bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Exercise Training and Physical Activity Adherence in People Recently Hospitalized With Heart Failure
Authors: Adsett Julie A. , Morris Norman R. , Mudge Alison M. 
Published: March 2019

Purpose:
For individuals with heart failure (HF), frequent attendance at exercise training programs and meeting physical activity (PA) guidelines are significantly associated with improvements in 6-min walk distance. Despite the evidence, adherence to exercise interventions remains poor. The aim of this study was to identify predictors of these 2 variables in patients recently hospitalized with HF.

Methods:
In this substudy of the Exercise Joins Education: Combined Therapy to Improve Outcomes in Newly-discharged Heart Failure (EJECTION-HF) trial, all participants were enrolled in a HF disease management program, including weekly review of a home exercise program for 12 wk. Intervention group participants additionally undertook twice weekly supervised exercise training. Primary outcomes were frequent exercise training program attendance (≥12 sessions) and attainment of PA guidelines (150 min/wk of moderate intensity exercise) at 12 wk. Participant and clinical characteristics were analyzed using a logistic regression model to identify significant predictors of each outcome.

Results:
A total of 278 participants provided PA data and 140 contributed attendance data. New diagnosis of HF was a significant predictor of frequent program attendance (OR = 2.3; 95% CI, 1.1-4.7; P = .03). Predictors of meeting PA guidelines at follow-up included new HF diagnosis (OR = 2.4; 95% CI, 1.2-4.8, P = .013), and being physically active at baseline (OR = 2.7; 95% CI, 1.3-5.6; P = .007). Gender, symptom severity, multimorbidity, and disability were not significantly associated with either outcome in multivariate analysis.

Conclusion:
To improve adherence, specific strategies may be required for patients with decompensated HF and those physically inactive at time of referral.
Thorax CT Dose Reduction Based on Patient Features: Effect of Patient Characteristics on Image Quality and Effective Dose
Authors: Koc Gizem Gul , Koc Zafer , Kaniyev Tahir , Kokangul Ali 
Published: March 2019

Abstract
Computed tomography (CT) radiation dose reduction is vital without compromising image quality. The aim was to determine the effects of patient characteristics on the received radiation dose and image quality in chest CT examinations and to be able to predict dose and image quality prior to scanning. Consecutive 230 patients underwent routine chest CT examinations were included. CT examination and patients input parameters were recorded for each patient. The effect of patients’ demographics/anthropometrics on received dose and image quality was investigated by linear regression analysis. All parameters were evaluated using an artificial neural network (ANN). Of all parameters, patient demographics/anthropometrics were found to be 98% effective in calculating dose reduction. Using ANN on 60 new patients was more than 90% accurate for output parameters and 91% for image quality. Patient characteristics have a significant impact on radiation dose and image quality. Dose and image quality can be determined before CT. This will allow setting the most appropriate scanning parameters before the CT scan.
The Cost and Economics of Endoscopic Cyclophotocoagulation in the United Kingdom: A Tertiary Center Experience
Authors: Ho Henrietta , Ho Jason , Rodrigues Ian , Syrimi Marina , Goyal Saurabh , Lim Kin Sheng 
Published: March 2019

Precis:
As the only microinvasive glaucoma surgery (MIGS) with a reusable component, the cost per procedure of endoscopic cyclophotocoagulation (ECP) diminishes with each successive use. We present a cost comparison of ECP with other MIGS devices, based on our clinical practice.

Purpose:
ECP delivers diode laser via a reusable probe to the ciliary processes under direct visualization. The aim of our study is to evaluate the direct cost of ECP based on a retrospective review of cases and compare the cost per procedure with other MIGS devices.

Methods:
We conducted a retrospective review of ECP procedures performed at St Thomas’ Hospital over 4.5 years. The cost of the ECP endoscope and diode laser consoles, reusable probes, and maintenance contracts were obtained from the hospital procurement log. The on-site Central Sterile Services Department was contacted for probe sterilization and repackaging costs. The cost per device for ECP and commonly performed MIGS procedures were obtained from the product specialists of each company.

Results:
A total of 332 procedures were performed using 37 ECP probes during the study period. Each reusable ECP laser probe was found to give an average of 8.97 laser treatments. The cost per procedure decreased over the course of 4.5 years from £819.43 for the first 42 cases to £341.50 after 332 cases. Compared with other MIGS devices, the cost per procedure of ECP after 100 procedures is second lowest to the Kahook Dual Blade and reduces with each successive procedure performed.

Conclusion:
The ability to reuse each ECP probe significantly lowers the cost per procedure compared with other MIGS devices in the United Kingdom. The cost per procedure continues to reduce with each successive procedure.
Modification of the Neuropathic Pain Symptom Inventory for use in eye pain (NPSI-Eye)
Authors: Farhangi Monika , Feuer William , Galor Anat , Bouhassira Didier , Levitt Roy C. , Sarantopoulos Constantine D. , Felix Elizabeth R. 
Published: March 2019

Abstract
Chronic eye pain, which has previously been assumed to be due to ocular surface abnormalities (ie, “dry eye [DE] disease”), has recently garnered attention as a potential indicator of neuropathic ocular pain in some patients. The purpose of this study was to evaluate the psychometric properties of a modified version of the Neuropathic Pain Symptom Inventory in individuals with eye pain (NPSI-Eye). Enrolled participants (n = 397) completed the NPSI-Eye, general pain severity questionnaires, DE symptom report, and psychological health indices. Participants also underwent mechanical pain sensitivity testing of the cornea, tear film assessment, and evaluation of the efficacy of anesthetic eye drops to relieve pain. Short-term test–retest reliability of the NPSI-Eye was excellent (intraclass correlation coefficient = 0.98, P < 0.001). Correlations between the NPSI-Eye and indicators of general eye pain were ≥0.65 (P < 0.001), whereas correlations between the NPSI-Eye and DE symptom severity and psychological health indices were lower (rho = 0.56, 0.32, 0.37; all P < 0.001). Individuals who reported little or no decrease in pain after anesthetic eye drops (hypothesized to indicate eye pain with at least partial central involvement) had significantly higher NPSI-Eye scores than participants whose eye pain was completely relieved by anesthetic (P < 0.05). Overall, our results support preliminary validation of the NPSI-Eye, yielding similar metrics to those reported in Bouhassira et al.'s original NPSI publication (2004). However, additional evaluation and refinement of some questions may be desirable, including the potential elimination of items that were not highly endorsed.
Cognitive Reserve Over the Lifespan: Neurocognitive Implications for Aging With HIV
Authors: Vance David E. , Lee Loretta , Muñoz-Moreno Jose A. , Morrison Shannon , Overton Turner , Willig Amanda , Fazeli Pariya L. 
Published: March 2019

Abstract
Approximately 59% of adults living with HIV experience HIV-associated neurocognitive disorder, a collection of symptoms and cognitive deficits in various cognitive domains. As the HIV population ages, the prevalence and severity of such cognitive deficits are expected to grow. Understanding how these cognitive deficits manifest is important for nurses and health care providers. This article provides an overview of cognitive reserve and evidence of how it is compromised by HIV, aging, and individual characteristics. Within this context of cognitive reserve, the role of neuroinflammation, neurotoxicity, substance use, comorbidities, depression and anxiety, social isolation, and sedentary lifestyle is reviewed. From this, strategies used to address cognitive deficits are provided, including topics such as psychostimulants, cognitive training, multimodal lifestyle interventions, and compensation strategies. Scenarios of successful and unsuccessful cognitive aging are presented to provide a lifespan perspective of cognitive reserve. Implications for clinical practice and research are provided, as it relates to aging.
Rethinking the cost of care: Nurse practitioners as stewards of clinical and patient resources
Authors: Mehra Mukul 
Published: March 2019

ABSTRACT
Clinicians are the building blocks of value-based care, yet the cumulative human and financial cost of daily care decisions are mostly hidden from them. As essential primary care providers, nurse practitioners play a role in driving efficiency and resourcefulness in care. The growth and expanded capabilities of the specialty give nurse practitioners a powerful voice in setting standards for clinical stewardship. Yet to be successful in this effort, nurse practitioners must have a better understanding of cost containment and cost reduction to make better decisions. This means synthesizing cost and risk data, efficacy, and patient advocacy to propagate value-based decision making and standardized quality care across our organizations. Clinicians need to understand that caring about patients means being good stewards while caring for patients.
Metastatic pheochromocytoma and paraganglioma: recent advances in prognosis and management
Authors: Hamidi Oksana 
Published: March 2019

Purpose of review
Metastatic pheochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumors with variable prognosis. This review highlights recent studies on outcomes and management of patients with metastatic PPGL.

Recent findings
Latest advances were made in identifying predictors of favorable outcomes of patients with metastatic PPGL. Recent studies evaluated the efficacy of tyrosine kinase inhibitors, high-specific-activity radiopharmaceuticals, and peptide receptors radionuclide therapy in treatment of metastatic disease. Moreover, ongoing studies are assessing the effects of hypoxia-inducible factor 2αα and heat shock protein 90 inhibitors as potential therapies.

Summary
Several active studies are evaluating the efficacy of systemic chemo, immuno, radiopharmaceutical, and peptide receptor radionuclide therapies to relieve local and adrenergic symptoms and provide survival benefit for patients with symptomatic and/or progressive advanced metastatic PPGL. Owing to rarity and wide-outcome variability, multidisciplinary team effort and personalized approach are central in caring for patients with metastatic PPGL.
The role of plasma exchange in hypertriglyceridemia-induced acute pancreatitis
Authors: Biberci Keskin Elmas , Koçhan Koray , Köker İbrahim H. , Gülen Bedia , İnce Ali T. , Şentürk Hakan 
Published: March 2019

Background
Hypertriglyceridemia (HTG)-induced acute pancreatitis (AP) leads to higher morbidity and mortality compared with other etiologies. The role of plasma exchange (PE) in this context is still not well established. We aimed to assess the clinical outcomes of patients with HTG-induced AP who underwent PE and compare it with those who did not.

Patients and methods
We retrospectively evaluated the data of patients who were admitted with HTG-induced AP between January 2013 and May 2018. The endpoint of the study was to assess the clinical outcomes, which included complication rates, mortality, and pancreatitis recurrence rate.

Results
Overall, 41 patients were included in the final analysis. Of these, 12 (29.2%) underwent PE. Patients undergoing PE had more severe pancreatitis on the basis of the Japanese Severity Score [10 (83.3%) vs. 14 (48.3%), P=0.03, respectively). Although mortality was higher in patients who underwent PE [three (25.0%) vs. zero, P<0.01, respectively], there was no difference in terms of complications and recurrence rates. Over a median 21 months of follow-up, 11 (26.8%) patients had recurrent AP.

Conclusion
Although PE effectively reduced plasma triglyceride levels, there was no decrease in mortality or recurrences.
Perioperative prophylaxis with single-dose cefazolin for liver transplantation: a retrospective study
Authors: Statlender Liran , Yahav Dafna , Ben-Zvi Haim , Margalit Ili , Ferder Ayelet , Goldberg Elad , Mor Eytan , Bishara Jihad , Cohen Jonathan 
Published: March 2019

Background
Early infections are common during the first month after liver transplantation (LT), whereas no consensus exists on the optimal prophylactic antimicrobial therapy. We aimed to evaluate the effectiveness of cefazolin perioperative prophylaxis in LT.

Patients and methods
We documented our experience with single-dose cefazolin as prophylaxis for LT. Infections occurring within 30 days following LT during 2006–2015 were documented retrospectively. Univariate and multivariate analyses of risk factors for infection were carried out.

Results
Among 113 LT recipients receiving cefazolin as prophylaxis, infections occurred in 50 (44%) patients, including surgical site infections (n=24, 21%) and bacteremia (n=14, 12%). Bacteria resistant to cefazolin were documented in 59/72 (82%) isolates. Enterococcal infections were documented in 6% (7/113). Almost half of the infections (44%) occurred in the first week following LT and the vast majority within 2 weeks. The 30-day mortality rate (7%, 8/113) was significantly higher among infected patients (7/50, 14% vs. 1/63, 1.6%, P=0.011). Model for End-stage Liver Disease score, age, and requirement for at least 5 U of packed red cells during transplantation were predictive for postoperative infections.

Conclusion
In our center, cefazolin was insufficient as perioperative prophylaxis in LT. We suggest that all LT recipients should receive antibiotic prophylaxis targeting microorganisms on the basis of local bacterial ecology and patterns of resistance irrespective of preoperative or intraoperative risk assessment.
Procedural Outcomes of Patients With Heart Failure Undergoing Catheter Ablation of Atrial Fibrillation
Authors: Jayanna Manju Bengaluru , Mohsen Ala , Inampudi Chakradhari , Alvarez Paulino , Giudici Michael C. , Briasoulis Alexandros 
Published: March 2019

Background:
Catheter ablation is being increasingly performed for rhythm control of atrial fibrillation (AF). Heart failure (HF) frequently coexists with AF because they share common risk factors.

Study Question:
This study aims at identifying the characteristics and procedural outcomes of patients with HF undergoing catheter ablation of AF.

Study Design:
In this retrospective cohort study, we analyzed 264 consecutive patients who underwent catheter ablation for AF. Seventy-three patients (28%) had a known history of stage C HF either with reduced ejection fraction or preserved ejection fraction.

Measures and Outcomes:
We compared procedural outcomes between patients who had known HF with those who did not.

Results:
Patients with HF were more likely to have higher rates of atrial fibrillation recurrence at both 3 months (odds ratio 2.9, confidence interval = 1.5–5.7, P = 0.0022) and 1 year after the procedure (odds ratio 2.3, confidence interval 1.2–4.3, P = 0.0097) and risk factors for recurrence of AF including left atrial enlargement, persistent AF, and a higher CHA2DS2-VASc score. However, on logistic regression analysis adjusting for left atrial size, atrial fibrillation type (persistent vs. paroxysmal), and CHA2DS2-VASc score as covariates, there was no significant difference in AF recurrence rates at both 3 months and 1 year. Recurrence rates did not differ significantly between patients with HF either with reduced ejection fraction or preserved ejection fraction. Among patients with paroxysmal AF, HF was predictive of AF recurrence at both 3 months and 1 year after ablation. The procedure length was longer in patients with HF, but there were no differences in periprocedural complications.

Conclusion:
Patients with HF undergoing catheter ablation of AF tend to have more risk factors for recurrence, but after adjustment for risk factors, the recurrence rates were similar at 3 months and 1 year. Among patients with paroxysmal atrial fibrillation, HF was predictive of higher recurrence rates.
Management of benign vocal fold lesions: current perspectives on the role for voice therapy
Authors: White Anna 
Published: March 2019

Purpose of review
Benign vocal fold lesions (BVFLs) cause dysphonia by preventing full vocal fold closure, interrupting vibratory characteristics and increasing compensatory muscle tension. Management includes phonosurgery, voice therapy, pharmacological treatment or more commonly a combination of these interventions. This review aims to present current perspectives on the management of BVFLs, particularly exploring the role of voice therapy.

Recent findings
The review highlights variation in the management of BVFLs. There is evidence that phonosurgery is a well tolerated and effective intervention for BVFLs. Primary voice therapy can frequently prevent surgery in vocal fold nodules and some types of polyps. Used as an adjunct to phonosurgery, preoperative and postoperative voice therapy can improve patient-reported outcomes and acoustic parameters of the voice. However, heterogeneity of studies and poor descriptions of intervention components prevent a robust analysis of the impact of voice therapy.

Summary
The current evidence consists of low-level studies using mixed aetiology groups, which compromises internal and external validity. There are a few exceptions to this. Poor reporting and heterogeneous methodologies lead to difficulties determining the components of a voice therapy intervention for this population. Consequently, we are unable to evaluate, which intervention elements are beneficial to patients.
Should Proton Pump Inhibitors be Systematically Prescribed in Patients With Esophageal Atresia After Surgical Repair?
Authors: Righini Grunder Franziska , Petit Laetitia‐Marie , Ezri Jessica , Jantchou Prevost , Aspirot Ann , Laberge Sophie , Faure Christophe 
Published: March 2019

ABSTRACTObjective:To evaluate outcomes of patients with esophageal atresia (EA) on systematic treatment with proton pump inhibitors (PPI) since the neonatal period and to determine factors associated with successful discontinuation of PPI.Study design:Longitudinal cohort study with prospective data collection of 73 EA patients, over 11 years systematically treated with PPI. Outcome and predictive factors for discontinuation of PPI treatment were evaluated at study end in February 2017. The incidence of anastomotic strictures was compared with a historical cohort of 134 EA patients followed in the same institution between 1990 and 2005 before the era of systematic PPI treatment.Results:PPI treatment was discontinued definitively in 48% of patients during follow‐up. Prematurity, longer initial hospitalization, moderate‐to‐severe tracheomalacia, anastomotic leak and anastomotic stricture had a significant negative association with PPI discontinuation on univariate analysis (P < 0.05). On adjusted multivariable Cox regression analysis, moderate‐to‐severe tracheomalacia and anastomotic leak were negatively associated with discontinuation of PPI treatment (hazard ratio 0.26 [95% CI 0.12–0.59]; P = 0.001 and hazard ratio 0.38 [95% CI 0.16–0.93]; P = 0.03, respectively). There was no significant difference in the incidence of anastomotic strictures in the present cohort compared with the historical cohort (44% vs 39%); (P > 0.05).Conclusions:PPI treatment does not prevent the formation of anastomotic strictures and appears to be over‐prescribed in children with airway symptoms because of tracheomalacia. This suggests that PPI treatment could be prescribed more selectively. Close monitoring and long‐term follow‐up, however, of these vulnerable patients in specialized multidisciplinary clinics is imperative.
Impact of Integrase Inhibition Compared With Nonnucleoside Inhibition on HIV Reservoirs in Lymphoid Tissues
Authors: Rothenberger Meghan , Nganou-Makamdop Krystelle , Kityo Cissy , Ssali Francis , Chipman Jeffrey G. , Beilman Gregory J. , Hoskuldsson Torfi , Anderson Jodi , Jasurda Jake , Schmidt Thomas E. , Calisto Samuel P. , Pearson Hope , Reimann Thomas , David Caitlin , Perkey Katherine , Southern Peter , Wietgrefe Steve , Helgeson Erika , Reilly Cavan , Haase Ashley T. , Douek Daniel C , Fletcher Courtney V. , Schacker Timothy W. 
Published: March 2019

Background:
HIV is produced in lymphoid tissues (LT) and stored on the follicular dendritic cell network in LT. When antiretroviral therapy is started, plasma viremia decays in 2 phases; the first within days of starting therapy and the second over weeks. Raltegravir (RAL), an integrase inhibitor, has been associated with only a single rapid phase of decay, and we speculated this may be due to higher intracellular concentration (IC) of RAL in LT. We have previously measured suboptimal ICs of antiretroviral therapy agents in LT, which were associated with slower decay of both vRNA+ cells and the follicular dendritic cell network pool.

Setting:
Outpatient clinic at the Joint Clinical Research Center in Kampala, Uganda.

Methods:
We compared the rate of decay in LT in people starting RAL with those starting efavirenz (EFV).

Results:
There was no difference in the rate of virus decay in LT. The ratio of the ICs of RAL and EFV in lymph node to the concentration of drug that inhibits 95% of virus in blood was 1 log lower in lymph node for EFV and >3 logs lower for RAL.

Conclusion:
These data further highlight the challenges of drug delivery to LT in HIV infection and demonstrate that RAL is not superior to EFV as judged by direct measurements of the source of virus in LT.
Evaluation of Neural Tube Defects (NTDs) After Exposure to Raltegravir During Pregnancy
Authors: Shamsuddin Hala , Raudenbush Casey L. , Sciba Brittany L. , Zhou Yun-Ping , Mast T. Christopher , Greaves Wayne L. , Hanna George J. , Leong Ronald , Straus Walter 
Published: March 2019

Objective:
To evaluate the risk of neural tube defects (NTDs) after exposure to raltegravir during pregnancy.

Methods:
Exposures to raltegravir during pregnancy reported cumulatively through May 31, 2018, to the company safety database were reviewed to identify cases of NTDs. This database includes all reports of pregnancy from Merck-sponsored clinical trials, spontaneous postmarketing reports, and non-interventional data sources, including the Antiretroviral Pregnancy Registry (APR). Reports were classified as prospective (before knowledge of pregnancy outcome) or retrospective (after knowledge of pregnancy outcome). We also reviewed data from 2 ongoing pregnancy cohorts.

Results:
A total of 2426 pregnancies with reported outcomes were identified among women exposed to raltegravir: 1238 from the Merck database and 1188 from United Kingdom/Ireland and French pregnancy cohorts. Among all 2426 reports, 1991 were prospective. No cases of NTDs were identified among the prospective pregnancy reports, of which 767 were first trimester, including 456 in the periconception period (at or within 28 days after conception). Among the 435 retrospective reports, 3 NTD cases per APR criteria were identified (anencephaly, and 2 meningomyelocele), of which only one (meningomyelocele) was among exposures in the periconception period. Given the inherent limitations and bias of retrospective reports, it is not appropriate to calculate an incidence rate.

Conclusions:
Prospectively collected pregnancy outcome data do not suggest an association between raltegravir exposure in the periconception period and NTDs. The current data support the updated DHHS and EACS treatment guidelines for use of raltegravir as a preferred integrase inhibitor in all stages of pregnancy.