bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Respiratory Distress Syndrome in Pregnant Women
Authors: Rush Barret , Martinka Pawel , Kilb Brett , McDermid Robert C. , Boyd John H. , Celi Leo Anthony 
Published: February 2017

OBJECTIVE:
To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality.

METHODS:
We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created.

RESULTS:
A total of 55,208,382 hospitalizations from the 2006–2012 Nationwide Inpatient Samples were analyzed. There were 2,808 pregnant patients with ARDS who underwent mechanical ventilation included in the cohort. The overall mortality rate for the cohort was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% confidence interval [CI] 33.1–39.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 57.7–61.4) per 100,000 live births in 2012. Factors associated with a higher risk of death were prolonged mechanical ventilation (adjusted odds ratio [OR] 1.69, 95% CI 1.25–2.28), renal failure requiring hemodialysis (adjusted OR 3.40, 95% CI 2.11–5.47), liver failure (adjusted OR 1.71, 95% CI 1.09–2.68), amniotic fluid embolism (adjusted OR 2.31, 95% CI 1.16–4.59), influenza infection (OR 2.26, 95% CI 1.28–4.00), septic obstetric emboli (adjusted OR 2.15, 95% CI 1.17–3.96), and puerperal infection (adjusted OR 1.86, 95% CI 1.28–2.70). Factors associated with a lower risk of death were: insurance coverage (adjusted OR 0.56, 95% CI 0.37–0.85), tobacco use (adjusted OR 0.53, 95% CI 0.31–0.90), and pneumonia (adjusted OR 0.70, 95% CI 0.50–0.98).

CONCLUSION:
In this nationwide study, the overall mortality rate for pregnant patients mechanically ventilated for ARDS was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% CI 33.5–41.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 54.3–65.3) per 100,000 live births in 2012.
Modified Beef Tongue Model for Fourth-Degree Laceration Repair Simulation
Authors: Illston Jana D. , Ballard Alicia C. , Ellington David R. , Richter Holly E. 
Published: February 2017

BACKGROUND:
An existing model for fourth-degree laceration repair uses beef tongue with plastic or vinyl tubing. This modified model substitutes beef tripe for the anal mucosa and chicken leg muscles for the anal sphincter muscle analogs to create a realistic model.

METHOD:
Tripe is tunneled through the body of the trimmed beef tongue and sutured like an ostomy to simulate the anal canal. The tongue is incised toward the tripe “anal canal.” Chicken leg muscles are tunneled from the incision out to the cut edges of the beef tongue to create anal sphincter muscle analogs. Procedures can be repeated on the opposite side. Two double-sided models can be made per tongue.

EXPERIENCE:
The model can be refrigerated or frozen and thawed before use. A fourth-degree laceration can be cut immediately before use. Materials were obtained at a local supermarket for $5–7 per half-tongue, double-sided model. Residents responded positively to the model and stated that animal tissue provided realistic haptic simulation.

CONCLUSION:
The modified beef tongue model utilizing tripe and chicken leg muscles as anal mucosa and anal sphincter muscle analogs, respectively, provided excellent perceived haptic fidelity. Moreover, it is an innovative, inexpensive, and well-received teaching tool to augment resident education.
Detecting Pulmonary Edema in Obstetric Patients Through Point-of-Care Lung Ultrasonography
Authors: Pachtman Sarah , Koenig Seth , Meirowitz Natalie 
Published: February 2017

BACKGROUND:
Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy.

TECHNIQUE:
Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units.

EXPERIENCE:
Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema. Findings expedited diagnosis and treatment in both cases.

CONCLUSION:
Lung ultrasonography has potential to be used in obstetrics for detecting pulmonary edema in preeclampsia. It is a well-established tool in critical care settings and use in obstetric patients should be studied given the availability of ultrasonography on labor and delivery and the importance of timely care for critically ill pregnant patients. It is a safe modality to evaluate pregnant women with respiratory symptoms and the necessary skills can be easily acquired by obstetric practitioners familiar with obstetric ultrasonography. Training of obstetric practitioners in this application of ultrasonography is needed.
Association Between Senior Obstetrician Supervision of Resident Deliveries and Mode of Delivery
Authors: Bardos Jonah , Loudon Holly , Rekawek Patricia , Friedman Frederick , Brodman Michael , Fox Nathan S. 
Published: February 2017

OBJECTIVE:
In December 2012, the Mount Sinai Hospital implemented a program to have senior obstetricians (more than 20 years of experience) supervise residents on labor and delivery during the daytime. The objective of this study was to estimate the association of resident supervision by senior obstetricians with mode of delivery.

METHODS:
This was a retrospective cohort study of all resident deliveries at Mount Sinai from July 2011 to June 2015. We included all patients with live, term, singleton, vertex fetuses. We compared delivery outcomes between patients delivered before December 2012 and patients delivered December 2012 and later using logistic regression analysis to control for age, body mass index, parity, induction, and prior cesarean delivery. During the study period there were no other specific departmental initiatives to increase forceps deliveries aside from having six obstetricians with significant experience in operative deliveries supervise and teach residents on labor and delivery.

RESULTS:
There were 5,201 live, term, singleton, vertex deliveries under the care of residents, 1,919 (36.9%) before December 2012 and 3,282 (63.1%) December 2012 or later. The rate of forceps deliveries significantly increased from 0.6% to 2.6% (adjusted odds ratio [OR] 8.44, 95% confidence interval [CI] 3.1–23.1), and the rate of cesarean deliveries significantly decreased from 27.3% to 24.5% (adjusted OR 0.68, 95% CI 0.55–0.83). There were no statistically significant differences in the rates of third- or fourth-degree lacerations or 5-minute Apgar scores less than 7. Among nulliparous women, the forceps rate increased from 1.0% to 3.4% (adjusted OR 4.87, 95% CI 1.74–13.63) and the cesarean delivery rate decreased from 25.6% to 22.7% (adjusted OR 0.69, 95% CI 0.53–0.89). The increase in forceps deliveries and the decrease in cesarean deliveries were seen only in daytime hours (7 am to 7 pm), that is, the shift that was covered by senior obstetricians.

CONCLUSION:
Having senior obstetricians supervise resident deliveries is significantly associated with an increased rate of forceps deliveries and a decreased rate of cesarean deliveries.
Infection and Complications After Low-velocity Intra-articular Gunshot Injuries
Authors: Nguyen Mai P. , Reich Michael S. , O'Donnell Jeffrey A. , Savakus Jonathan C. , Prayson Nicholas F. , Golob Joseph F. , McDonald Amy A. , Como John J. , Vallier Heather A. 
Published: February 2017

Objectives:
The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications after intra-articular (IA) gunshot wounds.

Design:
Retrospective review.

Setting:
Level I trauma center.

Patients/Participants:
Fifty-three patients with 55 civilian low-velocity IA gunshot injuries with a minimum of 4 weeks follow-up were included in the study. Seven patients had associated vascular injuries.

Interventions:
Most patients (84.9%) received antibiotic prophylaxis, consisting most often of cefazolin (93.3%). Based on injury pattern and surgeon preference, joint injuries were either treated nonoperatively (43.6%), with surgical debridement only (20.0%), with surgical debridement plus fracture fixation and/or neurovascular repair (32.7%), or with percutaneous fracture fixation without debridement (3.6%).

Main Outcome Measures:
Incidence of deep infection.

Results:
Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared with those without vascular injury (28.6% vs. 0.0%, P = 0.02). Two of 24 (8.3%) injuries that were originally managed nonoperatively required delayed surgical procedures, 1 for bullet removal and 1 for ulnar nerve allograft. No patient treated nonoperatively developed an infection.

Conclusions:
The incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. In the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Patients with vascular injury deserve special attention, as they are at higher risk of infection.

Level of Evidence:
Prognostic Level III. See Instructions for authors for a complete description of levels of evidence.
Biopharmaceuticals: Reference Products and Biosimilars to Treat Inflammatory Diseases
Authors: Gils Ann , Bertolotto Antonio , Mulleman Denis , Bejan-Angoulvant Theodora , Declerck Paul J. 
Published: February 2017

Abstract:
Biopharmaceuticals are primarily therapeutic proteins developed to perform specific functions by acting on the disease pathophysiology. Compared with low-molecular chemically synthesized drugs, production of biopharmaceuticals is much more complex and routes of administration and pharmacokinetics differ. Biopharmaceuticals are blockbusters in the treatment of inflammatory diseases, such as psoriasis, multiple sclerosis, rheumatic diseases, and inflammatory bowel diseases, and the introduction of these drugs has revolutionized treatment. Disadvantages include their high costs and the fact that they can evoke antidrug antibodies leading to decreased efficacy. Treatment can be optimized through the development of dosing algorithms and cost can be reduced by biosimilars, after a comparable biological activity, safety, and efficacy have been demonstrated.
Less Anti‐infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators
Authors: Kansen Hannah M. , van Rheenen Patrick F. , Houwen Roderick H.J. , Tjon A Ten Walther , Damen Gerard M. , Kindermann Angelika , Escher Johanna C. , Wolters Victorien M. ,   Kids with Crohn's, Colitis (KiCC) Working Group for Collaborative Paediatric IBD Research in the Netherlands
Published: February 2017

ABSTRACTObjectives:To evaluate the effect of immunomodulators on formation of antibodies to infliximab (ATI) in paediatric patients with Crohn disease (CD) and the association of ATI and loss of response.Methods:Retrospective multicentre observational study (January 2009–December 2014) among Dutch children with CD treated with infliximab (IFX). ATI formation was analysed with Chi‐square test and time‐to‐ATI formation with Kaplan‐Meier and log‐rank test.Results:A total of 229 children were identified. ATIs were measured in 162 patients (70.7%) and 25 (15%) developed ATIs: 6 of 62 (10%) on continuous combined immunosuppression (CCI), 11 of 81 (14%) on early combined immunosuppression (ECI), and 8 of 19 (42%) on IFX monotherapy. ATI formation was higher in patients on IFX monotherapy compared to CCI (P = 0.003) and ECI (P = 0.008), whereas no significant difference was found between CCI and ECI. Sixteen out of 25 patients (64%) with ATIs had loss of response, compared with 32 of 137 patients (19%) without ATIs (P < 0.00002, log rank 0.02). Among patients treated with ECI, 10 of 55 (18%) developed ATIs within the first 12 months, compared to 1 of 26 (4%) after more than 12 months.Conclusions:In children with CD combination therapy is associated with significant reduction of antibody formation and prolonged effectivity compared to IFX monotherapy. ECI for at least 12 months, followed by IFX monotherapy, may be an equally effective alternative to CCI.
Syphilis Masquerading As Mass Lesions: The Utility of Modern-Day Imaging and Molecular Sequencing in Clinical Diagnosis
Authors: Lin Ray Junhao , Choudhury Saugata , Lee Cheng Chuan , Lee Tau Hong 
Published: February 2017

Abstract
Syphilis has been known to present in a myriad of symptoms throughout the ages, and until this day, the diagnosis remains elusive to the modern physician. We present 2 unusual cases of syphilis that posed diagnostic challenges even in the current era of new and advancing diagnostic tests.
Comparison of In-Person Versus Telephone Interviews for Early Syphilis and Human Immunodeficiency Virus Partner Services in King County, Washington (2010–2014)
Authors: Heumann Christine L. , Katz David A. , Dombrowski Julia C. , Bennett Amy B. , Manhart Lisa E. , Golden Matthew R. 
Published: February 2017

Background
The relative effectiveness of in-person versus telephone interviews for human immunodeficiency virus (HIV)/sexually transmitted disease partner services (PS) is uncertain.

Methods
We compared outcomes of in-person versus telephone PS interviews for early syphilis (ES) and newly diagnosed HIV in King County, Washington from 2010 to 2014. We used multivariable Poisson regression to evaluate indices (number of partners per original patient [OP]) for partners named, notified, tested, diagnosed, and treated (ES only). Analyses controlled for OP age, sex, race/ethnicity, sexual orientation, time to interview, place of diagnosis, and staff performing interviews.

Results
For ES, 682 and 646 OPs underwent in-person and telephone interviews, respectively. In-person syphilis PS were associated with higher indices of partners named (in-person index [IPI], 3.43; telephone index [TI], 2.06; adjusted relative risk [aRR], 1.68; 95% confidence interval [CI], 1.55–1.82), notified (IPI, 1.70; TI, 1.13; aRR, 1.39; 95% CI, 1.24–1.56), tested (IPI, 1.15; TI, 0.72; aRR, 1.34; 95% CI, 1.16–1.54), and empirically treated (IPI, 1.03; TI, 0.74; aRR, 1.19; 95% CI, 1.03–1.37), but no difference in infected partners treated (IPI, 0.28; TI, 0.24; aRR, 0.93; 95% CI, 0.72–1.21). For HIV, 358 and 489 OPs underwent in-person and telephone interviews, respectively. In-person HIV PS were associated with higher indices of partners named (IPI, 1.87; TI, 1.28; aRR, 1.38; 95% CI, 1.18–1.62), notified (IPI, 1.38; TI, 0.92; aRR, 1.24; 95% CI, 1.03–1.50), and newly diagnosed with HIV (IPI, 0.10; TI, 0.05; aRR, 2.17; 95% CI, 1.04–4.50), but no difference in partners tested (IPI, 0.61; TI, 0.48; aRR, 1.15; 95% CI, 0.88–1.52).

Conclusions
Although in-person syphilis PS were associated with some increased PS indices, they did not increase the treatment of infected partners. In contrast, in-person HIV PS resulted in increased HIV case finding. These data support prioritizing in-person PS for HIV and suggest that in-person PS for syphilis may not have major public health benefit.
A Handoffs Software Led to Fewer Errors of Omission and Better Provider Satisfaction: A Randomized Control Trial
Authors: Kashiouris Markos G. , Stefanou Christos , Sharma Deepankar , Yshii-Tamashiro Cecilia , Vega Ryan , Hartigan Sarah , Albrecht Charles , Brown Robert H. 
Published: February 2017

Background
Computer-assisted communication is shown to prevent critical omissions (“errors”) in the handoff process.

Objective
The aim of the study was to study this effect and related provider satisfaction, using a standardized software.

Methods
Fourteen internal medicine house officers staffed 6 days and 1 cross-covering teams were randomized to either the intervention group or control, employing usual handoff, so that handoff information was exchanged only between same-group subjects (daily, for 28 days).

Results
In the intervention group, fewer omissions (among those studied) occurred intravenous access (17 versus 422, P < 0.001), code status (1 versus 158, P < 0.001), diet/nothing per mouth (28 versus 477, P < 0.001), and deep venous thrombosis prophylaxis (17 versus 284, P < 0.001); duration to compose handoff was similar; and physicians perceived less workload adjusted for patient census and provider characteristics (P = 0.004) as well as better handoff quality (P < 0.001) and clarity (P < 0.001).

Conclusions
The intervention was associated with fewer errors and superior provider satisfaction.
Patients’ and Care Partners’ Perspectives on Dignity and Respect During Acute Care Hospitalization
Authors: Gazarian Priscilla K. , Morrison Constance R.C. , Lehmann Lisa Soleymani , Tamir Orly , Bates David W. , Rozenblum Ronen 
Published: February 2017

Background
Delivering patient-centered care (PCC) is essential to our healthcare system. Patient dignity and respect are foundational elements of PCC. Understanding patients’ and their care partner’s perspectives on the meaning of dignity and respect within a clinical care environment is critical to achieving our goal of PCC.

Objective
The aim of the study was to understand how patients and their care partners define, describe, and experience dignity and respect during hospitalization.

Methods
We conducted a qualitative study with 22 patients and care partners hospitalized in high-acuity patient care areas in 1 academic medical center. Data collected from semistructured interviews were analyzed using grounded theory open coding in Atlas Ti software.

Results
Our data provide a definition of dignity and respect during hospitalization from the patient and care partner perspective and a conceptual model of the factors needed to enhance patients’ and care partners’ experience of dignity and respect in the hospital setting. Dignity was felt to be intrinsic to personhood including the recognition of that person’s value by others. Respect was characterized as the behavioral or social norms that acknowledge dignity. Determinants of dignity and respect were categorized at the organizational (macro) level and within the microsystem between clinicians, patients, and their care partners.

Conclusions
The definition of dignity and respect and the conceptual model presented here represent an important supplement to our understanding of dignity and respect during hospitalization. Healthcare organizations should focus on the key factors found in this study to create a culture that treats patients with dignity and respect.
In Vivo Ultrasound Characteristics of Vaginal Mesh Kit Complications
Authors: Javadian Pouya , Quiroz Lieschen H. , Shobeiri S. Abbas 
Published: February 2017

Objective
The objective of this study was to investigate the ultrasound characteristics of vaginal mesh in women with vaginal mesh complications.

Methods
This was a cross-sectional study of women presenting with extrusion complications from vaginal mesh kit for prolapse at our tertiary care center between years 2009 and 2014. We included women who concurrently underwent a 3-dimensional endovaginal ultrasound (EVUS) as part of the clinical evaluation. We excluded women with incomplete charts and poor imaging quality. Subjects were categorized by the presence or absence of associated pelvic pain. Based on ultrasound findings, we compared the location of mesh, the appearance of mesh pattern (flat, folding, prominence, convoluted), and other EVUS characteristics of mesh.

Results
Forty-six women with vaginal mesh complications and good image quality were included. When comparing mesh length between posterior and anterior compartments, the posterior meshes were significantly longer than the anterior meshes (42.1 [SD, 11.9] mm vs 25.8 [SD, 9] mm; P < 0.0001) and more often associated with pain. In the posterior compartment, the mean mesh length seen on EVUS was significantly longer in women with pain than in women without pain (46.5 [SD, 9] mm vs 31.8 [SD, 12.1] mm; P = 0.0001). There was also a higher proportion of a “flat” mesh pattern, 14 (58.3%) of 25, in the posterior compartment associated with the presence of pain (P = 0.013). In the posterior compartment, a smaller distance between the distal edge of the mesh and the anal sphincter was significantly associated with the presence of pain (8 mm [0–37] vs 21 mm [8–35], P = 0.024). In both compartments, the EVUS had 100% sensitivity for detection of mesh extrusions.

Conclusions
In this population of patients presenting with mesh complications, the posterior meshes were more often visualized as a “flat” pattern with a higher frequency of pain. Mesh complications of the anterior compartment had a higher frequency of folding and shrinkage.
Calcitonin gene-related peptide in peripheral blood as a biomarker for migraine
Authors: Ramón César , Cernuda-Morollón Eva , Pascual Julio 
Published: February 2017

Purpose of review
There is no available biomarker for any of the primary headaches, including migraine. As demonstrated in jugular blood, during a migraine attack, trigeminal activation releases several neuropeptides, very especially calcitonin gene-related peptide (CGRP), which gives rise to the typical throbbing migraine pain. Here, we review the current evidence for measurement of peripheral CGRP levels as a potential biomarker for trigemino-vascular activation in migraine.

Recent findings
Several studies, including a limited number of migraine patients, have shown increased peripheral CGRP levels during migraine attacks. The maximum increase in plasma CGRP levels was reached within 2 h of the onset of the attacks and can be reverted by triptans. In addition, CGRP levels measured in peripheral blood outside migraine attacks and in the absence of symptomatic medication have been shown to be increased in chronic migraine patients. Increased CGRP levels were able to predict the response to onabotulinumtoxinA treatment and were reduced 1 month after onabotulinumtypeA therapy.

Summary
Although CGRP data must be confirmed and expanded in future studies and specificity of CGRP levels should be studied in entities able to resemble migraine, it seems that peripheral CGRP levels are a good biomarker of acute migraine and somewhat specific and sensitive interictally in chronic migraine.
Postviral autoimmune encephalitis: manifestations in children and adults
Authors: Prüss Harald 
Published: February 2017

Purpose of review
Autoimmune encephalitis is an increasingly recognized neuropsychiatric condition seen in patients of all ages. Herpes virus infections of the brain can antedate the development of pathogenic autoantibodies against N-methyl-D-aspartate receptors and further neuronal surface proteins, leading to neuronal dysfunction and relapsing symptoms. This review will recapitulate the recent scientific progress, clinical manifestations in children and adults, therapeutic options, and etiological concepts on how autoimmunity develops.

Recent findings
Postviral autoimmune encephalitis has been established as disease mechanism after herpes simplex virus encephalitis. Relapsing symptoms in the absence of virus occur in up to 20% of cases. The clinical presentation is relatively stereotyped in children, consisting of choreoathetosis and reduced levels of consciousness. Adults commonly present with psychiatric abnormalities and cognitive changes. Virus-induced antibody generation seems to be a widespread mechanism not confined to Herpesviridae and N-methyl-D-aspartate receptor antibodies

Summary
The presence of prolonged, atypical, or relapsing symptoms after virus encephalitis must be actively determined, requiring early follow-up visits of patients, and should always prompt the search for underlying autoantibodies. Relapsing symptoms can markedly improve with immunotherapy, thus treatment, including corticosteroids, plasma separation, immunoglobulins, and rituximab is usually recommended, even if no specific antibody was detected.