bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel insights of disability assessment in adult myositis
Authors: Espinosa-Ortega Hector Fabricio , Moreno-Ramirez Mariana , Alexanderson Helene 
Published: August 2017

Purpose of review
To review the novel development of standardized clinical outcome measures used in adult patients with idiopathic inflammatory myopathies (IIMs). A further aim was to determine what aspects of IIM are covered by these outcome measures according to the International Classification of Functioning, Disability and Health (ICF).

Recent findings
The sporadic inclusion body myositis functional assessment (sIFA) is the first diagnosis-specific patient-driven patient-reported outcome measure. The adult myositis assessment tool (AMAT) is a new outcome measure assessing physical performance. Also, new criteria to assess response to treatment have been presented for both adults and children with IIM. The ICF provides a standardized frame and structure to report outcome, including functional disability. Using this framework, it is evident that there is a lack of validated patient-reported outcome measures to assess disease aspects important to patient, and that no studies have evaluated life-style factors such as physical activity in these patients.

Summary
The sIFA will ensure patient-relevant patient-reported assessment of activity limitations in patients with inclusion body myositis. The AMAT is a partly validated tool that needs to be used in clinical trials for further validation. The response criteria will enhance assessment of individual response to different treatments.
Myoepithelioma of Soft Tissue With Both Squamous and Adipocytic Metaplasia
Authors: Elsensohn Ashley , Mo Joshua H. , Maly Tyler J. , Lee Patrick K. , de Feraudy Sebastien 
Published: August 2017

Abstract:Soft tissue, or cutaneous, myoepitheliomas are rare tumors arising solely from a myoepithelial origin. These neoplasms are typically associated with uncertain differentiation and can contain cellular morphologies that include spindle, plasmacytoid, epithelioid, or clear cell forms. Soft tissue myoepitheliomas are commonly found on the lower limbs and in the pelvic girdle but can occur throughout the body. A small minority display heterogenous differentiation, typically osseous or cartilaginous in nature. Squamous and adipocytic cell types are much rarer. We report the case of myoepithelioma of soft tissue with both squamous and adipocytic metaplasia. In the largest myoepithelioma series of 101 soft tissue myoepitheliomas, there were only 2 cases of squamous metaplasia and 1 case of adipocytic metaplasia. Our case displays the unique occurrence of 2 rare histologic findings occurring simultaneously within an already uncommon neoplasm.
Measurement Bias of Polyp Size at Colonoscopy
Authors: Sakata Shinichiro , Klein Kerenaftali , Stevenson Andrew R. L. , Hewett David G. 
Published: August 2017

BACKGROUND:
The success of current and proposed strategies to reduce colorectal cancer (CRC) incidence and mortality rates are fundamentally based on measurement accuracy.

OBJECTIVE:
The aim of this study was to evaluate the densities of colorectal polyps individually measured at colonoscopy and whether measurement bias is a systemic phenomenon among colonoscopists.

DESIGN:
A population-wide, observational study.

SETTING:
All hospitals of the government-funded health system in Brisbane, Australia.

PATIENTS:
Our study investigated measurement bias at colonoscopy through systematic analysis of 8,591 individual polyp measurements recorded from 12,597 colonoscopies. All colonoscopies performed over a 12-month period between December 1, 2014, and November 30, 2015, were included.

RESULTS:
A total of 12,597 electronic colonoscopy reports were individually reviewed, hospital-by-hospital, and 8,591 individual size measurements from 18,276 detected polyps (47%) were obtained.

LIMITATIONS:
Our study is limited because the true size of unresected polyps was unknown. We chose not to compare pathologic and histologic sizes as resection specimens sent to pathologists are morphologically different and are measured differently to the pre-resection polyp images seen by endoscopists.

CONCLUSIONS:
Colonoscopists may be inaccurate in the measurement of polyp size and appear biased towards and against certain size measurements. These findings cast doubt over the validity of international post-polypectomy surveillance guidelines and the safety of optical diagnosis as a potential management paradigm for diminutive colorectal polyps. They also question the historical accuracy of polyp size data and risk estimates upon which these strategies were based.
Analysis of Wait Times and Impact of Real-Time Surveys on Patient Satisfaction
Authors: Pena Sandra M. , Lawrence Naomi 
Published: August 2017

BACKGROUND
Increasing emphasis is being placed on patient satisfaction, which is linked to reimbursement rates. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a national, standardized survey used to assess patient satisfaction. Its limitations include the length of the survey, delay in administration, and generalization to all specialties. Ideal patient satisfaction surveys should collect information in a way that allows for corrective action in a timely manner.

OBJECTIVE
To evaluate patient dissatisfaction with wait time using a short, in-office, real-time survey.

METHODS
A cross-sectional study in which patients from one provider's office completed a real-time survey. These results were compared with the CAHPS survey data of the same time period.

RESULTS
Seven hundred fifty-six patients were seen and 251 surveys were collected. The real-time survey response rate was 33% compared with 9% for the CAHPS survey. Overall, 95.74% of patients who completed the real-time survey were satisfied with their wait times and the duration of their visit, versus 84.2% from the CAHPS survey.

CONCLUSION
Implementation of a short in-office survey immediately after patient care can provide better feedback that can be used to ensure that improvement measures are aimed at making significant strides in improving overall health outcomes for patients.
Serum uric acid levels and hormone therapy type: a retrospective cohort study of postmenopausal women
Authors: Jung Jae H. , Song Gwan G. , Lee Young H. , Kim Jae-Hoon , Hyun Myung H. , Choi Sung J. 
Published: August 2017

Abstract

Objective:
Serum uric acid levels increase in postmenopausal women, but decrease when hormone therapy (HT) is administered. No study has, however, evaluated the effects of different types of HT on serum uric acid levels. We therefore examined whether estrogen therapy (ET), estrogen plus progestogen therapy (EPT), and tibolone use affected serum uric acid levels in this population.

Methods:
We performed a retrospective cohort study of postmenopausal women. From 2005 to 2015, postmenopausal women who had undergone blood uric acid-level testing at least twice were enrolled. Participants were grouped according to HT regimen: ET, EPT, or tibolone. The nonhormone therapy group did not receive HT. Differences in serum uric acid levels were examined in each group. Our analysis was adjusted to accommodate different follow-up intervals for individual participants. Multiple variables were adjusted using the Tukey-Kramer method. Age, body mass index, hypertension, diabetes mellitus, dyslipidemia, estimated glomerular filtration rate, alcohol consumption, smoking status, and comedications were also adjusted.

Results:
After adjusting for multiple variables, the serum uric acid level increased to 0.87 ± 0.27 mg/dL (least squares mean ± standard error) in the nonhormone therapy group, and serum uric levels in the EPT group were found to be significantly lower (−0.38 ± 0.29 mg/dL, P < 0.001). The serum uric acid levels in the ET and tibolone groups did not, however, differ significantly from the nonhormone therapy group level.

Conclusions:
We attribute our findings to the effects of progestogen, rather than estrogen.
PAIN AND ANTISEPSIS AFTER OCULAR ADMINISTRATION OF POVIDONE-IODINE VERSUS CHLORHEXIDINE
Authors: Oakley Carmen , Allen Penny , Hooshmand Joobin , Vote Brendan J. T. 
Published: August 2017

Purpose:
To investigate ocular bacterial count before and after antisepsis with aqueous chlorhexidine (AC) or povidone-iodine (PI) and to assess discomfort with each agent.

Methods:
Bacterial swabs were taken from participants' eyes before and after antisepsis. These underwent microscopy, culture, and sensitivity testing. Aqueous chlorhexidine drops were administered to left eyes and PI to right eyes. Participants rated their pain (scale 0–10) for each eye but were blinded to the type of drop.

Results:
There were 20 participants (17 women, 3 men), and the mean age was 43 years. Pain scores were significantly higher in right (PI) than in left (AC) eyes (mean 7 vs. mean 2, P < 0.001). No abnormalities were detected on specimen microscopy and gram staining. Seven preantisepsis swabs (three left and four right) grew bacteria in culture. Two postantisepsis swabs grew bacteria in primary culture plate (1 after AC and 1 after PI). For an additional one post-PI swab, bacteria were detected in enrichment broth only.

Conclusion:
The efficacy of AC and PI are similar, and patient discomfort is lower with AC. Aqueous chlorhexidine is a good alternative to PI for antisepsis before intravitreal injection.
Psychotropics, Environmental Temperature, and Hospital Outcomes in Older Medical Patients
Authors: Mangoni Arduino A. , Kholmurodova Feruza , Mayner Lidia , Hakendorf Paul , Woodman Richard J. 
Published: August 2017

Abstract

Purpose
The authors investigated whether the use of psychotropics and environmental temperature on admission influence hospital length of stay (LOS) and mortality in older medical patients.

Methods
Clinical and demographic characteristics, Charlson Comorbidity Index, use of psychotropic and nonpsychotropic drugs, hospital LOS, and mortality were retrospectively collected in medical patients 65 years and older (n = 382) admitted to a metropolitan teaching hospital during 5 consecutive heat waves (HWs) between 2007 and 2009. Patients admitted either before or after each HW, matched for HW period, age, and admission day of the week, served as controls (non-HW, n = 1339).

Results
Total number of psychotropic and nonpsychotropic drugs, Charlson Comorbidity Index, comorbidities, number of daily admissions, LOS, and mortality were similar in the HW and non-HW groups. After adjusting for clinical and demographic confounders, competing risks regression showed that psychotropic use, particularly antipsychotics, predicted increased LOS during non-HW (subdistribution hazard ratio: 95% CI, 0.82, 0.72–0.94; P = 0.003) but not HW (subdistribution hazard ratio: 95% CI, 0.89, 0.69–1.14; P = 0.36) periods. The effect of psychotropics on LOS during normal weather conditions was particularly evident in the old-old subgroup (difference [SE] in coefficients between non-HW and HW periods: −0.52 [0.25], P = 0.036 in patients >80 years; 0.11 [0.19], P = 0.54, in patients 65–80 years). By contrast, psychotropics did not predict hospital mortality during non-HW or HW periods.

Conclusions
Psychotropic use on admission, particularly antipsychotics, predicted hospital LOS, but not mortality, in older medical patients, particularly those older than 80 years, during normal environmental temperature. However, there was no effect of psychotropics on LOS during extreme heat.
A Pilot Study of the Usefulness of a Single Olanzapine Plasma Concentration as an Indicator of Early Drug Effect in a Small Sample of First-Episode Psychosis Patients
Authors: Zabala Arantzazu , Bustillo Mariana , Querejeta Imanol , Alonso Marta , Mentxaka Oiane , González-Pinto Ana , Ugarte Amaia , Meana J. Javier , Gutiérrez Miguel , Segarra Rafael 
Published: August 2017

Abstract

Purpose/Background
Studies analyzing concentration-effect relationships in second-generation antipsychotics have reported contradictory results in chronic schizophrenia. No data are available for the early stages of the disease. The present study aims to evaluate the association between a single olanzapine plasma concentration, clinical response, and severity of adverse effects in first-episode psychosis (FEP); to test the utility of various plasma breakpoints as markers of early response to treatment; and to identify variables affecting olanzapine concentrations.

Methods
Data from 23 compliant FEP patients receiving olanzapine monotherapy (5–30 mg/d) were evaluated 2 months after beginning treatment. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale and the Montgomery-Åsberg Depression Rating Scale. Adverse effects were rated using the Udvalg for Kliniske Undersøgelser scale. Plasma samples were drawn at 11 (SD, 1) hours after dosing and analyzed with high-performance liquid chromatography/tandem mass spectrometry.

Findings
Consistent with findings on chronic disease, dose, age, sex, weight, and cigarettes/day accounted for some of the variability in olanzapine concentrations. While no relationship was found between olanzapine concentrations and adverse effects or improvement of depressive symptoms, response of psychotic symptoms was associated with concentrations between 22.56 and 77.92 ng/mL. Plasma breakpoints did not show sufficiently high specificity, resulting in a large number of false-positive results.

Implications
Although olanzapine concentrations do not seem to be reliable indicators of early drug effect in FEP, they may still prove useful for detecting noncompliance, as well as pharmacokinetically relevant comorbidities or genetic particularities in drug metabolism.
Hearing Preservation During Cochlear Implantation and Electroacoustic Stimulation in Patients With SLC26A4 Mutations
Authors: Roh Kyung Jin , Park Sera , Jung Jin Se , Moon In Seok , Kim Sung Huhn , Bang Mi Young , Choi Jae Young 
Published: August 2017

Background and Objectives:
Patients with SCL26A4 mutations presenting with Mondini deformity and enlarged vestibular aqueduct (EVA) tend to have comparable residual hearing. Although cochlear implantation (CI) produces good results in this group, deterioration of residual hearing can be an adverse event after surgery due to accompanying cochlear malformation and perilymph leakage during cochleostomy. The purpose of this study was to investigate if CI in patients with SCL26A4 mutations via the round window (RW) approach could achieve preservation of residual hearing, and to evaluate their speech reception with electroacoustic stimulation (EAS).

Subjects and Methods:
This is a retrospective chart review of eight patients with bilateral EVA, who were bi-allelic patients with SCL26A4 mutations. CI was performed in all patients by a single surgeon using the RW approach. Audiological results were compared before and after implantation.

Results:
Additional hearing loss after CI was less than 10 dBHL in five out of eight patients. Average hearing deterioration after CI was 8.75 dB (range, 0–26). Six out of eight patients used EAS mode after CI. The acoustic stimulation frequency ranged from 271 to 438 Hz. Patients showed better speech recognition in quiet and in noise using EAS mode compared with electrical stimulation alone.

Conclusions:
Preservation of residual hearing could be achieved after CI in patients with the SLC26A4 mutation via the RW approach. For successful preservation of residual hearing, application of newly-developed soft electrode and meticulous surgical is necessary. Our study showed that patients with the SLC26A4 mutation can be good candidates for EAS surgery.
Comparing Outcomes Following Salvage Microsurgery in Vestibular Schwannoma Patients Failing Gamma-knife Radiosurgery or Microsurgery
Authors: Lee Hyun-Jin , Kim Mi Joo , Koh Seung Hyun , Chang Won Seok , Moon In Seok 
Published: August 2017

Objective:
The increasing use of primary gamma-knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) has led to a concomitant increase in the number of patients requiring salvage surgery for GKS failure. When patients underwent GKS as the primary treatment, it is known that dissecting tumor from adjacent nerves during salvage surgery is more difficult. In this report, we share our clinical experience with such patients and analyze the clinical findings of patients with tumor regrowth/recurrence.

Study Design:
Retrospective chart review.

Setting:
Tertiary center.

Patients:
Nine patients who underwent salvage surgery for VS regrowth/recurrence after GKS or microsurgery were enrolled.

Main Outcome Measures:
Symptom progression, radiological changes, intraoperative findings, and surgical outcomes were evaluated and compared.

Results:
Six patients with previous GKS and three with previous microsurgery underwent salvage microsurgery. The most obvious symptom of tumor regrowth was aggravation of hearing loss. Salvage surgery in all patients was limited to subtotal or near-total resection via a translabyrinthine/transotic approach. Severe adhesion, thickening, and fibrosis were more prominent findings in the GKS than in the previous microsurgery group. Dissection of the tumor from the facial nerve was more difficult in the GKS than in the microsurgery patients. Despite anatomical preservation of the facial nerve in all the six patients, three in the GKS group, but none in the revision microsurgery group, had worsening of facial nerve function.

Conclusion:
Salvage microsurgery of VS after failed GKS is more difficult than revision microsurgery, and the facial nerve outcomes are relatively poor. Therefore, the primary method of VS treatment should be carefully chosen. Additional imaging studies are recommended in patients with a sudden change in hearing loss who underwent GKS.
Initial Alpha-Fetoprotein Response Predicts Prognosis in Hepatitis B-related Solitary HCC Patients After Radiofrequency Ablation
Authors: Yu Su Jong , Kwon Jee Hye , Kim Won , Yoon Jung-Hwan , Lee Jeong Min , Lee Jae Young , Cho Eun Ju , Lee Jeong-Hoon , Kim Hwi Young , Jung Yong Jin , Kim Yoon Jun 
Published: August 2017

Background:
Radiofrequency ablation (RFA) is effective for early-stage hepatocellular carcinoma but recurrence is problem.

Goals:
To identify prognostic factors including alpha-fetoprotein (AFP) for overall survival and intrahepatic recurrence after RFA.

Patients and Methods:
Not only naïve but also previously treated patients with solitary hepatitis B virus-related hepatocellular carcinoma <5 cm were prospectively enrolled and a ≥50% decrease from baseline to 1 month after RFA was defined as an initial AFP response. Tumor responses were assessed by the modified response evaluation criteria in solid tumors.

Results:
Among 255 patients, 156 patients (61.2%) developed intrahepatic recurrence. Radiologic progression occurred in 54.8% (86/157) in the AFP responders and 71.4% (70/98) in the AFP nonresponders. In multivariate analysis, a history of previous treatment [hazard ratio (HR), 2.037; P=0.015 for percutaneous ethanol injection vs. none; and HR, 2.642; P<0.001 for transarterial chemoembolization vs. none] and an initial AFP nonresponse (HR, 1.899; P<0.001) were independent predictors of accelerated progression after RFA. Moreover, those who had a history of previous treatment and did not achieve an initial AFP response had significantly unfavorable overall survival (HR, 3.581; P<0.001) and the increased risk of intrahepatic remote recurrence (HR, 5.385; P<0.001) compared with those with an initial AFP response and no history of previous treatment.

Conclusions:
Biological response evaluation by the measurement of serial AFP levels is a useful predictor of overall survival and intrahepatic remote recurrence after RFA. Therefore, an initial AFP response may aid in determining the need of closer follow-up as a therapeutic response indicator of RFA.
Addressing Occupational Fatigue in Nurses
Authors: Steege Linsey M. , Pinekenstein Barbara J. , Rainbow Jessica G. , Arsenault Knudsen Élise 
Published: August 2017

OBJECTIVE
The aim of this study was to describe the current state of fatigue risk management systems (FRMS) to address nurse fatigue in hospitals.

BACKGROUND
Although multiple studies have examined sources and consequences of fatigue, little is known about the current state of FRMS.

METHODS
This study used a sequential exploratory mixed-method design including a survey of nurse leaders from across the United States.

FINDINGS
Although healthcare organizations have implemented strategies to address fatigue, most participants’ organizations did not have a formal FRMS in place. Monitoring individual nurses’ levels of fatigue and using tools to predict fatigue risk were rare.

CONCLUSIONS
Significant opportunities exist to implement formal FRMS in healthcare. Nursing leaders, in partnership with other organizational leaders, should develop a formal plan to monitor fatigue and implement multiple levels of interventions to prevent fatigue and mitigate its consequences.
Acyanotic Hypoxia in a Febrile Child
Authors: Murphy Fiona , Blackham Julian , Moppett John , Lyttle Mark 
Published: August 2017

Abstract
Glucose-6-phosphate dehydrogenase deficiency affects approximately 400 million people worldwide and is an X-linked disorder most commonly found in individuals of African, Asian, Mediterranean, and Middle Eastern descent. It can present with acute hemolysis in response to certain drugs, infections, or fava beans, and affected individuals may not be aware that they have glucose-6-phosphate dehydrogenase deficiency. This case illustrates the importance of those working in the acute and urgent care sector having an awareness of the condition and the value of a full set of vital signs in an unwell child.
Gray matter alteration associated with pain catastrophizing in patients 6 months after lumbar disk surgery: a voxel-based morphometry study
Authors: Chehadi Omar , Suchan Boris , Konietzny Kerstin , Köster Odo , Schmidt-Wilcke Tobias , Hasenbring Monika I. 
Published: August 2017

Abstract

Introduction:
Pain catastrophizing (PC), the increased attention to harmful aspects of pain (magnification), and the belief of low controllability (helplessness) has been shown to be important in the maintenance of pain. A growing research on structural alterations in chronic pain revealed an association between PC and brain areas that are involved in affective and cognitive pain processing. However, little is known about a differential effect of the components magnification and helplessness.

Objective:
The aim of this study was to identify brain regions associated with overall PC and with the single components of magnification and helplessness.

Methods:
We investigated 29 patients 6 months after lumbar disk surgery using voxel-based morphometry. Magnification and helplessness were assessed with subscales of the Avoidance-Endurance Questionnaire (AEQ); overall PC was computed using the sum score. The structural brain imaging data were preprocessed and analyzed using SPM8 and VBM8. Multiple regression analyses were performed with PC scales as predictors and depression as covariate.

Results:
Pain catastrophizing was significantly associated with cortical gray matter in brain areas involved in processing attentional, sensory, and affective aspects of pain, including the left posterior cingulate cortex, supplementary motor area, and medial frontal gyrus. In addition, we provide preliminary evidence for brain structure association related to magnification and helplessness.

Conclusion:
This study provides evidence for PC-related structural alterations in patients with low back pain, which are consistent with findings from previous research in different chronic pain disorders. This study is the first to evaluate brain changes related to differential domains of PC.