bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiotherapy Alone or With Chemotherapy in the Management of Carcinoma of the Supraglottic Larynx
Authors: Rao Amy R. , Jones Daniel A. , Mendenhall Charles M. , Rizvi Syed N. , Kirwan Jessica , Morris Christopher G. , Johns Andrew , McAfee William J. , Mendenhall William M. 
Published: June 2017

Objectives:
The purpose of this study was to retrospectively review outcomes for patients treated with definitive radiotherapy for carcinoma of the supraglottic larynx at a community hospital and to compare our results with the literature.

Materials and Methods:
Treatment records of 46 patients with localized carcinoma of the supraglottic larynx treated from January 1987 through January 2012 were reviewed. Overall, 18 (39%) presented with stage I or II disease, whereas 28 (61%) presented with stage III to IV. In total, 30 patients (65%) were treated using hyperfractionation, whereas 16 (35%) received once-daily fractionation. Twelve patients (26%) received concurrent chemotherapy with weekly cisplatin. The Kaplan-Meier method was used to assess outcomes.

Results:
The median follow-up for the living patients was 6.7 years (range, 1.7 to 23.1 y). At 5 years, the local-regional control (LRC), ultimate LRC, laryngeal preservation, and overall survival (OS) rates were 70%, 82%, 65%, and 53%, respectively. At 5 years, disease-free survival and cause-specific survival rates were 75% and 76%, respectively. The 5-year OS rates by American Joint Committee on Cancer stage were as follows: I to II, 61%; III, 51%; and IV, 44%. For those receiving concurrent chemotherapy, there was no improvement in 5-year LRC (83% vs. 66%; P=0.4081) or OS (55% vs. 50%; P=0.7697). For those receiving hyperfractionation, there was no improvement in 5-year LRC (75% vs. 63%; P=0.3369) or OS (55% vs. 50%; P=0.4161).

Conclusions:
Our outcomes are similar to those reported in the literature. Neither hyperfractionation nor chemotherapy appeared to confer a benefit for disease control or OS possibly owing to small sample size and the inherent bias of a retrospective review.
PI3Ks in Diabetic Cardiomyopathy
Authors: Li Mingchuan , Murabito Alessandra , Ghigo Alessandra , Hirsch Emilio 
Published: June 2017

Abstract:Diabetic cardiomyopathy is a heart disease in diabetic patients, identified as ventricular dysfunction in the absence of coronary artery disease and hypertension. The molecular mechanisms underlying diabetic cardiomyopathy are still poorly understood. The protein and lipid kinase phosphoinositide 3-kinases (PI3Ks) have been suggested to regulate cardiac injury during diabetes. In this review, we will summarize the role of different PI3K isoforms and of their downstream signaling in the pathogenesis of diabetic cardiomyopathy, including the regulation of cardiac metabolism, contractility, hypertrophy, myocardial cell death, and inflammation.
Older Adult Attendance in Cardiac Rehabilitation
Authors: Zullo Melissa D. , Dolansky Mary A. , Josephson Richard A. , Cheruvu Vinay K. 
Published: July 2017

Purpose:
Older adults who use postacute care (PAC) after hospitalization for myocardial infarction (MI) are often overlooked as cardiac rehabilitation (CR) candidates because of physical limitations. This research describes the impact of functional status and PAC, including inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home health care (HHC), on CR initiation in Medicare beneficiaries discharged from the hospital following an index MI.

Methods:
The Chronic Condition Warehouse database of Medicare beneficiaries discharged to PAC following index MI in 2008 (n = 63 092) was used for this retrospective study. Functional status at PAC discharge was described as dependent, needed assistance, needed supervision, or independent. Logistic regression examined factors associated with CR initiation.

Results:
CR was initiated by 3% and 21% of beneficiaries discharged from PAC as dependent or independent, respectively. Beneficiaries who were dependent, needed assistance, or needed supervision were 78% (95% CI, 0.18-0.28), 60% (0.32-0.49), and 51% (0.41-0.57) less likely to initiate CR compared with independent beneficiaries. Those who had used IRF were 40% more likely to initiate CR compared with those who had used HHC, with no difference observed between those who had used SNF compared with HHC.

Conclusions:
Functional status at PAC discharge was strongly associated with CR initiation. Beneficiary initiation of CR was at proportions corresponding to the level of independence. Beneficiaries discharged from PAC as independent initiated CR at rates slightly higher than non-PAC users, and those discharged from IRF were more likely to initiate CR. These findings are promising and more targeted recruitment from PAC may increase CR initiation and completion, resulting in continued improvement in functional status.
Sustaining multistakeholder alliances
Authors: D’Aunno Thomas , Hearld Larry , Alexander Jeffrey A. 
Published: July 2017

Background:
Multistakeholder alliances that bring together diverse organizations to work on community-level health issues are playing an increasingly prominent role in the U.S. health care system. Yet, these alliances by their nature are fragile. In particular, low barriers to exit make alliances particularly vulnerable to disruption if key stakeholders leave. What factors are linked to the sustainability of alliances? One way to approach this question is to examine the perceptions of alliance participants, whose on-going involvement in alliances likely will matter much to their sustainability.

Purpose:
This study addresses the question: “Under what conditions do participants in alliances consider that their alliances are well positioned for the future, will perform well over time, and will be able to deal effectively with future challenges?”

Methods:
We draw on cross-sectional survey data collected in the summer of 2015 from a total number of 638 participants in 15 alliances that participated in the Robert Wood Johnson Foundation’s Aligning Forces for Quality program.

Results:
Results from regression analyses indicate that alliance participants are more likely to view their alliances as sustainable when they (a) share a common vision, goals, and strategies for the alliance and (b) perceive that the alliance has performed effectively in the past.

Practice Implications:
Leaders of multistakeholder alliances may need to ensure that alliances are collective efforts that build success one step at a time: to the extent that participants believe they share a vision and strategies and have had some prior success working together, the more likely they are to view the alliance as sustainable.
OUTCOMES OF PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION TREATED WITH ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR THREE OR MORE YEARS
Authors: Qin Vivian L. , Young Jason , Silva Fabiana Q. , Conti Felipe F. , Singh Rishi P. 
Published: July 2017

Purpose:
To summarize the findings of long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy (≥36 months) in patients with exudative age-related macular degeneration.

Methods:
Studies reporting long-term outcomes (≥36 months) of anti-VEGF therapy (n = 11) were identified and analyzed for changes in visual acuity (VA), optical coherence tomography, and safety findings.

Results:
Six prospective extension studies of Phase 3 clinical trials and five retrospective evaluation studies were identified. The largest improvements in VA with anti-VEGF treatment were found in Years 1 to 2 after treatment initiation. In five studies, VA ultimately declined below patients' pretreatment initial baseline; in three studies, VA ultimately returned to patients' baseline; in three studies, VA decreased but ultimately remained improved over patients' baseline. There was a trend demonstrating that a higher frequency of intravitreous injections showed a better maintenance in VA. Rates of adverse events were similar to previous registration studies of anti-VEGF drugs.

Conclusion:
The body of evidence to date regarding long-term anti-VEGF treatment indicates a variable course at greater than 36 months follow-up and seems to be dependent on the treatment protocol. Consistent dosing with fluid-free interval is suggested to maintain VA gains in patients with exudative age-related macular degeneration. There is no evidence suggesting that there are additional adverse events from long-term anti-VEGF use.
QUANTITATIVE ANALYSIS OF THE INNER RETINAL LAYER THICKNESSES IN AGE-RELATED MACULAR DEGENERATION USING CORRECTED OPTICAL COHERENCE TOMOGRAPHY SEGMENTATION
Authors: Muftuoglu Ilkay Kilic , Ramkumar Hema L. , Bartsch Dirk-Uwe , Meshi Amit , Gaber Raouf , Freeman William R. 
Published: June 2017

Purpose:
To characterize inner retinal damage in patients with dry age-related macular degeneration (AMD) using high-resolution spectral domain optical coherence tomography images.

Methods:
Sixty eyes of 60 patients with AMD were categorized using the Age-Related Eye Disease Study (AREDS) severity scale. Spectral domain optical coherence tomography images of these patients were quantified by manually correcting the segmentation of each retinal layer, including the retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer to ensure accurate delineation of layers. The mean ganglion cell complex thickness values (ganglion cell layer + inner plexiform layer + retinal nerve fiber layer) were compared with 30 eyes of 30 healthy subjects.

Results:
Ninety percent of eyes (81 eyes) required manual correction of segmentation. Compared with healthy subjects, mean ganglion cell complex thicknesses significantly decreased in more advanced dry AMD eyes, and this decrease was predominantly related to a change in inner plexiform layer thickness. There was no significant difference in thickness-related measurements between milder dry AMD (AREDS-2) eyes and healthy eyes (P > 0.05).

Conclusion:
In patients with dry AMD, automatic optical coherence tomography segmentation algorithms may be erroneous. As the severity of dry AMD increases, the inner plexiform layer layer becomes thinned, suggesting that transsynaptic degeneration may be occurring, as the photoreceptor layer is affected by AMD.
NOVEL PATIENT POSITIONING APPARATUS FOR RETINAL SURGERY IN A CASE OF SEVERE KYPHOSIS
Authors: Iaboni Douglas S. M. , Seamone Mark E. , Stairs Mary S. , O'Brien Daniel M. , Bisson M. Sheldon , Gupta R. Rishi 
Published: June 2017

Purpose:
To describe a novel patient positioning apparatus for intraocular surgery capable of accommodating patients with thoracic kyphosis.

Methods:
Case report.

Results:
A 60-year-old man presented with a macula-off retinal detachment and severe ankylosing spondylitis. The patient was scheduled for combined pars plana vitrectomy and scleral buckle. Because of the patient's severe kyphosis, a custom-designed positioning apparatus was built. The setup involved a canvas with 10 sewn-on straps and a Skytron operating table with strap inserts. Padding and blankets were also used to secure the patient comfortably in the Trendelenburg position. Surgery was uncomplicated and retinal detachment repair was successfully performed.

Conclusion:
To the authors' knowledge, this is the first report detailing a vest-like support apparatus for patients with thoracic kyphosis used in vitreoretinal surgery. This apparatus can be prepared using any conventional operating table, and it offers an effective approach to intraocular surgery for patients who cannot lie flat.
Influenza-associated Encephalitis/Encephalopathy Identified by the Australian Childhood Encephalitis Study 2013–2015
Authors: Britton Philip N. , Dale Russell C. , Blyth Christopher C. , Macartney Kristine , Crawford Nigel W. , Marshall Helen , Clark Julia E. , Elliott Elizabeth J. , Webster Richard I. , Cheng Allen C. , Booy Robert , Jones Cheryl A. 
Published: June 2017

Background:
Influenza-associated encephalitis/encephalopathy (IAE) is an important cause of acute encephalitis syndrome in children. IAE includes a series of clinicoradiologic syndromes or acute encephalopathy syndromes that have been infrequently reported outside East Asia. We aimed to describe cases of IAE identified by the Australian Childhood Encephalitis study.

Methods:
Children ≤ 14 years of age with suspected encephalitis were prospectively identified in 5 hospitals in Australia. Demographic, clinical, laboratory, imaging, and outcome at discharge data were reviewed by an expert panel and cases were categorized by using predetermined case definitions. We extracted cases associated with laboratory identification of influenza virus for this analysis; among these cases, specific IAE syndromes were identified where clinical and radiologic features were consistent with descriptions in the published literature.

Results:
We identified 13 cases of IAE during 3 southern hemisphere influenza seasons at 5 tertiary children’s hospitals in Australia; 8 children with specific acute encephalopathy syndromes including: acute necrotizing encephalopathy, acute encephalopathy with biphasic seizures and late diffusion restriction, mild encephalopathy with reversible splenial lesion, and hemiconvulsion-hemiplegia syndrome. Use of influenza-specific antiviral therapy and prior influenza vaccination were infrequent. In contrast, death or significant neurologic morbidity occurred in 7 of the 13 children (54%).

Conclusions:
The conditions comprising IAE are heterogeneous with varied clinical features, magnetic resonance imaging changes, and outcomes. Overall, outcome of IAE is poor emphasizing the need for optimized prevention, early recognition, and empiric management.
Neuroborreliosis in Swedish Children: A Population-based Study on Incidence and Clinical Characteristics
Authors: Södermark Liv , Sigurdsson Vignir , Näs Wilhelmina , Wall Pernilla , Trollfors Birger 
Published: June 2017

Background:

Borrelia burgdorferi is a common cause of bacterial meningitis, but there are very few studies on incidence in Europe. The aim of this study was to report the incidence and symptoms of neuroborreliosis in Swedish children.

Methods:
Medical records of children (< 15 years) treated for neuroborreliosis 2002–2014 were studied retrospectively. The patients were identified in the computerized registers of discharge diagnoses at the Departments of Pediatrics and Infectious Diseases in Gothenburg, Borås, Trollhättan and Halmstad using International Classification of Diseases 10 diagnosis codes G51.0, G01.9 and/or A69.1. Of those, patients with symptoms compatible with neuroborreliosis and a white blood cell count in cerebrospinal fluid ≥ 7 cells/mm3 with ≥ 80% mononuclear cells were included. Only children living in the city of Gothenburg and 10 surrounding municipalities were included.

Results:
Five hundred forty-eight children were included. The median age was 7 (1–14) years. The total incidence for the 13-year-period was 2.8/10,000 and remained unchanged during the period. The incidence was significantly higher in rural (4.0/10,000) than in urban municipalities (2.1/10,000). The most common presenting symptoms were headache (n = 335), fatigue (n = 330) and cranial nerve palsies (n = 329). The median duration of symptoms before admittance was 4.0 days for facial palsy and 14.0 days for other symptoms (P < 0.001). The median white blood cell count in cerebrospinal fluid was 129 (7–1069) cells/mm3.

Conclusions:
This study is the largest so far in a pediatric population. The incidence of neuroborreliosis was higher than in previous European reports. This might be explained by increased Borrelia awareness, the distribution of tick population in Sweden, and the possibility that Swedish children more frequently play outdoors.
Proactive Safety Management in Trauma Care: Applying the Human Factors Analysis and Classification System
Authors: Cohen Tara N. , Cabrera Jennifer S. , Litzinger Tracy L. , Captain Kevin A. , Fabian Michael A. , Miles Steven G. , Reeves Scott T. , Shappell Scott A. , Boquet Albert J. 
Published: July 2017

Introduction:
This article examines the reliability of the Human Factors Analysis and Classification System (HFACS) for classifying observational human factors data collected prospectively in a trauma resuscitation center.

Methods:
Three trained human factors analysts individually categorized 1,137 workflow disruptions identified in a previously collected data set involving 65 observed trauma care cases using the HFACS framework.

Results:
Results revealed that the framework was substantially reliable overall (κ = 0.680); agreement increased when only the preconditions for unsafe acts were investigated (κ = 0.757). Findings of the analysis also revealed that the preconditions for unsafe acts category was most highly populated (91.95%), consisting mainly of failures involving communication, coordination, and planning.

Conclusion:
This study helps validate the use of HFACS as a tool for classifying observational data in a variety of medical domains. By identifying preconditions for unsafe acts, health care professionals may be able to construct a more robust safety management system that may provide a better understanding of the types of threats that can impact patient safety.
Low-Intensity Pulsed Ultrasound Therapy for a Symptomatic Persistent Olecranon Physis in an Adolescent Baseball Pitcher
Authors: Botwin Kenneth , McMillen Thurston , Botwin Ariel 
Published: June 2017

Abstract:
A 15-year-old competitive right-handed high school baseball pitcher experienced an acute onset of right elbow pain when throwing. He initially treated it conservatively with rest alone for 3 months, but on return to throwing, he was still experiencing pain. Radiographs revealed that he had a persistent olecranon physis. He proceeded with a trial of low-intensity pulsed ultrasound therapy and attained radiographic evidence of bony union at 7 months postinjury, thus avoiding surgical intervention. He returned to pitching competitively 9 months after injury without elbow pain. This is the first reported case of using ultrasound bone stimulation for treatment of a symptomatic persistent olecranon physis in a baseball pitcher.
Multidisciplinary Assessment of 100 Athletes With Groin Pain Using the Doha Agreement: High Prevalence of Adductor-Related Groin Pain in Conjunction With Multiple Causes
Authors: Taylor Rachel , Vuckovic Zarko , Mosler Andrea , Agricola Rintje , Otten Roald , Jacobsen Philipp , Holmich Per , Weir Adam 
Published: June 2017

Objective:
To examine the prevalence of different causes of groin pain in athletes using the recent Doha consensus classification of terminology and definitions of groin pain in athletes.

Design:
Descriptive epidemiological study.

Setting:
Multidisciplinary sports groin pain clinic at Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.

Patients:
The clinical records of 100 consecutive athletes with complaints of groin pain who attended the multidisciplinary sports groin pain clinic between January and December 2014 were analyzed.

Main Outcome Measures:
The causes of groin pain were categorized according to terminology and definitions agreed upon at the Doha consensus meeting on groin pain classification in athletes. The classification system has 3 main subheadings; defined clinical entities for groin pain (adductor-related, iliopsoas-related, inguinal-related, and pubic-related groin pain), hip-related groin pain, and other causes of groin pain in athletes.

Results:
The majority of athletes were male (98%) soccer players (60%). Multiple causes for groin pain were found in 44% of the athletes. Adductor-related groin pain was the most prevalent defined clinical entity (61% of athletes), and pubic-related groin pain was the least prevalent (4% of athletes).

Conclusions:
Adductor-related groin pain is the most commonly occurring clinical entity in this athlete population in mainly kicking and change of direction sports and frequently, multiple causes are found.

Clinical Relevance:
This is the first study to use the Doha agreement classification system and highlights the prevalence of adductor-related groin pain and that often multiple clinical entities contribute to an athlete's groin pain. Consequently, prevention programs should be implemented with these factors in mind.
Assuring Sustainable Gains in Interdisciplinary Performance Improvement: Creating a Shared Mental Model During Operating Room to Cardiac ICU Handoff
Authors: Riley Christine M. , Merritt Amber D. , Mize Justine M. , Schuette Jennifer J. , Berger John T. 
Published: June 2017

Objective:
To understand sustainability and assure long-term gains in multidisciplinary performance improvement using an operating room to cardiac ICU handoff process focused on creation of a shared mental model.

Design:
Performance improvement cohort project with pre- and postintervention assessments spanning a 4-year period.

Setting:
Twenty-six bed pediatric cardiac ICU in a tertiary care children’s hospital.

Patients:
Cardiac surgery patients admitted to cardiac ICU from the operating room following cardiac surgery.

Interventions:
An interdisciplinary workgroup overhauled our handoff process in 2010. The new algorithm emphasized role delineation, standardized communication, and creation of a shared mental model. Our “I-5” mnemonic allowed validation and verification of a shared mental model between multidisciplinary teams. Staff orientation and practice guidelines were revised to incorporate the new process, visual aids were distributed and posted at each patient’s bedside, and lapses/audit data were discussed in multidisciplinary forum.

Measurements and Main Results:
Audits assessing equipment and information transfer during handoff were performed 8 weeks following implementation (n = 29), repeated at 1 year (n = 37), 3 years (n = 15), and 4 years (n = 50). Staff surveys prior to implementation, at 8 weeks, and 4 years postintervention assessed satisfaction. Comprehensiveness of information transfer improved in the 4 years following implementation, and staff satisfaction was maintained. At 4 years, discussion of all elements of information transfer was 94%, increased from 85% 8 weeks following implementation and discussion of four or more information elements was 100% increased from 93%. Of the 73% of staff who completed the survey at 4 years, 91% agreed that they received all necessary information, and 87% agreed that the handoff resulted in a shared mental model.

Conclusions:
Our methods were effective in creating and sustaining high levels of staff communication and adherence to the new process, thus achieving sustainable gains. Performance improvement initiatives require proactive interdisciplinary maintenance to be successful long term.