bluuebunny/crossref_metadata_2025_split huggingface dataset:
Appointment Wait Time, Primary Care Provider Status, and Patient Demographics are Associated With Nonattendance at Outpatient Gastroenterology Clinic
Authors: Shrestha Manish P. , Hu Chengcheng , Taleban Sasha 
Published: September 2016

Goals:
We intended to identify the factors associated with missed appointments at a gastroenterology (GI) clinic in an academic setting.

Background:
Missed clinic appointments reduce clinic efficiency, waste resources, and increase costs. Limited data exist on subspecialty clinic attendance.

Study:
We performed a case-control study using data from the electronic health record of patients scheduled for an appointment at the adult GI clinic at the Banner University Medical Center between March and October of 2014. Patients who missed their appointment during the study period served as cases. Controls were randomly selected from patients who completed their appointment during the study period. Analysis included univariate and multivariate logistic regression analysis.

Results:
Of 2331 scheduled clinic appointments, 195 (8.4%) were missed appointments. Longer waiting time from referral to scheduled appointment was significantly associated with missed appointment (AOR=1.014; 95% CI, 1.01-1.02; P<0.001). Patients with primary care providers (PCPs) were less likely to miss their appointment than those without PCPs (AOR=0.35; 95% CI, 0.18-0.66; P=0.001). Among patient demographic characteristics, ethnicity and marital status were associated with missed appointment.

Conclusions:
Wait time, ethnicity, marital status, and PCP status were associated with missed GI clinic appointments. Further investigations are needed to assess the effects of intervention strategies directed at reducing appointment wait time and increasing PCP-based care.
Diagnostic accuracy of confocal laser endomicroscopy for the characterization of liver nodules
Authors: Pierangelo Angelo , Fuks David , Validire Pierre , Benali Ali , Gayet Brice 
Published: September 2016

Objectives
Probe-based confocal laser endomicroscopy (pCLE) is a promising new imaging technique enabling in-vivo analysis of tissues at the cellular level, in real time. The aim of the present study was to prospectively evaluate the feasibility and accuracy of indocyanine green-aided pCLE for the diagnosis of malignant liver nodules.

Patients and methods
From October 2014 to July 2015, liver specimens from 30 consecutive patients were analyzed ex vivo using pCLE directly after resection, with indocyanine green as contrast agent. The final diagnosis was obtained histologically, as per standard of care. In phase 1, a pathologist and a physicist established pCLE image criteria to distinguish normal parenchyma, malignant nodules, and metastases that had completely responded to chemotherapy. In phase 2, a pathologist and a surgeon reviewed selected videos retrospectively to assess the effectiveness of these.

Results
In phase 1, the healthy nodules were characterized by fluorescent hepatocytes with nonfluorescent nuclei and the malignant nodules were identified as strongly fluorescent, irregular cancer-cell clusters. The extracellular matrix was substantially less fluorescent compared with the cancerous clusters of cells. After chemotherapy, a very dense and strongly fluorescent fibrosis replaced tubular structures of cancerous cells. The retrospective evaluation in phase 2 resulted in 78 and 100% sensitivity, 100 and 89% specificity, 90 and 100% positive predictive value, and 90 and 100% negative predictive value for the surgeon and the pathologist, respectively, for the detection of malignant nodules.

Conclusion
This series emphasized that characterization of liver metastases is possible with pCLE, with high performance results.
Antithrombin Concentrate Use in Pediatric Extracorporeal Membrane Oxygenation: A Multicenter Cohort Study*
Authors: Wong Trisha E. , Nguyen Thuan , Shah Samir S. , Brogan Thomas V. , Witmer Char M. 
Published: September 2016

Objective:
To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System–participating children’s hospital.

Design:
Retrospective, multi-center, cohort study.

Setting:
Forty-three free-standing children’s hospitals participating in Pediatric Health Information System.

Subjects:
Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012.

Interventions:
Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation.

Measurements and Main Results:

International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36–1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14–1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04–1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89–1.11; p = 0.90).

Conclusions:
In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.
Outcomes for Students Receiving School-Based Physical Therapy as Measured by the School Function Assessment
Authors: Effgen Susan K. , McCoy Sarah Westcott , Chiarello Lisa A. , Jeffries Lynn M. , Starnes Catherine , Bush Heather M. 
Published: September 2016

Purpose:
To describe School Function Assessment (SFA) outcomes after 6 months of school-based physical therapy and the effects of age and gross motor function on outcomes.

Methods:
Within 28 states, 109 physical therapists and 296 of their students with disabilities, ages 5 to 12 years, participated. After training, therapists completed 10 SFA scales on students near the beginning and end of the school year.

Results:
Criterion scores for many students remained stable (46%-59%) or improved (37%-51%) with the most students improving in Participation and Maintaining/Changing Positions. Students aged 5 to 7 years showed greater change than 8- to 12-year-olds on 5 scales. Students with higher gross motor function (Gross Motor Function Classification System levels I vs IV/V and II/III vs IV/V) showed greater change on 9 scales.

Conclusions:
Positive SFA change was recorded in students receiving school-based physical therapy; however, the SFA is less sensitive for older students and those with lower functional movement.
Layout for Assessing Dynamic Posture: Development, Validation, and Reproducibility
Authors: Noll Matias , Candotti Cláudia Tarragô , da Rosa Bruna Nichele , Sedrez Juliana Adami , Vieira Adriane , Loss Jefferson Fagundes 
Published: September 2016

Purpose:
To determine the psychometric properties of the layout for assessing dynamic posture (LADy).

Methods:
The study was divided into 2 phases: (1) development of the instrument and (2) determination of validity and reproducibility. The LADy was designed to evaluate the position adopted in 9 dynamic postures.

Results:
The results confirmed the validity and reproducibility of the instrument. From a total of 51 criteria assessing 9 postures, 1 was rejected. The reproducibility for each of the criteria was classified as moderate to excellent.

Conclusions:
The LADy constitutes a valid and reproducible instrument for the evaluation of dynamic postures in children 11 to 17 years old. It is low cost and applicable in the school environment.
A Modified Version of the Timed Up and Go Test for Children Who Are Preschoolers
Authors: Verbecque Evi , Vereeck Luc , Boudewyns An , Van de Heyning Paul , Hallemans Ann 
Published: September 2016

Purpose:
This study investigated factors predicting the Timed Up and Go (TUG) test in children who are preschoolers, using a modified protocol of the TUG.

Method:
This was a cross-sectional study of children 3 to 5 years old (n = 192). Regression analysis identified predictive factors for TUG performances. Differences in mean values (standard deviation) were calculated for each age group.

Results:
The results of 172 children were analyzed. Age and ethnicity were predictive of TUG performance (R
2 = 0.280). Children who are preschoolers with Flemish ethnicity need less time to perform the TUG than their peers with another ethnicity (P < .05), but this difference is not significant for the age groups. The TUG performance differs significantly among all age groups (P < .05).

Conclusions:
A modified protocol for the TUG, which is sensitive to age-related changes in dynamic balance control, is proposed for children who are preschoolers.
Reliability and Responsiveness of the Timed Up and Go Test in Children With Cerebral Palsy
Authors: Carey Helen , Martin Kathy , Combs-Miller Stephanie , Heathcock Jill C. 
Published: September 2016

Purpose:
The purpose of this study was to determine the absolute reliability and responsiveness of the Timed Up and Go (TUG) test, as measured using minimal detectable change (MDC) and minimal clinical important difference (MCID) values.

Methods:
Prospective observational study of children aged 3 to 10 years with cerebral palsy (CP) in Gross Motor Function Classification System levels I-III who completed the TUG test. Minimal detectable change estimates were calculated using baseline data. MCID estimates for each Gross Motor Function Classification System (GMFCS) level were calculated using distribution- and anchor-based methods.

Results:
Minimal detectable change values ranged from 1.40 to 8.74 seconds and MCID estimates ranged from 0.22 to 5.31 seconds.

Conclusions:
The TUG test is a reliable and responsive measure of balance and mobility for children with CP between 3 and 10 years of age in GMFCS levels I-III. Study results support improved use of the TUG test in clinical and research settings by providing reliability values and estimates of meaningful change.

Video Abstract:
For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A117.
Gastrointestinal Stromal Tumor of Stomach: A Gentle Enemy of the Surgeon. Our Experience in Confronting the Disease
Authors: Bard Vyacheslav , Menasherov Nikolai , Morgenstern Sara , Haddad Riad , Kashtan Hanoch 
Published: September 2016

Background:
Surgical resection is considered to be the best treatment for gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the gastrointestinal tract. Tumor size, mitotic rate, and anatomic locations are directly related to the potential malignancy, surgical approach, oncological treatment, and recurrence rate.

Materials and Methods:
This was a retrospective study of 40 patients who underwent surgical resection of histologically or immunohistochemistry-proven GIST of the stomach at the Rabin and Kaplan Medical Center between 2004 and 2013. Tumor size, location, margin status, pathologic characteristics, surgical approach, surgical outcome, and long-term follow-up were analyzed from hospital records.

Results:
The most common presentation was upper gastrointestinal bleeding (40%), although 30% of cases were asymptomatic. A laparoscopic approach was the preferred technique whenever feasible; 85% of tumors were localized in the proximal stomach, with a median size of 5.6 cm. Most of the resected tumors revealed a low mitotic rate and thus had low-moderate risks of malignancy. All tumors were completely resected with free surgical margins. The median follow-up period was 40 months with 93% disease-free survival.

Conclusions:
Gastric GIST is a snake in the grass and its diagnosis is often incidental to endoscopy and computed tomographic scan. The most important technical point is to avoid tumor rupture during removal.
Neuroleptics in the management of delirium in patients with advanced cancer
Authors: Hui David , Dev Rony , Bruera Eduardo 
Published: September 2016

Purpose of review
Delirium is the most common and distressing neuropsychiatric syndrome in cancer patients. Few evidence-based treatment options are available due to the paucity of high quality of studies. In this review, we shall examine the literature on the use of neuroleptics to treat delirium in patients with advanced cancer. Specifically, we will discuss the randomized controlled trials that examined neuroleptics in the front line setting, and studies that explore second-line options for patients with persistent agitation.

Recent findings
Contemporary management of delirium includes identification and management of any potentially reversible causes, coupled with nonpharmacological approaches. For patients who do not respond adequately to these measures, pharmacologic measures may be required. Haloperidol is often recommended as the first-line treatment option, and other neuroleptics such as olanzapine, risperidone, and quetiapine represent potential alternatives. For patients with persistent delirium despite first-line neuroleptics, the treatment strategies include escalating the dose of the same neuroleptic, rotation to another neuroleptic, or combination therapy (i.e., the addition of a second neuroleptic or other agent). We will discuss the advantages and disadvantages of each approach, and the available evidence to support each strategy.

Summary
Adequately powered, randomized trials involving proper control interventions are urgently needed to define the optimal treatment strategies for delirium in the oncology setting.
Cytochrome P450 2C9 gene polymorphism and warfarin maintenance dosage in pediatric patients: A systematic review and meta‐analysis
Authors: Zhang Jinhua , Tian Lihong , Huang Jinlong , Huang Sihan , Chai Tingting , Shen Jianzhen 
Published: September 2016

SummaryAimTo assess the effect of Cytochrome P450 2C9 (CYP2C9) gene polymorphism on pediatric warfarin maintenance dosage requirement.MethodsA previously developed search strategy was conducted in PubMed, EMBASE, and the Cochrane Library. Eligible studies published prior to January 27, 2016, were identified and compared against strict inclusion/exclusion criteria. Required data were extracted, and researchers were consulted for additional data if needed. Review Manager version 5.2.3 software was used to analyze the relationship between CYP2C9 polymorphisms and warfarin maintenance doses in pediatric patients. Eight articles with a combined total of 507 pediatric patients were included in the meta‐analysis.ResultsMaintenance warfarin doses in patients with CYP2C9 *1/*2 genotype, CYP2C9 *1/*3 genotype, and CYP2C9 variant carriers which contain at least one variant allele (*2 or *3) were from 15% to 41% lower than doses in patients with the wild‐type allele (CYP2C9 *1/*1): All differences were significant with P‐values <.05. The Fontan procedure as a medical indication for anticoagulation was also associated with a lower warfarin maintenance dose; however, target INR range was not.ConclusionsWe found that CYP2C9 gene polymorphism (referring to the presence of *1/*2, *1/*3, and variant genotypes in the population in addition to the wild type) was significantly associated with decreased warfarin maintenance dose requirements. Additionally, a specific indication for warfarin, the Fontan procedure, was associated with a lower daily warfarin dose. However, the results of our study require confirmation from more research with larger numbers of pediatric patients.
Physician attitudes and experiences with Maryland's prescription drug monitoring program (PDMP)
Authors: Lin Dora H. , Lucas Eleanor , Murimi Irene B. , Jackson Katherine , Baier Michael , Frattaroli Shannon , Gielen Andrea C. , Moyo Patience , Simoni‐Wastila Linda , Alexander G. Caleb 
Published: September 2016

AbstractAimsPhysicians’ use of prescription drug monitoring programs (PDMPs) varies by state. Among Maryland physicians, we sought to (1) estimate the PDMP impact on changes in opioid prescribing, (2) approximate the scope of PDMP utility and (3) determine the barriers to PDMP use after its 2013 implementation.DesignCross‐sectional postal survey linking responses to state records of PDMP registration and use, randomly sampling physicians within specialty and registration strata.SettingMaryland, USA.ParticipantsA total of 1000 surveyed primary care, pain and emergency medicine physicians stratified into three subpopulations: PDMP non‐registrants, PDMP registrants who were non‐users and PDMP users; 405 respondents (44%) of 916 eligible physicians were analysed.MeasurementsPrimary outcome measure was PDMP use. Key predictors were clinic characteristics, including type of practice and number of patients prescribed opioids.FindingsNo response‐wave bias was identified. Seventy per cent of physicians believed PDMP access decreased their amount and increased their comfort level in prescribing opioids. Three‐fourths (74%) of PDMP users reported the data very useful for informing opioid prescribing, although one‐fifth (20%) reported difficulty accessing the data. Commonly reported barriers to PDMP use were lack of knowledge regarding its existence and registration process. In multivariable analysis after adjusting for key clinic characteristics, practicing at a managed care organization was associated with lower PDMP use [incidence rate ratio (IRR) = 0.19, 95% confidence interval (CI) = 0.05–0.73]. Conversely, physicians who prescribed opioids for more than 50 patients accessed the PDMP three times as often as those prescribing opioids for fewer than 10 patients monthly (IRR = 3.00, 95 % CI = 1.07–8.43).ConclusionsIn this survey of Maryland, USA physicians, most participants reported that prescription drug monitoring programs (PDMPs) improved their opioid prescribing by decreasing prescription amounts and increasing comfort with prescribing opioids. Common barriers to PDMP use included not knowing about the program, registration difficulties and data access difficulties.
Assessment of children's nutritional attitudes before oral food challenges to identify patients at risk of food reintroduction failure: a prospective study
Authors: Polloni L. , Ferruzza E. , Ronconi L. , Toniolo A. , Lazzarotto F. , Bonaguro R. , Celegato N. , Muraro A. 
Published: September 2016

AbstractBackgroundInappropriate dietary eliminations may impair quality of life, affect children's growth and unnecessarily impact on healthcare costs. Previous retrospective studies reported that around 25% of children continue a food‐avoidance diet despite a negative oral food challenge (OFC). A definite pattern has not been found yet for patients not reintroducing the food. This study aimed to examine the role of child's nutritional attitudes and maternal anxiety in reintroducing food after a negative OFC.MethodsA prospective study was conducted involving 81 mothers of children with IgE‐mediated food allergy. They completed a survey on nutritional behaviour and attitudes and the State‐Trait Anxiety Inventory on the day of OFC and 6 months later.ResultsIn total, 11.1% of children never or rarely ate the food after a negative OFC. Consumption of the reintroduced food is positively correlated to child's interest in tasting new foods before and after OFC and to changes in child's nutritional habits after OFC. It is negatively correlated to monotony of the diet after OFC. No correlations were found with other participants’ characteristics or maternal anxiety. State anxiety significantly decreased after the OFC. A correlation was found between trait and state anxiety and the degree of change in nutritional habits after OFC.ConclusionsEvaluating child's approach towards food before the OFC is a promising approach to identify patients at risk of food reintroduction failure. Furthermore, it underlined the importance of reassessing food consumption in all patients after a negative OFC and supporting patients in the reintroduction of food.
Population pharmacokinetics of paritaprevir, ombitasvir, dasabuvir, ritonavir and ribavirin in hepatitis C virus genotype 1 infection: analysis of six phase III trials
Authors: Mensing Sven , Eckert Doerthe , Sharma Shringi , Polepally Akshanth R. , Khatri Amit , Podsadecki Thomas J. , Awni Walid M. , Menon Rajeev M. , Dutta Sandeep 
Published: September 2016

AimThe aim of the current study was to characterize the population pharmacokinetics of a triple direct‐acting antiviral (DAA) regimen (3D) (ombitasvir, paritaprevir–ritonavir and dasabuvir) and adjunctive ribavirin, and estimate covariate effects in a broad spectrum of subjects with hepatitis C virus (HCV) genotype 1 infection.MethodsPharmacokinetic data from six phase III studies and one phase II study in subjects receiving the currently approved doses of the 3D ± ribavirin regimen for treating HCV genotype 1 infection for 12 weeks or 24 weeks were characterized using separate population pharmacokinetic models, built using each component of the regimen from nonlinear mixed‐effects methodology in NONMEM 7.3. In the models, demographic and clinical covariates were tested. Models were assessed via goodness‐of‐fit plots, visual predictive checks and bootstrap evaluations.ResultsThe population pharmacokinetic models for each component of the 3D ± ribavirin regimen (DAAs and ritonavir, n = 2348) and ribavirin (n = 1841) adequately described their respective plasma concentration–time data. Model parameter estimates were precise and robust, and all models showed good predictive ability. Significant covariate effects associated with apparent clearance and volume of distribution included age, body weight, gender, cirrhosis, HCV subtype, opioid or antidiabetic agent use, and creatinine clearance.ConclusionThe population pharmacokinetics of the 3D ± ribavirin regimen components in HCV‐infected patients were characterized using phase II and III HCV clinical trial data. Although several statistically significant covariates were identified, their effects were modest and not clinically meaningful to necessitate dose adjustments for any component of the 3D regimen.