bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Mortality Between Pregnant and Nonpregnant Women After Cardiopulmonary Resuscitation
Authors: Mogos Mulubrhan F. , Salemi Jason L. , Spooner Kiara K. , McFarlin Barbara L. , Salihu Hamisu M. 
Published: September 2016

OBJECTIVE:
To examine the association between pregnancy status and in-hospital mortality after cardiopulmonary resuscitation (CPR) in an inpatient setting.

METHODS:
We conducted a population-based cross-sectional study using the Nationwide Inpatient Sample databases (2002–2011). International Classification of Diseases, 9th Revision, Clinical Modification codes were used to define cases, comorbidities, and clinical outcomes. Rates of CPR among study groups were calculated by patient and hospital characteristics. Survey logistic regression was used to estimate adjusted odds ratios (ORs) that represent the association between pregnancy status and mortality after CPR. Joinpoint regression was used to describe temporal trends in CPR and mortality rates.

RESULTS:
During the study period, 5,923 women (13–49 years) received inpatient CPR annually. Cardiopulmonary resuscitation rates increased significantly from 2002 to 2011, by 6.4% and 3.8% annually, for pregnant and nonpregnant women, respectively. In-hospital mortality rates after CPR were lower among pregnant women 49.4% (45.4–53.4) than nonpregnant women 71.1% (70.1–72.2), even after adjusting for confounders (adjusted OR 0.46, 95% confidence interval 0.39–0.56).

CONCLUSION:
Cardiopulmonary resuscitation in an inpatient pregnant woman is associated with improved survival compared with this procedure in nonpregnant women. Elucidating reasons behind this association could help to improve CPR outcomes in both pregnant and nonpregnant women.
Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus
Authors: Guelfi Kym J. , Ong Ming Jing , Crisp Nicole A. , Fournier Paul A. , Wallman Karen E. , Grove J. Robert , Doherty Dorota A. , Newnham John P. 
Published: September 2016

OBJECTIVE:
To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus (GDM) together with other aspects of maternal health and obstetric and neonatal outcomes.

METHODS:
This randomized controlled trial allocated women with a history of GDM to an exercise intervention (14-week supervised home-based stationary cycling program) or to a control group (standard care) at 13±1 weeks of gestation. The primary outcome was a diagnosis of GDM. Secondary outcomes included maternal fitness, psychological well-being, and obstetric and neonatal outcomes. A sample size of 180 (90 in each group) was required to attain 80% power to detect a 40% reduction in the incidence of GDM.

RESULTS:
Between June 2011 and July 2014, 205 women provided written consent and completed baseline assessments. Of these, 33 (16%) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test (OGTT), leaving 172 randomized to exercise (n=85) or control (n=87). Three women miscarried before the assessment of outcome measures (control=2; exercise=1). All remaining women completed the postintervention OGTT. The recurrence rate of GDM was similar between groups (control 40% [n=34]; exercise 40.5% [n=34]; P=.95) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT (glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L; P>.05). Maternal fitness was improved by the exercise program (P<.01) and psychological distress was reduced (P=.02). There were no differences in obstetric and neonatal outcomes between groups (P>.05).

CONCLUSION:
Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM; however, it was associated with important benefits for maternal fitness and psychological well-being.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, https://clinicaltrials.gov, NCT01283854.
Ovarian Conservation and Overall Survival in Young Women With Early-Stage Low-Grade Endometrial Cancer
Authors: Matsuo Koji , Machida Hiroko , Shoupe Donna , Melamed Alexander , Muderspach Laila I. , Roman Lynda D. , Wright Jason D. 
Published: September 2016

OBJECTIVE:To characterize contributing factors for ovarian conservation during surgical treatment for endometrial cancer and to examine the association of ovarian conservation on survival of young women with early-stage, low-grade tumors.METHODS:This was a population-based study using the Surveillance, Epidemiology, and End Results program to identify surgically treated stage I type I (grade 1–2 endometrioid histology) endometrial cancer cases diagnosed between 1983 and 2012 (N=86,005). Multivariable models were used to identify independent factors for ovarian conservation. Survival outcomes and cause of death were examined for women aged younger than 50 with stage I type I endometrial cancer who underwent ovarian conservation (1,242 among 12,860 women [9.7%]).RESULTS:On multivariable analysis, age younger than 50 years, grade 1 endometrioid histology, and tumor size 2.0 cm or less were noted to be independent factors for ovarian conservation (all,P<.001). For 9,110 women aged younger than 50 years with stage I grade 1 tumors, cause-specific survival was similar between ovarian conservation and oophorectomy cases (20-year rates 98.9% compared with 97.7%,P=.31), whereas overall survival was significantly higher in ovarian conservation cases than oophorectomy cases (88.8% compared with 82.0%,P=.011). On multivariable analysis, ovarian conservation remained an independent prognostic factor for improved overall survival (adjusted hazard ratio 0.73, 95% confidence interval [CI] 0.54–0.98,P=.036) and was independently associated with a lower cumulative risk of death resulting from cardiovascular disease compared with oophorectomy (20-year rates, 2.3% compared with 3.7%, adjusted hazard ratio 0.40, 95% CI 0.17–0.91,P=.029). Contrary, cause-specific survival (20-year rates 94.6% compared with 96.1%,P=.68) and overall survival (81.0% compared with 80.6%,P=.91) were similar between ovarian conservation and oophorectomy among 3,750 women aged younger than 50 years with stage I grade 2 tumors.CONCLUSION:Ovarian conservation is performed in less than 10% of young women with stage I type I endometrial cancer. Ovarian conservation is associated with decreased mortality in young women with stage I grade 1 tumors.
Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer
Authors: Cham Stephanie , Chen Ling , Burke William M. , Hou June Y. , Tergas Ana I. , Hu Jim C. , Ananth Cande V. , Neugut Alfred I. , Hershman Dawn L. , Wright Jason D. 
Published: September 2016

OBJECTIVE:
To examine the use and predictors of sentinel node biopsy in women with vulvar cancer.

METHODS:
The Perspective database, an all-payer database that collects data from more than 500 hospitals, was used to perform a retrospective cohort study of women with vulvar cancer who underwent vulvectomy and lymph node assessment from 2006 to 2015. Multivariable models were used to determine factors associated with sentinel node biopsy. Length of stay and cost were compared between women who underwent sentinel node biopsy and lymphadenectomy.

RESULTS:
Among 2,273 women, sentinel node biopsy was utilized in 618 (27.2%) and 1,655 (72.8%) underwent inguinofemoral lymphadenectomy. Performance of sentinel node biopsy increased from 17.0% (95% confidence interval [CI] 12.0–22.0%) in 2006 to 39.1% (95% CI 27.1–51.0%) in 2015. In a multivariable model, women treated more recently were more likely to have undergone sentinel node biopsy, whereas women with more comorbidities and those treated at rural hospitals were less likely to have undergone the procedure. The median length of stay was shorter for those undergoing sentinel node biopsy (median 2 days, interquartile range 1–3) compared with women who underwent inguinofemoral lymphadenectomy (median 3 days, interquartile range 2–4). The cost of sentinel node biopsy was $7,599 (interquartile range $5,739–9,922) compared with $8,095 (interquartile range $5,917–11,281) for lymphadenectomy.

CONCLUSION:
The use of sentinel node biopsy for vulvar cancer has more than doubled since 2006. Sentinel lymph node biopsy is associated with a shorter hospital stay and decreased cost compared with inguinofemoral lymphadenectomy.
Impact of Surgical Complications Following Resection of Locally Advanced Rectal Adenocarcinoma on Adjuvant Chemotherapy Delivery and Survival Outcomes
Authors: Jamnagerwalla Murtaza , Tay Rebecca , Steel Malcolm , Keck Jamie , Jones Ian , Faragher Ian , Gibbs Peter , Wong Rachel 
Published: September 2016

BACKGROUND:
Surgical complications after resection for locally advanced rectal cancer may influence adjuvant treatment outcomes and survival. Few studies have examined this effect.

OBJECTIVE:
This study aimed to examine the impact of surgical complications on adjuvant therapy delivery and survival in patients with locally advanced rectal cancer treated with long-course chemoradiation followed by surgery.

DESIGN:
This is a retrospective analysis of a prospectively collected multicenter colorectal cancer database.

SETTINGS:
Data were collected from the Australian Comprehensive Cancer Outcomes and Research Database.

PATIENTS:
All patients who completed neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer between January 2003 and December 2014 were selected.

MAIN OUTCOME MEASURES:
We examined the types and frequency of surgical complications and their impact on the delivery of adjuvant chemotherapy and survival.

RESULTS:
Data were available for 517 patients, of whom 147 (28%) had a surgical complication. Patients with a surgical complication were less likely to commence adjuvant chemotherapy (33% vs 66%; p = 0.0005) and more likely to have adjuvant treatment commencing more than 8 weeks from surgery (71.8% vs 21.2%; p = 0.004). Wound-related complications (p = 0.001), return to operating theater (p = 0.004), and readmission within 30 days (p = 0.02) had the most significant negative impact on the delivery of adjuvant chemotherapy. Surgical complications were significantly more likely in males (31.6% vs 20.8%, p = 0.003) and laparoscopic converted cases (47.8% vs 21.8%, p = 0.03). For the entire patient population, adjuvant chemotherapy compared with surveillance was not associated with an improved recurrence-free survival (HR, 1.06; p = 0.83) but was associated with an improved overall survival (HR, 0.53; p = 0.04).

LIMITATIONS:
This study was limited by its retrospective design.

CONCLUSION:
Surgical complications in patients having surgery following neoadjuvant chemoradiotherapy for locally advanced rectal cancer were associated with significantly reduced uptake and delays to receiving adjuvant therapy. Surgical complications, however, were not associated with either significantly reduced recurrence-free or overall survival. Adjuvant chemotherapy delivery was associated with improved overall survival.
No Difference in Overall Survival Between Hospital Volumes for Patients With Colorectal Cancer in The Netherlands
Authors: Bos Amanda C. R. K. , van Erning Felice N. , Elferink Marloes A. G. , Rutten Harm J. , van Oijen Martijn G. H. , de Wilt Johannes H. W. , Lemmens Valery E. P. P. 
Published: September 2016

BACKGROUND:
High-volume hospitals have been associated with improved patient outcomes for tumors with a relatively low incidence that require complex surgeries, such as esophageal and pancreatic cancer. The volume-outcome association for colorectal cancer is under debate.

OBJECTIVE:
This study investigated whether hospital volume for colorectal cancer is associated with surgical care characteristics and 5-year overall survival.

DESIGN:
This is a population-based study.

SETTING:
Data were gathered from the Netherlands Cancer Registry. Hospitals were grouped by volume for colon (<50, 50–74, 75–99, and ≥100 resections per year) and rectum (<20, 20–39, and ≥40 resections per year).

PATIENTS:
All of the patients with primary nonmetastatic colorectal cancer who underwent resection between 2005 and 2012 were included.

MAIN OUTCOME MEASURES:
Differences in surgical approach, anastomotic leakage, and postoperative 30-day mortality between hospital volumes were analyzed using χ2 tests and multivariable logistic regression analyses. Cox proportional hazard models were used to investigate the effect of hospital volume on overall survival.

RESULTS:
This study included 61,394 patients with colorectal cancer. In 2012, 31 of the 91 hospitals performed less than 50 colon cancer resections per year, and 21 of the 90 hospitals performed less than 20 rectal cancer resections per year. No differences in anastomotic leakage rates between hospital volumes were observed. Only small differences between hospital volumes were revealed for conversion of laparoscopic to open resection (OR of less than 50 versus 100 or more resections per year = 1.25 (95% CI, 1.06–1.46)) and postoperative 30-day mortality (colon: OR of less than 50 versus 100 or more resections per year = 1.17 (95% CI, 1.02–1.35); rectum: OR of less than 20 versus 40 or more resections per year = 1.42 (95% CI, 1.09–1.84)). No differences in overall survival were found between hospital volumes.

LIMITATIONS:
Although we adjusted for several patient and tumour characteristics, data regarding comorbidity, surgeon volume, local recurrences, and specific postoperative complications other than anastomotic leakage were not available.

CONCLUSIONS:
In the Netherlands, no differences in 5-year survival rates were revealed between hospital volumes for patients with nonmetastatic colorectal cancer.
Patient-Reported Roles, Preferences, and Expectations Regarding Treatment of Stage I Rectal Cancer in the Cancer Care Outcomes Research and Surveillance Consortium
Authors: Tyler Ellis C. , Charlton Mary E. , Stitzenberg Karyn B. 
Published: September 2016

BACKGROUND:
Historically, stage I rectal cancer was treated with total mesorectal excision. However, there has been growing use of local excision, with and without adjuvant therapy, to treat these early rectal cancers. Little is known about how patients and providers choose among the various treatment approaches.

OBJECTIVE:
The purpose of this study was to identify patient roles, preferences, and expectations as they relate to treatment decision making for patients with stage I rectal cancer.

DESIGN:
This is a population-based study.

SETTINGS:
The study included a geographically diverse population and health-system–based cohort.

PATIENTS:
A total of 154 adults with newly diagnosed and surgically treated stage I rectal cancer between 2003 and 2005 were included.

MAIN OUTCOME MEASURES:
We compared patients by surgical treatment groups, including total mesorectal excision and local excision. Clinical, sociodemographic, and health-system factors were assessed for association with patient decision-making preferences and expectations.

RESULTS:
A total of 80% of patients who underwent total mesorectal excision versus 63% of patients who underwent local excision expected that surgery would be curative (p = 0.04). The total mesorectal excision group was less likely to report that radiation would cure their cancer compared with the local excision group (27% vs 63%; p = 0.004). When asked about their preferred role in decision making, 28% of patients who underwent total mesorectal excision preferred patient-controlled decision making compared with 48% of patients who underwent local excision (p = 0.046). However, with regard to the treatment actually received, 38% of the total mesorectal excision group reported making their own surgical decision compared with 25% of the local excision group (p = 0.18).

LIMITATIONS:
The study was limited by its sample size.

CONCLUSIONS:
The preferred decision-making role for patients did not match the actual decision-making process. Future efforts should focus on bridging the gap between the decision-making process and patient preferences regarding various treatment approaches. This will be particularly important as newer innovative procedures play a more prominent role in the rectal cancer treatment paradigm.
Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection: Post Hoc Analysis of a Randomized Controlled Trial
Authors: Qin Qiyuan , Ma Tenghui , Deng Yanhong , Zheng Jian , Zhou Zhiyang , Wang Hui , Wang Lei , Wang Jianping 
Published: September 2016

BACKGROUND:
Evidence regarding the effect of preoperative radiotherapy on anastomotic integrity remains conflicting in rectal cancer surgery. Prospective comparisons with appropriate controls are needed.

OBJECTIVE:
This study aimed to assess the impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection.

DESIGN:
This was a post hoc analysis of a randomized controlled trial (NCT01211210).

SETTINGS:
Data were retrieved from the leading center of the trial, which is a tertiary hospital.

PATIENTS:
The full analysis population of 318 patients was included.

INTERVENTIONS:
Patients were randomly assigned to receive preoperative radiation (50 Gy per 25 fractions) and 5-fluorouracil infusion, alone (arm A) or combined with oxaliplatin (arm B), or preoperative chemotherapy with 5-fluorouracil and oxaliplatin without radiation (arm C).

MAIN OUTCOME MEASURES:
The rates of anastomotic leakage and stenosis were calculated for each treatment arm. Multivariate analysis was used to verify the effect of preoperative radiotherapy.

RESULTS:
The treatment arms were comparable in terms of most baseline characteristics, but more diversions were used in the chemoradiotherapy arms. Anastomotic leakage occurred in 20.2% of patients in arm A, 23.6% of patients in arm B, and 8.5% of patients in arm C (p = 0.007). The corresponding rates of stenosis were 17.0%, 18.9%, and 6.8% (p = 0.02). Multivariate analysis confirmed the correlation between preoperative radiotherapy and clinical leakage (p = 0.02), which was associated with delayed stenosis (p < 0.001). For patients undergoing chemoradiotherapy, radiation proctitis was identified as an independent risk factor for clinical leakage (p = 0.01) and stenosis (p < 0.001).

LIMITATIONS:
The main limitations were discrepancies in stoma creation and chemotherapy regimen among the treatment arms.

CONCLUSIONS:
Preoperative radiotherapy increases the risk of anastomotic leakage and stenosis after rectal cancer resection. Clinical leakage independently contributes to the development of stenosis.
Significant Individual Variation Between Pathologists in the Evaluation of Colon Cancer Specimens After Complete Mesocolic Excision
Authors: Munkedal Ditte Louise E. , Laurberg Søren , Hagemann-Madsen Rikke , Stribolt Katrine J. , Krag Søren R. P. , Quirke Philip , West Nicholas P. 
Published: September 2016

BACKGROUND:
After the introduction of complete mesocolic excision, a new pathological evaluation of the resected colon cancer specimen was introduced. This concept has quickly gained acceptance and is often used to compare surgical quality. The grading of colon cancer specimens is likely to depend on both surgical quality and the training of the pathologist.

OBJECTIVE:
The purpose of this study was to validate the principles of the pathological evaluation of colon cancer specimens.

DESIGN:
This was an exploratory study.

SETTINGS:
The study was conducted in Aarhus, Denmark, and Leeds, United Kingdom.

PATIENTS:
Colon cancers specimens were used.

MAIN OUTCOME MEASURES:
The agreement of gradings between participants was of interest. Four specialist GI pathologists and 2 abdominal surgeons evaluated 2 rounds of colon cancer specimens, each at 2 separate time points. Each round contained 50 specimens. After the first round, a protocol of detailed principles for the grading procedure was agreed on. Results from an experienced pathologist were considered as the reference results.

RESULTS:
In the first round, the distribution of gradings between participants showed substantial variation. In the second round, the variation was reduced. Intraobserver agreement was mostly fair to good, whereas interobserver agreement was frequently poor. This did not significantly change from round 1 to round 2.

LIMITATIONS:
The small sample size of 100 specimens provided a very small number of specimens resected in the muscularis propria plane, which renders the evaluation of this group potentially unreliable. The evaluations were made on photos and not on fresh specimens.

CONCLUSIONS:
This study demonstrates significant variation in the pathological evaluation of colon cancer specimens. It demonstrates that it cannot be used in clinical studies, and care should be taken when comparing results between different hospitals.
Improving Health-Related Quality of Life in Wounded Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb–Prosthetic Interface
Authors: Miletta Nathanial R. , Kim Sang , Lezanski-Gujda Amanda , Rossi Anthony M. , Marquart Jason D. 
Published: September 2016

BACKGROUND
Wounded warriors with lower limb amputations using prosthetics commonly develop dermatologic complaints at the residual limb–prosthetic interface, which impact their health-related quality of life (HRQOL). To optimize this interface, military dermatologists routinely treat the subset of issues related to the pilosebaceous unit with laser hair removal (LHR).

OBJECTIVE
To characterize the impact of residual limb skin conditions on HRQOL in wounded warriors using lower limb prosthetics before and after treatment with LHR.

METHODS AND MATERIALS
Twenty wounded warriors with lower limb amputations using prosthetics were administered a validated HRQOL survey, the Skindex-16, before and after an average of 3 treatments of LHR to their residual lower limbs. Responses were statistically analyzed within the symptoms, emotions, and functioning subscales of the survey and in aggregate.

RESULTS
Statistically significant (p < .05) improvement in HRQOL was observed across the symptoms, emotions, and functioning subscales and in aggregate.

CONCLUSION
Dermatologic complaints at the residual limb–prosthetic interface in patients with traumatic lower limb amputation are well-established in the literature. The authors present the first report subjectively quantifying this impact on HRQOL and the marked improvement observed with LHR to the residual limb.