bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic octreotide does not reduce the incidence of postoperative chylothorax following lobectomy
Authors: Zhang Chu , Zhang Hui , Wu Wenbin , Liu Dong , Yang Dunpeng , Zhang Miao , Lu Cuntao 
Published: July 2019

Abstract
Chylothorax after lobectomy is common, lacking reliable preventive measures. Octreotide is widely used for treatment of chyle leakage, but its role in preventing chylothorax has not been estimated. The aim of this study was to evaluate whether prophylactic octreotide could reduce the incidence of postoperative chylothorax.
Patients who underwent lobectomy for lung cancer from January 2016 to September 2018 were retrospectively reviewed. The cases in prophylactic group received octreotide 1 day before the surgery until removal of chest tubes, while those in the control group did not use it unless the diagnosis of chylothorax.
A total of 379 patients were enrolled, with 190 patients in control and 189 cases in prophylactic group. Octreotide was well tolerated in patients who received this agent. No 30-day mortality was indicated. Seven cases in control (3.7%, 7/190) and 3 cases in prophylactic group (1.6%, 3/189) with chylothorax were observed (P = .337). The patients in prophylactic group showed shorter duration of chest drainage ([3.6 ± 1.6] days vs [4.1 ± 2.0] days, P = .006) and reduced drainage volume ([441.8 ± 271.1] mL vs [638.7 ± 463.3] mL, P < .001). In addition, they showed similar stations and numbers of dissected lymph nodes, surgery-related complications, and postoperative hospital stay. Besides, 11 (5.8%, 11/190) patients in control and 6 (3.2%, 6/189) cases in the prophylactic group were readmitted for pleural effusion needing reinsertion of chest tubes (P = .321). Moreover, multivariable logistic analysis showed that induction therapy (odds ratio [OR] =12.03; 95% confidence interval [CI] 3.15–46.03, P < .001) was a risk factor, while high-volume experience of the surgeon (OR = 0.23; 95% CI 0.06–0.97, P = .045) was a preventive factor of surgery-related chylothorax. Additionally, prophylactic octreotide (OR = 0.18; 95% CI 0.11–0.28, P < .001) and perioperative low-fat diet (OR = 0.46; 95% CI 0.29–0.73, P = .001) were negatively associated with the drainage volume of pleural effusion. Furthermore, high-volume experience of the surgeon (OR = 6.03; 95% CI 1.30–27.85, P = .021) and induction therapy (OR = 8.87; 95% CI 2.97–26.48, P < .001) were risk factors of unplanned readmission.
Prophylactic octreotide does not reduce the incidence of postoperative chylothorax or unplanned readmission following anatomic lobectomy. The routine application of octreotide should not be recommended. High-quality trials are required to validate these findings.
Pharmacological interventions for preventing postoperative nausea and vomiting in adult patients undergoing ambulatory surgery
Authors: Choi Geun Joo , Lee Je Jin , Seong Hee-Kyeong , Kang Hyun 
Published: July 2019

Abstract

Background:
We aimed to conduct a systematic review and network meta-analysis (NMA) of published studies to comprehensively compare and rank the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Methods:
A systematic and comprehensive search will be performed using the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases, beginning from their inceptions to July and August 2019. Only randomized clinical trials on the efficacy and safety of pharmacologic interventions for preventing nausea and vomiting after ambulatory surgery will be included.
The primary endpoints will be the incidences of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) in the following recovery phases: before discharge (recovery phase I and II), after discharge but within 24 hours following surgery, and after discharge, after the initial 24-hour postoperative period.
The incidences of delayed post-discharge nausea, post-discharge vomiting, and post-discharge nausea and vomiting, which occur after the initial 24-hour postoperative period, severities of PON, POV, and PONV, use of rescue antiemetics, and the incidence of complete response, as well as safety issues, including complications, such as headache, dizziness, and drowsiness, will be also assessed.
We will conduct both pairwise meta-analysis and NMA. We will use surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX).

Results:
The results of this systematic review and NMA will be published in a peer-reviewed journal.

Conclusion:
This systematic review and NMA will provide comprehensive and convincing evidence summarizing the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Trial registration number:
CRD42018103068.
Changes in Hospital Referral Patterns to Skilled Nursing Facilities Under the Hospital Readmissions Reduction Program
Authors: Kim K. Lucy , Li Li , Kuang Meng , Horwitz Leora I. , Desai Sunita M. 
Published: July 2019

Background:
The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for higher-than-expected readmission rates. Almost 20% of Medicare fee-for-service (FFS) patients receive postacute care in skilled nursing facilities (SNFs) after hospitalization. SNF patients have high readmission rates.

Objective:
The objective of this study was to investigate the association between changes in hospital referral patterns to SNFs and HRRP penalty pressure.

Design:
We examined changes in the relationship between penalty pressure and outcomes before versus after HRRP announcement among 2698 hospitals serving 6,936,393 Medicare FFS patients admitted for target conditions: acute myocardial infarction, heart failure, or pneumonia. Hospital-level penalty pressure was the expected penalty rate in the first year of the HRRP multiplied by Medicare discharge share.

Outcomes:
Informal integration measured by the percentage of referrals to hospitals’ most referred SNF; formal integration measured by SNF acquisition; readmission-based quality index of the SNFs to which a hospital referred discharged patients; referral rate to any SNF.

Results:
Hospitals facing the median level of penalty pressure had modest differential increases of 0.3 percentage points in the proportion of referrals to the most referred SNF and a 0.006 SD increase in the average quality index of SNFs referred to. There were no statistically significant differential increases in formal acquisition of SNFs or referral rate to SNF.

Conclusions:
HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNF differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital
Authors: Yakusheva Olga , Weiss Marianne E. , Bobay Kathleen L. , Costa Linda , Hughes Ronda G. , Hamilton Morris , Bang James , Buerhaus Peter I. 
Published: July 2019

Objective:
Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits].

Research Design:
Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics.

Subjects:
A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016.

Measures:
Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return.

Results:
Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P<0.001) and an ED visit (−0.29 absolute percentage points, P=0.042).

Conclusions:
Variability in individual clinician productivity can have implications for acute care quality patient outcomes.
Trained immunity and atherosclerotic cardiovascular disease
Authors: Riksen Niels P. 
Published: July 2019

Purpose of review
The two major challenges in cardiovascular medicine are to refine risk prediction and to improve pharmacological prevention and treatment. The concept of innate immune memory, which is called trained immunity, has the potential to improve clinical practice in these regards.

Recent findings
Monocytes and macrophages have the capability to develop a long-term proinflammatory and proatherogenic phenotype after brief exposure to inflammatory stimuli, such as oxidized low-density lipoprotein particles. This innate immune memory develops because of rewiring of intracellular metabolic pathways and epigenetic reprogramming of histone modifications. The persistence of circulating hyperresponsive monocytes in vivo is explained by the fact that training occurs in myeloid progenitor cells in the bone marrow. Several recent studies reported the presence of monocytes with a trained immune phenotype in patients with established atherosclerosis, and in patients with an increased risk for atherosclerosis because of dyslipoproteinemia.

Summary
In monocytes and their bone marrow progenitors, metabolic and epigenetic reprogramming can induce trained immunity, which might contribute to the persistent nonresolving inflammation that characterizes atherosclerosis. These pathways offer exciting novel drug targets to improve the prevention and treatment of cardiovascular disease.
Maximizing the benefits of cholesterol-lowering drugs
Authors: Feingold Kenneth R. 
Published: July 2019

Purpose of review
Drugs to lower LDL-C levels are very widely used. In this brief review, I will use selected recent studies to delineate several important principles that provide a rationale for how to maximize the benefits of using LDL-C lowering drugs to reduce cardiovascular disease. The focus will be on using statins, ezetimibe, and PCSK9 monoclonal antibodies as recent studies have predominantly utilized these agents.

Recent findings
The key principles to consider when using LDL-C-lowering drugs to reduce cardiovascular disease are: the lower the LDL-C the better; the sooner and the longer one lowers LDL-C the better; the higher the risk of cardiovascular disease the greater the absolute benefit; the higher the baseline LDL-C the greater the absolute benefit; and compared with the benefits of cholesterol-lowering drugs on reducing cardiovascular disease the risk of side effects is very modest.

Summary
Understanding and employing these key concepts in caring for patients will allow one to use cholesterol-lowering drugs wisely to maximize the reduction of cardiovascular events.
Middle fossa approach for spontaneous cerebrospinal fluid fistula and encephaloceles
Authors: Tolisano Anthony M. , Kutz Joe Walter 
Published: July 2019

Purpose of review
The aim of this article is to describe the middle fossa craniotomy (MFC) approach for the repair of cerebrospinal (CSF) fistula and encephaloceles.

Recent findings
The MFC approach has a greater than 93% success rate for managing CSF fistula and encephaloceles located along the tegmen tympani and tegmen mastoideum. Posterior fossa defects cannot be managed by an MFC approach. Multilayer repair with the combination of soft tissue and durable substances is preferred. Hydroxyapatite bone cement provides a durable repair of thinned or absent areas of bone with a low risk of infection. Concurrent management of symptomatic superior semicircular canal dehiscence may be readily performed. Small keyhole craniotomies with the utilization of the endoscope are possible as a means to minimize temporal lobe retraction.

Summary
MFC repair of CSF fistula and encephaloceles is a highly effective approach for the repair of tegmen mastoideum and tegmen tympani defects.
The evolution of presenting signs and symptoms of lateral skull base cerebrospinal fluid leaks
Authors: Naples James G. , Shah Ravi R. , Ruckenstein Michael J. 
Published: July 2019

Purpose of review
To review the presenting signs and symptoms of spontaneous cerebrospinal fluid (CSF) leaks of the lateral skull base.

Recent findings
Research continues to demonstrate that CSF leaks from the lateral skull base are insidious, and present with subtle signs and symptoms. Patients commonly present with symptoms of aural fullness, middle ear effusion, and otorrhea following tympanostomy tube insertion that can be confused for chronic otitis media. More recently headache, pulsatile tinnitus, and dizziness/vertigo are being recorded as symptoms at presentation, which is likely a reflection of the association of spontaneous CSF leak with obesity, intracranial hypertension, and superior canal dehiscence. The presence of these less common symptoms in the setting of middle ear effusion should raise suspicion for CSF leak. The rate of meningitis in spontaneous CSF leak is not negligible, and patients should be counseled on this life-threatening risk.

Summary
Spontaneous CSF leak from the lateral skull base presents with subtle signs and symptoms and remains a diagnostic challenge. Less common symptoms may represent associations with underlying comorbidities, and awareness of the increasing coincidence of diseases that accompany spontaneous CSF leak is essential to prompt diagnosis and management.
The role of obesity, sleep apnea, and elevated intracranial pressure in spontaneous cerebrospinal fluid leaks
Authors: Rabbani Cyrus C. , Saltagi Mohamad Z. , Nelson Rick F. 
Published: July 2019

Purpose of review
Spontaneous cerebrospinal fluid (sCSF) leaks often occurs in middle age, obese females. Here we investigate the role of obesity, idiopathic intracranial hypertension (IIH), and obstructive sleep apnea (OSA) in the pathophysiology of sCSF leaks.

Recent findings
The association of obesity and sCSF leaks has been well established in many studies. It has now been revealed that sCSF leak patients have thinner calvariums along with the skull base. An intracranial process likely leads to calvarium and skull base thinning in sCSF leaks patients since this occurs independent of extracranial bone thinning and independent of obesity. OSA, which is known to cause spikes in intracranial pressure (ICP), has been found to be significantly prevalent in the sCSF population and has been shown to lead to both calvarial and skull base thinning. Chronically elevated ICP (IIH) has also been shown to impact calvarial and skull base thicknesses.

Summary
The incidence of sCSF leaks has increased in recent decades along with an increasing rate of obesity. OSA and IIH, which are obesity-related factors and cause transient and chronic elevations in ICP, have now been implicated as critical factors leading to calvarial and skull base thinning and resultant sCSF leaks.
A review of psychological treatments for vomiting associated with paediatric functional gastrointestinal disorders
Authors: Jerson Bradley , Lamparyk Katherine , van Tilburg Miranda A.L. 
Published: July 2019

Purpose of review
Vomiting can be a primary symptom or associated with various other functional gastrointestinal disorders (FGIDs). The purpose of this review was to discuss the evidence for psychological treatments for vomiting in pediatric FGID.

Recent findings
Vomiting of functional origin is an increasingly recognized symptom among children and adolescents. It is highly aversive and associated with disability and poor quality of life. Cognitive behavioral therapy, lifestyle modification (especially sleep), diaphragmatic breathing, and hypnosis can be helpful in preventing vomiting episodes and reducing disability. However, no randomized clinical trials have been performed. An evidence base for psychological treatments in children with vomiting of functional origin is highly needed.

Summary
Increased evidence is demonstrating value and efficacy of incorporating psychogastroenterology practices into ongoing treatment plans for digestive conditions. Current psychological treatments are focused on prevention of vomiting through stress reduction and lifestyle modification, reduction of disability by limiting avoidance behaviours, as well as counteracting biological factors. However, psychological treatments have not been shown to be helpful during an acute vomiting episode. More research is needed to build an evidence base for psychological treatments in vomiting disorders.
Stem cells: will they cure pediatric heart failure?
Authors: Bernstein Daniel 
Published: July 2019

Purpose of review
The purpose of this review is to provide an overview of the state of cardiac regenerative medicine, including the unique opportunities and challenges in its application to pediatric patients.

Recent findings
There has been a rapid proliferation of clinical studies using stem cells in adults with heart failure, yet little convincing evidence of clinically significant improvement. Readers will develop an understanding of the current limitations of stem cell treatments and the challenges to be overcome before they can achieve successful clinical translation.

Summary
Clinical trials in cardiac regeneration using stem cells are advancing rapidly despite clear knowledge of mechanism and rigorous evidence in animal models. The potential for cardiac regeneration in children may be greater than in adults, given the smaller degree of scar present in nonischemic heart disease and the greater potential of the younger heart for repair. However, similar to adult trials, there has yet to be convincing evidence of a positive effect in pediatric patients, and rigorous controlled studies are still lacking. There is still much biology to be learned in cardiac regeneration; future clinical trials in children should be based on solid evidence in animal models of both efficacy and safety.
Fibrodysplasia ossificans progressiva: lessons learned from a rare disease
Authors: Akyuz Gulseren , Gencer-Atalay Kardelen , Ata Pinar 
Published: July 2019

Purpose of review
Fibrodysplasia ossificans progressiva (FOP) is an extremely rare and severely disabling autosomal dominant disease that is yet to be clearly understood. The purpose of this review is to present recent literature on pathophysiology, clinical features, diagnosis and treatment of FOP.

Recent findings
FOP is characterized by congenital great toe deformity and progressive heterotopic ossifications in connective tissue. Heterotopic ossifications occur after painful flare-ups that can arise spontaneously or can be triggered by minor trauma. Each flare-up ultimately causes restriction of related-joint, and along with the others eventually leads to immobility. Death is usually caused by pulmonary complications because of chest wall involvement. The causative gene of FOP is activin A receptor type 1 (ACVR1), a bone morphogenetic protein-signalling component, which normally acts to inhibit osteoblastogenesis. The treatment of FOP is still preventive and supportive.

Summary
Although there are still gaps in the underlying mechanism of FOP, effective treatment options, such as potential pharmacologic targets and cell-based therapies are promising for the future. Some of these were tested without a clinical trial setting, and are currently in the process of evidence-based research.
Pediatric heart transplantation in the current era
Authors: D’Addese Laura , Joong Anna , Burch Michael , Pahl Elfriede 
Published: July 2019

Purpose of review
To provide an international perspective and current review of pediatric heart transplantation (PHTx).

Recent findings
Waitlist survival and long-term outcomes in PHTx continue to improve. Strategies to maximize donor pool utilization include ABO incompatible listing for infants and expanded donor-to-recipient weight ranges. However, there is a high degree of practice variation internationally, from listing strategies and donor acceptance practices to chronic immunosuppression regimens, long-term graft surveillance, and consideration for retransplantation.

Summary
Common indications for PHTx include end-stage congenital heart disease and cardiomyopathy. Current median graft survival among PHTx recipients ranges from 13 to 22 years. Common morbidities include infection, rejection, renal dysfunction, coronary allograft vasculopathy, and posttransplant lymphoproliferative disease. International registry data, collaborative initiatives to standardize management, and multicenter studies continue to improve knowledge and advancement of the field.
Recent developments in understanding the mechanisms of food allergy
Authors: Schmiechen Zoe C. , Weissler Katherine A. , Frischmeyer-Guerrerio Pamela A. 
Published: July 2019

Purpose of review
The prevalence of food allergy is rising globally. This review will discuss recent discoveries regarding the immunologic mechanisms that drive the initial sensitization and allergic response to food antigens, which may inform prevention and treatment strategies.

Recent findings
Tolerance to food antigens is antigen-specific and promoted by oral exposure early in life and maternal transfer of immune complexes via breast milk. IgG can inhibit both the initiation and effector phases of allergic responses to food antigens in mice, and high levels of food-specific IgG4 are associated with acquisition of tolerance in humans. Disruption of the skin barrier provides a route for food sensitization through the actions of mast cells, type 2 innate lymphoid cells, and IL-33 signaling. Regulatory T cells (Tregs) promote acquisition of oral tolerance, although defects in circulating allergen-specific Tregs are not evident in children with established food allergy. Certain microbes can offer protection against the development of IgE and food allergic responses, while dysbiosis increases susceptibility to food allergy.

Summary
Tolerance to food antigens is antigen-specific and is promoted by oral exposure early in life, maternal transfer of immune complexes, food-specific IgG, Tregs, an intact skin barrier, and a healthy microbiome.