bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Mobile Application for Multiplier Method Growth and Epiphysiodesis Timing Predictions
Authors: Wagner Pablo , Standard Shawn C. , Herzenberg John E. 
Published: June 2016

Background:
The multiplier method (MM) is frequently used to predict limb-length discrepancy and timing of epiphysiodesis. The traditional MM uses complex formulae and requires a calculator. A mobile application was developed in an attempt to simplify and streamline these calculations. We compared the accuracy and speed of using the traditional pencil and paper technique with that using the Multiplier App (MA).

Methods:
After attending a training lecture and a hands-on workshop on the MM and MA, 30 resident surgeons were asked to apply the traditional MM and the MA at different weeks of their rotations. They were randomized as to the method they applied first. Subjects performed calculations for 5 clinical exercises that involved congenital and developmental limb-length discrepancies and timing of epiphysiodesis. The amount of time required to complete the exercises and the accuracy of the answers were evaluated for each subject.

Results:
The test subjects answered 60% of the questions correctly using the traditional MM and 80% of the questions correctly using the MA (P=0.001). The average amount of time to complete the 5 exercises with the MM and MA was 22 and 8 minutes, respectively (P<0.0001).

Conclusions:
Several reports state that the traditional MM is quick and easy to use. Nevertheless, even in the most experienced hands, performing the calculations in clinical practice can be time-consuming. Errors may result from choosing the wrong formulae and from performing the calculations by hand. Our data show that the MA is simpler, more accurate, and faster than the traditional MM from a practical standpoint.

Level of Evidence:
Level II.
Patient Comorbidity and Serious Adverse Events after Outpatient Colonoscopy: Population-based Study From Three States, 2006 to 2009
Authors: Chukmaitov Askar , Siangphoe Umaporn , Dahman Bassam , Bradley Cathy J. , BouHaidar Doumit 
Published: June 2016

BACKGROUND AND OBJECTIVE:Serious GI adverse events in the outpatient setting were examined for patients with a full spectrum of comorbid conditions and combinations of multiple comorbidities.DESIGN:This is a retrospective follow-up study.SETTING:Ambulatory surgery and hospital discharge data sets from California, Florida, and New York, 2006 to 2009, were used.PATIENTS:The outpatient colonoscopies of 4,234,084 adults aged 19 to 85 and over and payers were examined.MAIN OUTCOME:Thirty-day hospitalizations due to colonic perforations and GI bleeding, measured as cumulative outcomes, were investigated.RESULTS:About 24% of patients undergoing outpatient colonoscopy had a comorbid condition. In comparison with patients without comorbidities, the adjusted risks of adverse events were greater for patients with several single comorbidities and combinations of multiple comorbid conditions. Elderly patients and those treated in freestanding Ambulatory Surgery Centers had higher odds of colonic perforations and GI bleeding than younger patients and patients treated in hospital outpatient departments.LIMITATION:The study was constrained by limitations inherent in administrative data.CONCLUSIONS:Given the large number of outpatient colonoscopies performed in the United States, these procedures should be provided with caution to patients with chronic and multiple comorbidities and the elderly, because these populations are associated with higher rates of colonic perforations and GI bleeding.
Development of The American Society of Colon and Rectal Surgeons’ Rectal Cancer Surgery Checklist
Authors: Glasgow Sean C. , Morris Arden M. , Baxter Nancy N. , Fleshman James W. , Alavi Karim S. , Luchtefeld Martin A. , Monson John R. T. , Chang George J. , Temple Larissa K. 
Published: June 2016

BACKGROUND:
There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality.

OBJECTIVE:
The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer.

DESIGN:
A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed.

SETTINGS:
The study was conducted through meetings and discussion to consensus.

PATIENTS:
Patient data were extracted from an initial literature review.

MAIN OUTCOME MEASURES:
The checklist was measured by its ability to improve care in complex rectal surgery cases by reducing the possibility of omission through the division of treatment into 3 distinct phases.

RESULTS:
The process generated a 25-item checklist covering the spectrum of care for patients with rectal cancer who were undergoing surgery.

LIMITATIONS:
The study was limited by its lack of prospective validation.

CONCLUSIONS:
The American Society of Colon and Rectal Surgeons rectal cancer surgery checklist is composed of the essential elements of preoperative, intraoperative, and postoperative care that must be addressed during the surgical treatment of patients with rectal cancer.
Do Appendicitis and Diverticulitis Share a Common Pathological Link?
Authors: Harvey Jesslynne , Roberts Patricia L. , Schoetz David J. , Hall Jason F. , Read Thomas E. , Marcello Peter W. , Francone Todd D. , Ricciardi Rocco 
Published: June 2016

OBJECTIVE:
The aim of this study was to determine whether there is an association between appendicitis and diverticulitis.

DESIGN:
This study is a retrospective cohort analysis.

SETTING:
This study was conducted in a subspecialty practice at a tertiary care facility.

PATIENTS:
We examined the rate of appendectomy among 4 cohorts of patients: 1) patients with incidentally identified diverticulosis on screening colonoscopy, 2) inpatients with medically treated diverticulitis, 3) patients who underwent left-sided colectomy for diverticulitis, and 4) patients who underwent colectomy for left-sided colorectal cancer.

INTERVENTIONS:
There were no interventions.

MAIN OUTCOME MEASURES:
The primary outcome measured was the appendectomy rate.

RESULTS:
We studied a total of 928 patients in this study. There were no differences in the patient characteristics of smoking status, nonsteroidal use, or history of irritable bowel syndrome across the 4 study groups. Patients with surgically treated diverticulitis had significantly more episodes of diverticulitis (2.8 ± 1.9) than the medically treated group (1.4 ± 0.8) (p < 0.0001). The rate of appendectomy was 8.2% for the diverticulosis control group, 13.5% in the cancer group, 23.5% in the medically treated diverticulitis group, and 24.5% in the surgically treated diverticulitis group (p < 0.0001). After adjusting for demographics and other clinical risk factors, patients with diverticulitis had 2.8 times higher odds of previous appendectomy (p < 0.001) than the control groups.

LIMITATIONS:
The retrospective study design is associated with selection, documentation, and recall bias.

CONCLUSIONS:
Our data reveal significantly higher appendectomy rates in patients with a diagnosis of diverticulitis, medically or surgically managed, in comparison with patients with incidentally identified diverticulosis. Therefore, we propose that appendicitis and diverticulitis share similar risk factors and potentially a common pathological link.
Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome
Authors: Kwik Michele , Maxwell Elizabeth 
Published: June 2016

Purpose of review
Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS.

Recent findings
The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.
Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers.

Summary
More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.
Juvenile-onset Normal Tension Glaucoma From Chronic, Recurrent Low Cerebrospinal Fluid Pressure
Authors: Yusuf Imran H. , Ratnarajan Gokularaj , Kerr Richard S. , Salmon John F. 
Published: June 2016

Introduction:
The evidence for low cerebrospinal fluid pressure (CSFP) as a key parameter in the pathogenesis of glaucoma is increasing. Primate models have demonstrated the onset normal tension glaucoma (NTG) from experimentally induced chronic intrathecal hypotension; an approach not possible in human subjects.

Case Presentation:
A 27-year-old man presented with a central scotoma in his left eye. He had undergone 8 CSF shunt revision procedures over a 25-year period secondary to recurrent low CSFP following surgical excision of a pinealoblastoma, aged 2. A focal nerve fiber layer defect was detected in the left eye associated with reduced retinal sensitivity on microperimetry. Three adjacent optic disc hemorrhages had been documented in the same position over an 18-month period. A diagnosis of left-sided NTG was made; the patient was started on Latanoprost 0.005%. A new generation CSF shunting device (ProGAV)—which neutralizes CSFP fluctuations analogously to trabeculectomy surgery for intraocular pressure—was considered necessary in this patient to alleviate persistent headaches and reduce the risk of progressive glaucomatous visual loss.

Conclusions:
This exceptional case illustrates how premature onset NTG may occur as a result of chronic, recurrent intrathecal hypotension—a “pure” human model. We describe an original management approach of implanting an adjustable, programmable CSF shunt valve (ProGAV) to reduce fluctuations in the translaminar cribrosa pressure difference, and reduce the risk of glaucomatous visual loss.
Evaluation of the Implementation of an Allergy Assessment Tool as an Antimicrobial Stewardship Initiative
Authors: Shannon Kathleen T. , Krop Lynne C. 
Published: June 2016

Background
Novel antimicrobial stewardship initiatives are crucial to decrease the prevalence of multidrug-resistant pathogens and decrease morbidity and mortality at a time when the development of new antibiotic agents is slow-moving and antimicrobial resistance is increasing. The aim of this study was to compare the percentage of patients who received β-lactam therapy for the treatment of bacterial infections before and after the implementation of a formal allergy assessment protocol. This study also compared the clinical outcomes and incidence of adverse events in patients who underwent a pharmacist-driven allergy assessment to guide antibiotic therapy compared with patients who did not receive a formal allergy assessment.

Methods
A total of 63 adult inpatients with a β-lactam allergy reported in the electronic medical record and active orders for alternative antibiotic agents were prospectively enrolled between October 2014 and April 2015 and were compared with 63 patients at a sister hospital with similar infectious diagnoses to determine the percentage of patients transitioned to β-lactam therapy.

Results
The percentage of patients transitioned to β-lactam antibiotics in the intervention and control groups (63 patients each) was 36 (57%) and 14 (22%), respectively (P = 0.0019). The incidence of mortality was similar between groups at 1 (2%) of 63 patients in the intervention group and 4 (6%) of 63 patients in the control group (P = 0.168). There were no infusion-related or allergic reactions reported in the intervention group.

Conclusions
Standardized, pharmacist-led allergy assessments allow for easier conversion to first-line β-lactam antibiotic therapy, indicating that formal allergy assessments may serve as an important antimicrobial stewardship tool.
Retroperitoneal Abscess Caused by Streptococcus mitis
Authors: Rishi Muhammad Tipu , Rishi Abdul , Macaron Shady H. , Palesty Alexander 
Published: June 2016

Abstract
Retroperitoneal abscess is an uncommon infection that is associated with high morbidity. Early diagnosis is imperative; however, due to its insidious onset and subtle presentation, the diagnosis is often missed. We report a case of a retroperitoneal abscess caused by Streptococcus mitis which is usually not implicated as a serious pathogen, at least in immunocompetent patients.
Posttraumatic stress disorder symptoms in youth with vs without chronic pain
Authors: Noel Melanie , Wilson Anna C. , Holley Amy Lewandowski , Durkin Lindsay , Patton Michaela , Palermo Tonya M. 
Published: June 2016

Abstract
Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.
Anabolic and anticatabolic agents in critical care
Authors: Stanojcic Mile , Finnerty Celeste C. , Jeschke Marc G. 
Published: June 2016

Purpose of review
A complex network of hormones and other effectors characterize the hypermetabolic response in critical illness; these mediators work together to induce numerous pathophysiologic alterations. Increased incidence of infection, multiorgan failure, long-term debilitation, delays in rehabilitation, and death result from an inability to meet the prohibitively elevated protein and energy requirements, which occur during illness and can persist for several years. Pharmacologic interventions have been successfully utilized to attenuate particular aspects of the hypermetabolic response; these modalities are a component of managing critically ill patients – including those patients with severe burns. Here, we review recent advances in pharmacologically attenuating the hypermetabolic and catabolic responses.

Recent findings
Propranolol, a nonspecific β-adrenergic receptor antagonist, is one of the most widely used anticatabolic therapies. Oxandrolone, testosterone, and intensive insulin therapy represent anabolic pharmacological strategies. Promising therapies, such as metformin, glucagon-like peptide 1, peroxisome proliferator-activated receptor agonists, are currently being investigated.

Summary
Profound metabolic derangements occur in critically ill patients; this hypermetabolic response is a major contributor to adverse outcomes. Despite the pharmacological therapies currently available to counteract this devastating cascade, future studies are warranted to explore new multimodality agents that will counteract these effects while maintaining glycemic control and preventing unfavorable complications.
Impact of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration on the management of pancreatic cystic lesions
Authors: Rodríguez-D’Jesús Antonio , Fernández-Esparrach Glòria , Boadas Jaume , Busquets Juli , Fernández-Cruz Laureano , Ferrer Joana , Vaquero Eva C. , Molero Xavier , Navarro Salvador , Sánchez-Cabús Santiago , Araujo Isis K. , Sendino Oriol , Córdova Henry , Sánchez-Montes Cristina , Ginès Angels 
Published: June 2016

Background and study aims
Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are well-recognized techniques for the study of pancreatic cystic lesions (PCLs). However, little evidence exists on their impact on clinical care. The aim of this study is to determine how often EUS and EUS-FNA alter the diagnosis and management of patients with PCLs.

Patients and methods
Eight physicians expert in pancreatic diseases were asked to report their diagnoses and management recommendations for 49 different PCLs. Clinical information was sequentially disclosed in a stepwise manner – progressively from clinical data plus computed tomography or MRI (level 1), to EUS (level 2) and EUS-FNA results including cytology, carcinoembryonic antigen, and amylase levels (level 3).

Results
EUS led to a change in the diagnosis and management in 30% [95% confidence interval (CI): 26–35%] and 19% (95% CI: 16–23%) of cases, respectively, usually to a more intensive approach (14%; 95% CI: 11–18%). EUS-FNA altered the diagnosis and management in an additional 39% (95% CI: 34–44%) and 21% (95% CI: 17–25%) of the evaluations, respectively. EUS-FNA also increased the consensus in the diagnosis among the specialists that ranged from fair with computed tomography/MRI (κ-index=0.32) to substantial with EUS-FNA (κ-index=0.43).

Conclusion
EUS and EUS-FNA impact the diagnosis and management of patients with PCLs; therefore, both are necessary in the workup of these patients. EUS-FNA markedly improves the agreement between physicians in terms of diagnosis, but not management. This study highlights the need for more research and standardization in the field.
New clinical and molecular insights into Silver–Russell syndrome
Authors: Giabicani Eloïse , Netchine Irène , Brioude Frédéric 
Published: June 2016

Purpose of review
The purpose of review is to summarize new outcomes for the clinical characterization, molecular strategies, and therapeutic management of Silver–Russell syndrome (SRS).

Recent findings
Various teams have described the clinical characteristics of SRS patients by genotype. A clinical score for the definition of SRS and for orienting molecular investigations has emerged. Insulin-like growth factor 2 (a major fetal growth factor) has been implicated in the pathophysiology of SRS, as the principle molecular mechanism underlying the disease is loss of methylation of the 11p15 region, including the imprinted insulin-like growth factor 2 gene. Maternal uniparental disomy of chromosome 7 and recently identified rare molecular defects have also been reported in patients with SRS. However, 40% of patients still have no molecular diagnosis.

Summary
The definition of SRS has remained clinical since the first description of this condition, despite the identification of various molecular causes. The clinical issues faced by these patients are similar to those faced by other patients born small for gestational age (SGA), but patients with SRS require specific multidisciplinary management of their nutrition, growth, and metabolism, as they usually present an extreme form of SGA. Molecular analyses can confirm SRS, and are of particular importance for genetic counseling and prenatal testing.
Propofol Use in Pediatric Patients With Food Allergy and Eosinophilic Esophagitis
Authors: Mehta Pooja , Sundaram Shikha S. , Furuta Glenn T. , Pan Zhaoxing , Atkins Dan , Markowitz Scott 
Published: June 2016

ABSTRACTPropofol is a safe, well‐tolerated anesthetic that is labeled as contraindicated in patients with egg or soy allergy. This contraindication has become increasingly problematic given the rising incidence of food allergy and eosinophilic esophagitis (EoE). To address this issue, we studied practice patterns of propofol use for esophagogastroduodenoscopies in children with EoE and food allergies at our institution. A retrospective observational study of 1365 esophagogastroduodenoscopies from January 2013 to June 2014 was performed. Data were analyzed using Student t tests, chi square tests, Fisher exact tests, and multivariable logistic regression. We found that propofol was used significantly less in patients with egg or soy allergy, and in patients with EoE, even after adjusting for the presence of food allergy. There was no difference in complication rates relative to propofol use. Propofol was used safely in pediatric patients with EoE and food allergy in this limited single‐center review.
Are Expectations Too High for Transitioning Adolescents With Inflammatory Bowel Disease? Examining Adult Medication Knowledge and Self‐Management Skills
Authors: Fishman Laurie N. , Mitchell Paul D. , Lakin Paul R. , Masciarelli Lisa , Flier Sarah N. 
Published: June 2016

ABSTRACTObjective:Transition readiness assessment has focused attention on adolescent knowledge and skills, but data‐driven benchmarks have not been established.Methods:Patients with inflammatory bowel disease (IBD), ages 25 to 50 years, attending an outpatient gastroenterology clinic, were recruited to complete a voluntary, confidential survey asking patients to recall medications and potential side effects, and to rate their degree of independence performing health maintenance tasks.Results:The 141 respondents (48% response rate) had mean age of 36 years with median disease duration of 11 years. They were 60% female, 54% had Crohn disease, and 23% were diagnosed before age 18. Nearly all patients were fully independent answering doctor's questions during the visit (93%) and scheduling office visits (92%). Excluding pharmacy pick up, full independence seen in only 57%, whereas 16% significantly delegated tasks. No differences by sex, disease type, medication class, age at disease onset, or disease duration were found across levels of self‐management. Almost all (97%) respondents could recall medication name, whereas fewer were able to recall dose (63%) or frequency (65%). Side effect knowledge was poor; among 81 patients on a biologic or immunomodulator, only 17 (21%) cited cancer and 22 (27%) cited infection.Conclusions:Adolescent IBD transition programs now have empirical data from the present study about adult benchmarks for independence in self‐management skills. Further research can establish which skills correlate with medication adherence and active collaboration with the medical team. The present study also exposes important gaps in medication risk knowledge and may allow improved patient education for subgroups of adult patients with IBD.