bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceived Racial Bias and Health-Related Stigma Among Youth with Sickle Cell Disease
Authors: Wakefield Emily O. , Popp Jill M. , Dale Lourdes P. , Santanelli James P. , Pantaleao Ashley , Zempsky William T. 
Published: January 2017

ABSTRACT:

Objective:
Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being.

Methods:
Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden.

Results:
Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life.

Conclusion:
Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.
A Cross-Sectional Review of Reporting Variation in Postoperative Bowel Dysfunction After Rectal Cancer Surgery
Authors: Chapman Stephen J. , Bolton William S. , Corrigan Neil , Young Neville , Jayne David G. 
Published: January 2017

BACKGROUND:
Postoperative bowel dysfunction affects quality of life after sphincter-preserving rectal cancer surgery, but the extent of the problem is not clearly defined because of inconsistent outcome measures used to characterize the condition.

OBJECTIVE:
The purpose of this study was to assess variation in the reporting of postoperative bowel dysfunction and to make recommendations for standardization in future studies. If possible, a quantitative synthesis of bowel dysfunction symptoms was planned.

DATA SOURCES:
MEDLINE and EMBASE databases, as well as the Cochrane Library, were queried systematically between 2004 and 2015.

STUDY SELECTION:
The studies selected reported at least 1 component of bowel dysfunction after resection of rectal cancer.

MAIN OUTCOME MEASURES:
The main outcome measures were reporting, measurement, and definition of postoperative bowel dysfunction.

RESULTS:
Of 5428 studies identified, 234 met inclusion criteria. Widely reported components of bowel dysfunction were incontinence to stool (227/234 (97.0%)), frequency (168/234 (71.8%)), and incontinence to flatus (158/234 (67.5%)). Urgency and stool clustering were reported less commonly, with rates of 106 (45.3%) of 234 and 61 (26.1%) of 234. Bowel dysfunction measured as a primary outcome was associated with better reporting (OR = 3.49 (95% CI, 1.99–6.23); p < 0.001). Less than half of the outcomes were assessed using a dedicated research tool (337/720 (46.8%)), and the remaining descriptive measures were infrequently defined (56/383 (14.6%)).

LIMITATIONS:
Heterogeneity in the reporting, measurement, and definition of postoperative bowel dysfunction precluded pooling of results and limited interpretation.

CONCLUSIONS:
Considerable variation exists in the reporting, measurement, and definition of postoperative bowel dysfunction. These inconsistencies preclude reliable estimates of incidence and meta-analysis. A broadly accepted outcome measure may address this deficit in future studies.
Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse
Authors: Eftaiha Saleh M. , Calata Jed F. , Sugrue Jeremy J. , Marecik Slawomir J. , Prasad Leela M. , Mellgren Anders , Nordenstam Johan , Park John J. 
Published: January 2017

BACKGROUND:
The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence.

OBJECTIVE:
The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone.

DESIGN:
A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed.

SETTINGS:
Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital.

PATIENTS:
Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared.

INTERVENTIONS:
All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct.

MAIN OUTCOME MEASURES:
The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented.

RESULTS:
Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05).

LIMITATIONS:
This study was limited by nature of being a retrospective review.

CONCLUSIONS:
Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.
Reducing Readmissions While Shortening Length of Stay: The Positive Impact of an Enhanced Recovery Protocol in Colorectal Surgery
Authors: Shah Puja M. , Johnston Lily , Sarosiek Bethany , Harrigan Amy , Friel Charles M. , Thiele Robert H. , Hedrick Traci L. 
Published: January 2017

BACKGROUND:
Hospital readmission rates are an increasingly important quality metric since enactment of the 2012 Hospital Readmissions Reduction Program. The proliferation of enhanced recovery protocols and earlier discharge raises concerns for increased readmission rates.

OBJECTIVE:
We evaluated the effect of enhanced recovery on readmissions and identified risk factors for readmission.

DESIGN:
This study involved implementation of a multidisciplinary enhanced recovery protocol.

SETTINGS:
It was conducted at a large academic medical center

PATIENTS:
All patients undergoing elective colorectal surgery between 2011 and 2015 at our center were included.

MAIN OUTCOME MEASURES:
This cohort study compared patients before and after enhanced recovery initiation, looking at 30-day readmission as the primary outcome. A multivariable logistic regression model identified predictors of 30-day readmission. Kaplan–Meier analysis identified differences in time to readmission.

RESULTS:
A total of 707 patients underwent colorectal procedures between 2011 and 2015, including 383 patients before enhanced recovery protocol was implemented and 324 patients after enhanced protocol was implemented. Length of stay decreased from a median 5 days to a median 4 days before and after enhanced recovery implementation (p < 0.0001). Thirty-day readmission decreased from 19% (72/383) in the pre-enhanced recovery pathway to 12% (38/324) in the enhanced recovery pathway (p = 0.009). Twenty-one percent (21/99) of patients who underwent ileostomy were readmitted before enhanced recovery implementation compared with 19% (18/93) of patients who underwent ileostomy after enhanced recovery implementation (p = 0.16). Multivariable logistic regression identified ileostomy as increasing the risk of readmission (p = 0.04), whereas enhanced recovery protocol decreased the risk of readmission (p = 0.006).

LIMITATIONS:
The study is limited because it was conducted at a single institution and used a before-and-after study design.

CONCLUSIONS:
These data suggest that use of a standardized enhanced recovery protocol significantly reduces length of stay and readmission rates in an elective colorectal surgery population. However, the presence of an ileostomy maintains a high association with readmission, serving as a significant burden to patients and providers alike. Ongoing efforts are needed to further improve the management of patients undergoing ileostomy in the outpatient setting after discharge to prevent readmissions.
Hypertension's 3 Dilemmas and 3 Solutions: Pharmacology of the Kidney in Hypertension
Authors: Pettinger William A. 
Published: January 2017

Abstract:Summary
The Hypertension Community has 3 conflicting dilemmas: a goal systolic pressure of 120 mm Hg or less (the SPRINT Trials), 40% of our 60,000,000 hypertensives still sustain blood pressures above 140/90 mm Hg, and our most potent antihypertensive drug minoxidil sits on the sidelines, imprisoned in the Food and Drug Administration's Black Box designation. My solutions to these dilemmas are: (1) review of the facts of our most potent antihypertensive drug minoxidil which is essentially free of toxicity, (2) treatment focus on the fundamental cause of high blood pressure, that is excess dietary sodium and, (3) prevention of, and/or reversal of, the fundamental mechanism of worsening hypertension, arteriolar hypertrophy.
The Hypertension Community has 3 conflicting dilemmas: a goal systolic pressure of 120 mm Hg or less (the SPRINT Trials), 40% of our 60,000,000 hypertensives still sustain blood pressures above 140/90 mm Hg, and our most potent antihypertensive drug minoxidil sits on the sidelines, imprisoned in the Food and Drug Administration's Black Box designation. My solutions to these dilemmas are: (1) review of the facts of our most potent antihypertensive drug minoxidil which is essentially free of toxicity, (2) treatment focus on the fundamental cause of high blood pressure (HBP) and excess dietary sodium and, (3) prevention of, and/or reversal of, the fundamental mechanism of worsening hypertension, arteriolar hypertrophy. My focus at UT Southwestern in Dallas was on extremely severely hypertensive patients with a quantifiable, measurable complication of HBP, progression of nephrosclerotic damage to kidneys. This model had the greatest likelihood of exposing fundamental disregulatory mechanisms in hypertensive patients (which it did) and the potential for study of the most relevant antihypertensive drug interactions to achieve optimal blood pressure control (which it did). By maintaining diastolic pressures at 80 mm Hg or less in the first National Institutes of Health–supported, long-term randomized clinical trial to save the kidneys, the bases for a fundamental blood pressure support mechanism (arteriolar hypertrophy) was illuminated but not fully described until now. This fundamental hypertensinogenic mechanism results from HBP but with time and severity, becomes its own raison d'être. I am now aged 84 years. As a result of a stroke 20 years ago, which caused permanent double vision, and because of poor blood pressure control with triple therapy, I started using minoxidil 5 mg/d along with atenolol and occasional furosemide. Now, along with some dietary salt restriction, my resting blood pressure is 110/65–125/75 and, despite >30 years history of HBP, I have no retinal arteriolar hypertrophy nor arcus senilis (Dr. Schwartz-U. of Miami) which is almost universally present at this age. Yes, prevention of, or reversal of, arteriolar hypertrophy should be a central focus of HBP treatment. I simply wish to share a bit of accumulated wisdom that might be of use to others.
Mental Health Problems in a Community After the Great East Japan Earthquake in 2011: A Systematic Review
Authors: Ando Shuntaro , Kuwabara Hitoshi , Araki Tsuyoshi , Kanehara Akiko , Tanaka Shintaro , Morishima Ryo , Kondo Shinsuke , Kasai Kiyoto 
Published: January 2017

Abstract

Introduction
On March 11, 2011, the Great East Japan Earthquake caused a tsunami and led to the collapse of the Fukushima-Daiichi Nuclear Power Plant, thus severely damaging the surrounding area.

Methods
A systematic review was conducted in March 2015 with the following objectives: (1) to clarify the type, severity, and prevalence of mental health problems in the areas affected by the disaster, (2) to investigate trends in mental health problems over time, (3) to reveal demographic and socio-environmental characteristics associated with the post-disaster risk for developing mental health problems, and (4) to examine the impact of this natural disaster on the mental health of people in Fukushima.

Results
Forty-two papers were included in this review. The reported prevalence of posttraumatic stress reaction exceeded 10% in all studies. While some longitudinal studies observed an improvement in posttraumatic stress reaction over time, none reported a decrease in depression. Most risk factors for mental health problems were related to resettlement of daily lives, preexisting illnesses, and social networks. Overall, the reported prevalence of posttraumatic stress reaction seemed to be higher in Fukushima than in other affected areas.

Conclusion
Given that some mental health problems had not improved even two years after the disaster occurred, long-term mental health support is required for people in the affected area. Our finding that mental health problems seemed to be more severe in residents of Fukushima than among those in other areas suggests that residents in this prefecture require special care.
Predictors of Employment Outcomes in Veterans With Traumatic Brain Injury: A VA Traumatic Brain Injury Model Systems Study
Authors: Dillahunt-Aspillaga Christina , Nakase-Richardson Risa , Hart Tessa , Powell-Cope Gail , Dreer Laura E. , Eapen Blessen C. , Barnett Scott D. , Mellick Dave , Haskin Adam , Silva Marc A. 
Published: January 2017

Objectives:
To examine the length of time to return to work (RTW) among service members and veterans (SM/V) with traumatic brain injury (TBI) and to identify variables predictive of RTW.

Setting:
Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRC).

Participants:
SM/V enrolled in the VA PRC Traumatic Brain Injury Model Systems database who were of 18 to 60 years of age and admitted with the diagnosis of TBI.

Design:
Prospective observational cohort study.

Main Outcome Measures:
Employment status at 1-year postinjury follow-up; Time to Employment (ie, number of days it took to RTW) as documented during 1-year postinjury follow-up.

Results:
The final sample (n = 293) included male (96%) SM/V with severe TBI (69%). Approximately 21% of the sample participants were employed at 1 year postinjury. Younger individuals who self-identified as nonminority returned to work sooner. Significant associations were observed for time to employment for cause of injury and injury severity.

Conclusions:
Few SM/V with moderate to severe TBI returned to work at 1 year postinjury. Predictors such as younger age at the time of injury, minority status, and severity of TBI affected time to and probability of RTW. Findings from this study have important implications for rehabilitation planning and service delivery across the continuum of recovery.
Brain Cholinergic Function and Response to Rivastigmine in Patients With Chronic Sequels of Traumatic Brain Injury: A PET Study
Authors: Östberg Anna , Virta Jere , Rinne Juha O. , Oikonen Vesa , Luoto Pauliina , Någren Kjell , Arponen Eveliina , Tenovuo Olli 
Published: January 2017

Objective:
To investigate quantitative positron emission tomography (PET) findings and to study whether the cholinergic function differs between respondents to cholinergic medication versus nonrespondents.

Setting:
Outpatient clinic and university PET imaging center.

Participants:
We studied 17 subjects for more than 1 year after at least moderate traumatic brain injury. Ten of the subjects were respondents and 7 nonrespondents to cholinergic medication.

Design:
Cholinergic function was assessed with [methyl-11C] N-methylpiperidyl-4-acetate-PET (11C-MP4A-PET), which reflects the activity of the acetylcholinesterase (AChE) enzyme. The subjects were PET scanned twice: without medication and after a 4-week treatment with rivastigmine 1.5 mg twice a day.

Measures:
Regional cerebral AChE activity was measured with PET.

Results:
At baseline Statistical Parametric Mapping analyses showed significantly lower AChE activity in respondents bilaterally in the frontal cortex as compared with nonrespondents. Region of interest (ROI) analysis revealed that the difference was most pronounced in the lateral frontal cortex (−9.4%, P = .034) and anterior cingulate (−6.0%, P = .049). After rivastigmine treatment, AChE activity was notably lower throughout the cortex in both respondents and nonrespondents, without significant differences between them.

Conclusion:
Our study suggests that frontal cholinergic dysfunction is associated with the clinical response to cholinergic stimulation in patients with traumatic brain injury.
SURGICAL OUTCOMES OF 27-GAUGE VITRECTOMY FOR A CONSECUTIVE SERIES OF 163 EYES WITH VARIOUS VITREOUS DISEASES
Authors: Yoneda Kazuhito , Morikawa Keisuke , Oshima Yusuke , Kinoshita Shigeru , Sotozono Chie ,   Japan Microincision Vitrectomy Surgery Study Group
Published: January 2017

Purpose:
To evaluate the safety and efficacy of 27-gauge vitrectomy for various vitreoretinal disorders.

Methods:
In this retrospective comparative study, 163 consecutive eyes with various diseases that underwent 27-gauge pars plana vitrectomy with or without ultraspeed transformer by a single surgeon from June 2012 through December 2014 were analyzed in regard to best-corrected visual acuity, intraocular pressure, intraoperative and postoperative complications, and surgery time.

Results:
In 2 eyes (1.2%), peripheral retina breaks were encountered intraoperatively, yet no other complications were found in those eyes. No cases required larger-gauge vitrectomy. Mean best-corrected visual acuity improved from 20/58 (logarithm of the minimum angle of resolution, 0.46 ± 0.64) preoperatively to 20/32 (logarithm of the minimum angle of resolution, 0.20 ± 0.40) postoperatively (P < 0.001). Mean follow-up was 16.7 months (range, 6–33 months). Intraocular pressure remained stable throughout the postoperative course. Hypotony was seen in 15 eyes (9.2%) at 1-day postoperative, yet that spontaneously improved within 1 week. No case of retinal detachment or endophthalmitis was recorded. In macular surgeries, such as idiopathic epiretinal membrane and macular hole combined with cataract surgery, the mean surgery time was 32.1 ± 6.9 minutes with ultraspeed transformer (n = 38) and 37.1 ± 7.7 minutes without ultraspeed transformer (n = 40) (P = 0.004).

Conclusion:
The 27-gauge pars plana vitrectomy was found to be safe and effective for treating various vitreoretinal disorders.
Advantages of Anterior Segment Optical Coherence Tomography Evaluation of the Kayser–Fleischer Ring in Wilson Disease
Authors: Sridhar Mittanamalli S. 
Published: January 2017

Purpose:
To present anterior segment optical coherence tomography (AS-OCT) findings of the Kayser–Fleischer (KF) ring in Wilson disease (WD) and to discuss the potential advantages of evaluating the KF ring by AS-OCT.

Methods:
This is a retrospective case series of 7 patients with WD with KF rings seen in our institute during the study period (August 2015 to June 2016). All patients underwent slit-lamp examination of the cornea and AS-OCT (Optovue RTVue Premier). In 2 patients, the length of the KF ring was measured using the gray scale of AS-OCT.

Results:
The KF ring on the gray scale of AS-OCT was visualized as a hyperreflective deep corneal layer at the level of Descemet membrane in all eyes. The OCT color scale revealed the KF ring as a greenish, greenish-yellow, yellow, or yellow-orange band. The gray scale of AS-OCT could easily measure the length of the KF ring in patients 6 and 7.

Conclusions:
AS-OCT is an alternative method of evaluating the KF ring in WD, which can be used in combination with slit-lamp examination. The KF ring can be easily measured using the gray scale of AS-OCT. Further studies are required to study the potential advantages of AS-OCT including assessing the density of the KF ring, as a tool to assess response to treatment in WD, in differentiating the KF ring of WD disease from copper deposits in other situations and pigmented corneal rings in non-Wilsonian liver disease.
The Hook and Release Technique During Enucleation Surgery
Authors: Jordan David R. , Stoica Bazil , Dutton Jonathan J. 
Published: January 2017

Purpose:
To describe the results and potential benefit of direct muscle release from the globe during enucleation surgery without identifying sutures in the rectus muscle insertion sites, a technique referred to as the hook and release technique.

Methods:
Single center, retrospective chart review of patients who underwent enucleation with direct removal of the rectus muscles without identifying sutures in their insertion sites between January 2011 and September 2015 was carried out. The inclusion criteria were primary enucleation without previous strabismus surgery, retinal detachment surgery, or orbital surgery that entered the fibrous connective tissue framework. Forty charts of enucleated patients that had direct release of their extraocular muscles without identifying sutures before releasing them from the globe were identified and reviewed. The primary outcome measure was intraoperative or immediate postoperative complications. This retrospective chart review was performed with research ethics board approval and in compliance with the Declaration of Helsinki.

Results:
Data show that following the hook and release technique, the rectus muscles were easily located and reconnected to the orbital implant wrap. The oblique muscles were not reattached. In each of the 40 patients, the 4 rectus muscles were easily located by gently applying traction anteriorly at the conjunctiva/Tenons’ edge using double-pronged skin hooks. There was no instance of a lost or slipped muscle following the hook and release technique.

Conclusion:
The hook and release technique is a simple and efficient method to remove the 4 rectus muscles from the globe and still easily locate them. They are not “lost” and do not “slip out of position” but held in place by the orbital connective tissue framework and the extraocular muscle pulley system. This technique has been very helpful teaching resident staff how to do enucleation surgery as it avoids the more time consuming placement of double-armed locking sutures through the rectus muscle insertions and the potential risk of globe penetration while the muscles remain attached to the eye. If the surgeon desires to attach the muscles to the orbital implant, then sutures are passed after the eye is removed, thus eliminating the worry of globe penetration and avoiding accidentally cutting preplaced extraocular muscle sutures during the remaining enucleation procedure.