bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Wait Times for Cosmetic Blepharoplasty by ASOPRS Members
Authors: Knezevic Alexander , Yoon Michael K. 
Published: May 2017

Purpose:
Adequate access to subspecialty care is of concern to patients and physicians alike. One measure of availability is the wait time for cosmetic procedures. The authors investigated geographical differences in wait times for cosmetic upper eyelid blepharoplasty of American Society of Ophthalmic Plastic and Reconstructive Surgery members across the country.

Methods:
This study surveyed all 533 American Society of Ophthalmic Plastic and Reconstructive Surgery members’ practices in the United States based on the publically available contact information (www.asoprs.org). Scripted telephone calls were made requesting self-referred cosmetic upper eyelid blepharoplasty. Wait times until the first available appointment and time until the first available surgery date were collected.

Results:
Of the membership, 387 (72.6% response rate) respondents offered appointments for cosmetic upper eyelid blepharoplasty. Overall, 84.2% of respondents were male. Practice breakdown was 83.4% in private practice and 16.5% in academic practice. Median wait time until the next available appointment was 14 days (mean 21.2 days, 0–205 days; p = 0.145). Private practice wait time was shorter than academic (median 14 vs. 18 days, mean 19.7 vs. 28.9 days; p =0.004). However, there was wide variability based on region.

Conclusions:
Patients seeking cosmetic upper eyelid blepharoplasty have good access to care by American Society of Ophthalmic Plastic and Reconstructive Surgery members. There are variabilities based on academic versus private practice. Further study can evaluate whether similar findings exist for medically necessary functional procedures. This information may help assess the need for additional practitioners.
Effects of acute psychological stress on placebo and nocebo responses in a clinically relevant model of visceroception
Authors: Roderigo Till , Benson Sven , Schöls Margarita , Hetkamp Madeleine , Schedlowski Manfred , Enck Paul , Elsenbruch Sigrid 
Published: May 2017

Abstract
There is evidence to suggest a role of emotions in placebo and nocebo effects, but whether acute psychological stress changes the magnitude of placebo or nocebo responses has not been tested. In a clinically relevant model of visceroception, we assessed effects of acute psychological stress on changes in urgency and pain in response to positive or negative treatment suggestions. In 120 healthy volunteers, perceived urge-to-defecate and pain in response to individually calibrated rectal distensions were measured with visual analogue scales during a BASELINE. Participants then underwent the Trier Social Stress Test (N = 60) or a simple cognitive task (control, N = 60) and were randomized to positive (placebo), negative (nocebo), or neutral treatment information regarding intravenous administration of saline. The series of distensions was repeated, and changes in visual analogue scales from BASELINE to TEST were compared between groups using analysis of covariance and planned post hoc tests. Treatment information emerged as a main factor (P <0.001), supporting treatment information effects for both urgency and pain. Effects for urgency were modulated by stress (interaction effect: P <0.05): Positive information reduced urgency (P = 0.025), while negative information increased urgency (P = 0.026) only in stressed groups. For pain, effects of stress emerged for nocebo responses, which were only evident in stressed groups (P = 0.009). This is the first experimental study supporting effects of acute psychological stress on placebo and nocebo responses in visceroception. Results call for mechanistic as well as patient studies to assess how psychological stress shapes patients' treatment expectations and thereby affects health outcomes.
Improving Staffing and Nurse Engagement in a Neuroscience Intermediate Unit
Authors: Nadolski Charles , Britt Pheraby , Ramos Leah C. 
Published: May 2017

ABSTRACT
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit’s capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. Methods: This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. Design: The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. Discussion: The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
The Experiences of Medical Marijuana Patients: A Scoping Review of the Qualitative Literature
Authors: Ryan Jennie , Sharts-Hopko Nancy 
Published: May 2017

ABSTRACT
Medical marijuana is now legal in more than half of the United States but remains federally prohibited and classified as a schedule 1 drug. The chemical compounds in marijuana are known neuroprotectants; however, their clinical efficacy and safety have not been proven. Many healthcare providers remain unaware of the therapeutic potential of marijuana and its adverse effects. The conflicting laws and lack of guidance from healthcare professionals can lead to confusion and frustration for patients seeking this medication. Multiple factors contribute to the unique and varied experiences of medical marijuana patients. Because more individuals with neurological disorders seek therapeutic marijuana, it is important for healthcare professionals to understand their distinctive experiences. Qualitative research methodology is ideal to capture the thick descriptions of these experiences. This review examines the qualitative research exploring the experiences of medical marijuana patients and discusses common themes across all studies.
Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access
Authors: Perez Claudia Andira , Figueroa Stephen A. 
Published: May 2017

ABSTRACT

Introduction: Hyperosmolar therapy with hypertonic saline (HTS) is a cornerstone in the management of intracranial hypertension and hyponatremia in the neurological intensive care unit. Theoretical safety concerns remain for infiltration, thrombophlebitis, tissue ischemia, and venous thrombosis associated with continuous 3% HTS administered via peripheral intravenous (pIV) catheters. It is common practice at many institutions to allow only central venous catheter infusion of 3% HTS. Methods: Hospital policy was changed to allow the administration of 3% HTS via 16- to 20-gauge pIVs to a maximum infusion rate of 50 mL/h in patients without central venous access. We prospectively monitored patients who received peripheral 3% HTS as part of a quality improvement project. We documented gauge, location, maximum infusion rate, and total hours of administration. Patients were assessed for infiltration, erythema, swelling, phlebitis, thrombosis, and line infection. Results: There were 28 subjects across 34 peripheral lines monitored. Overall, subjects received 3% HTS for a duration between 1 and 124 hours with infusion rates of 30 to 50 mL/h. The rate of complications observed was 10.7% among all subjects. Documented complications included infiltration (n = 2), with an incidence of 6%, and thrombophlebitis (n = 1), with an incidence of 3%. Conclusions: There has been a long concern among healthcare providers, including nursing staff, in regard to pIV administration of prolonged 3% HTS infusion therapy. Our study indicates that peripheral administration of 3% HTS carries a low risk of minor, nonlimb, or life-threatening complications. Although central venous infusion may reduce the risk of these minor complications, it may increase the risk of more serious complications such as large vessel thrombosis, bloodstream infection, pneumothorax, and arterial injury. The concern regarding the risks of pIV administration of 3% HTS may be overstated and unfounded.
Lifestyle Counseling Intervention Effects on Counseling Quality in Patients With Stroke and Transient Ischemic Attack
Authors: Oikarinen Anne , Engblom Janne , Kyngäs Helvi , Kääriäinen Maria 
Published: May 2017

ABSTRACT

Background: Studies have shown that counseling about risk factor–related lifestyle habits can produce significantly beneficial changes in the lifestyle habits of patients with stroke. However, it is not sufficient only to provide a patient with appropriate information, but the quality of lifestyle counseling is also essential. The aim of the study was to investigate the effects of a lifestyle counseling intervention on lifestyle counseling quality in patients with stroke and transient ischemic attack. Methods: Posttest control group design was used. Patients with stroke and transient ischemic attack (n = 98), divided into intervention and control groups, completed the Counseling Quality Questionnaire after receiving lifestyle counseling at the hospital (January 2010 to October 2011). Data were analyzed with an analysis of variance. Results: The patients rated lifestyle counseling quality quite high in terms of all sum variables except patient centeredness. Counseling quality except for counseling resources was estimated to be significantly better by the intervention group. Conclusions: Lifestyle counseling quality at the hospital can be enhanced by a counseling intervention. More attention to factors that promote patient centeredness of counseling is required because patient centeredness has repeatedly been recognized as the weakest aspect of counseling by both patients with stroke and other patient groups.
Management of different types of gastric varices with band ligation: a 3-year experience
Authors: Seleem Waseem M. , Hanafy Amr S. 
Published: May 2017

Background and aim
Gastric varices (GVs) occur with an incidence of 20% in patients with portal hypertension. The aim of this study was to evaluate the efficacy of endoscopic band ligation (BL) as an option in the management of small-to-moderate nonbleeding GVs in cirrhotic patients.

Patients and methods
A total of 50 patients (GOV2; n=6, IGV1; n=34, IGV2; n=10) with nonbleeding small-to-moderate-sized GVs without local risk signs of bleeding, such as large size, red-colored elevated areas or red wales, and systemic factors of bleeding risk such as an international normalized ratio of at least 2 and a platelet count of 80 000/µl or less were subjected to endoscopic BL. The patients were followed up every 2 weeks for 1 month and then every 1.5 months for 6 months. The primary outcome was GV eradication, detection of complications such as postprocedural bleeding ulceration and mortality.

Results
The mean number of BL sessions was 2.2±0.8; post-BL ulceration occurred in two (4%) patients (n=2 in IGV1, P=0.61), bleeding occurred in one (2%) patient (n=1 in IGV1, P=0.79), and epigastric pain occurred in six (12%, n=4 in GOV2, n=2 in IGV1) patients. There was no mortality reported among patients treated with BL.

Conclusion
Endoscopic BL resulted in better outcome and a lower incidence of complications when used to treat small-to-medium-sized nonbleeding GVs. Further, early eradication can save effort and cost, thus avoiding the future risk of treatment of large or risky GVs with sclerotherapy.
Prevalence of intestinal complications in inflammatory bowel disease: a comparison between paediatric-onset and adult-onset patients
Authors: Herzog Denise , Fournier Nicolas , Buehr Patrick , Rueger Vanessa , Koller Rebekka , Heyland Klaas , Nydegger Andreas , Braegger Christian P. 
Published: May 2017

Introduction
Intestinal complications in inflammatory bowel disease indicate active inflammation and typically result in the intensification of therapy.

Aim
To analyse whether the rates of intestinal complications were associated with age at disease onset.

Patients and methods
Data from 1506 individuals with Crohn’s disease (CD) and 1201 individuals with ulcerative colitis (UC) were obtained from the Swiss inflammatory bowel disease cohort study database, classified into groups on the basis of age at diagnosis (<10, <17, <40 and >40 years of age), and retrospectively analysed.

Results
In CD patients, the rates of stricturing (29.1–36.2%), abdominal penetrating disease (11.9–18.2%), resectional surgery (17.9–29.8%) and perianal disease (14.7–34.0%) were correlated with disease duration, but not age at diagnosis. However, paediatric-onset CD was associated with higher rates of multiple, rectal and anal strictures and earlier colon surgery. In addition, perianal disease occurred earlier, required earlier surgical intervention, and was more often combined with stricturing and penetrating disease. Finally, anal fissures were more prevalent among younger patients. In UC patients, the rates of progression or extension of disease (0–25.8%) and colectomy (3.0–8.7%) were dependent on disease duration, but not age at disease onset. Paediatric-onset disease was associated with a higher rate of extensive colitis at diagnosis and earlier progression or extension of disease, and nonsurgically treated patients with the youngest ages at onset more frequently required antitumour necrosis factor-α treatments.

Conclusion
The higher rates of intestinal complications, including those of the small and large bowel and in the anal region, in paediatric-onset CD patients point towards a level of inflammation that is more difficult to control. Similar findings were also evident in UC patients.
Diabetic status and grade of nonalcoholic fatty liver disease are associated with lower baroreceptor sensitivity in patients with nonalcoholic fatty liver disease
Authors: Singh Akanksha , Kumar Mavidi S. , Jaryal Ashok K. , Ranjan Piyush , Deepak Kishore K. , Sharma Sanjay , Lakshmy Ramakrishnan , Pandey Ravindra M. , Vikram Naval K. 
Published: May 2017

Objectives
Baroreceptor sensitivity (BRS), a functional consequence of vascular stiffness, may be affected by the presence of diabetes mellitus (DM) and nonalcoholic fatty liver disease (NAFLD). The present study was designed to assess the effect of diabetic status and NAFLD grade on the BRS in patients with NAFLD.

Methods
Seventy-five individuals (25 NAFLD without DM, 25 NAFLD with DM and 25 controls) were recruited for the study who underwent anthropometric and body composition analysis along with estimation of plasma glucose, serum insulin and serum lipids. BRS and blood pressure variability (BPV) analysis was carried out in both time and frequency domains. Carotid–radial and carotid–dorsalis pedis artery pulse wave velocity, and radial artery augmentation index were computed as measures of arterial stiffness.

Results
BRS was found to be lower in the NAFLD with DM group as well those with grade II NAFLD compared with the controls. Correlation analysis showed a negative correlation of BRS with postprandial blood glucose level (r=−0.39) and BMI (r=−0.467). The diabetic status and grade of NAFLD were associated independently with a decrease in BRS as well as the low-frequency component of diastolic BPV. The augmentation index and carotid–distal pulse wave velocity were higher in the NAFLD with DM group compared with controls.

Conclusion
Both the diabetic status and grade of NAFLD were shown to have an independent effect on the decrease in the BRS with a consequent effect on BPV, with a greater influence of diabetic status rather than NAFLD grade on arterial stiffness.
Assessment of liver fibrosis with acoustic radiation force impulse imaging versus liver histology in patients with chronic hepatitis C: a pilot study
Authors: Kohla Mohamed A.S. , Abbasy Mohamed , Abozeid Mai , El-Abd Osama , Ezzat Sameera , Kohla Samah , Abdel-Rahman Mohamed 
Published: May 2017

Background
Acoustic radiation force impulse imaging (ARFI) involves the mechanical excitation of tissues using short-duration acoustic pulses to generate localized displacements in tissue. The displacements results in shear-wave propagation, tracked by ultrasonography (US) correlation-based methods and recorded in meters per seconds.

Aim
To compare (ARFI) integrated into a conventional US with the standard histological examination of liver biopsy specimens for the assessment of liver fibrosis.

Materials and methods
Histological fibrosis staging with standard liver biopsy using the Metavir scoring system as well as fibrosis assessment using ARFI were performed to 80 patients with chronic hepatitis C over a 3-month period.

Results
ARFI findings were identical to the biopsy findings in 61 (76.25%) patients.
Fifty-eight (67.5%) patients with an early fibrosis stage (F0, F1, and F2) by histology had identical fibrosis stages using ARFI.
Only 20 out of 26 patients with an advanced fibrosis stage (F3 and F4) using ARFI had advanced fibrosis histologically. In the advanced fibrosis stages, the sensitivity of ARFI was 70% and specificity was 80%, with positive and negative predictive values of 53.8 and 88.9%, respectively. The accuracy of detection of advanced fibrosis by ARFI was 77.5%.

Conclusion
ARFI imaging is a promising noninvasive US-based method for the assessment of liver fibrosis.
Impact of gastroesophageal reflux disease symptoms on the quality of life in pregnant women: a prospective study
Authors: Fill Malfertheiner Sara , Seelbach-Göbel Birgit , Costa Serban-Dan , Ernst Wolfgang , Reuschel Edith , Zeman Florian , Malfertheiner Peter , Malfertheiner Maximilian V. 
Published: May 2017

Objective
Pregnant women often suffer from gastroesophageal reflux disease (GERD). GERD symptoms are known to influence the quality of life; however, there is a lack of data in pregnant women. The aim of this study was to establish the impact of GERD symptoms on health-related quality of life (HRQOL) during pregnancy.

Participants and methods
A prospective longitudinal cohort study to investigate the impact of GERD symptoms on the HRQOL was carried out in 510 pregnant women and 330 nonpregnant women as controls. Two validated questionnaires, the Reflux Disease Questionnaire and the Quality of Life in Reflux and Dyspepsia Questionnaire, were used.

Results
The study showed a significant negative impact on HRQOL in pregnant women with GERD symptoms. All five areas, emotional distress, sleep disturbance, vitality, food/drink problems, and physical/social functioning, were significantly reduced, but the most significant impact was on sleep (Quality of Life in Reflux and Dyspepsia Questionnaire score −35%). Overall, quality of life in women with GERD worsened throughout pregnancy.

Conclusion
GERD is frequently seen in pregnant women and has a negative impact on HRQOL, especially in late pregnancy. Therefore, there is a need for adequate therapy of GERD in pregnant women and HRQOL could be an adequate monitoring tool in this population.
Cardiac Dysrhythmias Associated With Substitutive Use of Loperamide: A Systematic Review
Authors: Riaz Irbaz Bin , Khan Muhammad Shahzeb , Kamal Muhammad Umar , Sipra Qurat-ul-Ain Riaz , Riaz Anum , Zahid Umar , Bhattacharjee Sandipan 
Published: May 2017

Background:
Recently, several deaths secondary to cardiac arrhythmias have been reported in association with substitutive use of loperamide. Therefore, we conducted a systematic review of all reported cases to overview the epidemiologic patterns and clinical outcomes to better elucidate loperamide-induced cardiac complications.

Areas of Uncertainty:
Association between substitutive use of loperamide and cardiac arrhythmias.

Data Sources:
A comprehensive literature search was conducted across 6 databases using variety of keywords to identify all reports of cardiac side effects associated with loperamide abuse. Only original case reports of cardiac toxicity or cardiac arrhythmias after loperamide abuse or overuse were included. Data were extracted by 2 authors independently using a structured template from the selected reports. Quality assessment of the reports was performed by using a high-quality evaluation tool.

Results:
Thirteen reports describing 19 cases were included in our review. Except for coronary artery spasm in one case, cardiac arrhythmias were the major reported cardiac adverse event. The average age of patients was 31 years with majority being men (79%). The most common presentation was syncope (63%). All cases were reported in US except for 1 case. Three patients were concomitantly taking cimetidine, which is known to cause inhibition of CYP3A4 and CYP2C8 leading to increased levels of loperamide. Thirteen of 19 patients were successfully treated and discharged in a stable condition.

Conclusions:
Our results indicate that measures such as restricting over-the-counter availability of loperamide and increasing awareness regarding loperamide's toxicity are imperative to prevent deaths associated with loperamide abuse.
Application of Population Pharmacokinetic Modeling for Individualized Infliximab Dosing Strategies in Crohn Disease
Authors: Frymoyer Adam , Hoekman Daniël R. , Piester Travis L. , de Meij Tim G. , Hummel Thalia Z. , Benninga Marc A. , Kindermann Angelika , Park K.T. 
Published: May 2017

ABSTRACT

Objectives:
The pharmacokinetics of infliximab (IFX) is highly variable in children with Crohn disease (CD), and a one-size-fits-all approach to dosing is inadequate. Model-based drug dosing can help individualize dosing strategies. We evaluated the predictive performance and clinical utility of a published population pharmacokinetic model of IFX in children with CD.

Methods:
Within a cohort of 34 children with CD who had IFX trough concentrations measured, the pharmacokinetics of each patient was estimated in NONMEM using a published population pharmacokinetic model. Infliximab concentrations were then predicted based on each patient's dosing history and compared with actual measured concentrations (n = 59). In addition, doses 5 to 10 mg/kg and dosing intervals every 4 to 8 weeks were simulated in each patient to examine dose-trough relationships.

Results:
Predicted concentrations were within ±1.0 μg/mL of actual measured concentrations for 88% of measurements. The median prediction error (ie, measure of bias) was −0.15 μg/mL (95% confidence interval −0.37 to −0.05 μg/mL) and absolute prediction error (ie, measure of precision) was 0.26 μg/mL (95% confidence interval 0.15 to 0.40 μg/mL). At standard maintenance dosing of 5 mg/kg every 8 weeks, a trough >3 μg/mL was predicted to be achieved in 32% of patients. To achieve a trough >3 μg/mL, a dosing interval ≤every 6 weeks was predicted to be required in 29% of patients.

Conclusions:
A published IFX population pharmacokinetic model demonstrated accurate predictive performance in a pediatric CD population. Individualized IFX dosing strategies in children with CD will be critical to consistently achieve trough concentrations associated with optimal outcomes.