bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Apical Clearance on Mini-Scleral Lens Settling, Clinical Performance, and Corneal Thickness Changes
Authors: Esen Fehim , Toker Ebru 
Published: May 2016

Purpose:
The purpose of this work was to define the timing and magnitude of scleral contact lens settling, the factors influencing settling, and to examine whether the amount of apical clearance has an impact on clinical performance or is associated with hypoxia-induced corneal changes.

Methods:
Eleven patients (22 eyes) with keratoconus were fitted with a mini-scleral lens (Esclera, Brazil). Three different lenses with successively greater sagittal depths were applied to achieve 3 levels of initial apical clearance: 100 to 200 μm (low), 200 to 300 μm (medium), and greater than 300 μm (high). Corneal apical clearance was measured at 15 min, 1, 2, 4, 6, and 8 hr with optical coherence tomography (OCT). Central corneal thickness was measured with OCT and Pentacam, in the morning and immediately after removal of the contact lens.

Results:
Mean settling was 26.8±18.8 μm (42.7%) at 1 hr, 39.5±26.5 μm (62.9%) at 2 hr, 50.7±31.6 μm (80.8%) at 4 hr, 57.4±34.6 μm (91.4%) at 6 hr, and 62.8±38.4 μm (100%) at 8 hr. Settling rate was significantly lower in low apical clearance group (P=0.01). The smaller diameter lenses settled more (P=0.03). There was a slight statistically significant increase of 1.3% in central corneal thickness measured with OCT (P=0.03). Central corneal thickness measured with Pentacam at three locations increased slightly (P=0.001). Settling showed significant intrasubject and intersubject variations. The amount of corneal swelling and comfort scores did not differ significantly according to apical clearance.

Conclusions:
The average amount of settling was 62.8 μm after 8 hr, 80% of which occurred during the first 4 hr. Slight corneal swelling (1.3%) occurred after 8 hr of wear.
Pain sensitivity profiles in patients with advanced knee osteoarthritis
Authors: Frey-Law Laura A. , Bohr Nicole L. , Sluka Kathleen A. , Herr Keela , Clark Charles R. , Noiseux Nicolas O. , Callaghan John J. , Zimmerman M. Bridget , Rakel Barbara A. 
Published: May 2016

AbstractThe development of patient profiles to subgroup individuals on a variety of variables has gained attention as a potential means to better inform clinical decision making. Patterns of pain sensitivity response specific to quantitative sensory testing (QST) modality have been demonstrated in healthy subjects. It has not been determined whether these patterns persist in a knee osteoarthritis population. In a sample of 218 participants, 19 QST measures along with pain, psychological factors, self-reported function, and quality of life were assessed before total knee arthroplasty. Component analysis was used to identify commonalities across the 19 QST assessments to produce standardized pain sensitivity factors. Cluster analysis then grouped individuals who exhibited similar patterns of standardized pain sensitivity component scores. The QST resulted in 4 pain sensitivity components: heat, punctate, temporal summation, and pressure. Cluster analysis resulted in 5 pain sensitivity profiles: a “low pressure pain” group, an “average pain” group, and 3 “high pain” sensitivity groups who were sensitive to different modalities (punctate, heat, and temporal summation). Pain and function differed between pain sensitivity profiles, along with sex distribution; however, no differences in osteoarthritis grade, medication use, or psychological traits were found. Residualizing QST data by age and sex resulted in similar components and pain sensitivity profiles. Furthermore, these profiles are surprisingly similar to those reported in healthy populations, which suggests that individual differences in pain sensitivity are a robust finding even in an older population with significant disease.
Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment
Authors: Bhandari Rashmi P. , Feinstein Amanda B. , Huestis Samantha E. , Krane Elliot J. , Dunn Ashley L. , Cohen Lindsey L. , Kao Ming C. , Darnall Beth D. , Mackey Sean C. 
Published: May 2016

Abstract
The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.
Improving Operating Room Efficiency: First Case On-Time Start Project
Authors: Phieffer Laura , Hefner Jennifer L. , Rahmanian Armin , Swartz Jason , Ellison Christopher E. , Harter Ronald , Lumbley Joshua , Moffatt-Bruce Susan D. 
Published: May 2016

Background:
Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011.

Methods:
The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback.

Results:
By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department.

Conclusions:
Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.
The Use of Claims-Based Data in Inpatient Public Reporting and Pay-for-Performance Programs: Is There Opportunity for Improvement?
Authors: Crews Hazel R. , Chamness Amy R. , Terry Colin L. , Helft Paul R. 
Published: May 2016

Purpose:
This study examined whether self-reported, facility-based data validation practices for claims submissions of cases flagged as Patient Safety Indicators (PSIs) match professional and regulatory standards.

Methods:
The National Association of Healthcare Quality members who work in an inpatient setting were invited to complete an anonymous survey to self-report their practices around facility-based data validation of PSI cases.

Results:
The authors found widespread variation in how PSI administrative data are internally validated; inconsistency in the education and training required of staff who participate in this process; and relatively poor compliance with physician query guidelines and documentation amendment standards.

Conclusions:
The self-described wide variation and nonadherence to professional and regulatory standards within the facility-based validation process for PSIs raise concerns about the use of these data to make meaningful judgments about quality and safety. The authors recommend a standardized approach to reporting and validation be implemented for use of PSIs in public reporting and pay-for-performance programs.
Postoperative respiratory disorders
Authors: Ball Lorenzo , Battaglini Denise , Pelosi Paolo 
Published: May 2016

Purpose of review
Postoperative pulmonary complications (PPC) are a prominent determinant of postoperative morbidity, mortality, and increased use of healthcare resources. Several scores have been developed to identify patients at higher risk of PPC and have been proposed or validated as tools to predict postoperative respiratory disorders, stratify risk among patients requiring surgery, and to plan clinical studies. The aim of this review is to provide an update on the recent progresses in perioperative medicine concerning the risk assessment, prevention, and treatment of PPCs.

Recent findings
Efforts are being made to develop a uniform definition of PPCs; several scores have been developed and some of them externally validated. Their use can help the clinician to identify patients at higher risk, develop tailored strategies to mitigate the risk, and to perform a thoughtful allocation of healthcare resources. Intraoperative protective ventilation, with low tidal volume, low plateau pressure, low driving pressure and positive end expiratory pressure set at low-moderate levels titrated to avoid an increase in driving pressure and to achieve an acceptable gas exchange, can reduce the incidence of PPCs. Noninvasive positive pressure ventilation has an important role in the treatment of early stages of postoperative respiratory impairment, whereas not enough evidence is available concerning the use of routine prophylactic noninvasive continuous positive airway pressure postoperatively.

Summary
Several strategies can improve patients’ outcome, including risk assessment, intraoperative protective ventilation and postoperative noninvasive ventilation.
Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis
Authors: Pind Marie-Louise L. , Bendtsen Flemming , Kallemose Thomas , Møller Søren 
Published: May 2016

Background and aims
Portal hypertension is a severe consequence of chronic liver disease, responsible for the main clinical complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) provides important clinical information, but the procedure is invasive and demands expert skills of the staff.
In the present study, we aimed to investigate the relationship between the constant infusion indocyanine green (ICG) clearance, the calculated ICG retention test after 15 min (ICG-r15), and HVPG in patients with different severity of cirrhosis for validation of ICG-r15 as a noninvasive predictor of portal hypertension.

Methods
A total of 325 patients were studied. During a hemodynamic investigation, the ICG clearance was determined using the constant infusion technique and ICG-r15 was calculated.

Results
Assessment of the diagnostic performance of ICG clearance and ICG-r15 as predictors of HVPG above 10 mmHg was performed by receiver operating characteristic curve analyses.
The ICG clearance and ICG-r15 performed well in all three Child classes, with the most significant results among Child class A patients [area under the receiver operating characteristic (AUROC)=0.832] and less significant results in Child class B (AUROC=0.7448) and Child class C patients (AUROC=0.7392). Only six out of 102 patients in Child class C had HVPG of less than 12 mmHg.

Conclusion
ICG-r15 can be used as an indirect assessment of significant portal hypertension in compensated cirrhotic patients. ICG-r15 may be suitable as a screening tool for the identification of patients for endoscopy and measurement of HVPG.
Further validation of ICG-r15 together with other predictors of portal hypertension and its clinical use is encouraged.
Attitudes and practice related to Helicobacter pylori infection among primary care physicians
Authors: Boltin Doron , Kimchi Nimrod , Dickman Ram , Gingold-Belfer Rachel , Niv Yaron , Birkenfeld Shlomo 
Published: May 2016

Objectives

Helicobacter pylori infection is a major public health concern and primary care physicians (PCPs) are at the forefront of H. pylori management. We aimed to assess PCP attitudes related to H. pylori and identify areas where PCP practice deviates from the accepted guidelines.

Methods
A 13-item multiple-choice internet-based questionnaire was distributed to PCPs on a national level. Five questions were related to H. pylori detection, two were related to treatment, three were related to gastric cancer, and three were related to screening. The Maastricht IV/Florence Consensus Report was used as the benchmark for correct responses.

Results
A total of 314 PCP responses were included [140 (52%) men, age 48.2±12.9 years]. Of the total, 292 (93.0%) prescribed clarithromycin-based triple therapy for first-line treatment, 95 (30.3%) prescribed levofloxacin or bismuth-based protocols for second-line treatment, and 137 (43.6%) routinely confirmed eradication. Screening relatives of gastric cancer patients and screening before NSAID treatment was reported by 87 (30.9%) and 39 (14.1%) PCPs, respectively. Of all, 130 (45.0%) believed that the organism is definitely carcinogenic and only 188 (65.0%) agreed that H. pylori eradication reduces the risk of developing gastric cancer. Adherence with guidelines was associated with younger age, central urban clinic location, and a high volume of H. pylori patients.

Conclusion
Overall PCP adherence to H. pylori management guidelines is low. Public health agencies should advance educational initiatives aimed at closing these gaps.
Red blood cell distribution width and globulin, noninvasive indicators of fibrosis and inflammation in chronic hepatitis patients
Authors: Wang Huan , Xu Hongqin , Qu Limei , Wang Xiaomei , Wu Ruihong , Gao Xiuzhu , Jin Qinglong , Niu Junqi 
Published: May 2016

Aims
We aimed to develop new simple predictive models for significant fibrosis and inflammation in chronic hepatitis patients using routine laboratory parameters.

Methods
A total of 218 patients who had undergone liver biopsy were enrolled in our study. Among these, 116 had chronic hepatitis B, 65 had primary biliary cirrhosis, and 37 had autoimmune hepatitis. Patients were divided into two groups: absent–mild (S0–S1, G0–G1) and moderate–severe (S2–S4, G2–G4) according to the histologic severity of liver fibrosis and inflammation. All common demographics and routine laboratory parameters were analyzed.

Results
Red blood cell distribution width (RDW) and globulin values increased with progressive liver fibrosis and inflammation. After adjustment for other potent predictors, liver fibrosis was associated independently with RDW and platelet (odds ratio=0.976 and 1.487, respectively), whereas significant inflammation was associated independently with globulin, alanine aminotransferase, red blood cell, and platelet (odds ratio=1.153, 1.017, 0.392, and 1.487, respectively). The sensitivity and specificity of model A were 73.4 and 79.1% for the detection of significant liver fibrosis [area under the receiver-operating characteristic curve (AUROC)=0.81, P<0.001]. The sensitivity and specificity of model B were 75.9 and 88.9% for predicting advanced liver inflammation (AUROC=0.89, P<0.001). Compared with pre-existing indicators, model A achieved the highest AUROC (0.81, P<0.001) for liver fibrosis, whereas model B showed the highest AUROC (0.89, P<0.001) for liver inflammation.

Conclusion
RDW may provide a useful clinical value for predicting liver fibrosis; meanwhile, globulin may provide a useful clinical value for predicting liver inflammation in chronic hepatitis patients with other markers.
Heterogeneity of the bone marrow niche
Authors: Yu Vionnie W.C. , Scadden David T. 
Published: May 2016

Purpose of review
The bone marrow niche is increasingly recognized as heterogeneous with specific subtypes of mesenchymal niche cells governing the development or homeostasis of selective parenchymal hematopoietic subsets. The present review outlines recent efforts in dissecting these microniches regulated by unique cell pairings within the bone marrow and provides an overview of how the bone marrow orchestrates multiple facets of hematopoiesis.

Recent findings
Recent advancement in technologies has significantly improved our understanding of the cellular and molecular constituents that contribute to regulation of hematopoiesis and to maintenance of the hematopoietic stem cells (HSCs). Transgenic mouse models that enable endogenous cell deletion or lineage tracing, coupled with advanced intravital microscopy has identified several mesenchymal cell types, including the osteolineage cells, megakaryocytes, macrophages, perivascular cells, and Schwann cells, to be indispensible regulators of hematopoiesis. These niche cells, when perturbed, each caused very specific hematopoietic consequences including impairment in B-cell maturation, T lineage development, erythropoiesis, and impact different aspects of HSC behavior such as quiescence, mobilization, and response to acute stress signals.

Summary
The emerging concept is that the bone marrow environment is composed of multiple microniches, each consisting of unique pairing of distinct supportive stromal cells with distinct hematopoietic subtypes to regulate a particular branch of hematopoietic cell process. The bone marrow can be viewed as a carrier with subcompartments tailored to support different hematopoietic activities.
Advances in scar management: prevention and management of hypertrophic scars and keloids
Authors: Del Toro Drew , Dedhia Raj , Tollefson Travis T. 
Published: May 2016

Purpose of review
Abnormal scarring remains a poorly understood but functional and aesthetic consequence of surgical and traumatic wounds. The purpose of this review is to describe the current state of the science behind the prevention and management of these scars.

Recent findings
A recent update in the International Clinical Recommendations on Scar Management provides a wealth of information on new and revised treatments for hypertrophic scars and keloids. Silicone-based products continue to be the premier option for prevention and initial treatment of hypertrophic and keloid scars. There is growing evidence demonstrating the efficacy of intralesional corticosteroids and 5-fluorouracil. Laser therapy remains a second-line treatment option, with low-level evidence supporting the use of pulse dye lasers and ablative fractional lasers.

Summary
Although there remains no ‘gold standard’ for the prevention and treatment of hypertrophic scars and keloids, silicone gel products and microporous paper tape present the best conservative options. A stepwise algorithm for the treatment of hypertrophic scars or keloids based on the characteristics and responsiveness of the scar presents the best management strategy. Combination therapy (including steroid injections, 5-fluorouracil, and pulse dye laser) proves to be the strongest option for the nonsurgical management of severe hypertrophic scars and keloids.
Estimation of Fat‐free Mass at Discharge in Preterm Infants Fed With Optimized Feeding Regimen
Authors: Larcade Julie , Pradat Pierre , Buffin Rachel , Leick‐Courtois Charline , Jourdes Emilie , Picaud Jean‐Charles 
Published: May 2016

ABSTRACTObjectives:The purpose of the present study was to validate a previously calculated equation (E1) that estimates infant fat‐free mass (FFM) at discharge using data from a population of preterm infants receiving an optimized feeding regimen.Methods:Preterm infants born before 33 weeks of gestation between April 2014 and November 2015 in the tertiary care unit of Croix‐Rousse Hospital in Lyon, France, were included in the study. At discharge, FFM was assessed by air displacement plethysmography (PEA POD) and was compared with FFM estimated by E1. FFM was estimated using a multiple linear regression model.Results:Data on 155 preterm infants were collected. There was a strong correlation between the FFM estimated by E1 and FFM assessed by the PEA POD (r = 0.939). E1, however, underestimated the FFM (average difference: −197 g), and this underestimation increased as FFM increased. A new, more predictive equation is proposed (r = 0.950, average difference: −12 g).Conclusions:Although previous estimation methods were useful for estimating FFM at discharge, an equation adapted to present populations of preterm infants with “modern” neonatal care and nutritional practices is required for accuracy.
Learning From Experience: Improving Early Tracheal Extubation Success After Congenital Cardiac Surgery*
Authors: Winch Peter D. , Staudt Anna M. , Sebastian Roby , Corridore Marco , Tumin Dmitry , Simsic Janet , Galantowicz Mark , Naguib Aymen , Tobias Joseph D. 
Published: May 2016

Objectives:
The many advantages of early tracheal extubation following congenital cardiac surgery in young infants and children are now widely recognized. Benefits include avoiding the morbidity associated with prolonged intubation and the consequences of sedation and positive pressure ventilation in the setting of altered cardiopulmonary physiology. Our practice of tracheal extubation of young infants in the operating room following cardiac surgery has evolved and new challenges in the arena of postoperative sedation and pain management have appeared.

Design:
Review our institutional outcomes associated with early tracheal extubation following congenital cardiac surgery.

Patients:
Inclusion criteria included all children less than 1 year old who underwent congenital cardiac surgery between October 1, 2010, and October 24, 2013.

Measurements and Main Results:
A total of 416 patients less than 1 year old were included. Of the 416 patients, 234 underwent tracheal extubation in the operating room (56%) with 25 requiring reintubation (10.7%), either immediately or following admission to the cardiothoracic ICU. Of the 25 patients extubated in the operating room who required reintubation, 22 failed within 24 hours of cardiothoracic ICU admission; 10 failures were directly related to narcotic doses that resulted in respiratory depression.

Conclusions:
As a result of this review, we have instituted changes in our cardiothoracic ICU postoperative care plans. We have developed a neonatal delirium score, and have adopted the “Kangaroo Care” approach that was first popularized in neonatal ICUs. This provision allows for the early parental holding of infants following admission to the cardiothoracic ICU and allows for appropriately selected parents to sleep in the same beds alongside their postoperative children.