bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Comparison of Home Telehealth and Nursing Care With or Without Rehabilitation Therapy on Rehospitalization Rates of Individuals With Heart Failure
Authors: Martin Stacy , Anderson Bill , Vincenzo Jennifer L. , Zai Sajid Yousuf 
Published: December 2016

PURPOSE:
Congestive heart failure (CHF) is the most common reason for rehospitalization among the aging population, accounting for one-fifth of all hospital admissions. To date, there is no research comparing the rehospitalization rates between patients with CHF (PWCHF) who receive telehealth and home health nursing care versus a multidisciplinary team consisting of telehealth, home nursing, physical therapy (PT), and/or occupational therapy (OT).

METHODS:
A retrospective analysis was performed with 132 Medicare Part A home health patients discharged from an inpatient setting with a primary or secondary diagnosis of CHF receiving daily telehealth over the course of 1 year. Allscripts Home Care and Lifestream software was used to query data from patient records. Rehospitalization rates were analyzed using Cochran-Mantel-Haenszel tests. Patients were divided into 3 groups: (1) nursing only; (2) nursing and PT or OT; or (3) nursing, PT, and OT.

RESULTS:
A total of 41 of the 132 patients (31.06%) were rehospitalized during their home health 60-day episode of care. This percentage includes all-cause rehospitalizations. Cochran-Mantel-Haenszel tests indicated there were no differences in rehospitalization rates between the 3 groups after controlling for the confounding variables: (1) multiple hospitalizations (P = .15); (2) history of falls (P = .16); or (3) depression (P = .18).

CONCLUSIONS:
There was no statistically significant difference between the 3 groups for all-cause rehospitalization rates. Further prospective research is required to determine best practices and multidisciplinary protocols to further reduce rehospitalization rates in this population.
OUTCOMES OF PARS PLANA VITRECTOMY IN THE MANAGEMENT OF REFRACTORY AQUEOUS MISDIRECTION SYNDROME
Authors: Al Bin Ali Ghada Y. , Al-Mahmood Ammar M. , Khandekar Rajiv , Abboud Emad B. , Edward Deepak P. , Kozak Igor 
Published: December 2016

Purpose:
To determine the efficacy and complications of pars plana vitrectomy (PPV) and adjunct surgeries for aqueous misdirection refractory to medical therapy.

Methods:
A retrospective review of consecutive eyes with refractory aqueous misdirection at the King Khaled Eye Specialist Hospital between 2002 and 2010. Patients underwent two-port and three-port pars plana vitrectomy (PPV) with adjunct procedures including pars plana lensectomy combined with posterior capsulectomy, hyaloido-zonulo-iridectomy, and synechiolysis. Main outcome measures included anatomical success, functional success, and factors associated with the outcomes.

Results:
Sixty-nine eyes were evaluated over a mean follow-up period of 17.6 ± 3.8 months (3–156 months). Anatomical success was achieved in 62 eyes (90%) and functional success in 54 eyes (78%) that underwent PPV as a primary surgery. The factors associated with the altering misdirected aqueous flow and reducing intraocular pressure significantly associated with a two-line improvement of best-corrected visual acuity included surgical treatment within 4 weeks of presentation (P = 0.004) and preoperative intraocular pressure (P = 0.001). The success of two-port PPV and standard three-port PPV was similar (P = 0.7). The intraoperative and postoperative complications included retinal detachment in two eyes and endophthalmitis in one eye.

Conclusion:
The PPV was effective for managing aqueous misdirection refractory to medical therapy. Two-port or three-port PPV did not change the success rate but early surgery improved both anatomical and functional outcomes.
CHOROIDAL THICKNESS CHANGES AFTER VITRECTOMY WITH SILICONE OIL TAMPONADE FOR PROLIFERATIVE VITREORETINOPATHY RETINAL DETACHMENT
Authors: Odrobina Dominik , Gołębiewska Joanna , Maroszyńska Iwona 
Published: December 2016

Purpose:
To access the potential effect of vitrectomy and silicone oil tamponade on the choroid.

Methods:
Eighteen patients (18 eyes) who had undergone pars plana vitrectomy with 1,000-cSt silicone oil tamponade for proliferative vitreoretinopathy retinal detachment were included in this retrospective study. All patients underwent ophthalmologic examinations before treatment and 1 week and 1, 3, and 6 months after vitrectomy with silicone oil tamponade. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography (Spectralis; Heidelberg Engineering) in a horizontal and vertical section beneath the fovea.

Results:
Choroidal thickness statistically significantly decreased till 3 months after pars plana vitrectomy with silicone oil tamponade: under the center of the fovea (P = 0.014) and in the temporal (P = 0.029), superior (P = 0.046), and inferior areas, determined at 1,500 μm from the center of the fovea (P = 0.030). After 6 months, the desired effect in the form of a decrease in the choroidal thickness was even more prominent, both under the center of the fovea (P < 0.001) and in the nasal (P < 0.001), temporal (P < 0.001), superior (P < 0.001), and inferior areas at 1,500 μm from the center of the fovea (P < 0.001).

Conclusion:
Choroidal thickness is reduced in eyes receiving silicone oil intraocular tamponade. Silicone oil tamponade may have an impact on the structure and proper functioning of the choroid. The measurements of the choroidal thickness by optical coherence tomography might be a very good tool to detect early changes in choroidal thickness and impact the decision when to remove silicone oil.
MOBILE SUBRETINAL CYSTICERCUS IMAGED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY WITH MOTION TRACKER
Authors: Bypareddy Ravi , Takkar Brijesh , Chawla Rohan , Sachdeva Neha , Azad Shorya V. , Tripathy Koushik 
Published: December 2016

Purpose:
To report optical coherence tomography–based videoimaging of alive subretinal cysticercus along with its mobile scolex.

Methods:
Spectral-domain optical coherence tomography was used to record high-definition videoimages, using the inbuilt motion tracker, in a 12-year-old boy with history of neurocysticercosis.

Result:
The scolex was found to be sensitive to light, and contractile movements were seen in the cyst wall and the germinative layers. The patient underwent vitrectomy, and the diagnoses were confirmed with histopathologic assessment.

Conclusion:
Optical coherence tomography is a useful tool for diagnosing posterior segment cysticercosis. The intense motion of scolex does not impact the surrounding ocular structures.
RETINAL VASCULITIS ASSOCIATED WITH EPSTEIN–BARR VIRUS INFECTION, A CASE REPORT
Authors: Victor Andi A. , Sukmana Nanang 
Published: December 2016

Purpose:To report a case of retinal vasculitis associated with Epstein–Barr virus infection.Methods:Case report.Results:A 26-year-old woman came with blurry vision. Funduscopy illustrated vasculitis with frosted branch-like appearance. The patient was treated with systemic acyclovir and topical steroid. Circulating polymerase chain reaction was positive for Epstein–Barr virus antibodies. Two months of treatment resolved the clinical manifestations.Conclusion:Epstein–Barr infection should be considered as the etiology of retinal vasculitis with similar clinical manifestations.
SERPIGINOUS CHOROIDITIS IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: El Ameen Ala'a , Herbort Carl P. 
Published: December 2016

Purpose:
To report a case of serpiginous choroiditis imaged with optical coherence tomography angiography (OCT-A).

Methods:
Case report.

Results:
Multimodal imaging and OCT-A were performed to investigate serpiginous choroiditis in a 65-year-old patient. Comparison between OCT-A images and intermediate and late phase indocyanine green angiography revealed that the hypofluorescent areas on indocyanine green angiography corresponded topographically to the dark areas seen in the choriocapillaris layer of OCT-A.

Conclusion:
The OCT-A was shown to be able to detect vascular nonperfusion at the level of the choriocapillaris and could be helpful, especially for follow-up purposes, in clinical practice for choriocapillaritis such as serpiginous choroiditis.
ANTERIOR LENS CAPSULE IN THE MANAGEMENT OF CHRONIC FULL-THICKNESS MACULAR HOLE
Authors: Yepez Juan B. , Murati Felipe A. , De Yepez Jazmin , Petitto Michele , Arevalo J. Fernando 
Published: December 2016

Purpose:
To report the use of anterior lens capsule flap transplantation in two cases with chronic full-thickness macular hole (MH).

Methods:
Case series.

Results:
Two cases of chronic MH with a new treatment approach were reported. In the first case, a 66-year-old man presented with a chronic idiopathic MH in the left eye for 2 years. Presenting visual acuity was hand motion. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. At 5 months postoperatively, the visual acuity was 20/200 with MH closure. In the second case, a 68-year-old woman presented with decreased visual acuity for 2 years. Her visual acuity was hand motion in the right eye. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. Visual acuity improved to 20/400 with reduction in the MH diameter. Vision and MH diameter remained stable over 5 months postoperatively.

Conclusion:
Lens capsular flap transplantation is useful in closing chronic MH in the short term.
Seroprevalence of Hepatitis E Virus Antibodies in Portuguese Children
Authors: Oliveira Ricardo , Mesquita João Rodrigo , Pereira Sara , Abreu-Silva Joana , Teixeira Joana , Nascimento Maria São José 
Published: December 2016

Background:
Hepatitis E virus (HEV) has become a growing public health concern in industrialized countries. Most of the HEV seroprevalence studies have focused on adult populations, and reports regarding HEV seroepidemiology among children are scarce in these countries. The aims of this work were to perform a nationwide seroprevalence study on HEV infection in Portuguese children and to compare the HEV seropositivity in this 2015 children cohort with results in sera performed 20 years earlier.

Methods:
Sera (N = 352) from children collected in 2015 from all regions of Portugal were screened for anti-HEV IgG and IgM using the commercial enzyme-linked immunosorbent assay recomWell HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany), and positive samples were retested by immunodot assay recomLine HEV IgG/IgM (2015 version; Mikrogen, Neuried, Germany). For the comparative assessment of HEV seropositivity of the 2 children cohorts, children’s sera (N = 71) archived since 1995 were screened for anti-HEV IgG and results were compared with that of the 2015 cohort, matched by sex, age and region.

Results:
Anti-HEV antibodies were detected in 4 children giving an overall HEV seroprevalence in the 2015 cohort of 1.1%. A healthy 10–15-year-old female was found positive for anti-HEV IgM indicating a current or recent HEV infection. No statistically significant difference was observed in HEV seroprevalence regarding gender, age group and region of residence. Comparison of the HEV seropositivity of the 2 children cohorts showed a statistical significant decrease with time (P = 0.024).

Conclusions:
This is the first national study of HEV seroprevalence in Portuguese children and the first to demonstrate a decrease of anti-HEV antibodies in this age group over time.
Relative Difficulties of Daily Living Tasks with Retinitis Pigmentosa
Authors: Latham Keziah , Baranian Mohammad , Timmis Matthew A. , Fisher Andy , Pardhan Shahina 
Published: December 2016

ABSTRACT

Purpose
To determine the relative difficulty of activity of daily living tasks for people with retinitis pigmentosa (RP).

Methods
Participants with RP (n = 166) rated the difficulty of tasks (n = 43) underpinning the Dutch Activity Inventory goals of mobility indoors and outdoors, shopping, and using public transport. Demographic characteristics were also determined. Responses were Rasch analyzed to determine properties of the scale, derive unidimensional subscales, and consider differential item functioning (DIF).

Results
After removal of one ill-fitting item, the remaining 42 tasks formed a scale with reasonable Rasch parameters but poor unidimensionality. The most difficult tasks were orienting in poor and bright light both indoors and outdoors, and avoiding peripheral obstacles outdoors. Eight subscales were derived with unidimensional properties, each of which could be considered as requiring similar skills. DIF identified that tasks from the “poor light and obstacles” subscale were more difficult for those younger than the median age, nonusers of mobility aids, and those not registered or registered sight impaired. Tasks from the “finding products” and “public transport” subscales were more difficult for those older than the median age, with longer duration of visual loss, users of mobility aids, and those registered severely sight impaired.

Conclusions
The most difficult tasks for people with RP of orienting in poor light and avoiding peripheral obstacles are relatively more difficult for those not registered as “severely sight impaired,” but are less difficult for those who use mobility aids. Mobility aids (guide dog or cane), therefore, do benefit users in their perceived ability in these particular tasks. The derived unidimensional subscales reorganize the tasks from those grouped together by goal (researcher driven) to those perceived as requiring similar skills by people with RP (patient driven) and can be used as an evidence base for orientation and mobility training protocols.
Cancer Risk after Fat Transfer: A Multicenter Case-Cohort Study
Authors: Myckatyn Terence M. , Wagner I. Janelle , Mehrara Babak J. , Crosby Melissa A. , Park Julie E. , Qaqish Bahjat F. , Moore Dominic T. , Busch Evan L. , Silva Amanda K. , Kaur Surinder , Ollila David W. , Lee Clara N. 
Published: December 2016

Background:
Fat transfer is an increasingly popular method for refining postmastectomy breast reconstructions. However, concern persists that fat transfer may promote disease recurrence. Adipocytes are derived from adipose-derived stem cells and express adipocytokines that can facilitate active breast cancer cells in laboratory models. The authors sought to evaluate the association between fat transfer to the reconstructed breast and cancer recurrence in patients diagnosed with local or regional invasive breast cancers.

Methods:
A multicenter, case-cohort study was performed. Eligible patients from four centers (Memorial Sloan Kettering, M. D. Anderson Cancer Center, Alvin J. Siteman Cancer Center, and the University of Chicago) were identified by each site’s institutional tumor registry or cancer data warehouse. Eligibility criteria were as follows: mastectomy with immediate breast reconstruction between 2006 and 2011, age older than 21 years, female sex, and incident diagnosis of invasive ductal carcinoma (stage I, II, or III). Cases consisted of all recurrences during the study period, and controls consisted of a 30 percent random sample of the study population. Cox proportional hazards regression was used to evaluate for association between fat transfer and time to recurrence in bivariate and multivariate models.

Results:
The time to disease recurrence unadjusted hazard ratio for fat transfer was 0.99 (95 percent CI, 0.56 to 1.7). After adjustment for age, body mass index, stage, HER2/Neu receptor status, and estrogen receptor status, the hazard ratio was 0.97 (95 percent CI, 0.54 to 1.8).

Conclusion:
In this population of breast cancer patients who had mastectomy with immediate reconstruction, fat transfer was not associated with a higher risk of cancer recurrence.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction
Authors: Sinha Indranil , Pusic Andrea L. , Wilkins Edwin G. , Hamill Jennifer B. , Chen Xiaoxue , Kim Hyungjin M. , Guldbrandsen Gretchen , Chun Yoon S. 
Published: December 2016

Background:
Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors.

Methods:
As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up.

Results:
Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found.

Conclusions:
The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do not present a complete assessment of infection associated with implant-based breast reconstructions or their long-term clinical outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
The Effect of Neoadjuvant Chemotherapy Compared to Adjuvant Chemotherapy in Healing after Nipple-Sparing Mastectomy
Authors: Frey Jordan D. , Choi Mihye , Karp Nolan S. 
Published: December 2016

Background:
Nipple-sparing mastectomy is the latest advancement in the treatment of breast cancer. The authors aimed to investigate the effects of neoadjuvant and adjuvant chemotherapy in nipple-sparing mastectomy.

Methods:
Patients undergoing nipple-sparing mastectomy from 2006 to June of 2015 were identified. Results were stratified by presence of neoadjuvant or adjuvant chemotherapy.

Results:
A total of 840 nipple-sparing mastectomies were performed. Twenty-eight were in those who received neoadjuvant chemotherapy and 93 were in patients receiving adjuvant chemotherapy. Patients receiving both neoadjuvant and adjuvant chemotherapy were included in the neoadjuvant group. Nipple-sparing mastectomies that received neoadjuvant (with or without adjuvant) chemotherapy were compared to those in patients who received adjuvant chemotherapy. Those with neoadjuvant (with or without adjuvant) chemotherapy were more likely to have explantation (p = 0.0239) and complete nipple-areola complex necrosis (p = 0.0021). Those with neoadjuvant (with or without adjuvant) chemotherapy were more likely to have implant explantation (p = 0.0015) and complete nipple-areola complex necrosis (p = 0.0004) compared to those with no chemotherapy. Compared to nipple-sparing mastectomies in patients with no chemotherapy, those with adjuvant chemotherapy were more likely to have a hematoma (p = 0.0021). Those that received both neoadjuvant and adjuvant chemotherapy were more likely to have complete nipple-areola complex necrosis compared with both the neoadjuvant chemotherapy–only and adjuvant chemotherapy–only groups (p < 0.0001).

Conclusions:
Nipple-sparing mastectomy is safe to perform in the setting of neoadjuvant and adjuvant chemotherapy. As a whole, neoadjuvant (with or without adjuvant) chemotherapy increases risk of complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Evidence-Based Medicine: The Evaluation and Treatment of Pressure Injuries
Authors: Ricci Joseph A. , Bayer Lauren R. , Orgill Dennis P. 
Published: December 2016

Learning Objective:
After studying this article, the participant should be able to: 1. Discuss the approach to and rationale for pressure injury management, including specific techniques for prevention and preoperative evaluation. 2. Develop a management algorithm for these wounds that includes operative and nonoperative modalities. 3. Understand how to identify and manage the complications of surgical intervention for pressure injuries, including recurrence.

Summary:
Pressure injuries are a common problem associated with great morbidity and cost, often presenting as complex challenges for plastic surgeons. Although the cause of these wounds is largely prolonged pressure, the true pathogenesis involves many other factors, including friction, shear, moisture, nutrition, and infection. This article outlines a systematic approach to evaluating and staging pressure injuries, and provides strategies for treatment and prevention. Critical to surgical intervention is thorough débridement, including any involved or causative bony tissues, and postoperative management to prevent wound dehiscence and recurrence.
Evidence-Based Medicine: Cutaneous Facial Malignancies: Nonmelanoma Skin Cancer
Authors: Connolly Karen L. , Nehal Kishwer S. , Disa Joseph J. 
Published: December 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Identify clinical features of nonmelanoma skin cancer; 2. Distinguish low-risk versus high-risk basal cell carcinoma and squamous cell carcinoma; 3. Define appropriate management based on current guidelines for various types of basal cell and squamous cell carcinoma.

Summary:
Skin malignancies are the most prevalent cancers, and plastic surgeons are often the primary physicians engaged in diagnosis and management of these lesions. Proper management includes distinguishing between high-risk and low-risk lesions and determining treatment accordingly. The aim of this Continuing Medical Education article is to review the diagnosis and management of common and uncommon facial skin malignancies, including basal cell carcinoma, squamous cell carcinoma, actinic keratosis, keratoacanthoma, Merkel cell carcinoma, atypical fibroxanthoma, sebaceous carcinoma, and microcystic adnexal carcinoma.
Evidence-Based Medicine: Options for Dupuytren’s Contracture: Incise, Excise, and Dissolve
Authors: Denkler Keith A. , Vaughn Carolyn J. , Dolan Estelle L. , Hansen Scott L. 
Published: December 2016

Learning Objectives:
After studying this article, the participant should be able to: 1. Understand updates in the basic science, epidemiology, and treatment of Dupuytren’s disease. 2. Understand treatment with needle aponeurotomy, collagenase, and fasciectomy. 3. Understand advanced needle techniques for Dupuytren’s contracture. 4. Understand the safety and effectiveness of a new treatment, collagenase.

Summary:
The literature on Dupuytren’s disease encompasses many specialties. Its treatment is generally by perforating, excising, or dissolving the affected tissues. This article reviews the changing understanding of this disease and treatment options.