bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Prescribing Practices by Orthopaedic Trauma Surgeons After Isolated Femur Fractures
Authors: Attum Basem , Rodriguez-Buitrago Andres , Harrison Nichelle , Evans Adam , Obremskey William , Sethi Manish K. , Jahangir A. Alex 
Published: October 2017

Objective:
The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/nonorthopaedic members to narcotic naive and previously exposed patients, and provide narcotic prescribing recommendations.

Methods:
Patients older than 18 years with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive analysis of MMEs was then performed. Outliers and patients without prescriptions from orthopaedic providers were excluded to eliminate skewing of data. Mean and standard deviations were then calculated for patients without a history of opiates prescribed within 1 year of injury and for patients with a history of opiates prescribed within 1 year before the injury.

Results:
Forty-five percent (40/88) of patients were opiate exposed at the time of injury. Previously exposed patients received 1491 MMEs (SD, 1044; median, 1350; range, 210–5140) and nonexposed patients received 1363 MMEs (SD, 977.2; median, 1260; range, 105–4935) from orthopaedic providers (P = 0.1473). Nonorthopedists prescribed 530 MMEs (SD, 780.7; median, 140; range, 0–3515) to previously exposed patients and 175 MMEs (SD, 393; median, 140; range, 0–1890) to patients without exposure (P < 0.0001).

Conclusion:
Patients with prior exposure are more likely to be prescribed more opiates after femoral shaft fracture treatment. We recommend a protocol of prescribing half the mean of MMEs currently prescribed by orthopedists equating to 47 (711 MMEs) pills of oxycodone 10 mg in up to 3 prescriptions.
Development and Validation of an Abbreviated Questionnaire to Easily Measure Cognitive Failure in ICU Survivors: A Multicenter Study
Authors: Wassenaar Annelies , de Reus Jorn , Donders A. Rogier T. , Schoonhoven Lisette , Cremer Olaf L. , de Lange Dylan W. , van Dijk Diederik , Slooter Arjen J. C. , Pickkers Peter , van den Boogaard Mark 
Published: October 2017

Objectives:
To develop and validate an abbreviated version of the Cognitive Failure Questionnaire that can be used by patients as part of self-assessment to measure functional cognitive outcome in ICU survivors.

Design:
A retrospective multicenter observational study.

Setting:
The ICUs of two Dutch university hospitals.

Patients:
Adult ICU survivors.

Interventions:
None.

Measurements and Main Results:
Cognitive functioning was evaluated between 12 and 24 months after ICU discharge using the full 25-item Cognitive Failure Questionnaire (CFQ-25). Incomplete CFQ-25 questionnaires were excluded from analysis. Forward selection in a linear regression model was used in hospital A to assess which of the CFQ-25 items should be included to prevent a significant loss of correlation between an abbreviated and the full CFQ-25. Subsequently, the performance of an abbreviated Cognitive Failure Questionnaire was determined in hospital B using Pearson’s correlation. A Bland-Altman plot was used to examine whether the reduced-item outcome scores of an abbreviated Cognitive Failure Questionnaire were a replacement for the full CFQ-25 outcome scores. Among 1,934 ICU survivors, 1,737 were included, 819 in hospital A, 918 in hospital B. The Pearson’s correlation between the abbreviated 14-item Cognitive Failure Questionnaire (CFQ-14) and the CFQ-25 was 0.99. The mean of the difference scores was –0.26, and 95% of the difference scores fell within +5 and –5.5 on a 100-point maximum score.

Conclusions:
It is feasible to use the abbreviated CFQ-14 to measure self-reported cognitive failure in ICU survivors as this questionnaire has a similar performance as the full CFQ-25.
The Smurf transition: new insights on ageing from end-of-life studies in animal models
Authors: Rera Michael , Vallot Céline , Lefrançois Christel 
Published: October 2017

Purpose of review
Over the past 5 years, many articles were published concerning the prediction of high risk of mortality in apparently healthy adults, echoing the first description in 2011 of the Smurf phenotype, a harbinger of natural death in drosophila.

Recent findings
These recent findings suggest that the end-of-life is molecularly and physiologically highly stereotyped, evolutionarily conserved and predictable.

Summary
Taken altogether, these results from independent teams using multiple organisms including humans draw the lines of future directions in ageing research. The ability to identify and study individuals about to die of natural causes with no apparent diseases is a game-changer in this field. In addition, the public health applications are potentially of tremendous impact in our ageing societies and raise important ethical questions.
Signs of Facial Aging in Men in a Diverse, Multinational Study: Timing and Preventive Behaviors
Authors: Rossi Anthony M. , Eviatar Joseph , Green Jeremy B. , Anolik Robert , Eidelman Michael , Keaney Terrence C. , Narurkar Vic , Jones Derek , Kolodziejczyk Julia , Drinkwater Adrienne , Gallagher Conor J. 
Published: October 2017

BACKGROUND
Men are a growing patient population in aesthetic medicine and are increasingly seeking minimally invasive cosmetic procedures.

OBJECTIVE
To examine differences in the timing of facial aging and in the prevalence of preventive facial aging behaviors in men by race/ethnicity.

METHODS
Men aged 18 to 75 years in the United States, Canada, United Kingdom, and Australia rated their features using photonumeric rating scales for 10 facial aging characteristics. Impact of race/ethnicity (Caucasian, black, Asian, Hispanic) on severity of each feature was assessed. Subjects also reported the frequency of dermatologic facial product use.

RESULTS
The study included 819 men. Glabellar lines, crow's feet lines, and nasolabial folds showed the greatest change with age. Caucasian men reported more severe signs of aging and earlier onset, by 10 to 20 years, compared with Asian, Hispanic, and, particularly, black men. In all racial/ethnic groups, most men did not regularly engage in basic, antiaging preventive behaviors, such as use of sunscreen.

CONCLUSION
Findings from this study conducted in a globally diverse sample may guide clinical discussions with men about the prevention and treatment of signs of facial aging, to help men of all races/ethnicities achieve their desired aesthetic outcomes.
Tissue Augmentation with Allograft Adipose Matrix For the Diabetic Foot in Remission
Authors: Shahin Tala B. , Vaishnav Kairavi V. , Watchman Marcy , Subbian Vignesh , Larson Ethan , Chnari Evangelia , Armstrong David G. 
Published: October 2017

Background:Repetitive stress on the neuropathic plantar foot is the primary cause of diabetic foot ulcers. After healing, recurrence is common. Modulating plantar pressure has been associated with extension of ulcer free days. Therefore, the goal of this study was to determine the effects of an injectable allograft adipose matrix in providing a protective padding and reducing the pressure in the plantar foot.Methods:After healing his recurrent ulcer using total contact casting, a 71-year-old man with a 9-year history of recurrent diabetic foot ulcers was treated with injection of allograft adipose matrix, procured from donated human tissue. This was delivered under postulcerative callus on the weight-bearing surface of the distal end of the first ray resection. As is standard in our clinic for tissue augmentation procedures, our patient underwent serial plantar pressure mapping using an in-shoe pressure monitoring system.Results:There was a 76.8% decrease in the mean peak pressure due to the fat matrix injected into the second metatarsal region and a 70.1% decrease in mean peak pressure for the first ray resection at the site of the postulcerative callus. By 2 months postoperatively, there was no evidence of residual callus. This extended out to the end of clinical follow-up at 4 months.Conclusion:The results from this preliminary experience suggest that allograft adipose matrix delivered to the high risk diabetic foot may have promise in reducing tissue stress over pre- and postulcerative lesions. This may ultimately assist the clinician in extending ulcer-free days for patients in diabetic foot remission.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY TO DETECT MACULAR CAPILLARY ISCHEMIA IN PATIENTS WITH INNER RETINAL CHANGES AFTER RESOLVED DIABETIC MACULAR EDEMA
Authors: Moein Hamid-Reza , Novais Eduardo A. , Rebhun Carl B. , Cole Emily D. , Louzada Ricardo N. , Witkin André J. , Baumal Caroline R. , Duker Jay S. , Waheed Nadia K. 
Published: October 2017

Purpose:
To compare foveal vascular anatomy between patients with and without disorganization of retinal inner layers (DRILs) after resolved diabetic macular edema using optical coherence tomography angiography (OCTA).

Methods:
Twenty-four eyes of 21 age- and sex-matched patients with resolved diabetic macular edema were included in this retrospective, cross-sectional study. All eyes were imaged with enhanced high-definition line or cross-line structural B scans and 3 × 3-mm OCTA scans. Optical coherence tomography B scans were analyzed for the presence of DRIL, and based on this, eyes were classified as either DRIL present or DRIL absent. The foveal avascular zone area on OCTA was compared between patients with and without DRIL. The foveal avascular zone area was correlated with visual acuity.

Results:
Nine eyes with DRIL and resolved diabetic macular edema were compared with 15 control eyes without DRIL and resolved diabetic macular edema. Area of ischemia on OCTA scans corresponded to the area of DRIL as determined on OCT B scans. The foveal avascular zone area in full retina as well as superficial and deep retinal plexuses OCTA slabs were significantly larger in patients with DRIL as compared to those without DRIL (P = 0.005, P < 0.001, and P = 0.004, respectively). The larger foveal avascular zone in full retinal segmentation (r = 0.72, P = 0.03) and superficial plexus (r = 0.74, P = 0.02) were positively correlated with lower visual acuity.

Conclusion:
Optical coherence tomography angiography can visualize retinal ischemia in patients with and without DRIL. Correspondence of impaired blood flow with DRIL suggests that retinal ischemia and loss of normal vasculature contributes to DRIL.
ACQUIRED VITELLIFORM LESIONS THAT RESPOND TO IMMUNE SUPPRESSION IN A PATIENT WITH SARCOIDOSIS
Authors: Heymann Hans B. , Jampol Lee M. 
Published: October 2017

Purpose:
To describe a patient with sarcoid uveitis who developed bilateral vitelliform lesions with subretinal fluid that responded to immune suppression on three occasions.

Methods:
Chart review was performed on a single patient to collect all relevant clinical information and diagnostic imaging.

Results:
A case of sarcoidosis with acquired vitelliform lesions is described.

Conclusion:
Patients with ocular sarcoidosis can rarely develop vitelliform lesions. Our patient responded to systemic immune suppression.
De-novo versus recurrent hepatocellular carcinoma following direct-acting antiviral therapy for hepatitis C virus
Authors: Abdelaziz Ashraf O. , Nabil Mohamed M. , Abdelmaksoud Ahmed H. , Shousha Hend I. , Cordie Ahmed A. , Hassan Eman M. , Omran Dalia A. , Leithy Rania , Elbaz Tamer M. 
Published: October 2017

Introduction
A recent appearance of direct-acting antivirals (DAAs) led to a surge in hepatitis C virus (HCV) management. Nowadays, a large proportion of treated patients have cirrhosis with a retained possibility to develop hepatocellular carcinoma (HCC) even after complete cure. We aimed to study tumoral differences between patients who developed HCC after DAAs as either a recurrence or de-novo HCC.

Methods
We retrospectively analyzed 89 patients who presented to our HCC multidisciplinary clinic with HCC lesions following DAA therapy. A total of 45 patients had complete response to HCC according to the modified Response Evaluation Criteria in Solid Tumors before DAAs intake. Another 44 patients developed de-novo lesions after DAA treatment. Both groups were compared regarding their baseline characteristics, tumor criteria, response to DAAs as well response to HCC treatment.

Results
Both groups showed no significant difference regarding their baseline characteristics (age, sex, Child–Pugh score, and performance status) or response to DAAs (P=0.5). No significant difference was present between groups according to number, site, and size of lesions. However, time elapsed between the end of DAAs therapy and first diagnosis of HCC was significantly longer in de-novo group (15.22±16.39 months) versus recurrence group (6.76±5.1 months) (P=0.008). In addition, response to ablation was significantly better in de-novo lesions compared with recurrent HCC (P=0.03).

Conclusions
Although de-novo HCC lesions significantly developed later than recurrent lesions in DAAs-treated patients, their response rates were significantly better. No differences were detected between both groups in their response to DAAs and their tumoral characteristics.
Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults
Authors: Koma Jonathan W. , Donohue Julie M. , Barry Colleen L. , Huskamp Haiden A. , Jarlenski Marian 
Published: October 2017

Introduction:
Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states’ decisions to expand Medicaid increased recent smoking cessation.

Methods:
Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011–2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18–64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex.

Results:
Residence in a state with Medicaid coverage among low-income adult smokers ages 18–64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25–3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (−0.1 percentage point, 95% confidence interval, −2.1 to 1.8). Similar increases in smoking cessation among those ages 18–64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively).

Conclusion:
Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.
Diagnosis-based Cost Groups in the Dutch Risk-equalization Model
Authors: Eijkenaar Frank , van Vliet René C.J.A. , van Kleef Richard C. 
Published: October 2017

Background:
The risk-equalization (RE) model in the Dutch health insurance market has evolved to a sophisticated model containing direct proxies for health. However, it still has important imperfections, leaving incentives for risk selection. This paper focuses on refining an important health-based risk-adjuster in this model: the diagnosis-based costs groups (DCGs). The current (2017) DCGs are calibrated on “old” data of 2011/2012, are mutually exclusive, and are essentially clusters of about 200 diagnosis-groups (“dxgroups”).

Methods:
Hospital claims data (2013), administrative data (2014) on costs and risk-characteristics for the entire Dutch population (N≈16.9 million), and health survey data (2012, N≈387,000) are used. The survey data are used to identify subgroups of individuals in poor or in good health. The claims and administrative data are used to develop alternative DCG-modalities to examine the impact on individual-level and group-level fit of recalibrating the DCGs based on new data, of allowing patients to be classified in multiple DCGs, and of refraining from clustering.

Results:
Recalibrating the DCGs and allowing enrolees to be classified into multiple DCGs lead to nontrivial improvements in individual-level and group-level fit (especially for cancer patients and people with comorbid conditions). The improvement resulting from refraining from clustering does not seem to justify the increase in model complexity this would entail.

Conclusions:
The performance of the sophisticated Dutch RE-model can be improved by allowing classification in multiple (clustered) DCGs and using new data. Irrespective of the modality used, however, various subgroups remain significantly undercompensated. Further improvement of the RE-model merits high priority.
Impact of Nursing Home Palliative Care Teams on End-of-Life Outcomes
Authors: Temkin-Greener Helena , Mukamel Dana B. , Ladd Heather , Ladwig Susan , Caprio Thomas V. , Norton Sally A. , Quill Timothy E. , Olsan Tobie H. , Cai Xueya 
Published: October 2017

Background:
Deficits in end-of-life care in nursing homes (NHs) are reported, but the impact of palliative care teams (PCTeams) on resident outcomes remains largely untested.

Objective:
Test the impact of PCTeams on end-of-life outcomes.

Research Design:
Multicomponent strategy employing a randomized, 2-arm controlled trial with a difference-in-difference analysis, and a nonrandomized second control group to assess the intervention’s placebo effect.

Subjects:
In all, 25 New York State NHs completed the trial (5830 decedent residents) and 609 NHs were in the nonrandomized group (119,486 decedents).

Measures:
Four risk-adjusted outcome measures: place of death, number of hospitalizations, self-reported moderate-to-severe pain, and depressive symptoms. The Minimum Data Set, vital status files, staff surveys, and in-depth interviews were employed. For each outcome, a difference-in-difference model compared the pre-post intervention periods using logistic and Poisson regressions.

Results:
Overall, we found no statistically significant effect of the intervention. However, independent analysis of the interview data found that only 6 of the 14 treatment facilities had continuously working PCTeams throughout the study period. Decedents in homes with working teams had significant reductions in the odds of in-hospital death compared to the other treatment [odds ratio (OR), 0.400; P<0.001), control (OR, 0.482; P<0.05), and nonrandomized control NHs (0.581; P<0.01). Decedents in these NHs had reduced rates of depressive symptoms (OR, 0.191; P≤0.01), but not pain or hospitalizations.

Conclusions:
The intervention was not equally effective for all outcomes and facilities. As homes vary in their ability to adopt new care practices, and in their capacity to sustain them, reforms to create the environment in which effective palliative care can become broadly implemented are needed.
Low Expression of miR-18a as a Characteristic of Pediatric Acute Lymphoblastic Leukemia
Authors: Mosakhani Neda , Missiry Mohamed El , Vakkila Emmi , Knuutila Sakari , Vakkila Jukka 
Published: October 2017

Background:
Acute lymphoblastic leukemia (ALL) occurs in both adults and children but the response to chemotherapy and survival is significantly worse in the adults. We aimed to study whether the expression of immune system-associated miRNAs would differ between adult and pediatric patients with ALL at the time of diagnosis.

Materials and Methods:
Inflammation-associated miRNA analysis was performed in 19 adults and 79 pediatric patients with ALL and involved miR-10, miR-15, miR-16, miR-17-92 cluster, miR-33, miR-146a, miR-150, miR-155, miR-181a, miR-222, miR-223, and miR-339. MiRNAs were first analyzed by miRNA microarray and thereafter validated by qRT-PCR. Sufficient RNA for qRT-PCR was available for 42 pediatric and 19 adult patients.

Results:
Of the studied miRNAs, only miR-18a differed significantly in microarray analysis between adult and pediatric ALL, being lower in children (FC, −3.74; P, 0.0037). Results were confirmed by qRT-PCR (down-regulated in pediatric patients, P 0.003161). The other members of the miR-17-92 cluster did not differ significantly.

Conclusions:
Pediatric and adult patients with ALL have remarkably similar patterns of immune-cell–associated miRNAs in their bone marrow at diagnosis. However, the low expression of miR-18a in pediatric ALL is interesting and demands further study.
Elevated Serum Interleukin-6 Predicts Favorable Response to Immunosuppressive Therapy in Children With Aplastic Anemia
Authors: Lu Shuanglong , Qiao Xiaohong , Xie Xiaotian 
Published: October 2017

Background:
Immunosuppressive therapy (IST) is the standard treatment for aplastic anemia (AA) children who lack a sibling donor, but the clinical response rate to IST varies. Predictors of response to IST are valuable for stratifying AA patients and making clinical decisions.

Methods:
The serum interleukin (IL)-6 levels of 41 AA patients were measured at the time of diagnosis and the response rate of the patients to IST was evaluated at 3, 6, and 12 months after IST. Receiver-operator characteristic (ROC) analysis was used to calculate the predictive value of initial IL-6 levels in determining response at 6 months after IST.

Results:
The initial IL-6 levels were significant higher in responders than nonresponders at 6 months after IST (211.89 vs. 18.09 pg/mL; P=0.005), using 36.8 pg/mL as a threshold, there were 80% sensitivity and 81% specificity for discriminating responders and nonresponders to IST. Patients with initial high IL-6 level (>36.8 pg/mL) have favorable response rates than those with initial low IL-6 level (<36.8 pg/mL) at 3, 6, and 12 months after IST (P<0.01).

Conclusion:
High levels of IL-6 at the time of diagnosis predict a favorable response to IST in children with AA and this may be helpful for patient’s stratification and clinical decisions.
Breast Reconstruction and Radiation Therapy: An Update
Authors: Nelson Jonas A. , Disa Joseph J. 
Published: October 2017

Summary:
With the indications for radiation therapy in the treatment of breast cancer continuing to expand, many patients present for reconstruction having previously had radiation or having a high likelihood of requiring radiation following mastectomy. Both situations are challenging for the plastic surgeon, with different variables impacting the surgical outcome. To date, multiple studies have been performed examining prosthetic and autologous reconstruction in this setting. The purpose of this article was to provide a general platform for understanding the literature as it relates to reconstruction and radiation through an examination of recent systematic reviews and relevant recent publications. We examined this with a focus on the timing of the radiation, and within this context, examined the data from the traditional surgical outcomes standpoint as well as from a patient-reported outcomes perspective. The data provided within will aid in patient counseling and the informed consent process.