bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Deep Surgical Site Infections After Pediatric Spinal Fusion Surgery
Authors: Warner Stephen J. , Uppstrom Tyler J. , Miller Andy O. , O’Brien Sean T. , Salvatore Christine M. , Widmann Roger F. , Perlman Stephanie L. 
Published: June 2016

Study Design.Single-institution, retrospective case series.Objective.To determine whether the microbiology of deep surgical site infections (SSIs) after spinal fusion surgery for deformity has changed over the last decade at our institution.Summary of Background Data.SSI after pediatric spinal deformity surgery results in significantly increased patient morbidity and health care costs. Although risk factors are multifactorial, prophylactic and treatment antibiotic coverage is based in part on historical epidemiologic data, which may evolve over time.Methods.This study represents a retrospective review of clinical and microbiology records of patients less than 21 years old who underwent spinal deformity surgery at a single institution between 2000 and 2012. Patients were included who underwent index surgery at our institution and developed a deep SSI. Patients with growth-preserving spine constructs were excluded.Results.The overall incidence of deep SSI was 3.6% (39/1094). The incidence of deep SSI following primary surgery was 3.3% (34/1034) and 8.3% (5/60) following revision surgery. The incidence of deep SSI varied by primary diagnosis: idiopathic (1.0%), neuromuscular (14.3%), syndromic (5.3%), congenital (5.7%), and kyphosis (0.0%). The most common inciting pathogens wereStaphylococcus epidermidis(26%), methicillin-sensitiveStaphylococcus aureus(MSSA, 18%),Propionibacterium acnes(P. acnes; 18%), andEscherichia coli(18%). Sixteen of the 18 (89%) gram-negative infections occurred in neuromuscular patients (P = 0.006). Between 2000 and 2006 and between 2007 and 2012, MSSA occurred in 2/18 (11%) and 5/21 (24%) of cases (P = 0.41), methicillin-resistantS. aureusoccurred in 1/18 (6%) and 3/21 (14%) (P = 0.61), andP. acnesoccurred in 3/18 (17%) and 4/21 (19%) (P = 1.0).Conclusion.The epidemiology of deep SSI following spinal fusion for deformity in pediatric patients at our institution has not changed significantly during 13 years. Prophylactic antibiotic coverage for both gram-positive and gram-negative organisms may be indicated for patients with primary neuromuscular diagnoses.Level of Evidence:4
Robotic-Assisted Upper Face Rejuvenation
Authors: Rybakin Arthur V. , Borovikov Alexei M. , Manturova Natalia E. , Gladyshev Dmitriy V. , Kamalov David M. , Shcherbakov Kirill G. , Staisupov Valeriy J. , Kuzin Danila A. 
Published: June 2016

Summary:
Robotic-assisted technology has not been used in aesthetic surgery so far. The authors examined the feasibility and potential advantages of robotic-assisted technology in upper face rejuvenation surgery, as well as utility of the tools available in the market. Forehead lift was performed along with blepharoplasty in 4 patients. Robotic da Vinci Surgical System (Intuitive Surgical, Inc.) was used at the stage of dissection. The stereo endoscope 30 degrees, 12 mm and later 8.5 mm in diameter, and the set of tools, 8 mm and later 5 mm in diameter, were used. Overall results appeared to be essentially the same as after usual endoscope-assisted brow lift. The advantages of the robotic-assisted surgery were as follows: the best possible display, scalability of the picture; lack of tremor, scalability of the movements’ amplitude; high degree of freedom of movements exceeding human capabilities; quick and easy switch between the endoscope and any of the 3 manipulating arms; and enhanced comfort for a surgeon. The drawbacks noted were as follows: cost, steep learning curve, lack of tactile feedback, and absence of instruments specially adjusted for aesthetic surgery. The authors conclude that robots will enter the field of aesthetic plastic surgery in the same way as endoscopy, the proviso being to adjust tools to the specific needs.
Aligning for accountable care
Authors: Hilligoss Brian , Song Paula H. , McAlearney Ann Scheck 
Published: June 2016

Background:
Alignment within accountable care organizations (ACOs) is crucial if these new entities are to achieve their lofty goals. However, the concept of alignment remains underexamined, and we know little about the work entailed in creating alignment.

Purpose:
The aim of this study was to develop the concept of aligning by identifying and describing the strategic practices administrators use to align the structures, processes, and behaviors of their organizations and individual providers in pursuit of accountable care.

Approach:
We conducted 2-year qualitative case studies of four ACOs that have assumed full risk for the costs and quality of care for defined populations.

Findings:
Five strategic aligning practices were used by all four ACOs. Informing both aligns providers’ understandings with the goals and value proposition of the ACO and aligns the providers’ attention with the drivers of performance. Involving both aligns ACO leaders’ understandings with the realities facing providers and aligns the policies of the ACO with the needs of providers. Enhancing both aligns the operations of individual provider practices with the operations of the ACO and aligns the trust of providers with the ACO. Motivating aligns what providers value with the goals of the ACO. Finally, evolving is a metapractice of learning and adapting that guides the execution of the other four practices.

Practice Implications:
Our findings suggest that there are second-order cognitive (e.g., understandings and attention) and cultural (e.g., trust and values) levels of alignment, as well as a first-order operational level (organizational structures, processes, and incentives). A well-aligned organization may require ongoing repositioning at each of these levels, as well as attention to both cooperative and coordinative dimensions of alignment. Implications for research and practice are discussed.
Contextual factors associated with hospitals’ decision to operate freestanding emergency departments
Authors: Patidar Nitish , Weech-Maldonado Robert , O’Connor Stephen J. , Sen Bisakha , Trimm J.M. “Mickey” , Camargo Carlos A. 
Published: June 2016

Background:
Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs.

Purpose:
The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs.

Methodology:
All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011. Data on FSEDs were merged with American Hospital Association Annual Survey, Centers for Medicare and Medicaid Services’ Cost Reports, and Area Resource File data. The outcome variable consists of whether or not the hospital operates an FSED. Independent variables include per capita income, percent population over age of 65 years, primary care and specialist physicians per capita, urban location, change in the unemployment rate, change in the population, change in poverty level, market competition, total satellite and autonomous FSEDs in the market, Medicare-managed care penetration rate, hospital beds, total margin, and system membership. We used logistic regression analysis with state and year fixed effects. Standard errors in the regression were clustered by hospital.

Principal Findings:
The number of hospitals operating satellite FSEDs increased from 32 (2.33%) in 2002 to 91 (5.76%) hospitals in 2011 among the 14 states included in the study sample. The results support the hypothesis that hospitals located in munificent environments and more competitive environments (presence of other FSEDs) are more likely to operate an FSED. Organizational level factors such as bed size and system membership are associated with a hospital operating an FSED.

Practice Implications:
The findings may be used by policy makers in developing regulations for hospitals opening FSEDs. Also, study findings of this study may be used by hospitals to make informed decisions when formulating strategies regarding FSEDs.
Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality
Authors: Baldwin Richard , Chenoweth Lynnette , dela Rama Marie , Wang Alex Y. 
Published: June 2016

Background:Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size.Purpose:The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality.Methods:A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality—those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance.Findings:The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance.Discussion:The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed.Practice Implications:The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.
RETINAL DEEP CAPILLARY ISCHEMIA ASSOCIATED WITH AN OCCLUDED CONGENITAL RETINAL MACROVESSEL
Authors: Hasegawa Taiji , Ogata Nahoko 
Published: June 2016

Purpose:
To report the case of a patient with an occluded congenital retinal macrovessel accompanied by retinal deep capillary ischemia.

Methods:
A 38-year-old woman presented with a 2-day history of a paracentral scotoma of her right eye.

Results:
Fundus photograph showed a dilated congenital retinal macrovessel with arteriovenous anastomosis, an intravascular white region indicating the thrombus at arteriovenous anastomotic region, and an area of retinal whitening temporal to the fovea. The spectral domain optical coherence tomography images through the area of retinal whitening showed a thickening and highly reflectivity at the level of the inner nuclear layer, which is likely due to the deep capillary ischemia. After 6 weeks, spectral domain optical coherence tomography images through the same area demonstrated a thinning and atrophy of only the inner nuclear layer, and the patient's paracentral scotoma persisted.

Conclusion:
Acute capillary hemodynamic changes caused deep capillary ischemia. The spectral domain optical coherence tomography showed a highly reflective lesion at the level of the inner nuclear layer in the acute phase.
Low-Flow Arterialized Venous Malformations of the Orbit
Authors: Callahan Alison B. , Meyers Philip M. , Garrity James A. , Son Jung H. , Petris Carisa , Kazim Michael 
Published: June 2016

Purpose:
Orbital vascular malformations are classified by their hemodynamic properties, either high or low flow. Low-flow lesions may be simple venous, lymphatic, or combined lymphaticovenous malformations. The authors report a series of cases in which predominantly low flow, venous lesions were unexpectedly noted to have arterial feeders.

Methods:
A retrospective chart review of patients identified by the authors as having orbital varices with arterial components was conducted. The authors identified 7 such cases. After careful review, 2 cases were excluded due to inconclusive neuroradiographic findings. The authors review the clinical, radiologic, histopathologic, and surgical information from the remaining 5 cases and discuss their clinical significance.

Results:
All 5 cases were most consistent with variceal lesions: 3 as clinically distensible lesions and 2 as thrombosed lesions. Additional arterial feeder vessels were noted by angiography (3) or intraoperative visualization (2). The arterial contribution varied from faint vessels to distinct branches of the ophthalmic artery. Ages ranged from 13 to 61 years without predilection for gender. Treatments consisted of excision, embolization, and observation. Two poignant cases are highlighted: the first illustrating that an angiogram in isolation of its clinical picture can be misleading and result in treatment intervention with undue risk, and the second illustrating that inadequate treatment of unrecognized arterial components may contribute to recurrences.

Conclusions:
Low-flow orbital variceal lesions may have less prominent, arterial components. This type of combined arterialized venous malformation is largely unrecognized in the ophthalmic literature. Correct identification of these lesions is critical in providing safe, effective, and durable treatment.
A Pilot Randomized Controlled Trial of the Feasibility of a Multicomponent Delirium Prevention Intervention Versus Usual Care in Acute Stroke
Authors: Rice Karen L. , Bennett Marsha J. , Berger Linley , Jennings Bethany , Eckhardt Lynn , Fabré-LaCoste Nicole , Houghton David , Vidal Gabriel , Gropen Toby , Diggs Erica , Barry Erin , St. John Jennilee , Mathew Sheena , Egger Allison , Ryan Stephanie , Egger Raymond , Galarneau David , Gaines Kenneth , Ely E. Wesley 
Published: June 2016

Background:
Delirium after acute stroke is a serious complication. Numerous studies support a benefit of multicomponent interventions in minimizing delirium-related complications in at-risk patients, but this has not been reported in acute stroke patients. The purpose of this study was to explore the feasibility of conducting a randomized (delirium care) versus usual standardized stroke care (usual care) in reducing delirium in acute stroke.

Objective:
This pilot study assessed the feasibility of (1) enrollment within the 48-hour window when delirium risk is greatest, (2) measuring cognitive function using the Montreal Cognitive Assessment, (3) delivering interventions 7 days per week, and (4) determining delirium incidence in stroke-related cognitive dysfunction.

Methods:
A 2-group randomized controlled trial was conducted. Patients admitted with ischemic and hemorrhagic strokes and 50 years or older, English speaking, and without delirium on admit were recruited, consented, and randomized to usual care or delirium care groups.

Results:
Data from 125 subjects (delirium care, n = 59; usual care, n = 66) were analyzed. All Montreal Cognitive Assessment subscales were completed by 86% of subjects (delirium care, mean [SD], 18.14 [6.03]; usual care, mean [SD], 17.61 [6.29]). Subjects in the delirium care group received a mean of 6.10 therapeutic activities (range, 2–23) and daily medication review by a clinical pharmacist using anticholinergic drug calculations. Delirium incidence was 8% (10/125), 3 in the delirium care group and 7 in the usual care group.

Conclusion:
Findings support the feasibility of delivering a multicomponent delirium prevention intervention in acute stroke and warrants testing intervention effects on delirium outcomes and anticholinergic medication administration.
Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients
Authors: García Saínza , Martínez-Cengotitabengoa Mónica , López-Zurbano Saioa , Zorrilla Iñaki , López Purificación , Vieta Eduard , González-Pinto Ana 
Published: June 2016

Abstract
Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients.
The science and art of pediatric critical care nutrition
Authors: Martinez Enid E. , Mehta Nilesh M. 
Published: June 2016

Purpose of review
Nutritional status and nutrient delivery during critical illness impact clinical outcomes. We have reviewed recent studies that may guide best practices regarding nutrition therapy in critically ill children.

Recent findings
Malnutrition is prevalent in the pediatric ICU population, and is associated with worse outcomes. Nutrition support teams, dedicated dietitians, and educational programs facilitate surveillance for existing malnutrition and nutrition risk, but specific tools for the pediatric ICU population are lacking. Estimation of macronutrient requirements is often inaccurate; novel strategies to accurately determine energy expenditure are being explored. Indirect calorimetry remains the reference method for measuring energy expenditure. Enteral nutrition is the preferred route for nutrition in patients with a functioning gut. Early enteral nutrition and delivery of adequate macronutrients, particularly protein, have been associated with improved clinical outcomes. Delivery of enteral nutrition is often interrupted because of fasting around procedures and perceived intolerance. Objective measures for detection and management of intolerance to nutrient intake are required. In low-risk patients who are able to tolerate enteral nutrition, supplemental parenteral nutrition may be delayed during the first week of critical illness.

Summary
Systematic research and consensus-based practices are expected to promote optimal nutritional practices in critically ill children with the potential to improve clinical outcomes.
The Long-term Prospective Follow-up of Pancreatic Function After the First Episode of Acute Alcoholic Pancreatitis
Authors: Nikkola Jussi , Laukkarinen Johanna , Lahtela Jorma , Seppänen Hanna , Järvinen Satu , Nordback Isto , Sand Juhani 
Published: June 2016

Background:
Data on the prevalence of pancreatic dysfunction after an episode of acute pancreatitis are conflicting. Our aim was to evaluate the natural course of endocrine and exocrine pancreatic function in the long-term follow-up after the first episode of acute alcoholic pancreatitis (AAP).

Methods:
A total of 77 patients who survived their first episode of AAP between January 2001 and February 2005 were prospectively followed up for a maximum of 13 years. During the follow-up, patients were repeatedly interviewed and monitored for recurrences, new diabetes, and chronic pancreatitis. The pancreatic function was evaluated repeatedly during the follow-up.

Results:
Of the patients, 35% had ≥1 recurrent acute pancreatitis (RAP) episodes during the follow-up. New pancreatogenic diabetes developed in 19% of the previously nondiabetic patients, but only in patients with RAP (13/26 vs. 0/42; OR=39; 95% CI, 4.6-327.1). In addition, 55% of the patients developed new prediabetes or diabetes, and even this was more frequent in patients with RAP (86% vs. 42%; OR=8.2; 95% CI, 1.2-54.3). Exocrine dysfunction developed in 24% of the patients and was associated with abnormal findings in the endocrine function (P=0.003). Patients with RAP had a higher overall mortality compared with patients without RAP episodes during the follow-up (36% vs. 13%; HR=4.0; 95% CI, 1.4-11.0).

Conclusions:
The risk for pancreatic endocrine dysfunction, pancreatogenic diabetes and mortality increases significantly if the patient has recurrent episodes of AAP. The risk of developing pancreatic dysfunction after AAP should be recognized and pancreatic function should be screened routinely during the years after the first episode of AAP.
Azathioprine and 6-Mercaptopurine-induced Liver Injury
Authors: Björnsson Einar S. , Gu Jiezhun , Kleiner David E. , Chalasani Naga , Hayashi Paul H. , Hoofnagle Jay H. 
Published: June 2016

Objective:
The objective of the study was to define the clinical, biochemical, and histologic features of liver injury from thiopurines.

Background:
Azathioprine (Aza) and 6-mercaptopurine (6-MP) can cause liver injury, but no large series exist.

Methods:
Clinical and laboratory data and 6-month outcomes of patients with thiopurine hepatotoxicity from the Drug-Induced Liver Injury Network Prospective Study were analyzed.

Results:
Twenty-two patients were identified, 12 due to Aza and 10 due to 6-MP, with a median age of 55 years; the majority were female (68%). Inflammatory bowel disease was the indication in 55%, and the median thiopurine dose was 150 (range, 25 to 300) mg daily. The median latency to onset was 75 (range, 3 to 2584) days. Injury first arose after a dose escalation in 59% of patients, the median latency after dose increase being 44 (range, 3 to 254) days. At onset, the median alanine aminotransferase level was 210 U/L, alkaline phosphatase was 151 U/L, and bilirubin was 7.4 mg/dL (peak, 13.4 mg/dL). There were no major differences between Aza and 6-MP cases, but anicteric cases typically had nonspecific symptoms and a hepatocellular pattern of enzyme elevations, whereas icteric cases experienced cholestatic hepatitis with modest enzyme elevations in a mixed pattern. One patient with preexisting cirrhosis required liver transplantation; all others resolved clinically. One patient still had moderate alkaline phosphatase elevations 2 years after onset.

Conclusions:
Nearly three-quarters of patients with thiopurine-induced liver injury present with self-limited, cholestatic hepatitis, typically within 3 months of starting or a dose increase. The prognosis is favorable except in patients with preexisting cirrhosis.