bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Risk of Noncardiac Surgery After Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents
Authors: Smith Bradford B. , Warner Matthew A. , Warner Nafisseh S. , Hanson Andrew C. , Smith Mark M. , Rihal Charanjit S. , Gulati Rajiv , Bell Malcolm R. , Nuttall Gregory A. 
Published: August 2018

BACKGROUND:
Noncardiac surgery (NCS) following percutaneous coronary intervention (PCI) with stenting is sometimes associated with major adverse cardiac events (MACEs). Second-generation drug-eluting stents (DES) were developed to decrease the incidence of MACE seen with bare metal and first-generation DES.

METHODS:
The medical records of all adult patients who underwent second-generation DES placement between July 29, 2008 and July 28, 2011 followed by NCS between September 22, 2008 and July 1, 2013 were reviewed. All episodes of MACE following surgery were recorded.

RESULTS:
A total of 282 patients (74.8% male) were identified who underwent NCS after PCI with second-generation DES. MACE occurred in 15 patients (5.3%), including 11 deaths. The incidence of MACE changed significantly with time from PCI to NCS: 17.1%, 10.0%, 0.0%, and 3.1% for patients undergoing NCS at 0–90, 91–180, 181–365, and ≥366 days, respectively. Compared with those having NCS ≥366 days after PCI, the odds ratio for MACE (95% confidence interval) was 6.4 (1.9 to 21.3) at 0–90 days and 3.4 (0.8 to 15.3) at 91–180 days. Seven days prior to NCS, 146 (52%) patients were on dual antiplatelet therapy (DAPT), 106 (38%) were on aspirin, and 30 (11%) did not receive antiplatelet therapy. Excessive surgical bleeding occurred in 19 cases (6.7%). While observed bleeding rates were lowest in those not receiving antiplatelet therapy, there were no statistically significant differences based on the presence or absence of antiplatelet therapy (3% [1/30] for no antiplatelet therapy compared to 6% [6/106] for aspirin monotherapy and 8% [12/146] for DAPT; Fisher exact test: P = .655).

CONCLUSIONS:
The incidence of MACE in patients with second-generation DES undergoing NCS was 5.3% and was highest in the first 180 days following DES implantation. The rate of excessive surgical bleeding was 6.7% with the highest observed rate in those on DAPT. However, differences by the presence or absence of antiplatelet therapy were not significant, and future large observational studies will be necessary to further define bleeding risk with continued DAPT.
Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case–Control Study
Authors: Bauer Melissa E. , Housey Michelle , Bauer Samuel T. , Behrmann Sydney , Chau Anthony , Clancy Caitlin , Clark Erin A. S. , Einav Sharon , Langen Elizabeth , Leffert Lisa , Lin Stephanie , Madapu Manokanth , Maile Michael D. , McQuaid-Hanson Emily , Priessnitz Kristina , Sela Hen Y. , Shah Anuj , Sobolewski Paul , Toledo Paloma , Tsen Lawrence C. , Bateman Brian T. 
Published: August 2018

BACKGROUND:
Given the significant morbidity and mortality of maternal sepsis, early identification is key to improve outcomes. This study aims to evaluate the performance characteristics of the systemic inflammatory response syndrome (SIRS), quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA), and maternal early warning (MEW) criteria for identifying cases of impending sepsis in parturients. The secondary objective of this study is to identify etiologies and risk factors for maternal sepsis and to assess timing of antibiotics in patients diagnosed with sepsis.

METHODS:
Validated maternal sepsis cases during the delivery hospitalization from 1995 to 2012 were retrospectively identified at 7 academic medical centers in the United States and Israel. Control patients were matched by date of delivery in a 1:4 ratio. The sensitivity and specificity of SIRS, qSOFA, and MEW criteria for identifying sepsis were calculated. Data including potential risk factors, vital signs, laboratory values, and clinical management were collected for cases and controls.

RESULTS:
Eighty-two sepsis cases during the delivery hospitalization were identified and matched to 328 controls. The most common causes of sepsis were the following: chorioamnionitis 20 (24.4%), endometritis 19 (23.2%), and pneumonia 9 (11.0%). Escherichia coli 12 (14.6%), other Gram-negative rods 8 (9.8%), and group A Streptococcus 6 (7.3%) were the most commonly found pathogens. The sensitivities and specificities for meeting criteria for screening tools were as follows: (1) SIRS (0.93, 0.63); (2) qSOFA (0.50, 0.95); and (3) MEW criteria for identifying sepsis (0.82, 0.87). Of 82 women with sepsis, 10 (12.2%) died. The mortality rate for those who received antibiotics within 1 hour of diagnosis was 8.3%. The mortality rate was 20% for the patients who received antibiotics after >1 hour.

CONCLUSIONS:
Chorioamnionitis and endometritis were the most common causes of sepsis, together accounting for about half of cases. Notable differences were observed in the sensitivity and specificity of sepsis screening tools with the highest to lowest sensitivity being SIRS, MEW, and qSOFA criteria, and the highest to lowest specificity being qSOFA, MEW, and SIRS. Mortality was doubled in the cohort of patients who received antibiotics after >1 hour. Clinicians need to be vigilant to identify cases of peripartum sepsis early in its course and prioritize timely antibiotic therapy.
epiflows: an R package for risk assessment of travel-related spread of disease
Authors: Moraga Paula , Dorigatti Ilaria , Kamvar Zhian N. , Piatkowski Pawel , Toikkanen Salla E. , Nagraj VP , Donnelly Christl A. , Jombart Thibaut 
Published: August 2018

As international travel increases worldwide, new surveillance tools are needed to help identify locations where diseases are most likely to be spread and prevention measures need to be implemented. In this paper we present epiflows, an R package for risk assessment of travel-related spread of disease. epiflows produces estimates of the expected number of symptomatic and/or asymptomatic infections that could be introduced to other locations from the source of infection. Estimates (average and confidence intervals) of the number of infections introduced elsewhere are obtained by integrating data on the cumulative number of cases reported, population movement, length of stay and information on the distributions of the incubation and infectious periods of the disease. The package also provides tools for geocoding and visualization. We illustrate the use of epiflows by assessing the risk of travel-related spread of yellow fever cases in Southeast Brazil in December 2016 to May 2017.
Case Report: Post obstructive pulmonary edema (POPE) Type II following elective adenotonsillectomy requiring novel use of high frequency oscillatory ventilation (HFOV)
Authors: Moser Joanna J. , O'Connell Meghan , McAllister Debbie L. 
Published: August 2018

This case report describes a previously healthy 14 year-old patient undergoing elective outpatient adenotonsillectomy that was complicated by acute postoperative pulmonary edema requiring 12 hours of high frequency oscillatory ventilation (HFOV) support. We describe the clinical findings that led us to this rare diagnosis and management of post obstructive pulmonary edema (POPE) Type II, a rare but recognized complication following the surgical relief of an upper airway obstruction. This case is unique in that no previously published case report or review of POPE Type II has described the need for HFOV support.
Leveraging existing program data for routine efficiency measurement in Zambia
Authors: Homan Rick , Bratt John , Marchand Gregory , Kansembe Henry 
Published: August 2018

Background: As donor contributions for HIV/AIDS stagnate globally, national governments must seek ways to improve use of existing resources through interventions to drive efficiency at the facility level. But program managers lack routinely available information on unit expenditures at points of care, and higher-level planners are unable to assess how resources are used throughout the health system. Thus, managers cannot measure current levels of technical efficiency, and are unable to evaluate effectiveness of interventions to increase technical efficiency. Methods: FHI 360 developed the Routine Efficiency Monitoring System (REMS), a relational database that leverages existing budget, expenditure and output data to produce quarterly site-level estimates of unit expenditure per service. Along with the Government of the Republic of Zambia (GRZ) and implementation partner Avencion, we configured REMS to measure technical efficiency of Ministry of Health resources used to deliver HIV/AIDS services in 326 facilities in 17 high-priority districts in Copperbelt and Central Provinces. REMS allocation algorithms were developed through facility assessments and key informant interviews with MoH staff. Existing IFMIS and DHIS-2 data streams provide recurring flows of expenditure and output data needed to estimate service-specific unit expenditures. Trained users access REMS output through user-friendly dashboards delivered through a web-based application. Results: District health management teams are using REMS to identify “outlier” facilities to test performance improvement interventions. Provincial and national planners are using REMS to seek savings and ensure that resources are directed to geographic and programmatic areas with highest need. REMS can support reimbursement for social health insurance and provide time-series data on facility-level costs for modeling purposes. Conclusions: REMS gives managers and planners substantially-improved data on how programs transform resources into services. The GRZ is seeking funding to expand REMS nationally, covering all major disease areas. Improved technical efficiency supports the goal of a sustainable HIV/AIDS response.
Cost per insertion and couple year of protection for post-partum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda
Authors: Wall Kristin M. , Ingabire Rosine , Allen Susan , Karita Etienne 
Published: August 2018

Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented post-partum intrauterine device (PPIUD) and post-partum (PP) implant promotions and service delivery procedures between May and July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. Methods: Here, we detail the expenditures during the implementation from the payer perspective (including both the implementation costs and the cost of contraceptive methods) and estimate the cost per PPIUD insertion, PP implant insertion, and couple years of protection (CYP) for PPIUD and PP implant users. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: The PPIUD/PP implant service implementation provided services at a low cost per insertion and CYP. Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
Using nominal group technique to inform the development of a self-management app for patients with relapsed myeloma
Authors: Cormican Orlaith , Dowling Maura 
Published: August 2018

Background: The nominal group technique (NGT) allows stakeholders to directly generate items for needs assessment. The objective was to demonstrate the use of NGT to inform the development of a healthcare app in patients with relapsed myeloma. Healthcare professionals with experience in the care of patients with relapsed/refractory myeloma were invited to participate. Methods: One NGT group was conducted. In the group, health care professionals working in haematology were asked to vote anonymously in order of highest priority, on symptoms previously highlighted by relapsed/refractory myeloma patients in four focus groups. Results: A total of 18 healthcare professionals working in the area of haematology participated in the NGT discussion; consultants (n=6), haematology registrars (n=2), specialist nurses [Advanced Nurse Practitioner/Clinical Nurse Specialist] (haematology) (n=3), staff nurse (n=1), and “other” health care professionals (n=6). Participants ranged in experience of working with myeloma patients from 2 years to over 27 years. The symptoms voted in highest priority were: Pain, Fatigue, Peripheral Neuropathy, Infection Risk and Steroid Induced Side Effects. Conclusions: The NGT was an efficient method for obtaining information to inform a healthcare app.
Respostas eletroantenográficas e comportamentais de abelhas africanizadas, Apis mellifera (Linnaeus), ao feromônio de Nasanov e ao óleo essencial de capim-limão
Authors: Pires Patricia Daniela da Silva , Sant'Ana Josué , Bisotto-de-Oliveira Ricardo 
Published: August 2018

Resumo. O objetivo do estudo foi avaliar as respostas eletrofisiológicas e comportamentais de abelhas africanizadas, Apis mellifera (Linnaeus), em duas idades, ao feromônio de Nasanov sintético (FNS) e ao óleo essencial de capim-limão (OCL), e verificar a porcentagem de ocupação de enxames em caixas de papelão com iscas de FNS comercial (Swarm Catch Lure®) ou OCL formulado em emulsão de parafina. Foram observadas as respostas eletroantenográficas (mV) e comportamentais de abelhas operárias nutrizes e campeiras (1-5 e 20-30 dias de idade, respectivamente) aos referidos compostos, em olfatômetro de dupla escolha. Os bioensaios de campo foram conduzidos em Eldorado do Sul e Minas do Leão (Brasil, RS), utilizando-se doze caixas com dois caixilhos contendo uma tira de cera alveolada cada e iscadas com OCL ou FNS ou sem tais tratamentos (controle). Não foram observadas diferenças nas respostas eletrofisiológicas e comportamentais entre operárias jovens e velhas submetidas aos voláteis de FNS e OCL. O limiar de resposta para o feromônio foi de 0,1 mg/mL e para o óleo, 10 mg/mL. O feromônio de Nasanov e o óleo de capim-limão desencadearam resposta quimiotáxica positiva nas abelhas. Caixas com FNS atraíram mais enxames que as com OCL e controle.Electroanthenographic and behavioral responses of Africanized bees, Apis mellifera (Linnaeus), to nasanov pheromone and lemongrass essential oilAbstract. The study aimed to evaluate and compare the electrophysiological and behavioral responses of africanized honey bees (workers), Apis mellifera (Linnaeus) at different ages, to synthetic Nasanov pheromone (SNP) and to lemongrass essential oil (LGO), as well as, to verify occupancy percentage of swarms in baited cardboard boxes with SNP commercial (Swarm Catch Lure®) or LGO formulated in paraffin emulsion. Tests were conducted to observe electroantennographic responses (mV) and chemotactic behavior of nurse and forage workers bees (1-5 and 20-30 days old, respectively), to those compounds, in two choice olfactometer. The field bioassay was conducted by using twelve cardboard boxes with two bee wax sheet foundation placed in each frame, baited with SNP or LGO or without these treatments (control), in Eldorado do Sul and Minas do Leão (Brazil, RS). The mean number of swarms found in all treatments, were checked weekly. It was not observed electrophysiological and behavioral difference responses between young and old workers subjected to SNP and LGO odors. The threshold to Nasanov synthetic pheromone was 0.1 µg/µL and to lemongrass essential oil, 10 µg/µL. Synthetic Nasanov pheromone and lemon grass oil triggered positive chemotaxis in bees. Cardboard boxes with commercial SNP were more attractive to swarms than those baited with LGO and control treatment.
Beyond Reporting Early Warning Score Sensitivity: The Temporal Relationship and Clinical Relevance of “True Positive” Alerts that Precede Critical Deterioration
Authors: Winter Meredith C , Kubis Sherri , Bonafide Christopher P 
Published: August 2018

BACKGROUNDClinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts.OBJECTIVES(1) Evaluate the timing of pRI alerts and clinicians recognizing deterioration or escalating care prior to critical deterioration events (CDEs) and (2) determine whether the parameters triggering alerts were clinically related to deterioration.DESIGNCDEs are unplanned transfers to the intensive care unit with noninvasive ventilation, tracheal intubation, and/or vasopressor infusion in the 12 hours after transfer. Using one year of data from a large freestanding children's hospital without the pRI, we analyzed CDEs that would have been preceded by pRI alerts. We (1) compared the timing of pRI alerts to time‐stamped notes describing changes in patient status and orders reflecting escalations of care and (2) identified score component(s) that caused alerts to trigger and determined whether these were clinically related to CDE etiology.RESULTSFifty CDEs would have triggered pRI alerts if the pRI had been in use (sensitivity 68%). In 90% of CDEs, the first clinician note reflecting change in patient status and/or the first order reflecting escalation of care preceded the first pRI alert. All of the vital sign and laboratory components of the pRI and 51% of the nursing components were clinically related to the etiology of the CDE.CONCLUSIONSEvidence that clinicians were aware of deterioration preceded pRI alerts in most CDEs that generated alerts in the preceding 24 hours.
Electronic Order Volume as a Meaningful Component in Estimating Patient Complexity and Resident Physician Workload
Authors: Van Groningen Nicole , Prasad Priya A. , Najafi Nader , Rajkomar Alvin , Khanna Raman R. , Fang Margaret C. 
Published: August 2018

BACKGROUNDThough patient census has been used to describe resident physician workload, this fails to account for variations in patient complexity. Changes in clinical orders captured through electronic health records may provide a complementary window into workload. We aimed to determine whether electronic order volume correlated with measures of patient complexity and whether higher order volume was associated with quality metrics.METHODSIn this retrospective study of admissions to the internal medicine teaching service of an academic medical center in a 13‐month period, we tested the relationship between electronic order volume and patient level of care and severity of illness category. We used multivariable logistic regression to examine the association between daily team orders and two discharge‐related quality metrics (receipt of a high‐quality patient after‐visit summary (AVS) and timely discharge summary), adjusted for team census, patient severity of illness, and patient demographics.RESULTSOur study included 5,032 inpatient admissions for whom 929,153 orders were entered. Mean daily order volume was significantly higher for patients in the intensive care unit than in step‐down units and general medical wards (40 vs. 24 vs. 19, P < .001). Order volume was also significantly correlated with severity of illness (P < .001). Patients were 12% less likely to receive a timely discharge summary for every 100 additional team orders placed on the day prior to discharge (OR 0.88; 95% CI 0.82‐0.95).CONCLUSIONSElectronic order volume is significantly associated with patient complexity and may provide valuable additional information in measuring resident physician workload.
The posterior-only surgical approach in the treatment of tuberculosis of the spine
Authors: Ukunda U. N. F. , Lukhele M. M. 
Published: August 2018

Aims The surgical treatment of tuberculosis (TB) of the spine consists of debridement and reconstruction of the anterior column. Loss of correction is the most significant challenge. Our aim was to report the outcome of single-stage posterior surgery using bone allografts in the management of this condition. Patients and Methods The study involved 24 patients with thoracolumbar TB who underwent single-stage posterior spinal surgery with a cortical bone allograft for anterior column reconstruction and posterior instrumentation between 2008 and 2015. A unilateral approach was used for 21 patients with active TB, and a bilateral approach with decompression and closing-opening wedge osteotomy was used for three patients with healed TB. Results A median of 1.25 vertebrae were removed (interquartile range (IQR) 1 to 1.75) and the median number of levels that were instrumented was five (IQR 3 to 6). The median operating time was 280 minutes (IQR 230 to 315) and the median blood loss was 700 ml (IQR 350 to 900). The median postoperative kyphosis was 8.5° (IQR 0° to 15°) with a mean correction of the kyphosis of 71.6%. Good neurological recovery occurred, with only two patients (8%) requiring assistance to walk at a mean follow-up of 24 months (9 to 50), at which time there was a mean improvement in disability, as assessed by the Oswestry Disability Index, of 83% (90% to 72%). Conclusion The posterior-only approach using cortical allografts for anterior column reconstruction achieved good clinical and radiological outcomes. Differentiation should be made between flexible (active) and rigid (healed) TB spine. Cite this article: Bone Joint J 2018;100-B:1208–13.
The effect of multimorbidity on changes in health-related quality of life following hip and knee arthroplasty
Authors: Zhang L. , Lix L. M. , Ayilara O. , Sawatzky R. , Bohm E. R. 
Published: August 2018

Aims The aim of this study was to assess the effect of multimorbidity on improvements in health-related quality of life (HRQoL) following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients and Methods Using data from a regional joint registry for 14 573 patients, HRQoL was measured prior and one year following surgery using the Oxford Hip Score (OHS) and Oxford Knee Score (OKS), and the 12-Item Short-Form Health Survey Physical and Mental Component Summary scores (PCS and MCS, respectively). Multimorbidity was defined as the concurrence of two or more self-reported chronic conditions. A linear mixed-effects model was used to test the effects of multimorbidity and the number of chronic conditions on improvements in HRQoL. Results Almost two-thirds of patients had multimorbidity, which adversely effected improvements in HRQoL. For THA, mean improvements in HRQoL scores were reduced by 2.21 points in OHS, 1.62 in PCS, and 4.14 in MCS; for TKA, the mean improvements were reduced by 1.71 points in OKS, 1.92 in PCS, and 3.55 in MCS (all p < 0.0001). An increase in the number of chronic conditions was associated with increasing reductions in HRQoL improvements. Conclusion Multimorbidity adversely effects improvements in HRQoL following THA and TKA. Our findings are relevant to healthcare providers focused on the management of patients with chronic conditions and for administrators reporting and monitoring the outcomes of THA and TKA. Cite this article: Bone Joint J 2018;100-B:1168–74.