bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta
Authors: Shamshirsaz Alireza A. , Fox Karin A. , Erfani Hadi , Clark Steven L. , Shamshirsaz Amir A. , Nassr Ahmed A. , Sundgren Nathan C. , Jones Jeffery A. , Anderson Matthew L. , Kassir Elias , Salmanian Bahram , Buffie Alexandra W. , Hui Shiu-Ki , Espinoza Jimmy , Tyer-Viola Lynda A. , Rac Martha , Karbasian Niloofar , Ballas Jerasimos , Dildy Gary A. , Belfort Michael A. 
Published: January 2018

OBJECTIVE:
To compare outcomes between planned and urgent cesarean hysterectomy for morbidly adherent placenta managed by a multidisciplinary team.

METHODS:
This is a retrospective case–control study of women with singleton pregnancies with antenatally suspected and pathologically confirmed morbidly adherent placenta who underwent cesarean hysterectomy between January 1, 2011, and February 30, 2017. Timing of delivery was classified as either planned (delivery at 34–35 weeks of gestation) or urgent (need for urgent delivery as a result of uterine contractions, bleeding, or both). The primary outcome variable was composite maternal morbidity. Logistic regression analysis was used to evaluate risk factors for urgent delivery.

RESULTS:
One hundred thirty patients underwent hysterectomy. Sixty (46.2%) required urgent delivery. Composite maternal morbidity was identified in 34 (56.7%) of the urgent and 26 (37.1%) of the planned deliveries (P=.03). Fewer units of red blood cells and fresh frozen plasma were transfused in the planned delivery group (red blood cells, median interquartile range 3 [0–8] versus 1 [0–4], P=.02; fresh frozen plasma, median interquartile range 1 [0–2] versus 0 [0–0], P=.001). Rates of low Apgar score and respiratory distress syndrome were higher in the urgent compared with the planned delivery group (5-minute Apgar score less than 7, 34 [59.6%] versus 14 [23.3%], P<.01; respiratory distress syndrome, 34 [61.8%] versus 16 [27.1%], P<.01). A history of two or more prior cesarean deliveries was an independent predictor of urgent delivery (adjusted odds ratio 11.4, 95% CI 1.8–71.1).

CONCLUSION:
Women with morbidly adherent placenta requiring urgent delivery have a worse outcome than women with planned delivery. Women with morbidly adherent placenta and two or more prior cesarean deliveries are at increased risk for urgent delivery. In such women, scheduling delivery before the standard 34- to 35-week timeframe may be reasonable.
Associations Between Childbirth and Urinary Incontinence After Midurethral Sling Surgery
Authors: Bergman Ida , Westergren Söderberg Marie , Lundqvist Andrea , Ek Marion 
Published: January 2018

OBJECTIVE:
To assess whether subsequent childbirths affect the outcomes of midurethral sling surgery with regard to stress urinary incontinence (SUI).

METHODS:
In this population-based cohort study, we used the validated Swedish nationwide health care registers (the Patient Register and the Medical Birth Register) to identify women with a delivery after midurethral sling surgery (n=207, study group). From the same registers we then randomly identified a control group who had no deliveries after their midurethral sling procedure (n=521, control group). The women in the control group were matched to the women in the study group by age and year of surgery. The Urogenital Distress Inventory and the Incontinence Impact Questionnaire were sent out to the study population. Symptomatic SUI was defined as the primary outcome. Secondary outcomes included the total Urogenital Distress Inventory score, Urogenital Distress Inventory subscale scores, and Incontinence Impact Questionnaire scores.

RESULTS:
A total of 728 women were eligible for the study. The response rate was 74%; 163 in the study group (64 with vaginal delivery and 95 with cesarean delivery) and 374 women in the control group were included in the analysis. The rate of SUI (primary outcome) was 36 of 163 (22%) in the study group and 63 of 374 (17%) in the control group. In a multivariate regression analysis of the primary outcome, we found no significant difference between the groups (odds ratio [OR] 1.2, 95% CI 0.7–2.0). Vaginal childbirth after midurethral sling surgery did not increase the risk of SUI compared with cesarean delivery (22% vs 22%, OR 0.6, 95% CI 0.2–1.4). There were no significant differences in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores between any of the groups.

CONCLUSION:
Childbirth after a midurethral sling procedure is not associated with an increased risk of patient-reported SUI, and continence status is not affected by the mode of a subsequent delivery.
Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients
Authors: Jackson Taylor J. , Blumberg Todd J. , Shah Apurva S. , Sankar Wudbhav N. 
Published: January 2018

Background:
Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system.

Methods:
We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared.

Results:
Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (P<0.001), and less likely to have a sprain (P<0.001) or dislocation/subluxation (P<0.001). Over 40% of second visits were accounted for by 3 diagnoses (distal radius buckle fractures, nondisplaced Salter-Harris 1 fractures of the ankle, and buckle fractures of the finger). Across the whole cohort, the total financial impact of untimely visits was $36,265.78, representing an average cost of $342.93 per patient.

Conclusions:
Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in the treatment of common orthopaedic injuries in pediatric patients.

Level of Evidence:
Level III.
Bilateral Cochlear Implants: Maximizing Expected Outcomes
Authors: Wallis Kate E. , Blum Nathan J. , Waryasz Stephanie A. , Augustyn Marilyn 
Published: January 2018

CASE:
Sonia is a 4 years 1 month-year-old girl with Waardenburg syndrome and bilateral sensorineural hearing loss who had bilateral cochlear implants at 2 years 7 months years of age. She is referred to Developmental-Behavioral Pediatrics by her speech/language pathologist because of concerns that her language skills are not progressing as expected after the cochlear implant. At the time of the implant, she communicated using approximately 20 signs and 1 spoken word (mama). At the time of the evaluation (18 months after the implant) she had approximately 70 spoken words (English and Spanish) and innumerable signs that she used to communicate. She could follow 1-step directions in English but had more difficulty after 2-step directions.
Sonia was born in Puerto Rico at 40 weeks gestation after an uncomplicated pregnancy. She failed her newborn hearing test and was given hearing aids that did not seem to help.
At age 2 years, Sonia, her mother, and younger sister moved to the United States where she was diagnosed with bilateral severe-to-profound hearing loss. Genetic testing led to a diagnosis of Waardenburg syndrome (group of genetic conditions that can cause hearing loss and changes in coloring [pigmentation] of the hair, skin, and eyes). She received bilateral cochlear implants 6 months later.
Sonia's mother is primarily Spanish-speaking and mostly communicates with her in Spanish or with gestures but has recently begun to learn American Sign Language (ASL). In a preschool program at a specialized school for the deaf, Sonia is learning both English and ASL. Sonia seems to prefer to use ASL to communicate.
Sonia receives speech and language therapy (SLT) 3 times per week (90 minutes total) individually in school and once per week within a group. She is also receiving outpatient SLT once per week. Therapy sessions are completed in English, with the aid of an ASL interpreter. Sonia's language scores remain low, with her receptive skills in the first percentile, and her expressive skills in the fifth percentile.
During her evaluation in Developmental and Behavioral Pediatrics, an ASL interpreter was present, and the examiner is a fluent Spanish speaker. Testing was completed through a combination of English, Spanish, and ASL. Sonia seemed to prefer ASL to communicate, although she used some English words with errors of pronunciation. On the Beery Visual-Motor Integration Test, she obtained a standard score of 95. Parent and teacher rating scales were not significant for symptoms of attention-deficit/hyperactivity disorder.
What factors are contributing to her slow language acquisition and how would you modify her treatment plan?
INCIDENCE AND LONG-TERM VISUAL ACUITY OUTCOMES OF RETINAL PIGMENT EPITHELIUM TEARS AFTER INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Vazquez-Alfageme Clara , Nicholson Luke , Hamilton Robin D. , Patel Praveen J. 
Published: January 2018

Purpose:
To report the incidence of retinal pigment epithelium tears in eyes treated with aflibercept for neovascular age-related macular degeneration and compare it with ranibizumab, and to describe long-term visual outcomes of retinal pigment epithelium tears after intensive anti–vascular endothelial growth factor treatment.

Methods:
Retrospective analysis of clinical charts, spectral domain optical coherence tomography and fundus fluorescein angiography imaging of consecutive naive patients treated with intravitreal aflibercept or ranibizumab for neovascular age-related macular degeneration.

Results:
Eight hundred consecutive eyes were included in the study (300 treated with ranibizumab and 500 with aflibercept) with 34.0 ± 9.1 months of follow-up. The incidence of tears in the aflibercept group was 3.2% and 2.3% after ranibizumab (P = 0.52). Twenty-nine eyes with retinal pigment epithelium tears were followed for a mean of 30.76 months. Visual acuity at baseline was 20/100 (50.7 ± 19.3 Early Treatment Diabetic Retinopathy Study letters) and 20/200 (36.1 ± 26.1 Early Treatment Diabetic Retinopathy Study letters) at the end of follow-up. The mean number of injection was 7.3 at 12 months and 13.9 ± 8.1 at the end of the study. The number of injections positively correlated with the final visual outcome.

Conclusion:
There was a low rate of retinal pigment epithelium tears after aflibercept injections, similar to ranibizumab. The correlation between the number of anti–vascular endothelial growth factors received and visual outcomes supports the need for continuing anti–vascular endothelial growth factor therapy.
Corneal Collagen Cross-Linking With Riboflavin and Ultraviolet A Light for Pediatric Keratoconus: Ten-Year Results
Authors: Mazzotta Cosimo , Traversi Claudio , Baiocchi Stefano , Bagaglia Simone , Caporossi Orsola , Villano Antonio , Caporossi Aldo 
Published: January 2018

Purpose:
To assess the 10-year follow-up efficacy and safety of riboflavin ultraviolet A–induced cross-linking (CXL) in a population of pediatric patients aged 18 years and younger with progressive keratoconus (KC).

Methods:
The prospective longitudinal cohort study included 62 eyes of 47 keratoconic patients undergoing epithelium-off CXL who completed 10-year follow-up. The surgical procedure was performed in all patients according to the Siena (Dresden modified) protocol. Evaluation included uncorrected distance visual acuity, corrected distance visual acuity, Scheimpflug corneal tomography, and optical coherence tomography demarcation line measurement. Follow-up measurements taken up to 10 years after treatment were compared with baseline values, and statistical analysis was performed using a 2-tailed paired sample Student t test.

Results:
Uncorrected distance visual acuity and corrected distance visual acuity improved from 0.45 to 0.23 logarithm of the minimum angle resolution (P = 0.0001) and from 0.14 to 0.1 logarithm of the minimum angle resolution (P = 0.019). KC stability was recorded after 10 years of follow-up in nearly 80% of the patients. The overall 10-year follow-up progression rate was 24% including 13 eyes of 9 patients with Kmax progression over 1 diopter and 2 eyes of 2 patients who underwent corneal grafting.

Conclusions:
The study demonstrates the ability of CXL to slow down KC progression in pediatric patients, improving functional performance. Long-term stability may be correlated with CXL-induced delay in corneal collagen turnover and with spontaneous age-related KC stabilization. A 24% regression rate could be contemplated in the patients who were aged 15 years and younger at the time of inclusion in the treatment protocol.
Repeated Same-Day Versus Single Tomography Measurements of Keratoconic Eyes for Analysis of Disease Progression
Authors: Wonneberger Wolf , Sterner Bertil , MacLean Ulrika , Claesson Margareta , Zetterberg Madeleine 
Published: January 2018

Purpose:
Corneal tomography is used to assess progression of keratoconus and to direct clinical decisions regarding corneal cross-linking. The purpose of this study was to analyze the variability of repeated Scheimpflug-tomography (Pentacam Classic; Oculus, Wetzlar, Germany) measurements of keratoconic eyes in a clinical setting and to assess the validity of such measurements as a clinical decision-making tool.

Methods:
Eighty keratoconic eyes of 45 patients (age range 16–32 years) were examined at baseline and after follow-up periods of 3 to 6 months using 3 consecutive tomography measurements at each visit. Minimum corneal thickness and anterior sagittal curvature map parameters were studied [simulated keratometry (K) astigmatism (SimKast); maximum simulated K-reading (SimKmax); average SimK (SimKave); maximum K-readings on the 3-mm (Kmax3) and 5-mm (Kmax5) rings; and maximum K-reading (Kmax)].

Results:
When comparing the first measurements at the first and second visits, respectively, 9% to 20% of eyes were classified as progressive depending on which parameter was chosen. Using the average of 3 consecutive measurements at each visit, 5% to 19% of eyes were classified as progressive. An increase in the SD of 3 consecutive measurements of SimKast (SD_SimKast) at the first visit of 1 diopter makes true progression of keratoconus 3.6 times more likely (odds ratio = 3.6; 95% confidence interval: 0.846–16.027; area under the curve = 0.70).

Conclusions:
The approach used to analyze progression in keratoconus, that is, single versus repeated measurements, may confer a great impact on the decision to perform corneal cross-linking treatment or not.
Pathways to Congenital Syphilis Prevention: A Rapid Qualitative Assessment of Barriers, and the Public Health Response, in Caddo Parish, Louisiana
Authors: Kroeger Karen A. , Sangaramoorthy Thurka , Loosier Penny S. , Schmidt Rebecca , Gruber DeAnn 
Published: January 2018

Background
Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. Although CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and CS, with the highest number of CS cases in northwest Louisiana, where Shreveport is located.

Methods
We conducted qualitative interviews with community members (women and frontline providers) living in Caddo Parish to obtain their views about factors that negatively impact CS prevention.

Results
Participants described impediments in the pathways for prevention of CS. Lack of sexual and reproductive health education, discontinuities and fragmentation in health care insurance coverage, a dearth of referral points for prenatal care, and difficulty finding prenatal care providers who accept Medicaid can delay timely and adequate care for pregnant women. Participants reported that low reimbursement for necessary injections and difficulty obtaining required medication challenged efforts to screen and treat pregnant women according to guidelines.

Conclusions
Although CS is easily prevented, health system and policy obstacles in pathways to CS prevention and care may need remediation at state and local levels.
Pediatric Appendicitis
Authors: Drapkin Zachary , Dunnick Jennifer , Madsen Troy E. , Bryce Matthew , Schunk Jeff E. 
Published: January 2018

Objectives
We evaluated the association between the emergency department (ED) triage chief complaint and rate of missed appendicitis in children.

Methods
We performed a retrospective chart review of patients who presented to a pediatric ED and were diagnosed with appendicitis over 5 years (July 1, 2009 to June 30, 2014). We reviewed the medical record for any additional ED visits in the 7 days preceding the diagnosis of appendicitis. Triage chief complaints were classified as “suggestive of appendicitis” (abdominal pain, right lower quadrant pain, or rule out appendicitis) or “nonspecific” (fever, vomiting, dehydration, etc). We evaluated the association between triage chief complaint and missed diagnosis of appendicitis.

Results
We reviewed 1680 patients with appendicitis. In 67 (4%) cases, patients had at least 1 additional ED visit during the week preceding the diagnosis of appendicitis. When comparing those diagnosed with appendicitis at their initial ED visit to those diagnosed after multiple visits, we found no difference in age (9.9 vs 10.1 years, P = 0.665), sex (55.7% vs 49.3% male, P = 0.291), white blood cell count (14.4 vs 12.3 × 103/L, P = 0.115), or presence of fever (19.9% vs 19.4%, P = 0.920). Of patients with a triage chief complaint that was suggestive of appendicitis, 3.8% were missed on their initial ED visit versus 8.8% of those with a nonspecific triage chief complaint (odds ratio, 2.46; 95% confidence interval, 1.1–5.6).

Conclusions
A triage chief complaint less suggestive of appendicitis was associated with a higher rate of missed appendicitis in a pediatric ED. Our findings further confirm the potential impact of anchoring bias by a triage chief complaint when attempting to diagnose appendicitis.
Aspergillus and other respiratory fungal infections in the ICU: diagnosis and management
Authors: Paiva José-Artur , Mergulhão Paulo , Pereira José Manuel 
Published: January 2018

Purpose of review
Filamentous fungi respiratory infections, namely because of Aspergillus, Mucorales, Fusarium, or Scedosporium, show rising incidence and occur more in populations which are not classically immunosuppressed. This and their persistent dismal prognosis are the focus of this review.

Recent findings
Both an early diagnosis, rooted on a high level of suspicion and based on clinical picture, radiology, cultural microbiological exams, fungal biomarkers, PCR and biopsy, and an early therapy, including immunorecovery, whenever possible, good antifungal selection, and surgery for source control, are paramount to maximize the outcome in these diseases. An evolving antifungal armamentarium and a more Pharmacokinetics/Pharmacodynamics-based antifungal prescription may help to improve the prognosis.

Summary
Improved awareness of these infections may increase the level of suspicion, promoting early diagnosis and treatment, ideally supported with expert stewardship.
Determining when to stop antiepileptic drug treatment
Authors: Schachter Steven C. 
Published: January 2018

Purpose of review
As the number of patients diagnosed with epilepsy continues to rise and the pharmacological and device-based treatment options for epilepsy increase, determining when to stop antiepileptic drug (AED) treatment continues to be an important issue for patient management and counseling.

Recent findings
This review focuses on outcomes following AED withdrawal in seizure-free adults with epilepsy. Practical considerations are also discussed because, despite the importance of this topic, relatively little progress has been made in the past year regarding the identification of patients whose risk for recurrent seizures after AED withdrawal is no higher than that of the general population.

Summary
Although articles in the past year have updated the debates about whether and when to discontinue AEDs in seizure-free adults and have suggested potential utility for electroencephalograms as a prognostic tool for AED reduction as well as for an AED withdrawal risk calculator, decisions about AED withdrawal should still be based on the known risks and consequences of seizure recurrence and be made following well documented discussions between doctor and patient/carer.
ECT and Pronounced Impairment in Spatial Cognition
Authors: Andrade Chittaranjan , Prasad Yameni , Devaraj Aathira , Pinto Ekta Franscina , Shukla Lekhansh 
Published: January 2018

Introduction
Electroconvulsive therapy (ECT) is associated with memory deficits on neuropsychological assessment. The association of ECT with nonmemory cognitive deficits has been poorly studied.

Methods
We present a 40-year-old woman who showed a bizarre form of spatial cognition impairment on a subtest of the Tactual Performance Test (TPT) after recovering from depression with 6 alternate day, thrice-weekly, inpatient ECT treatments. This woman was part of a naturalistic, nonblind study that examined nonmemory cognitive deficits in antidepressant-treated depressed patients who did and did not receive ECT.

Results
The impairment was in the form of bizarrely drawn reproductions of differently shaped wooden blocks that had been presented to the patient when she was blindfolded. The impairment was still evident when she was retested (3 hours later) under substantially simplified conditions but was much attenuated approximately 2.5 weeks later.

Conclusions
On the surface, it seems that ECT had induced severe impairment in spatial cognition and that the impairment showed the familiar pattern of attenuation with the passage of time. However, another recovered patient in the study, who did not receive ECT, also showed substantial spatial deficits on the same subtest of the TPT, and the attenuation of the deficits across time in the ECT-treated patient was probably a result of repeated exposure to the task. We suggest that not all patients who seem to experience spectacular cognitive impairment after ECT have deficits that are attributable to ECT.