bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Evaluation of the Reliability and Utility of Quality of Life Measures in Patients With Hepatocellular Carcinoma
Authors: Kim Gi-Ae , Kim Ha Il , Chang Seheon , An Jihyun , Lee Danbi , Lee Han Chu , Han Seungbong , Shim Ju Hyun 
Published: May 2019

Objectives:
Little is known about how quality of life (QOL) can assist clinical decision-making for patients with hepatocellular carcinoma (HCC). This study aimed to investigate the reliability and validity of QOL as well as its prognostic value and utility.

Materials and Methods:
A prospective cohort of 300 HCC patients at various stages was recruited from 2015 to 2017 in Korea. The subjects answered the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30) and QLQ-HCC18 and the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire. Prognostic nomograms including the QOL scales were developed. The prediction performance of the Barcelona Clinic Liver Cancer (BCLC) and the American Joint Committee on Cancer (AJCC) staging systems when they were incorporated with QOL was investigated.

Results:
The EORTC QLQ-C30 and QLQ-HCC18 subscales showed higher reliability than FACT-Hep subscales. With regard to the validity, both questionnaires discriminated the patients by stages, treatment modalities, and performance status effectively. Multivariable analysis revealed that EORTC role functioning and EORTC appetite loss subscales were statistically associated with overall survival and disease progression. The developed nomograms accurately estimated the 1-year overall survival and disease progression–free rates. Incorporating the EORTC role functioning subscale or Hepatobiliary Cancer Subscale of FACT-Hep with the BCLC and AJCC systems improved the prognostic classification. Incorporating QOL into the AJCC system showed better predictive accuracy than incorporating performance status into it did.

Conclusions:
The findings suggest that QOL data can serve as a reliable predictive factor and assist prognostic calculation for HCC patients.
Deficient Emotional Self-Regulation in Children with Attention Deficit Hyperactivity Disorder: Mindfulness as a Useful Treatment Modality
Authors: Huguet Anna , Izaguirre Eguren Jon , Miguel-Ruiz Dolores , Vall Vallés Xavier , Alda José A. 
Published: May 2019

ABSTRACT:

Objective:
The aim of this study was to investigate the efficacy of a structured mindfulness group intervention program targeting deficient emotional self-regulation (DESR) in a sample of children with attention deficit hyperactivity disorder (ADHD).

Method:
Seventy-two children aged 7 to 12 years with ADHD were randomized into 2 groups (mindfulness and control). The dysregulation profile was measured using the Child Behavior Checklist (CBCL) Attention/Anxiety-Depression/Aggression scales.

Results:
Children with ADHD who received mindfulness-based group therapy showed lower levels of DESR after treatment, with a reduction in CBCL dysregulation profile (F (1,63) = 4.81; p = 0.032). All ADHD symptoms showed a moderately significant positive correlation with DESR (p < 0.01). Children with combined-type showed higher levels of DESR than children with inattentive-type (p = 0.018); however, no statistically significant changes were observed in the combined-type after mindfulness treatment.

Conclusion:
This study suggests that mindfulness in the form of structured group therapy might be clinically relevant in treating children with ADHD and thus make an impact on the overall clinical outcome, regardless of the ADHD subtype.
Safe, Effective Chin and Jaw Restoration With VYC-25L Hyaluronic Acid Injectable Gel
Authors: Ogilvie Patricia , Sattler Gerhard , Gaymans Frodo , Belhaouari Lakhdar , Weichman Barry M. , Snow Sean , Chawla Smita , Abrams Steve , Schumacher Andrew 
Published: May 2019

BACKGROUND
VYC-25L, a hyaluronic acid soft-tissue filler with lidocaine, is designed to restore and create facial volume in the chin and jaw.

OBJECTIVE
To evaluate the safety and effectiveness of VYC-25L in subjects with chin retrusion.

METHODS
Adults with chin retrusion (145°–165° glabella–subnasale–pogonion facial angle) were randomized (3:1) to receive VYC-25L in the chin/jaw at study onset (treatment group) or 3 months later (control group). Primary effectiveness end point was mean change in facial angle from baseline at Month 3. Safety assessments included injection site responses (ISRs), recorded in a subject diary, and adverse events (AEs).

RESULTS
VYC-25L was administered to 119 subjects (treatment group: n = 90; control group: n = 29). Mean change in facial angle from baseline at Month 3 was significantly greater in the treatment versus control group (difference: 2.51°; p < .0001). Effectiveness was also demonstrated by the proportion of subjects with improved/much improved Global Aesthetic Improvement Scale scores and responses on FACE-Q Satisfaction and Psychological Well-Being Scales. Treatment benefit remained evident at Month 12. Common ISRs were firmness (95.8%), tenderness (95.8%), and swelling (91.6%). No serious treatment-related AEs were reported.

CONCLUSION
VYC-25L significantly improved glabella–subnasale–pogonion facial angle and was generally safe and well tolerated.
Optimizing patient partnership in primary care improvement: A qualitative study
Authors: Alidina Shehnaz , Martelli Peter F. , J. Singer Sara , Aveling Emma-Louise 
Published: May 2019

Background
The need to expand and better engage patients in primary care improvement persists.

Purpose
Recognizing a continuum of forms of engagement, this study focused on identifying lessons for optimizing patient partnerships, wherein engagement is characterized by shared decision-making and practice improvement codesign.

Methodology
Twenty-three semistructured interviews with providers and patients involved in improvement efforts in seven U.S. primary care practices in the Academic Innovations Collaborative (AIC). The AIC aimed to implement primary care improvement, emphasizing patient engagement in the process. Data were analyzed thematically.

Results
Sites varied in their achievement of patient partnerships, encountering material, technical, and sociocultural obstacles. Time was a challenge for all sites, as was engaging a diversity of patients. Technical training on improvement processes and shared learning “on the job” were important. External, organizational, and individual-level resources helped overcome sociocultural challenges: The AIC drove provider buy-in, a team-based improvement approach helped shift relationships from providers and recipients toward teammates, and individual qualities and behaviors that flattened hierarchies and strengthened interpersonal relationships further enhanced “teamness.” A key factor influencing progress toward transformative partnerships was a strong shared learning journey, characterized by frequent interactions, proximity to improvement decision-making, and learning together from the “lived experience” of practice improvement. Teams came to value not only patients’ knowledge but also changes wrought by working collaboratively over time.

Conclusion
Establishing practice improvement partnerships remains challenging, but partnering with patients on improvement journeys offers distinctive gains for high-quality patient-centered care.

Practice Implications
Engaging diverse patient partners requires significant disruption to organizational norms and routines, and the trend toward team-based primary care offers a fertile context for patient partnerships. Material, technical, and sociocultural resources should be evaluated not only for whether they overcome specific challenges but also for how they enhance the shared learning journey.
Effect of Graft Shift Direction on Graft Detachment and Endothelial Cell Survival After Descemet Membrane Endothelial Keratoplasty
Authors: Yuda Kentaro , Kato Naoko , Takahashi Hidenori , Shimizu Toshiki , Oyakawa Itaru , Matsuzawa Akiko , Yuda Kenji , Hayashi Takahiko 
Published: May 2019

Purpose:
To investigate the effects of graft shift orientation on clinical outcomes after Descemet membrane endothelial keratoplasty (DMEK).

Methods:
This study used intraoperative video images to retrospectively examine the effect of graft shift direction in 50 eyes of 50 patients. Correlations were assessed between graft shift direction and multiple parameters.

Results:
The graft detachment rate was higher in eyes with an inferior graft shift than in those without (superior, 0% and 5.0%; nasal, 0% and 20.0%; inferior, 16.7% and 55.0%; temporal, 16.7% and 45.0%; and any segment, 23.3% and 65.0%; for graft shift–negative and graft shift–positive cases, respectively). Postoperative endothelial cell density reduction was higher in eyes with an inferior graft shift (1 month, 23.6% ± 13.7% and 37.5% ± 18.8%; 3 months, 31.6% ± 16.4% and 45.2% ± 15.2%; and 6 months, 39.8% ± 14.9% and 50.7% ± 16.6%; for graft shift–negative and graft shift–positive cases, respectively). Eyes with a superior graft shift had lower postoperative endothelial cell density reduction than those without (1 month, 36.9% ± 16.6% and 20.0% ± 13.1%; 3 months, 45.3% ± 13.3% and 27.4% ± 16.2%; and 6 months, 51.3% ± 14.6% and 35.9% ± 14.5%; for graft shift–negative and graft shift–positive cases, respectively). Graft shift direction did not affect postoperative best-corrected visual acuity or central corneal thickness.

Conclusions:
Graft shift direction in DMEK, especially inferior graft shift, affected the postoperative graft detachment rate. Superior graft shift had a beneficial effect on postoperative corneal endothelial values. These data suggest that inferior graft shift should be avoided in DMEK.
Outcomes of Wider Area Bleb Revision Using Bleb Knife With Adjunctive Mitomycin C
Authors: Nakakura Shunsuke , Noguchi Asuka , Tanabe Hirotaka , Tabuchi Hitoshi , Asaoka Ryo , Kiuchi Yoshiaki 
Published: May 2019

Precis:
Wider area bleb revision using bleb knife with adjunctive mitomycin C (MMC) had a good success rate, according to strict success criteria, except in patients with neovascular glaucoma (NVG).

Purpose:
We determined the efficacy of wider area bleb revision after filtering surgery using bleb knife with adjunctive MMC.

Patients and Methods:
In this retrospective single-center study, we analyzed 86 patients with glaucoma (46 primary open-angle, 18 exfoliations, 13 secondary, and 9 neovascular) after bleb revision using bleb knife with adjunctive MMC after a minimum follow-up of 6 months. A Kaplan-Meier survival analysis with log-rank tests and Cox proportional hazards regression analyses were performed. The main outcome measure was a successful initial bleb revision using bleb knife with adjunctive MMC, arbitrarily defined as intraocular pressure (IOP) control <15 mm Hg without any IOP-lowering medication, additional bleb revision, or glaucoma surgery.

Results:
The mean time since the initial filtering surgery was 243.8 days, and the mean prebleb revision IOP was 22.0±4.8 mm Hg. The total cumulative success rate of the bleb revision using bleb knife with MMC was 49% at 6 months and 30% at 1 year. Patients with primary open-angle glaucoma had the best success rate (64% at 6 mo and 40% at 1 y). Log-rank tests revealed that patients with NVG had the worst prognosis (P<0.01). NVG was the only significant risk factor identified for short survival time (odds ratio, 167.10; 95% confidence interval, 1.78-15620.44; P=0.027).

Conclusion:
Wider area bleb revision using bleb knife with adjunctive MMC had a good success rate, according to strict success criteria, except in patients with NVG.
Microarchitecture of Schlemm Canal Before and After Cataract Extraction Surgery
Authors: Rubinstein Yair , Fogel-Levin Miri , Singer Reut , Levkovitch-Verbin Hani , Moros Iris , Sher Ifat , Rotenstreich Ygal , Skaat Alon 
Published: May 2019

Precis:
Schlemm canal (SC) expands after cataract extraction (CE), both in the area and in volume by 25% as was measured using enhanced-depth imaging optical coherent tomography (EDI-OCT) in patients before and 1 week after CE.

Purpose:
This study aims to characterize the structural and volume changes on the microstructure of SC in patients before and after uneventful phacoemulsification CE by using EDI-OCT.

Materials and Methods:
Forty-one serial horizontal EDI-OCT B-scans (interval between B-scans, 69 µm) were obtained in the nasal corneoscleral limbus before and 1 week after CE. The structure of aqueous channels, conjunctival blood vessels and iris anatomy in each scan were used as landmarks to select for overlapping scans taken before and following CE. The SC cross-section area was measured in each of the selected scans and SC volume was determined following a 3-dimensional reconstruction.

Results:
Eleven eyes (6 females and 5 males) were imaged successfully before and after CE. Mean age was 70.54±11.38 years. The mean axial length was 23.10±0.87 mm. After CE, the mean best-corrected visual acuity in logMAR improved from 0.4±0.13 to 0.2±0.13 (P=0.028). There was no significant change in the mean intraocular pressure before and after CE (15.09±1.33 to 15.0±2.16 mm Hg; P=0.39). The mean SC cross-section area increased by 25%, from 4744±376 to 5941±1048 μm2 (P<0.001). SC volume in the analyzed region increased by 25% from 6,641,473±585,954 to 8,317,909±1,328,809 μm3 (P<0.001).

Conclusion:
CE expands SC dimensions in healthy eyes. EDI-OCT imaging of SC may prove useful in the evaluation of the SC dimensions in vivo before and after CE.
Use of Ceftazidime-avibactam for the Treatment of Extensively drug-resistant or Pan drug-resistant Klebsiella pneumoniae in Neonates and Children <5 Years of Age
Authors: Iosifidis Elias , Chorafa Elisavet , Agakidou Eleni , Kontou Aggeliki , Violaki Asimina , Volakli Eleni , Christou Eleni-Ifigeneia , Zarras Charalampos , Drossou-Agakidou Vassiliki , Sdougka Maria , Roilides Emmanuel 
Published: May 2019

Background:
Emergence of extensively drug-resistant (XDR) or pan drug-resistant (PDR) Enterobacteriaceae is a major public threat especially for young patients. Treatment options for these bacteria are extremely limited with no safety data existing for neonates and children. Ceftazidime-avibactam has activity against Gram-negative bacteria producing Klebsiella pneumoniae carbapenemase, but virtually no data exist on its use in neonatal and pediatric patients.

Methods:
We present a single-center case series of neonates and children <5 years treated with ceftazidime-avibactam for XDR or PDR K. pneumoniae infections until August 2018. Medical records of patients who received ceftazidime-avibactam for at least 2 days (6 doses) were reviewed. Clinical, laboratory and microbiologic data were collected using a prestructured form. Adverse events and clinical/microbiologic responses and 15- and 30-day outcome were assessed.

Results:
In our case series, 8 patients (median age 53 days, range from 13 days to 4.5 years) received 9 courses of ceftazidime-avibactam at a dose of 62.5 mg/kg q8h for suspected or proven XDR/PDR K. pneumoniae infections including bloodstream infections (8 courses), central nervous system infections (2 courses) and urinary tract infection (1 course). All patients were critically ill and received other antibiotics prior and concomitantly with the administration of ceftazidime-avibactam. There was no treatment discontinuation due to adverse events. Clinical and microbiologic responses occurred in all patients, and no patient died by day 30.

Conclusions:
Administration of ceftazidime-avibactam appears to be well tolerated and efficacious against in vitro susceptible XDR or PDR Enterobacteriaceae without being associated with significant adverse events.
Hospital Readmissions to Nonindex Hospitals: Patterns and Determinants Following the Medicare Readmission Reduction Penalty Program
Authors: Hasan Md. Mahmudul , Noor-E-Alam Md. , Wang Xiaoyi , Zepeda E. David , J. Young Gary 
Published: May 2019

ABSTRACT

Objective:
To examine patterns and determinants of nonindex readmissions for Medicare as well as non-Medicare patients both before and immediately after the adoption of Medicare's Hospital Readmission Reduction Program (HRRP) in 2012. Nonindex readmissions are readmissions to hospitals that are different from the one from which the patient was discharged.

Methods:
Observational analysis of statewide database from California comprising patient-level discharge reports. Mixed-effects logistic regression models examined the association between nonindex readmissions and both hospital- and patient-level characteristics.

Results:
Nonindex readmissions for the population studied were approximately 25%, but the percentage of such readmissions was significantly higher for non-Medicare patients than those enrolled in Medicare. Nonindex readmissions were associated with several patient- and hospital-level characteristics from which patients were discharged. The adoption of the HRRP did not have any appreciable impact on the general pattern of nonindex readmissions.

Conclusions:
A substantial percentage of hospital readmissions are to nonindex hospitals, but the general pattern and determinants of these events have not changed following the adoption of the HRRP. As preventable readmissions continue to gain attention as a key quality indicator for hospital care, further investigations are needed to understand the potential value of nonindex readmissions as a quality indicator for hospital care.
Factors Associated With Hospitalization Before the Start of Long-Term Care Among Elderly Disabled People
Authors: Arandelovic Andelija , Acampora Anna , Federico Bruno , Profili Francesco , Francesconi Paolo , Damiani Gianfranco 
Published: May 2019

ABSTRACT
The growing number of elderly people with functional limitations, cognitive impairment, and disability is an organizational challenge for the health care sector. This study investigated the factors associated with hospitalization in the period between evaluation and the start of a long-term care (LTC) program for patients on the waiting list. A population-based historical cohort study was performed using data extracted from different administrative databases. The cohort included disabled individuals 65 years and older who were evaluated for entrance into an LTC program between January 1, 2012, and December 31, 2013, in Tuscany, Italy. The sample consisted of 11,429 subjects. The characteristics positively associated with hospital admission were residence zone {urban incidence rate ratio (IRR) = 0.83 (95% confidence interval [CI] 0.74–0.94)}, number of prescribed drugs IRR = 1.01 (95% CI 1.00–1.02), a Charlson Comorbidity Index of 2 IRR = 1.44 (95% CI 1.26–1.64), and lower social conditions IRR = 0.99 (95% CI 0.98–1.00). The rate of hospitalization for patients with heart failure, chronic obstructive pulmonary disease, and dementia was higher than for patients without these diseases. Our results indicate that it may be possible to predict factors that can lead to hospitalization before the start of an LTC program.
Differentiated Antiretroviral Therapy Distribution Models: Enablers and Barriers to Universal HIV Treatment in South Africa, Uganda, and Zimbabwe
Authors: Duffy Malia , Sharer Melissa , Davis Nicole , Eagan Sabrina , Haruzivishe Clara , Katana Milly , Makina Ndinda , Amanyeiwe Ugochukwu 
Published: May 2019

Abstract
Emerging HIV treatment distribution models across sub-Saharan Africa seek to overcome barriers to attaining antiretroviral therapy and to strengthen adherence in people living with HIV. We describe enablers, barriers, and benefits of differentiated treatment distribution models in South Africa, Uganda, and Zimbabwe. Data collection included semistructured interviews and focus group discussions with 163 stakeholders from policy, program, and patient levels. Four types of facility-based and 3 types of community-based models were identified. Enablers included policy, leadership, and guidance; functional information systems; strong care linkages; steady drug supply; patient education; and peer support. Barriers included insufficient drug supply, stigma, discrimination, and poor care linkages. Benefits included perceived improved adherence, peer support, reduced stigma and discrimination, increased time for providers to spend with complex patients, and travel and cost savings for patients. Differentiated treatment distribution models can enhance treatment access for patients who are clinically stable.
The Female Genital Self-image Scale in Adult Women With Vulvar Lichen Sclerosus
Authors: Hodges Kelly R. , Wiener Courtney E. , Vyas Anuja S. , Turrentine Mark A. 
Published: May 2019

Objective
There is no agreed upon standard way to measure vulvar lichen sclerosus disease severity. The Female Genital Self-Image Scale (FGSIS) is a validated survey tool assessing female genital self-image and is positively correlated with women's sexual function. A lower score represents a negative genital self-image. We evaluated the FGSIS in women with vulvar lichen sclerosus.

Methods
Women with biopsy-proven lichen sclerosus and women presenting for routine gynecologic care without lichen sclerosus matched by age were surveyed with the 7-item FGSIS. National surveys of healthy women in the United States have shown the mean 7-item FGSIS score is 21. To detect one standard deviation (20% absolute difference) between groups with a power of 80% at p < .05, 15 women would are needed in each group.

Results
Sixteen women with lichen sclerosus and 16 matched controls were surveyed between February and July 2018. The mean ± SD age of women with lichen sclerosus was 56.8 ± 13.5 years, 94% were white, 69% married, 81% college educated, 69% postmenopausal, and 18% on hormone replacement therapy. None of these differences were statistically different from control women. Women with vulvar lichen sclerosus had a significantly lower median 7-item FGSIS when compared with control subjects, 18 (interquartile range = 16–21) versus 25 (interquartile range = 23–27), respectively, Mann–Whitney U test, p < .001.

Conclusions
Women with vulvar lichen sclerosus have a lower score on the 7-item Female Genital Self-Image Scale compared with healthy controls.
Management of Acute Mastoiditis With Immediate Needle Aspiration for Subperiosteal Abscess
Authors: Bartov Noam , Lahav Yonatan , Lahav Gil , Zloczower Elchanan , Katzenell Udi , Halperin Doron , Hilly Ohad , Shoffel-Havakuk Hagit 
Published: May 2019

Objectives:
The management of children with acute mastoiditis (AM) is still debated. Some advocate computed tomography (CT) and cortical mastoidectomy (CM) for all cases while others favor a more conservative management. This study assesses the safety and outcome of a conservative management scheme, with immediate myringotomy and postauricular needle aspiration (PANA) of a subperiosteal abscess (SPA).

Methods:
A retrospective cohort of children with AM younger than 12 years admitted to our institute between 1999 and 2017. Data collection includes patient characteristics, signs and symptoms, physical examination, laboratory tests, treatment regime, imaging findings, and long-term outcomes.

Results:
The study included 283 children. Ninety-eight children (34.6%) had a suspected SPA on admission and underwent a trial of immediate PANA, and 56.1% (55 cases) were positive. Of these 55, 83.6% (46) did not require CM. Twenty-four additional children had an SPA, proven by CT or during surgery, bringing the total SPA cases to 79 (27.9%). Of all children with proven SPA, 70.9% (56) did not require CM, with the practiced conservative management sufficing. Intracranial complication rates were 4.9% (14) and 8.8% (25) underwent CM. Long-term follow-up was available for 250 children. One child had hearing loss with a bilateral mixed hearing loss (50 decibels). There were no cases of neurological sequela.

Conclusions:
Conservative management of AM, involving prompt myringotomy for all patients and PANA for SPA, is safe and effective, and reduces the need for CT and CM. Conservative management obviates unnecessary radiation, general anesthesia, and surgery, without increasing the risk of immediate or long-term complications.