bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance Indicators in Spine Surgery
Authors: St-Pierre Godefroy Hardy , Yang Michael H. , Bourget-Murray Jonathan , Thomas Ken C. , Hurlbert Robin John , Matthes Nikolas 
Published: June 2017

Study Design.
Systematic review.

Objective.
To elucidate how performance indicators are currently used in spine surgery.

Summary of Background Data.
The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators.

Methods.
MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator.

Results.
The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery.

Conclusion.
The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance.

Level of Evidence: 1
Preadmission Use of Calcium Channel Blocking Agents Is Associated With Improved Outcomes in Patients With Sepsis: A Population-Based Propensity Score–Matched Cohort Study
Authors: Lee Chien-Chang , Lee Meng-tse Gabriel , Lee Wan-Chien , Lai Chih-Cheng , Chao Christin Chih-Ting , Hsu Wan-Ting Hsu , Chang Shy-Shin , Lee Matthew 
Published: June 2017

Objectives:
Use of calcium channel blockers has been found to improve sepsis outcomes in animal studies and one clinical study. This study determines whether the use of calcium channel blockers is associated with a decreased risk of mortality in patients with sepsis.

Design:
Population-based matched cohort study.

Setting:
National Health Insurance Research Database of Taiwan.

Patients:
Hospitalized severe sepsis patients identified from National Health Insurance Research Database by International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Interventions:
None.

Measurements and Main Results:
The association between calcium channel blocker use and sepsis outcome was determined by multivariate-adjusted Cox proportional hazard models and propensity score analysis. To examine the influence of healthy user bias, beta-blocker was used as an active comparator. Our study identified 51,078 patients with sepsis, of which, 19,742 received calcium channel blocker treatments prior to the admission. Use of calcium channel blocker was associated with a reduced 30-day mortality after propensity score adjustment (hazard ratio, 0.94; 95% CI, 0.89–0.99), and the beneficial effect could extend to 90-day mortality (hazard ratio, 0.95; 95% CI, 0.89–1.00). In contrast, use of beta-blocker was not associated with an improved 30-day (hazard ratio, 1.06; 95% CI, 0.97–1.15) or 90-day mortality (hazard ratio, 1.00; 95% CI, 0.90–1.11). On subgroup analysis, calcium channel blockers tend to be more beneficial to patients with male gender, between 40 and 79 years old, with a low comorbidity burden, and to patients with cardiovascular diseases, diabetes, or renal diseases.

Conclusions:
In this national cohort study, preadmission calcium channel blocker therapy before sepsis development was associated with a 6% reduction in mortality when compared with patients who have never received calcium channel blockers.
Victimization by Siblings in Children with Disability or Weight Problems
Authors: Tucker Corinna J. , Finkelhor David , Turner Heather 
Published: June 2017

ABSTRACT:

Objective:
Children with a physical disability, psychological disorder, or of nonnormative weight are often targets of peer victimization. Sibling victimization, however, is more common than peer victimization, but rarely explored. We investigated linkages between sibling victimization and whether children had a physical disability, psychological disorder (i.e., internalizing disorder, attention deficit disorder/attention-deficit hyperactivity disorder), and were perceived by parents as being thinner than average or overweight. Also, we explored how the extent and kinds of sibling victimization experiences were related to these characteristics in childhood.

Methods:
A US probability sample of adult caregivers of a child aged 0 to 9 (N = 780; 50% women; mean age 4.58) in 2-child households who completed a telephone interview.

Results:
Controlling for other forms of maltreatment and individual and family characteristics, children with a physical disability and parent-perceived children who are thinner than average and children who are overweight experienced more sibling victimization. Children with an internalizing disorder experienced less sibling victimization. Sibling victimization did not differ for children with and without ADHD. Children perceived to be overweight by parents and children with a physical disability were at increased risk of experiencing more types of sibling victimization. Children with a physical disability had greater odds of being victims of property victimization by a sibling.

Conclusion:
Children with a physical disability or perceived as different from average weight are at risk for sibling victimization. Using a nationally representative sample, this is the first study to highlight the importance of screening for sibling victimization in families of children with a disability and/or nonnormative weight status.
Substance Use Among Adolescents with Attention-Deficit/Hyperactivity Disorder: Reasons for Use, Knowledge of Risks, and Provider Messaging/Education
Authors: Harstad Elizabeth , Wisk Lauren E. , Ziemnik Rosemary , Huang Qian , Salimian Parissa , Weitzman Elissa R. , Levy Sharon 
Published: June 2017

ABSTRACT:

Objective:
Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for alcohol and marijuana use. This study's objective is to describe adolescents' ADHD-specific reasons for marijuana use, knowledge of ADHD-specific alcohol risks, and reported subspecialty provider messaging/education regarding alcohol use among adolescents with ADHD.

Methods:
Youths with ADHD aged 12 to 18 years completed a survey about alcohol and marijuana use, ADHD-specific reasons for marijuana use, knowledge of ADHD-specific alcohol risks, and reported provider messaging/education regarding alcohol use. We assessed knowledge toward substance use using descriptive statistics. We used χ2 and t tests to determine whether knowledge or provider messaging/education differed by sociodemographic characteristics.

Results:
Of the 96 participants, 61.5% were male, average age was 15.7 years; 31.3% reported past-year alcohol use and 20.8% reported past-year marijuana use. The majority (65.2%) said “no/don't know” to both “Can alcohol make ADHD symptoms worse?” and “Can alcohol interfere or get in the way of the medications you take?” Older participants were more likely to correctly answer the medication question “yes.” Despite most (74%) participants reporting that their provider asked about alcohol use, few youth reported that their providers gave specific messages/education that alcohol could make ADHD symptoms worse (9.4%) or interfere with ADHD medications (14.6%); older participants and past-year alcohol users were more likely to have received these alcohol-specific messages.

Conclusion:
Many youth with ADHD are unaware of the risks of alcohol use in relation to ADHD and providers are not consistently discussing these risks in the context of clinical ADHD care.
Assessing Estimates of Patient Safety Derived From Coded Data
Authors: Narain Wazim 
Published: June 2017

Abstract:
The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using administrative data. Use of PSIs to measure safety and quality of care raises questions since they rely heavily on coded data. The goal of this paper is to review literature on AHRQ PSIs, specifically their accuracy in detecting adverse events, and how recent coding changes affect the accuracy of these estimates. The Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) contains data on more than seven million hospital stays yearly. Trending these estimates over time indicate there has been a decrease in rates for the majority of PSIs, with Accidental Puncture or Laceration, Central Venous Catheter Blood Stream Infections, Iatrogenic Pneumothorax, and Deaths from complications decreasing significantly each year from 2008–2012. Birth Trauma, Retained Foreign Bodies, Post-op Sepsis and Post-Op Respiratory Failure PSIs show no improvement from 2008–2012. A literature review on accuracy of PSIs and the affect of the Present on Admission (POA) indicator on PSI estimates reveals mixed results. PSIs serve as a useful tool in identifying problem areas in quality of care but should be used cautiously in determining hospital performance.
Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units*
Authors: Shapiro Miriam C. , Donohue Pamela K. , Kudchadkar Sapna R. , Hutton Nancy , Boss Renee D. 
Published: June 2017

Objective:
To describe neonatologist and pediatric intensivist attitudes and practices relevant to high-stakes decisions for children with chronic critical illness, with particular attention to physician perception of professional duty to seek treatment team consensus and to disclose team conflict.

Design:
Self-administered online survey.

Setting:
U.S. neonatal ICUs and PICUs.

Subjects:
Neonatologists and pediatric intensivists.

Interventions:
None.

Measurements and Main Results:
We received 652 responses (333 neonatologists, denominator unknown; 319 of 1,290 pediatric intensivists). When asked about guiding a decision for tracheostomy in a chronically critically ill infant, only 41.7% of physicians indicated professional responsibility to seek a consensus decision, but 73.3% reported, in practice, that they would seek consensus and make a consensus-based recommendation; the second most common practice (15.5%) was to defer to families without making recommendations. When presented with conflict among the treatment team, 63% of physicians indicated a responsibility to be transparent about the decision-making process and reported matching practices. Neonatologists more frequently reported a responsibility to give decision making fully over to families; intensivists were more likely to seek out consensus among the treatment team.

Conclusions:
ICU physicians do not agree about their responsibilities when approaching difficult decisions for chronically critically ill children. Although most physicians feel a professional responsibility to provide personal recommendations or defer to families, most physicians report offering consensus recommendations. Nearly all physicians embrace a sense of responsibility to disclose disagreement to families. More research is needed to understand physician responsibilities for making recommendations in the care of chronically critically ill children.
Comparison of Steroid and Botulinum Toxin Type A Monotherapy with Combination Therapy for Treating Human Hypertrophic Scars in an Animal Model
Authors: Chen Hung-Chang , Yen Cheng-I , Yang Shih-Yi , Chang Cheng-Jen , Yang Jui-Yung , Chang Shu-Yin , Chuang Shiow-Shuh , Hsiao Yen-Chang 
Published: June 2017

Background:
The authors evaluated the efficacy of a combined regimen of botulinum toxin type A (Botox) and a steroid (triamcinolone acetonide) for treating hypertrophic scars in comparison with the treatment with each drug alone.

Methods:
Twenty excised human hypertrophic scar fragments obtained from surgically treated burn patients were divided into four groups: negative control (group A), triamcinolone alone (group B), Botox alone (group C), and a combination of triamcinolone and Botox (group D). These specimens were implanted into the backs of nude mice after intralesional injection from each group and were observed for 4 weeks. In total, 12 mice and 48 scars were studied. After 4 weeks, the hypertrophic scars were removed from the backs. The authors compared the scar weights, decorin staining, and the Cell Counting Kit-8 assay to evaluate treatment efficacy.

Results:
Significant differences in scar weight reduction were observed among the four groups (group A, 10 percent; group B, 17 percent; group C, 23 percent; and group D, 30 percent; p < 0.05). Treatment groups (groups B, C, and D) showed strong decorin staining. Significant differences in reduction of fibroblast proliferation were observed among the four groups (group A, 0.58; group B, 0.44; group C, 0.21; and group D, 0.08; p < 0.05). Botox or triamcinolone intralesional monotherapy showed significant therapeutic efficacy compared with the control group. The combined therapy further exhibited a significant therapeutic effect compared with monotherapy.

Conclusion:
This study indicates the potential of Botox and triamcinolone when combined for intralesional therapy in treating hypertrophic scars.
Selective Intraoperative Vasopressor Use Is Not Associated with Increased Risk of DIEP Flap Complications
Authors: Szabo Eltorai Ashley , Huang Chuan-Chin , Lu Jeffrey T. , Ogura Asako , Caterson Stephanie A. , Orgill Dennis P. 
Published: June 2017

Background:
During deep inferior epigastric perforator (DIEP) flap cases, anesthesiologists commonly avoid intravenous vasopressor administration because of the theoretical concern of inducing vasospasm, thrombosis, or congestion in the vessels of the anastomosis, potentially resulting in poor flap perfusion and ischemia and necessitating revision. In the setting of hypotension, however, vasopressor administration may actually improve outcomes by augmenting flap perfusion by means of increased mean arterial pressure.

Methods:
The authors reviewed 475 consecutive DIEP flap cases in 333 patients at a single large academic medical center over a 3-year period, addressing potential confounders using univariate analyses.

Results:
Ephedrine administration was significantly associated with decreased risk of intraoperative flap complications (OR, 0.88), including vasospasm, thrombosis, and congestion requiring revision, compared with controls, after controlling for the severity and duration of hypotension. Phenylephrine had no significant association with complication rates. Vasopressor administration was not associated with an increased risk of reoperation in the setting of necrosis within 60 days.

Conclusions:
Ephedrine treatment for hypotension during DIEP flap cases is associated with decreased intraoperative flap complication rates compared with controls who did not receive vasopressors, whereas phenylephrine has no significant association. The common clinical practice of complete abstinence from vasopressors out of concern for worsening DIEP flap outcomes is not supported by this study.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Evidence-Based Medicine: Nonsyndromic Craniosynostosis
Authors: Tahiri Youssef , Bartlett Scott P. , Gilardino Mirko S. 
Published: June 2017

Learning Objectives:
After reading this article, the participant should be able to: 1. Understand the craniofacial dysmorphology associated with nonsyndromic craniosynostosis. 2. Understand the functional concerns and preoperative considerations when treating patients with nonsyndromic craniosynostosis. 3. Understand the various treatment options available to address patients with nonsyndromic craniosynostosis. 4. Recognize the current debate with regard to timing and type of surgical intervention, and their impact on patient outcome, for patients with nonsyndromic craniosynostosis.

Summary:
Craniosynostosis is a pathologic condition associated with the premature fusion of one or more cranial sutures. When the cranial sutures fuse prematurely, the skull and the growing brain beneath the suture are restricted, leading to a compensatory expansion into regions of the skull that are not affected. Craniosynostosis can occur in isolation (nonsyndromic) or can be associated with other extracranial anomalies. When anomalies outside the skull are present, craniosynostosis is often part of a syndrome and usually involves multiple sutures (syndromic craniosynostosis). This article focuses on nonsyndromic craniosynostosis, and describes the current state of knowledge regarding its diagnosis, surgical management, and outcomes.
Preventing Soft-Tissue Triangle Collapse in Modern Rhinoplasty
Authors: Campbell Carey F. , Pezeshk Ronnie A. , Basci Deniz S. , Scheuer Jack F. , Sieber David A. , Rohrich Rod J. 
Published: June 2017

Summary:
The unique anatomy of the soft-tissue triangle makes it prone to notching in primary, secondary, and reconstructive rhinoplasty. Understanding the anatomy of the region is critical to appropriate treatment. This article is meant to further clarify the anatomy of the soft-tissue triangle and to present the senior author’s (R.J.R.) approach to proactive correction and prevention of soft-tissue triangle notching through five key steps: (1) precise dissection and incision placement, (2) providing internal support with cartilage grafting if needed, (3) closure of dead space, (4) avoiding undue tension during closure, and (5) providing external support postoperatively.
Polypropylene Mesh Predicts Mesh/Suture Exposure After Sacrocolpopexy Independent of Known Risk Factors: A Retrospective Case-Control Study
Authors: Durst Paula J. , Heit Michael H. 
Published: June 2017

Objective(s)
The aim of this study was to determine if ultralightweight polypropylene mesh reduced the risk of mesh/suture exposure after sacrocolpopexy compared with heavier-weighted polypropylene.

Methods
Bivariate and multivariate analyses were used to interpret data from 133 cases and 261 control subjects to evaluate independent predictors of mesh/suture exposure after sacrocolpopexy from 2003 to 2013.

Results
Multivariate logistic regression revealed that prior surgery for incontinence (odds ratio [OR], 2.87; 95% confidence interval [CI], 1.19–6.96), porcine acellular cross-linked collagen matrix with medium-weight polypropylene mesh (OR, 4.95; 95% CI, 1.70–14.42), other polypropylene mesh (OR, 6.73; 95% CI, 1.12–40.63), nonabsorbable braided suture for vaginal mesh attachment (OR, 4.52; 95% CI, 1.53–15.37), and immediate perioperative complications (OR, 3.64; 95% CI, 1.53–13.37) were independent risk factors for mesh/suture exposure. After multivariate analysis, ultralightweight polypropylene mesh was no longer associated with decreased rates of mesh/suture exposure after controlling for known risk factors identified during bivariate analysis (P = 0.423).

Conclusions
Both mesh choice and suture selection remained independent predictors of mesh/suture exposure, with heavier meshes increasing and monofilament suture decreasing rates of mesh/suture exposure. Based on this study, surgeons may consider use of delayed-absorbable, monofilament suture over nonabsorbable braided suture for attachment of vaginal mesh to reduce the risk of mesh/suture exposure when using mesh.
The Clinical Alliance and Research in Electroconvulsive Therapy Network
Authors: Martin Donel M. , Gálvez Verònica , Lauf Shani , Dong Vanessa , Baily Stephen A. , Cardoner Narcís , Chan Herng N. , Davidson Don , Fam Johnson , De Felice Nick , Martinez-Amoros Erika , Mohan Titus , Ramalingam Jothi , Sarma Shanthi I. , Tor Phern C. , Waite Susan , Loo Colleen K. 
Published: June 2017

Objective
There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data.

Methods
The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined.

Results
The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing.

Conclusions
There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.