bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Diagnostic Accuracy of Ultrasound in Detecting Distal Radius Fractures in a Pediatric Population
Authors: Ko Chae , Baird Matthew , Close Matthew , Cassas Kyle J. 
Published: November 2017

Objective:
Sports ultrasound (US) is becoming popular in diagnosing musculoskeletal injuries. This study, also called the Pediatric Distal Radius Ultrasound Study (PeDRUS), compared the diagnostic accuracy of sports US with plain radiographs in possible distal radius buckle fractures in pediatric population.

Methods:
In this prospective observational study, patients (2-15 years) presenting to an outpatient orthopedic injury clinic with distal forearm injuries without deformity were recruited. Bedside ultrasonography was performed and interpreted by the investigators as positive or negative for fracture. Plain radiographs were then performed and interpreted by the same investigator. The radiographs were considered the definitive imaging study for this investigation.

Results:
Fifty-one patients were included with a mean age of 9.9 years. Fractures were diagnosed on both US and plain radiographs in 34 patients. Fractures were ruled out on both US and plain radiographs in 16 patients. There was only one case in which the US was interpreted differently than radiograph. For fractures of the distal radius in this population, the sensitivity was 97.1% [95% confidence interval (CI) = 89.2-97.1] and the specificity was 100% (95% CI = 82.5-100). The positive predictive value was 100% (95% CI = 91.8-100), whereas the negative predictive value was 94.1% (95% CI = 77.7-94.1). The positive likelihood ratio was infinite, suggesting utility in confirming a fracture. The negative likelihood ratio was 0.03 (95% CI = 0.03-0.13), suggesting that US has value in ruling out a fracture.

Conclusions:
Our study suggests that diagnostic sports US is sensitive and specific for detecting distal radius fractures in pediatric patients with nondeformed forearm injuries, demonstrating that US is an acceptable alternative to plain radiographs for evaluating fractures in a pediatric population.
Estimating Associations Between Medical Home Adoption, Utilization, and Quality
Authors: Martsolf Grant R. , Kandrack Ryan , Baird Matthew , Friedberg Mark W. 
Published: November 2017

Background:Methodological differences between evaluations of medical home adoption might complicate readers’ ability to draw conclusions across studies.Objectives:To study whether associations between medical home adoption and patient care are affected by methodological choices.Design, Setting, and Subjects:Among 71 practices participating in the Pennsylvania Chronic Care Initiative (a medical home pilot), we estimated cross-sectional and longitudinal associations between 4 definitions of “medical home adoption” [National Committee on Quality Assurance (NCQA) recognition in year 3, Medical Home Index scores at baseline and 3, and within-practice changes in Medical Home Index scores between baseline and year 3] and utilization and quality.Measurements:Six utilization and 6 quality measures.Results:In cross-sectional analyses at year 3, NCQA recognition was associated with higher rates of nephropathy monitoring (7.23 percentage points; confidence interval, 0.45–14.02), breast cancer screening (7.48; 2.11–12.86), and colorectal cancer screening (8.43; 2.44–14.42). In longitudinal analyses, NCQA recognition was associated with increases in hospitalization rates (2.75 per 1000 patient-months; 0.52–4.98). In baseline cross-sectional analyses, higher Medical Home Index scores were associated with fewer ambulatory care-sensitive hospitalizations (−0.61 per 1000 patient per month; −1.11 to −0.11), all-cause emergency department visits (−6.80; −12.28 to −1.32), and ambulatory care-sensitive emergency department visits (−5.60; 10.32 to −0.88). There were no statistically significant associations between any other measure of medical home adoption and quality or utilization.Conclusions:The findings of medical home evaluations are sensitive to methodological choices. Meta-analyses, narrative reviews, and other syntheses of medical home studies should consider subdividing their findings by analytic approach.
The Role of Mental Health Disease in Potentially Preventable Hospitalizations
Authors: Medford-Davis Laura N. , Shah Rohan , Kennedy Danielle , Becker Emilie 
Published: November 2017

Background:
Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors.

Objective:
The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality.

Design/Subjects:
The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008.

Measures:
A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date.

Results:
A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22–1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12–1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66–3.72 for age above 75 years compared with 18–44 y), black race (OR 1.44; 95% CI, 1.43–1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51–1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22–1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17–1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations.

Conclusions:
Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.
Understanding Disease Biology and Informing the Management of Pancreas Cancer With Preclinical Model Systems
Authors: Whittle Martin C. , Hingorani Sunil R. 
Published: November 2017

Abstract
Recent advances in cytotoxic therapies for pancreatic ductal adenocarcinoma (PDA) are overshadowed by stalled clinical progress of more targeted strategies, the vast majority of which have failed in clinical trials. Inability to translate preclinical promise into clinical efficacy derives, in part, from imperfect disease modeling and mismatches between preclinical and clinical study design and execution. Into these gaps fall our patients who enter the clinical trial landscape expectantly and bear the brunt of its inadequacies. If improving patient survival is paramount, then it must be acknowledged that the failure of a phase III trial represents a larger failure of all of the work that preceded it. Repeated failures suggest a need to reappraise the current preclinical-to-clinical apparatus. Exceptional models of PDA are now available to researchers, and the first steps toward a new era of success can begin with improved selection and application of these systems. We discuss the key features of the major preclinical platforms for PDA and propose a paradigm for rigorous interrogation of prospective therapies.
Diagnosis and Detection of Pancreatic Cancer
Authors: Chu Linda C. , Goggins Michael G. , Fishman Elliot K. 
Published: November 2017

Abstract
Computed tomography is the first-line imaging modality for suspected pancreatic cancer. Magnetic resonance cholangiopancreatography is a second-line modality for suspected pancreatic cancer and is usually reserved for equivocal cases. Both computed tomography and MR are highly sensitive in the detection of pancreatic cancer, with up to 96% and 93.5% sensitivity, respectively. Computed tomography is superior to MR in the assessment of tumor resectability, with accuracy rates of up to 86.8% and 78.9%, respectively. Close attention to secondary signs of pancreatic cancer, such as pancreatic duct dilatation, abrupt pancreatic duct caliber change, and parenchymal atrophy, are critical in the diagnosis of pancreatic cancer. Emerging techniques such as radiomics and molecular imaging have the potential of identifying malignant precursors and lead to earlier disease diagnosis. The results of these promising techniques need to be validated in larger clinical studies.
Clinical Management
Authors: White Rebekah R. , Lowy Andrew M. 
Published: November 2017

Abstract
Despite the identification of more active systemic therapy combinations for pancreatic cancer, cures remain elusive and feasible only in patients with localized, operable disease. When examining outcome data from phase III adjuvant trials conducted during the past decade, the survival for patients with localized disease has improved, likely owing to a combination of factors including more active adjuvant therapy and improved surgical and perioperative care. Perhaps the greatest recent change in the care of patients with localized pancreatic cancer has been the extension of surgery to tumors previously thought to be inoperable because of involvement of major blood vessels. These so-called “borderline resectable pancreatic cancers” have now been objectively defined, and their management is being studied in randomized trials. This has been made feasible by the availability of more active systemic therapy combinations that are increasingly being used in the neoadjuvant setting. Given the increasing activity of systemic regimens, the challenges in delivering such therapy in the postoperative setting, and the numerous novel agents in late stages of clinical development, it is reasonable to hypothesize that the neoadjuvant setting may eventually become the standard of care for patients with resectable disease.
Ablative Radiotherapy Doses for Locally Advanced
Authors: Crane Christopher H. , O’Reilly Eileen M. 
Published: November 2017

Abstract
Standard palliative doses of radiation for locally advanced unresectable pancreatic cancer have had minimal to no impact on survival. Randomized trials evaluating these palliative doses have not shown a significant survival benefit with the use of radiation as consolidation after chemotherapy. Results from nonrandomized studies of 3- to 5-fraction low-dose stereotactic radiation (SBRT) have likewise had a minimal impact, but with less toxicity and a shorter treatment time. Doses of SBRT have been reduced to half the level that is necessary (biological equivalent dose, BED of 53 Gy) to achieve tumor ablation in the treatment of other solid tumors (100 Gy BED) to protect the gastrointestinal (GI) tract. The survival benefit of these palliative options is modest. In contrast, ablative doses of radiation (100 Gy BED) can be delivered using the same SBRT technique in 15 to 25 fractions. In addition to precision tumor targeting and solutions for respiratory motion as with SBRT, the delivery of ablative doses takes advantage of heterogeneous dosing, increased fractionation, which allows higher doses to be given, as well as adaptive planning to address day-to-day GI tract motion in selected cases. These higher doses have resulted in encouraging long-term survival results in multiple studies. In this review, we discuss the critical concepts and components of techniques that can be used to deliver ablative radiotherapy doses for patients with pancreatic tumors: fractionation, intentional dose heterogeneity, respiratory gating, image guidance, and adaptive planning.
A tonic heat test stimulus yields a larger and more reliable conditioned pain modulation effect compared to a phasic heat test stimulus
Authors: Lie Marie Udnesseter , Matre Dagfinn , Hansson Per , Stubhaug Audun , Zwart John-Anker , Nilsen Kristian Bernhard 
Published: November 2017

Abstract

Introduction:
The interest in conditioned pain modulation (CPM) as a clinical tool for measuring endogenously induced analgesia is increasing. There is, however, large variation in the CPM methodology, hindering comparison of results across studies. Research comparing different CPM protocols is needed in order to obtain a standardized test paradigm.

Objectives:
The aim of the study was to assess whether a protocol with phasic heat stimuli as test-stimulus is preferable to a protocol with tonic heat stimulus as test-stimulus.

Methods:
In this experimental crossover study, we compared 2 CPM protocols with different test-stimulus; one with tonic test-stimulus (constant heat stimulus of 120-second duration) and one with phasic test-stimuli (3 heat stimulations of 5 seconds duration separated by 10 seconds). Conditioning stimulus was a 7°C water bath in parallel with the test-stimulus. Twenty-four healthy volunteers were assessed on 2 occasions with minimum 1 week apart. Differences in the magnitude and test–retest reliability of the CPM effect in the 2 protocols were investigated with repeated-measures analysis of variance and by relative and absolute reliability indices.

Results:
The protocol with tonic test-stimulus induced a significantly larger CPM effect compared to the protocol with phasic test-stimuli (P < 0.001). Fair and good relative reliability was found with the phasic and tonic test-stimuli, respectively. Absolute reliability indices showed large intraindividual variability from session to session in both protocols.

Conclusion:
The present study shows that a CPM protocol with a tonic test-stimulus is preferable to a protocol with phasic test-stimuli. However, we emphasize that one should be cautious to use the CPM effect as biomarker or in clinical decision making on an individual level due to large intraindividual variability.
Long-Term Patient-Reported Outcomes following Free Flap Lower Extremity Reconstruction for Traumatic Injuries
Authors: Egeler Sabine A. , de Jong Tim , Luijsterburg Antonius J. M. , Mureau Marc A. M. 
Published: November 2017

Background:
Reconstruction of severe lower extremity injuries using free flaps has become a reliable approach. Knowledge of long-term surgical outcomes, limb function, and quality of life is limited.

Methods:
Two hundred thirty-nine patients undergoing a free flap reconstruction of an open lower extremity fracture between 1993 and 2014 were divided into three groups and studied, as follows: group 1, early free flap reconstruction within 6 weeks; group 2, delayed reconstruction after 6 weeks; and group 3, delayed reconstruction with osteomyelitis. Patient-reported outcomes were assessed with the 36-Item Short-Form Health Survey and the Lower Extremity Functional Scale. Independent variables predicting outcomes were identified using multivariate analyses.

Results:
Patients in group 3 significantly more often experienced delayed union. Questionnaires were completed by 108 patients (mean follow-up, 9.7 years). The 36-Item Short-Form Health Survey physical component scores were significantly lower in all three groups compared with Dutch norms, as was the mental health score in group 3. There were no significant differences in quality of life and lower limb function among the three groups. Chronic pain was an independent predictor for decreased quality of life and limb function in groups 1 and 2, as was delayed union for decreased limb function in group 3.

Conclusions:
After free flap reconstruction of severe lower extremity injuries, all patient groups showed significantly lower quality of life compared to the Dutch population; however, there were no significant differences between the groups. Predictors for poorer quality of life and limb function were chronic pain and delayed union.
Inconsistency in Automated Reports of Scientific Productivity and Impact in Academic Plastic Surgery
Authors: Plana Natalie M. , Massie Jonathan P. , Bekisz Jonathan M. , Fryml Elise M. , Spore Stuart , Diaz-Siso J. Rodrigo , Flores Roberto L. 
Published: November 2017

Background:
Currently, no consensus metric for measuring academic productivity within plastic surgery exists. The h-index is widely used, as it captures both the quantity and quality of an individual’s contribution. However, discrepancies in online reporting make accurate h-index calculation challenging. This study highlights inconsistencies within plastic surgery by assessing differences in reporting of the h-index and other measures of academic productivity across online scientific databases.

Methods:
Plastic surgery faculty at institutions with Accreditation Council for Graduate Medical Education–accredited residency programs were identified and searched across four databases: Web of Science, Scopus, Google Scholar, and the National Library of Medicine (PubMed). The total number of publications, citations, and h-index were recorded for each author and analyzed using a Mann-Whitney test.

Results:
Seven hundred twenty-two faculty members were included in this study. Reporting of publications was highest in Google Scholar and lowest in Web of Science. Because of incomplete information (PubMed) and underuse (Google Scholar), h-index could be assessed only between Web of Science and Scopus, where the average discrepancy in citations and h-index was 722 and 7.0 per author, respectively. Discrepancies were more significant among faculty members holding a Ph.D. degree, higher academic rank, or belonging to the male gender.

Conclusions:
Inconsistencies between online scientific databases profoundly affect plastic surgeons. Given the importance placed on metrics such as the h-index, it is imperative that the plastic surgery community push for solutions that ensure more reliable, transparent, and cohesive reporting of academic productivity.
Quantification of the Effect of Shuttling on Computed Tomography Perfusion Parameters by Investigation of Aortic Inputs on Different Table Positions From Shuttle-Mode Scans of Lung and Liver Tumors
Authors: Ghosh Payel , Chandler Adam G. , Hobbs Brian P. , Sun Jia , Rong John , Hong David , Subbiah Vivek , Janku Filip , Naing Aung , Hwu Wen-Jen , Ng Chaan S. 
Published: November 2017

Objectives
The aim of this study was to quantify the effect of shuttling on computed tomography perfusion (CTp) parameters derived from shuttle-mode body CT images using aortic inputs from different table positions.

Methods
Axial shuttle-mode CT scans were acquired from 6 patients (10 phases, 2 nonoverlapping table positions 1.4 seconds apart) after contrast agent administration. Artifacts resulting from the shuttling motion were corrected with nonrigid registration before computing CTp maps from 4 aortic levels chosen from the most superior and inferior slices of each table position scan. The effect of shuttling on CTp parameters was estimated by mean differences in mappings obtained from aortic inputs in different table positions. Shuttling effect was also quantified using 95% limits of agreement of CTp parameter differences within-table and between-table aortic positions from the interaortic mean CTp values.

Results
Blood flow, permeability surface, and hepatic arterial fraction differences were insignificant (P > 0.05) for both within-table and between-table comparisons. The 95% limits of agreement for within-table blood volume (BV) value deviations obtained from lung tumor regions were less than 4.7% (P = 0.18) compared with less than 12.2% (P = 0.003) for between-table BV value deviations. The 95% limits of agreement of within-table deviations for liver tumor regions were less than 1.9% (P = 0.55) for BV and less than 3.2% (P = 0.23) for mean transit time, whereas between-table BV and mean transit time deviations were less than 11.7% (P < 0.01) and less than 14.6% (P < 0.01), respectively. Values for normal liver tissue regions were concordant.

Conclusions
Computed tomography perfusion parameters acquired from aortic levels within-table positions generally yielded higher agreement than mappings obtained from aortic levels between-table positions indicating differences due to shuttling effect.
Comparing Fourth Generation Statistical Iterative Reconstruction Technique to Standard Filtered Back Projection in Pediatric Head Computed Tomography Examinations
Authors: Thomas Anna Kalathil , Southard Richard , Curran John , Augustyn Robyn 
Published: November 2017

Objective
Although advanced statistical iterative reconstruction (IR) techniques are valued in pediatric computed tomography (CT) imaging, there is little published data on how these techniques affect image quality and radiation dose in the pediatric population. This is particularly true in the context of pediatric head CT examinations. This study analyzed the differences in image quality and several standard metrics of radiation dose on multidetector pediatric head CT examinations performed using standard filtered back projection (FBP) with reconstructions using iDose4, a fourth-generation statistical iterative reconstruction technique.

Materials and Methods
Using a retrospective review of 282 pediatric head CT examinations, we compared how iDose4 fared against FBP for effects on several standard metrics of radiation dose and qualitative and quantitative assessment of image quality.

Results
Our assessment revealed that examinations obtained using low-dose protocols reconstructed using iDose4, when compared with standard-dose examinations reconstructed using FBP, resulted in significant radiation dose reduction while performing equally or better in quantitative image quality parameters. For most qualitative image quality parameters, the iDose4 group demonstrated equal performance to standard filtered back technique with a few notable exceptions. In the parameter of image sharpness in the 1.5 to 7 year olds, iDose4 fared better than FBP. However, FBP outperformed iDose4 in the qualitative parameters of decreased image graininess/noise in patients older than 13 years, improved image sharpness in patients aged between 7 and 13 years, and improved visibility of small parts for those aged 7 to 13 years.

Conclusions
We conclude that iDose4 is effective at allowing significant radiation dose reduction while maintaining or, rarely, even improving quantitative image quality compared with FBP in the setting of pediatric head CT examinations. However, for certain qualitative image quality parameters in older-aged children, the use of iDose4 resulted in a poorer performance compared with FBP.
Artifactual Appearance of Thrombosis on Using Metal Artifact Reduction Software Reconstruction in Computed Tomographic Angiography
Authors: Thomas Richard , Aghayev Ayaz , Steigner Michael L. 
Published: November 2017

Abstract
The authors attempted to use metal artifact reduction software in 2 computed tomographic angiogram studies to decrease beam hardening. Although the beam hardening artifacts were reduced in the postprocessed images, there was an artifactual appearance of thrombosis in the adjacent arteries in the first case and in the inflow cannula of a left ventricular assist device in the second case. Comparison of the reconstructed images with the original images is therefore essential to avoid a misdiagnosis.