden Robert , Piening Nicholas , Starr David , Xu Perry , Greenspon Jose , Fitzpatrick Colleen M. , Villalona Gustavo A. , Chatoorgoon Kaveer 
Published: April 2019

Objective
Screening blood work after minor injuries is common in pediatric trauma. The risk of missed injuries versus diagnostic necessity in an asymptomatic patient remains an ongoing debate. We evaluated the clinical utility of screening blood work in carefully selected asymptomatic children after minor trauma.

Methods
Patients seen at a level 1 pediatric center with “minor trauma” for blunt trauma between 2010 and 2015 were retrospectively reviewed. Exclusion criteria were age <4 of >18 years, a Glasgow Coma Scale score of <15, penetrating trauma, nonaccidental trauma, hemodynamic instability, abdominal findings (pain, distension, bruising, tenderness), hematuria, pelvic/femur fracture, multiple fractures, and operative intervention. Data abstraction included demographics, blood work, interventions, and disposition.

Result
A total of 1308 patients were treated during the study period. Four hundred thirty-three (33%) met inclusion criteria. Mean ± SD age was 12.7 ± 4 years (range, 4–18 years), and 59% were male. Seventy-eight percent were discharged home from the emergency department. All patients had blood work. Twenty-eight percent had at least one abnormal laboratory value. The most common abnormal blood work was leukocytosis (16%). Thirty percent had an intervention, and none prompted by abnormal blood work. One patient had an intra-abdominal finding (psoas hematoma).

Conclusion
When appropriately selected, screening laboratory testing in asymptomatic minor pediatric blunt trauma patients leads to unnecessary needle sticks without significant advantage.
Trends in Pediatric Poisoning-Related Emergency Department Visits: 2001–2011
Authors: Kline Jaclyn N. , Badolato Gia M. , Goyal Monika K. 
Published: April 2019

Objectives
We sought to understand the burden of pediatric poisonings on the health care system by characterizing poisoning-related emergency department (ED) visits among children on a national level.

Methods
This was a repeated cross-sectional analysis of the National Hospital Ambulatory Medical Care Survey from 2001 to 2011 of children 21 years or younger who presented to an ED. We measured annual rates of visits, trends over time, and patient and visit characteristics associated with poisoning-related ED visits using multivariable logistic regression. We also compared accidental to intentional poisonings.

Results
There were an estimated 713,345 ED visits per year for poisoning in children, and intentional poisoning–related visits increased over the study period (P trend < 0.001). Compared with all other ED visits, poisoning-related ED visits were more common among males (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.26–1.64) and uninsured patients (aOR, 1.26; 95% CI, 1.05–1.51). Poisoned children were more likely to arrive by ambulance (aOR, 3.38; 95% CI, 2.85–4.01) and be admitted (aOR, 1.35; 95% CI, 1.12–1.61). Compared with accidental poisonings, intentional poisonings were more common as age increased (aOR, 1.16; 95% CI, 1.13–1.92) and in children of non-Hispanic black race/ethnicity (aOR, 1.81; 95% CI, 1.12–2.93) and more likely to be associated with ambulance arrival (aOR, 1.49; 95% CI, 1.07–2.08) and hospital admission (aOR, 1.76; 95% CI, 1.25–2.48).

Conclusions
Poisoning-related ED visits among children have remained stable, with significant increase in intentional ingestions from 2001 to 2011. Poisoned children, and particularly those with intentional poisonings, require more health care resources than children with other health concerns. More study is needed on circumstances leading to pediatric poisonings, so that preventive efforts can be targeted appropriately.
Content Validation of Clinical Evidence Related to Self-Care Deficits of Patients With Stroke
Authors: Oliveira-Kumakura Ana Railka de Souza , da Silva Kelly Cristina Rodrigues , Sousa Cássia Milena Freitas Machado , Biscaro Jessica Aparecida , Spagnol Gabriela Salim , Morais Sheila Coelho Ramalho Vasconcelos 
Published: April 2019

AbstractObjectiveThe aim of the study was to develop the conceptual and operational definitions for the defining characteristics of each nursing diagnosis related to self-care deficits of patients with stroke and to validate these definitions with experts.MethodsThis was a methodological study. The definitions were evaluated by 32 specialists and analyzed using binomial testing.ResultsAll the defining characteristics analyzed were statistically significant (p< .05); three indicators showed agreement at a level lower than the ideal (<0.85).ConclusionThe definitions achieved validity for measuring self-care deficit for bathing, toileting, dressing, and eating.Implications for Nursing PracticeThese defining characteristics of each nursing diagnosis related to self-care deficits may enable more accurate assessment, driving relevant and individualized action plans in rehabilitation.