bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Abuse Prevention and Treatment: Lessons From South Carolina
Authors: Arnold Jason F. , Arshonsky Joshua H. , Bloch Kiera A. , Holzman Emily , Sade Robert M. 
Published: November 2018

Context:
Opioid-related overdoses in the United States have increased by 33% over the past 5 years. America's opioid crisis is increasing across demographic groups and spreading geographically. South Carolina is one of the states in the southern region of the United States that experiences an unusually high rate of opioid-related deaths. In 2016, 616 deaths occurred in South Carolina from drug overdoses from prescription opioid drugs, up 9% from 2015. South Carolina residents filled nearly 4.5 million opioid prescriptions in 2015, which is greater than 1.5 times the national average.

Implementation:
In 2017, the governor of South Carolina declared a statewide public health emergency in response to the growing opioid crisis. In response, a committee of the South Carolina House of Representatives released a report in January 2018 on its opioid abuse prevention study and made recommendations on ways to reduce the number of opioid-related deaths.

Evaluation:
This article examines the strengths and weaknesses of South Carolina's state action plan to combat opioid-related deaths in the context of what other states have done to address opioid abuse, as well as the scientific literature on pain management. Several state opioid action plans, including South Carolina's and West Virginia's, were identified and evaluated.

Discussion:
This article describes (1) several legislative and nonlegislative strategies being considered in South Carolina for addressing the crisis, (2) an assessment of the strengths and weaknesses of these proposals and how they compare with other states that have also implemented response plans, and (3) an examination of the scientific literature to determine best practices for treating patients who are currently taking opioids, as well as discussing alternative approaches to pain management. The authors make several recommendations to improve upon South Carolina's opioid abuse prevention plan, such as engaging communities and encouraging multistakeholder collaboration to expand access to treatment, particularly among the most vulnerable populations.
Cost Comparison Between 2 Responses to Hepatitis A Virus Incidents in Restaurant Food Handlers—New York City, 2015 and 2017
Authors: Baum Sarah E. , Reddy Vasudha , Vora Neil M. , Balter Sharon , Daskalakis Demetre , Barbot Oxiris , Misener Mark , Rakeman Jennifer , Rojas John , Starr David , Waechter HaeNa , Zucker Jane , Lee David 
Published: November 2018

Context:
While the New York City Department of Health and Mental Hygiene (DOHMH) can use agency-wide emergency activation to respond to a hepatitis A virus–infected food handler, there is a need to identify alternative responses that conserve scarce resources.

Objective:
To compare the costs incurred by DOHMH of responding to a hepatitis A case in restaurant food handlers using an agency-wide emergency activation (2015) versus the cost of collaborating with a private network of urgent care clinics (2017).

Design:
We partially evaluate the costs incurred by DOHMH of responding to a hepatitis A case in a restaurant food handler using agency-wide emergency activation (2015) with the cost of collaborating with a private network of urgent care clinics (2017) estimated for a scenario in which DOHMH incurred the retail cost of services rendered.

Results:
Costs incurred by DOHMH for emergency activation were $65 831 ($238 per restaurant employee evaluated) of which DOHMH personnel services accounted for 85% ($55 854). Costs of collaboration would have totaled $50 914 ($253 per restaurant employee evaluated) of which personnel services accounted for 6% ($3146).

Conclusions:
Accounting for incident size, collaborating with the clinic network was more expensive than agency-wide emergency activation, though required fewer DOHMH personnel services.
The Role of State Context in Promoting Service Coordination in Maternal, Infant, and Early Childhood Home Visiting Programs
Authors: West Allison , Duggan Anne K. , Gruss Kelsey , Minkovitz Cynthia S. 
Published: November 2018

Context:
The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program provides funding to states to promote health and development of at-risk expectant families and families with young children. MIECHV programs are required to coordinate services within a larger system of care; yet, little is known about state-level factors that support coordination.

Objective:
This study examined state-level supports and barriers for coordination of home visiting with other entities within the early childhood system of care.

Methods:
A Web-based survey was distributed in 2016 via e-mail to MIECHV administrators in all 50 states, 5 US territories, and the District of Columbia. The survey elicited information on 5 domains shown by theory and prior research to support coordination: MIECHV leadership, state leadership, shared goals across sectors, data systems, and finance. Respondents also rated their perceptions of state-level coordination.

Results:
Forty-two (75%) of the MIECHV administrators participated in the survey. States and territories varied widely within and across the 5 domains of support for coordination. MIECHV leadership was an area of relative strength, whereas data systems and finance showed the most room for improvement. State leadership and shared goals were associated with stronger perceptions of state-level coordination.

Conclusions:
The findings indicate opportunities for shared learning among states to enhance coordination infrastructure. Such efforts should include multiple stakeholder perspectives and consideration of local and organizational contexts. This work could be facilitated using the service coordination toolkit developed as part of this project.
Effect of Regional Hospital Market Competition on Use Patterns of Free Flap Breast Reconstruction
Authors: Cerullo Marcelo , Lee Clara , Offodile Anaeze C. 
Published: November 2018

Background:
Market competition is believed to promote patient access and health care delivery. The authors examined the relationship between market competition and use of surgical services for cancer, using free flap immediate breast reconstruction as a model scenario.

Methods:
This retrospective cross-sectional analysis of the 2008 to 2011 Nationwide Inpatient Sample identified female patients undergoing immediate breast reconstruction. The Herfindahl-Hirschman Index was used to describe hospital markets as competitive or consolidated. The relationship between market competition and free flap immediate breast reconstruction use was explored using a hierarchical model before and after race stratification.

Results:
Seven thousand three hundred seventy-two (10.7 percent) of 68,966 patients underwent free flap immediate breast reconstruction. A consolidated market was associated with 35 percent lower odds of free flap immediate breast reconstruction (95 percent CI, 0.43 to 0.97). Undergoing an operation in a later year [OR, 1.40; 95 percent CI (per year), 1.21 to 1.63], nonwhite race (OR, 1.33; 95 percent CI, 1.10 to 1.60), private insurance (OR, 2.09; 95 percent CI, 1.59 to 2.76), and teaching hospital status (OR, 2.67; 95 percent CI, 1.73 to 4.13) were associated with higher rates of free flap reconstruction. Market consolidation was associated with 48 percent lower odds of undergoing free flap immediate breast reconstruction in nonwhite patients only (95 percent CI, 0.29 to 0.92).

Conclusions:
A hospital’s willingness to provide surgical services may be subject to market pressures. Market competition is associated with increased odds of free flap immediate breast reconstruction and higher use by racial minorities.
Fat Graft Safety after Oncologic Surgery: Addressing the Contradiction between In Vitro and Clinical Studies
Authors: Orbay Hakan , Hinchcliff Katharine M. , Charvet Heath J. , Sahar David E. 
Published: November 2018

Background:
The authors investigate the in vitro and in vivo interaction of human breast cancer cells and human adipose-derived stem cells to address the controversy on the safety of postmastectomy fat grafting.

Methods:
The authors co-cultured human adipose-derived stem cells and MDA-MB-231 breast cancer cells in an in vitro cell migration assay to examine the migration of breast cancer cells. In the in vivo arm, the authors injected breast cancer cells (group I), human breast cancer cells plus human adipose-derived stem cells (group II), human breast cancer cells plus human fat graft (group III), and human breast cancer cells plus human fat graft plus human adipose-derived stem cells (group IV) to the mammary fat pads of female nude mice (n = 20). The authors examined the tumors, livers, and lungs histologically after 2 weeks.

Results:
Migration of breast cancer cells increased significantly when co-cultured with adipose-derived stem cells (p < 0.05). The tumor growth rate in group IV was significantly higher than in groups I and II (p < 0.05). The tumor growth rate in group III was also higher than in groups I and II, but this difference was not statistically significant (p > 0.05). Histologically, there was no liver/lung metastasis at the end of 2 weeks. The vascular density in the tumors from group IV was significantly higher than in other groups (p < 0.01).

Conclusion:
The injection of breast cancer cells, fat graft, and adipose-derived stem cells together increases breast cancer xenograft growth rates significantly.
“Brazilian Butt Lift” under Local Anesthesia: A Novel Technique Addressing Safety Concerns
Authors: Chia Christopher T. , Theodorou Spero J. , Dayan Erez , Tabbal Georges , Del Vecchio Daniel 
Published: November 2018

Background:
The gluteal lift (“Brazilian butt lift”) has improved significantly in technique and in outcomes. Some postulate that fat embolism occurs because of damage to veins superficial to the gluteus muscles and that fat must be injected intramuscularly to achieve satisfactory aesthetic results. The purpose of this article is to present data where gluteal lift is performed under local anesthesia, address safety concerns, and clarify these speculations.

Methods:
All patients underwent gluteal lift under local anesthesia using oral medications and tumescent infiltration. Fat was harvested by closed-system liposuction, separated by gravity, injected using a peristaltic pump and reticulating basket cannulas.

Results:
Thirty-two female patients with an average age of 38.6 years and a body mass index of 24.8 kg/m2 underwent 47 gluteal lift operations under local anesthesia over 52 months. The average volume of injected fat was 359 ml per buttock. There were no deaths or complications.

Conclusions:
Recent concerns regarding buttock injections have been raised due to death from fat embolism. Despite numerous theories on the mechanism of entry, the fact that venous injury occurs with the introduction of boluses of fat in enough quantities to cause mechanical disruption of the cardiopulmonary circuit is not in dispute. The authors believe this cannot occur in the awake patient without the surgeon being acutely aware of a misguided cannula. These data suggest that buttock fat grafting under local anesthesia is a safe and effective procedure with an excellent safety profile and durable results.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Assessing the Quality of Microvascular Breast Reconstruction Performed in the Urban Safety-Net Setting: A Doubly Robust Regression Analysis
Authors: Offodile Anaeze C. , Boukovalas Stefanos , Muldoon Lawrence , Lee Clara N. 
Published: November 2018

Background:
Safety-net hospitals serve vulnerable populations; however, care delivery may be of lower quality. Microvascular immediate breast reconstruction, relative to other breast reconstruction subtypes, is sensitive to the performance of safety-net hospitals and an important quality marker. The authors’ aim was to assess the quality of care associated with safety-net hospital setting.

Methods:
The 2012 to 2014 National Inpatient Sample was used to identify patients who underwent microvascular immediate breast reconstruction after mastectomy. Primary outcomes of interest were rates of medical complications, surgical inpatient complications, and prolonged length of stay. A doubly-robust approach (i.e., propensity score and multivariate regression) was used to analyze the impact of patient and hospital-level characteristics on outcomes.

Results:
A total of 858 patients constituted our analytic cohort following propensity matching. There were no significant differences in the odds of surgical and medical inpatient complications among safety-net hospital patients relative to their matched counterparts. Black (OR, 2.95; p < 0.001) and uninsured patients (OR, 2.623; p = 0.032) had higher odds of surgical inpatient complications. Safety-net hospitals (OR, 1.745; p = 0.005), large bedsize hospitals (OR, 2.170; p = 0.023), and Medicaid patients (OR, 1.973; p = 0.008) had higher odds of prolonged length of stay.

Conclusions:
Safety-net hospitals had comparable odds of adverse clinical outcomes but higher odds of prolonged length of stay, relative to non–safety-net hospitals. Institution-level deficiencies in staffing and clinical processes of care might underpin the latter. Ongoing financial support of these institutions will ensure delivery of needed breast cancer care to economically disadvantaged patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Uptake and Tracer Kinetic of O-(2-(18)F-fluoroethyl)-L-Tyrosine in Meningioma
Authors: Basse Victor , Dissaux Gurvan , Seizeur Romuald , Bourhis David , Querellou Solène 
Published: November 2018

Abstract

18F-fluoroethyltyrosine (FET) is a well-established PET tracer for the imaging of cerebral gliomas. Recent studies reported interest in meningiomas. A study published by Cornelius et al concludes that FET PET may provide additional information for noninvasive grading of meningiomas. Indeed, the combination of tumor background ratio with a cutoff value of 2.3 associated with time activity curve pattern slightly improved the differentiation of high-grade from low-grade meningiomas (accuracy, 92%; P = 0.001). We present the case of a 75-year-old man that underlined the need to confirm the performance of these tools (curve pattern, tumor background ratios) to characterize meningiomas.
Gastric Ulcer Mimicking Malignancy on FDG PET/CT
Authors: Zhang Shumao , Shao Fuqiang , Chen Yue 
Published: November 2018

Abstract
A 52-year-old woman with newly diagnosed cervical carcinoma was referred an 18F-FDG PET/CT for staging. The PET/CT images demonstrated the known carcinoma and multiple enlarged lymph nodes with increased FDG activity. In addition, there was a focus of intense FDG activity characteristic of hypermetabolic malignancy in the region of gastric antrum. Finally, this lesion was confirmed as gastric ulcer by biopsy. This patient responded well to antiulcer treatment.
Textbook Outcomes Among Medicare Patients Undergoing Hepatopancreatic Surgery
Authors: Merath Katiuscha , Chen Qinyu , Bagante Fabio , Beal Eliza , Akgul Ozgur , Dillhoff Mary , Cloyd Jordan M. , Pawlik Timothy M. 
Published: November 2018

Objective:
To define and test “Textbook Outcome” (TO)—a composite measure for healthcare quality—among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed.

Background:
Composite measures of quality may be superior to individual measures for the analysis of hospital performance.

Methods:
The Medicare Provider Analysis and Review (MEDPAR) Inpatient Files were reviewed to identify Medicare patients who underwent pancreatic and liver procedures between 2013 and 2015. TO was defined as: no postoperative surgical complications, no prolonged length of hospital stay, no readmission ≤ 90 days after discharge, and no postoperative mortality ≤ 90 days after surgery. Medicare payments were compared among patients who achieved TO versus patients who did not. Multivariable logistic regression was used to investigate patient factors associated with TO. A nomogram to predict probability of TO was developed and validated.

Results:
TO was achieved in 44% (n = 5919) of 13,467 patients undergoing hepatopancreatic surgery. Adjusted TO rates at the hospital level varied from 11.1% to 69.6% for pancreatic procedures and from 16.6% to 78.7% for liver procedures. Prolonged length of hospital stay represented the major obstacle to achieve TO. Average Medicare payments were substantially higher among patients who did not have a TO. Factors associated with TO on multivariable analysis were age, sex, Charlson comorbidity score, previous hospital admissions, procedure type, and surgical approach (all P > 0.05).

Conclusions:
Less than one-half of Medicare patients achieved a TO following hepatopancreatic procedures with a wide variation in the rates of TO among hospitals. There was a discrepancy in Medicare payments for patients who achieved a TO versus patients who did not. TO could be useful for the public reporting of patient level hospital performance and hospital variation.
Clinical Factors Associated With Practice Variation in Discharge Opioid Prescriptions After Pancreatectomy
Authors: Newhook Timothy E. , Vreeland Timothy J. , Dewhurst Whitney L. , Wang Xuemei , Prakash Laura , Feng Chun , Bruno Morgan L. , Kim Michael P. , Aloia Thomas A. , Vauthey Jean-Nicolas , Lee Jeffrey E. , Katz Matthew H. G. , Tzeng Ching-Wei D. 
Published: November 2018

Objective:
To characterize opioid discharge prescriptions for pancreatectomy patients.

Background:
Wide variation in and over-prescription of opioids after surgery contribute to the United States opioid epidemic through persistent use past the postoperative period. Objective strategies guiding discharge opioid prescriptions for oncologic surgery are lacking, and factors driving prescription amount are not fully delineated.

Methods:
Characteristics of pancreatectomy patients (March 2016–August 2017) were retrospectively abstracted from a prospective database. Discharge opioids prescriptions were converted to oral morphine equivalents (OME). Regression models identified variables associated with discharge OME.

Results:
In 158 consecutive patients, median discharge OME was 250 mg (range 0–3950). Discharge OME was labeled “low” (<200 mg) for 33 patients (21%) and “high” (>400 mg) for 38 (24%). Only shorter operative time (odds ratio [OR]—0.14, P = 0.004) and inpatient team (OR—15.39, P < 0.001) were independently associated with low discharge OME. Older age was the only variable associated with high discharge OME. Fifty-seven patients (36%) used zero opioids in the last 24-hours predischarge, yet 52 of 57 (91%) still received discharge opioids. Older age (OR—1.07), grade B/C pancreatic fistula (OR—3.84), and epidural use (OR—3.12) were independently associated with zero last-24-hours OME (all P ≤ 0.040).

Conclusions:
The wide variation in discharge opioid prescriptions is heavily influenced by provider routine/bias and not by objective criteria such as last-24-hours OME. Quality improvement strategies could include aggressive weaning protocols to increase the proportion of patients with zero/near-zero last-24-hour OME and limiting prescriptions to a conservative multiplier of the last-24-hour OME.
Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma
Authors: Yeung Lawrence L. , McDonald Amy A. , Como John J. , Robinson Bryce , Knight Jennifer , Person Michael A. , Lee Jane K. , Dahm Philipp 
Published: November 2018

BACKGROUND
The diagnostic evaluation and clinical management of bladder injuries caused by blunt force trauma are variable. We aim to formulate a practice management guideline using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

METHODS
The working group, patient, intervention, comparator, outcome (PICO), formulated four questions regarding the following topics: (1) diagnostic evaluation based on patient baseline risk of bladder injury (computed tomography cystography vs. no imaging); (2) management of intraperitoneal bladder injuries (operative versus nonoperative); (3) management of extraperitoneal bladder injuries based on complexity of injury (operative vs. nonoperative); and (4) diagnostic follow-up of bladder injuries based on complexity of repair (cystography vs. no cystography). A systematic review of the MEDLINE database for English language articles with adult patients was undertaken. RevMan 5 (Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) and GRADEpro (GRADEpro GDT: GRADEpro Guideline Development Tool [Software]. McMaster University, 2015) software were used. Recommendations were voted on by working group members. Consensus was obtained for each recommendation.

RESULTS
Three hundred ninety-three articles were screened, resulting in a full-text review of 64 articles. Seventeen articles were used to formulate the recommendations of this guideline. Several recommendations are made. The need for initial computed tomography cystography after trauma depends on characteristics of the trauma itself, but it is not recommended in patients without gross hematuria. In general, patients with intraperitoneal bladder ruptures should undergo operative repair. This is not routinely necessary in those with extraperitoneal ruptures unless the injury is complex. The need for follow-up cystography after bladder repair depends on the risk of urine leak. Those with low risk of urine leak do not require a follow-up study.

CONCLUSION
Using the GRADE process, the panel made nine recommendations based on four PICO questions concerning the evaluation and management of blunt force bladder injuries.
Outcome of Liver Transplant Patients With High Urgent Priority: Are We Doing the Right Thing?
Authors: de Boer Jacob D. , Braat Andries E. , Putter Hein , de Vries Erwin , Strassburg Christian H. , Máthé Zoltán , van Hoek Bart , Braun Felix , van den Berg Aad P. , Mikulic Danko , Michielsen Peter , Trotovsek Blaz , Zoller Heinz , de Boer Jan , van Rosmalen Marieke D. , Samuel Undine , Berlakovich Gabriela , Guba Markus 
Published: November 2018

Background.
About 15% of liver transplantations (LTs) in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients who have acute liver failure (ALF) or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization.

Methods.
Patients who were listed for LT with HU status from January 1, 2007, up to December 31, 2015, were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with laboratory Model for End-Stage Liver Disease (MELD) score (labMELD) scores ≥40 (MELD 40+).

Results.
In the study period, 2299 HU patients were listed for LT. Ten days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary ALF showed better patient survival at 3 years (69%) when compared with patients in the MELD 40+ group (57%). HU patients with labMELD ≥45 and patients with HU status for acute retransplantation and labMELD ≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively.

Conclusions.
Current prioritization for patients with ALF is highly effective in preventing mortality on the waiting list. Although patients with HU status for ALF have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU status, over other recipients with an expected, substantially better prognosis after transplantation.