bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis
Authors: Liu Minhui , McCurry Susan M. , Belza Basia , Buchanan Diana T. , Dobra Adrian , Von Korff Michael , Vitiello Michael V. 
Published: September 2018

Background:
Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications.

Objective:
To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA).

Research Design:
Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period.

Subjects:
Group Health Cooperative patients with a diagnosis of OA (N=2976).

Measures:
Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records.

Results:
In negative binomial models, pain [incidence rate ratio (IRR), 2.8–3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5–7.5 times. Combined effects increased with insomnia or depression severity.

Conclusions:
Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.
The Relative Ability of Comorbidity Ascertainment Methodologies to Predict In-Hospital Mortality Among Hospitalized Community-acquired Pneumonia Patients
Authors: Weir Ronald E. , Lyttle Christopher S. , Meltzer David O. , Dong Tien S. , Ruhnke Gregory W. 
Published: September 2018

Background:
Despite widespread use of comorbidities for population health descriptions and risk adjustment, the ideal method for ascertaining comorbidities is not known. We sought to compare the relative value of several methodologies by which comorbidities may be ascertained.

Methods:
This is an observational study of 1596 patients admitted to the University of Chicago for community-acquired pneumonia from 1998 to 2012. We collected data via chart abstraction, administrative data, and patient report, then performed logistic regression analyses, specifying comorbidities as independent variables and in-hospital mortality as the dependent variable. Finally, we compared area under the curve (AUC) statistics to determine the relative ability of each method of comorbidity ascertainment to predict in-hospital mortality.

Results:
Chart review (AUC, 0.72) and administrative data (Charlson AUC, 0.83; Elixhauser AUC, 0.84) predicted in-hospital mortality with greater fidelity than patient report (AUC, 0.61). However, multivariate logistic regression analyses demonstrated that individual comorbidity derivation via chart review had the strongest relationship with in-hospital mortality. This is consistent with prior literature suggesting that administrative data have inherent, paradoxical biases with important implications for risk adjustment based solely on administrative data.

Conclusions:
Although comorbidities derived through administrative data did produce an AUC greater than chart review, our analyses suggest a coding bias in several comorbidities with a paradoxically protective effect. Therefore, chart review, while labor and resource intensive, may be the ideal method for ascertainment of clinically relevant comorbidities.
The Impact of Public Performance Reporting on Market Share, Mortality, and Patient Mix Outcomes Associated With Coronary Artery Bypass Grafts and Percutaneous Coronary Interventions (2000–2016)
Authors: Dunt David , Prang Khic-Houy , Sabanovic Hana , Kelaher Margaret 
Published: September 2018

Objective:
Public performance reporting (PPR) of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) outcomes aim to improve the quality of care in hospitals, surgeons and to inform consumer choice. Past CABG and PCI studies have showed mixed effects of PPR on quality and selection. The aim of this study was to undertake a systematic review and meta-analysis of the impact of PPR on market share, mortality, and patient mix outcomes associated with CABG and PCI.

Methods:
Six online databases and 8 previous reviews were searched for the period 2000–2016. Data extraction, quality assessment, systematic critical synthesis, and meta-analysis (where possible) were carried out on included studies.

Results:
In total, 22 relevant articles covering mortality (n=19), patient mix (n=14), and market share (n=6) outcomes were identified. Meta-analyses showed that PPR led to a near but not significant reduction in short-term mortality for both CABG and PCI. PPR on CABG showed a positive effect on market share for hospitals (3 of 6 studies) and low-performing surgeons (2 of 2 studies). Five of 6 PCI studies found that high-risk patients were less likely to be treated in States with PPR.

Conclusions:
There is some evidence that PPR reduces mortality rates in CABG/PCI-treated patients. The significance of there being no strong evidence, in the period 2000–2016, should be considered. There is need for both further development of PPR practice and further research into the intended and unintended consequences of PPR.
Transient Elastography Measurements of Spleen Stiffness as a Predictor of Clinically Significant Varices in Children
Authors: Sutton Harry , Fitzpatrick Emer , Davenport Mark , Burford Charlotte , Alexander Emma , Dhawan Anil , Grammatikopoulos Tassos 
Published: September 2018

ABSTRACTObjectives:Investigate the use of spleen stiffness measurements (SSMs), measured by transient elastography (TE), for the prediction of clinically significant varices (CSV) in children with portal hypertension.Methods:This observational cohort study included children selected for endoscopy, as per department protocol, between September 2015 and June 2016. Those included underwent single TE FibroScan for liver stiffness measurements and SSM. Clinical and laboratory data were collected and variceal prediction scores were calculated at time of elastography.Results:In total 67 children (32 boys) underwent TE. Fifty‐two children (25 boys) had chronic liver disease (CLD), 15 (7 boys) portal vein thrombosis (PVT). In all children SSM was the best predictor of CSV+ve, with an optimal cut‐off value of 38.0 kPa (area under the receiver operator curve [AUROC] = 0.92, sensitivity = 89%, specificity = 82%, P < 0.01). In the CLD group SSM was also the best predictor, with an optimal cut‐off value of 38.05 kPa (AUROC = 0.90, sensitivity = 84%, specificity = 87%, P < 0.01). In the PVT group only SSM was predictive of CSV+ve, with an optimal cut‐off value of 16.8 kPa (AUROC = 1.00, sensitivity = 100%, specificity = 100%, P < 0.001). For the prediction of GI bleeding (n = 6), liver stiffness measurement performed the best, with an optimal cut‐off value of 34.3 kPa (AUROC = 0.84, sensitivity of 80%, specificity of 88%, P = 0.01).Conclusions:SSM was the greatest predictor of CSV+ve in the whole cohort, and individual CLD and PVT groups. SSM could be used as a noninvasive screening tool for children with portal hypertension to stratify the risk of having CSV.
Direct‐acting antiviral Therapy Is Safe and Effective in Pediatric Chronic Hepatitis C
Authors: Dhiman Radha K. , Grover Gagandeep S. , Premkumar Madhumita , Taneja Sunil , Duseja Ajay , Rathi Sahaj , Satsangi Sandeep 
Published: September 2018

ABSTRACTObjectives:We assessed the efficacy of decentralized public health services and safety of direct‐acting antiviral agents (DAAs) in the treatment of pediatric chronic hepatitis C (CHC) in the Mukh‐Mantri Punjab Hepatitis C Relief Fund, a public‐health initiative for prevention and control of CHC in Punjab, India.Methods:Consecutive children with CHC [age ≥12 to <18 years; both treatment‐naïve (TN) and treatment‐experienced (TE)] were enrolled. Genotyping was not recommended for non‐cirrhotic patients and were treated with sofosbuvir (SOF)+ daclatasvir (DCV) for 12 weeks, while genotyping was recommended for patients with cirrhosis. Patients with cirrhosis and genotype (G2) were treated with SOF+DCV+ribavirin (RBV) for 12 weeks, G3 with SOF+DCV+RBV for 24 weeks and G1, 4, 5, and 6 patients were treated with SOF+ledipasvir (LDV)+RBV for 12 weeks. Treatment duration was increased to 24 weeks if RBV was not tolerated.Results:In the first 16 months (June 18, 2016–October 31, 2017), 88 children (mean age 15.8 years; 69.3.3% boys, 72.3% rural) were enrolled. The mean baseline hepatitis C virus RNA log10 IU/mL was 6.0 (range 4.2–7.5 log10 IU/mL), 65.5% with G3, and 2 (2.5%) with cirrhosis. Of 57 with completed treatment, sustained virological response (SVR) 12 was achieved in 56 (98.2%). Unsafe medical practices (55.5%), IV drug abuse (11.1%), and prior surgery (2.7%) were risk‐factors for transmission (n = 36). Comparable results were noted in G3 (SVR at 12 weeks [SVR12], 94.3%) versus non‐G3 (SVR12, 100%; P = 0.073). No serious adverse effects like anemia and decompensation were reported.Conclusions:The study demonstrates that the decentralized algorithm‐based public‐health program can ensure high efficacy (SVR12, 98.2%) and low‐cost DAA‐based treatment of pediatric patients with CHC.
There Is No Excuse for Mortality Due to Lack of Competency and Training of Paediatric Endoscopists in Gastrointestinal Bleeding Therapy in 2018
Authors: Thomson Mike 
Published: September 2018

ABSTRACTAcute upper gastrointestinal bleeding in children is possibly the last medical emergency which continues to lead to the death of a child due to the lack of competency/clinical judgement of the doctor, as opposed to the disease itself, leading to mortality despite optimum medical intervention. This is unacceptable in any circumstances in 2018. It occurs due to a number of conspiring factors including lack of appreciation of the clinical presentation requiring urgent endoscopic intervention; misapprehension of the urgency of timing required of such an intervention predicated on the severity of the gastrointestinal (GI) bleed; lack of application of a paediatric‐specific validated score predicting for such endoscopic intervention; lack of skill in endo‐haemostatic intervention techniques by paediatric endoscopists; poor training in such techniques among paediatric endoscopists; paucity of cases with lack of exposure of the paediatric endoscopist regularly to enable skills to be maintained, once acquired; reluctance of adult endoscopists in many centres to support paediatric GI bleeding services. In essence then the paediatric GI community urgently needs to identify centres of excellence to whom these children should be transferred. Transfer is safe in all but the most critical cases once stabilised with transfusion, octreotide/terlipressin and iv proton pump inhibitors. The resources are country‐dependent but this is really no excuse. We must not let this parlous state of affairs continue. Solutions are explored in this article and please let this serve as a call to action for all those involved in this continuing debacle in order to save “save‐able” lives.
Severe Deoxyguanosine Kinase Deficiency in Austria
Authors: Waich Stephanie , Roscher Anne , Brunner‐Krainz Michaela , Cortina Gerard , Köstl Gerhard , Feichtinger Rene G. , Entenmann Andreas , Müller Thomas , Knisely A.S. , Mayr Johannes A. , Janecke Andreas R. , Vodopiutz Julia 
Published: September 2018

ABSTRACTMutations in the nuclear gene DGUOK, encoding deoxyguanosine kinase, cause an infantile hepatocerebral type of mitochondrial depletion syndrome (MDS). We report 6 MDS patients harboring bi‐allelic DGUOK mutations, of which 3 are novel, including a large intragenic Austrian founder deletion. One patient was diagnosed with hepatocellular carcinoma aged 6 months, supporting a link between mitochondrial DNA depletion and tumorigenesis; liver transplantation proved beneficial with regard to both tumor treatment and psychomotor development.
Diet and Exercise in Pediatric Liver Transplant Recipients
Authors: Chambers Julia H. , Zerofsky Melissa , Lustig Robert H. , Rosenthal Philip , Perito Emily R. 
Published: September 2018

ABSTRACTObjective:The aim of the study is to analyze the impact of physical activity and eating behaviors on precursors of cardiovascular disease—including overweight/obesity, hypertension, low high‐density lipoprotein, and impaired glucose tolerance—in pediatric liver transplant (LT) recipients and matched controls.Method:Cross‐sectional study of pediatric LT recipients 8 to 30 years, matched to controls from the National Health and Nutrition Examination Survey. Dietary intake assessed with 24‐hour recall. Physical activity assessed by standardized questionnaires. LT recipients ≥12 years completed a confidential survey on alcohol consumption.Results:LT recipients (n = 90) were 0.9 to 24.7 years post‐transplant. LT recipients and controls were equally likely to consume excess carbohydrates (32% vs 34%) and sugar, per age‐ and gender‐specific recommended dietary intake guidelines. LT recipients spent more hours sedentary or on the computer daily and fewer days each week physically active for >60 minutes than controls. More overweight/obese LT recipients spent 3+ hours at the computer than non‐overweight LT recipients (49% vs 27%; P = 0.02). Normal weight LT recipients spent more days doing vigorous activity each week (median 5 days, interquartile range 2–6) than did the overweight/obese LT recipients (median 3 days, interquartile range 2–4; P = 0.01). Among LT recipients, neither dietary intake nor physical activity were consistently associated with measures of hypertension, glucose intolerance, or dyslipidemia. Among LT adolescents and young adults (n = 38), 36% reported ever consuming alcohol; 38% of these reported significant alcohol consumption by frequency or quantity.Conclusions:Additional counseling during routine post‐LT care on the importance of physical activity and healthy diet may be useful. However, it is unlikely that these factors alone explain the increased prevalence of metabolic syndrome components in pediatric LT recipients.
Recurrent Abdominal Pain in Children
Authors: Singh Harveen K. , Ee Looi C. 
Published: September 2018

ABSTRACTRecurrent abdominal pain (RAP) in children is common, with most functional in origin. Colonoscopy has sometimes been performed to exclude pathology but its role is unclear. Our aim therefore was to assess the diagnostic yield and role of colonoscopy in these children. Retrospective review of consecutive colonoscopies in a tertiary pediatric hospital between November 2011 and October 2015 was undertaken. Only those with RAP as an indication for procedure were included. Chart review of patients with pain was undertaken to ensure they fulfilled Rome IV criteria. Patient demographics, indication for procedure, and adjunct preprocedure tests were noted. Statistical analyses were performed with SPSS software. A total of 652 colonoscopies were performed, of which 68 (10%) had abdominal pain as one of the indications, and was the sole indication in 15 (2%) patients. All 68 patients had preprocedure serum inflammatory markers measured and 53% (36/68) had stool calprotectin. Positive histology was found in 10% (7/68) including Crohn disease (n = 3), polyps (n = 2), and microscopic colitis (n = 2). The remaining 61 patients had normal colonoscopy and ileocolonic biopsies. Of the 36 patients 5 had raised fecal calprotectin, and all had abnormal histology. Serum inflammatory markers were raised in 4 patients and all also had abnormal calprotectin. No patient with isolated abdominal pain had positive histology. Rectal bleeding was the only associated indication to predict abnormal histology (P = 0.019). Colonoscopy is likely not warranted in children with RAP without bleeding, weight loss, or altered bowel habit. Fecal calprotectin is useful in helping predict positive findings.
Red Spot Lesions in the Duodenal Bulb Are a Highly Specific Endoscopic Sign of Celiac Disease
Authors: Silvester Jocelyn A. , Faucher Elizabeth A. , McCarty Caitlin E. , Kalansky Adie , Hintze Zackary J. , Mitchell Paul D. , Goldsmith Jeffrey D. , Weir Dascha C. , Leichtner Alan M. 
Published: September 2018

ABSTRACTWe have recognized red spot lesions (RSLs) in the duodenal bulb in children with celiac disease (CD) and believe they may represent an underappreciated and distinct endoscopic sign of CD. A total of 171 pediatric patients undergoing esophagogastroduodenoscopy with duodenal biopsy for symptoms consistent with CD were prospectively recruited. There were 75 patients who met criteria for CD and the remaining 96 patients served as symptomatic controls. As compared to endoscopic markers frequently mentioned in literature, RSLs had comparable sensitivity, specificity, positive predictive value, and negative predictive value of 31%, 94%, 80%, and 64%, respectively. If RSLs are noted during endoscopy in a patient with gastrointestinal symptoms that might be the result of CD, then sufficient duodenal biopsies to make the diagnosis of CD should be obtained.
The Effect of Biologics on Postoperative Complications in Children With Inflammatory Bowel Disease and Bowel Resection
Authors: Mitsuya Jennifer B. , Gonzalez Raquel , Thomas Ron , El‐Baba Mohammad 
Published: September 2018

ABSTRACTObjectives:There has been limited investigation of pediatric patients with inflammatory bowel disease (IBD) who have been treated with biologic agents and undergo operative management. Postoperative complications in the adult setting have been mixed and in the pediatric population the data have been limited. This study compares children with IBD treated with biologic agents to patients treated with nonbiologic therapy before bowel resection.Methods:This is a single‐center, retrospective chart review study of 62 children with IBD who underwent bowel resection between 2001 and 2017. Analysis included patient demographics, medications used before surgery, incidence of postoperative complications, indication for surgery, type of operation, and additional surgeries required. Postoperative complications were defined as superficial skin infection, leak at anastomotic site, intra‐abdominal abscess, wound dehiscence, and so on. Complications were compared based on medical therapy.Results:Of the 62 children reviewed, 21 carried the diagnosis of ulcerative colitis, 40 had Crohn disease, and 1 had IBD‐unspecified. Thirty‐seven of the patients were treated with infliximab, adalimumab, or vedolizumab before their bowel resection. There were 4 complications documented within 30 days of the operation, with an overall complication rate of 6.45%. There were 2 complications in each of the cohorts, including intra‐abdominal abscess (2), abdominal wall abscess (1), and pouchitis (1).Conclusion:The number of complications was the same between those who did and did not receive a preoperative biologic agent. This study suggests that biologics may be safe to use in patients undergoing bowel resection.
Maternal Prenatal Thyroid Function and Offspring ADHD: Findings From the ALSPAC Cohort
Authors: Fetene Dagnachew Muluye , Betts Kim S. , Alati Rosa 
Published: September 2018

Abstract
Thyroid hormone plays a pivotal role in the developing brain and may affect the development of attention deficit hyperactivity disorder (ADHD). This study aimed to examine the role of maternal thyroid function during pregnancy on offspring ADHD. A total of 2912 mother-child pairs were included from the Avon Longitudinal Study of Parents and Children. Thyroid parameters were assessed during the first trimester of pregnancy. Offspring ADHD was assessed using the Development and Well-Being Assessment at the ages of 7.5 and 15 years. The odds of presenting with ADHD were estimated using generalized estimating equations. Levels of thyroid-stimulating hormone (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.48–1.75), free thyroxine (OR, 1.07; 95% CI, 0.87–1.32), and thyroid peroxidase antibodies (OR, 1.00; 95% CI, 0.80–1.25) were not associated with ADHD in children aged 7.5 and 15 years. This study showed no association between maternal thyroid function and offspring ADHD.
Exploring NCLEX Failures and Standardized Assessments
Authors: Emory Jan 
Published: September 2018

Background
Nurse educators seek valid and reliable tools to assist in early identification and intervention for students at-risk of NCLEX-RN failure.

Purpose
The purpose of this cross-sectional study was to use principal component analysis to explore relationships within standardized assessment (SA) scores from a sample of students who failed the NCLEX-RN on the first attempt.

Methods
Standardized assessment scores were collected from prelicensure programs between 2009 and 2016 (n = 296). Mixed modeling sought to reveal SA scores that represented redundancy or duplication.

Results
The principal component analysis found 2 distinct components emerging from the 8 SAs included in the study, signifying duplication in the content assessed. Within these 2 components, maternal newborn and pharmacology had the strongest correlations among the SA scores.

Conclusions
Discovering those SAs that assess similar content and have the strongest correlations can provide additional information for decision making when implementing these tests throughout the nursing curriculum.
Risk Factor Reversal in Studies of Infectious Disease: Making Counterintuitive Results Intuitive Again
Authors: Kaufman Jay S. , Banack Hailey R. , Adams Joëlla W. , Marshall Brandon D. L. , Stovitz Steven D. 
Published: September 2018

Abstract
A previously published study reported the seemingly paradoxical finding that men who have sex with men status was strongly protective and recent sexual abstinence strongly deleterious in relation to mortality prognosis. We explain why these results are entirely logical and that the counterintuitive direction of the effects derives from the comparison group implied by the study design.