bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diabetes Mellitus Coding Training for Family Practice Residents
Authors: Urse Geraldine N. 
Published: June 2015

Abstract

Context: Although physicians regularly use numeric coding systems such as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to describe patient encounters, coding errors are common. One of the most complicated diagnoses to code is diabetes mellitus. The ICD-9-CM currently has 39 separate codes for diabetes mellitus; this number will be expanded to more than 50 with the introduction of ICD-10-CM in October 2015.

Objective: To assess the effect of a 1-hour focused presentation on ICD-9-CM codes on diabetes mellitus coding.

Methods: A 1-hour focused lecture on the correct use of diabetes mellitus codes for patient visits was presented to family practice residents at Doctors Hospital Family Practice in Columbus, Ohio. To assess resident knowledge of the topic, a pretest and posttest were given to residents before and after the lecture, respectively. Medical records of all patients with diabetes mellitus who were cared for at the hospital 6 weeks before and 6 weeks after the lecture were reviewed and compared for the use of diabetes mellitus ICD-9 codes.

Results: Eighteen residents attended the lecture and completed the pretest and posttest. The mean (SD) percentage of correct answers was 72.8% (17.1%) for the pretest and 84.4% (14.6%) for the posttest, for an improvement of 11.6 percentage points (P≤.035). The percentage of total available codes used did not substantially change from before to after the lecture, but the use of the generic ICD-9-CM code for diabetes mellitus type II controlled (250.00) declined (58 of 176 [33%] to 102 of 393 [26%]) and the use of other codes increased, indicating a greater variety in codes used after the focused lecture.

Conclusion: After a focused lecture on diabetes mellitus coding, resident coding knowledge improved. Review of medical record data did not reveal an overall change in the number of diabetic codes used after the lecture but did reveal a greater variety in the codes used.
Heart Failure With Preserved Ejection Fraction
Authors: Rogers Felix J. , Gundala Teja , Ramos Jahir E. , Serajian Asif 
Published: June 2015

Abstract
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition. Initially called diastolic heart failure, it soon became clear that this condition is more than the opposite side of systolic heart failure. It is increasingly prevalent and lethal. Currently, HFpEF represents more than 50% of heart failure cases and shares a 90-day mortality and readmission rate similar to heart failure with reduced ejection fraction. Heart failure with preserved ejection fraction is best considered to be a systemic disease. From a cardiovascular standpoint, it is not just a stiff ventricle. A stiff ventricle combined with a stiff arterial and venous system account for the clinical manifestations of flash pulmonary edema and the marked changes in renal function or systemic blood pressure with minor changes in fluid volume status. No effective pharmacologic treatments are available for patients with HFpEF, but an approach to the musculoskeletal system has merit: the functional limitations and exercise intolerance that patients experience are largely due to abnormalities of peripheral vascular function and skeletal muscle dysfunction. Regular exercise training has strong objective evidence to support its use to improve quality of life and functional capacity for patients with HFpEF. This clinical review summarizes the current evidence on the pathophysiologic aspects, diagnosis, and management of HFpEF.
Utility of Sonoelastography in Differentiating Ruptured From Unruptured Epidermal Cysts and Implications for Patient Care
Authors: Park Joonsoo , Chae In Soo , Kwon Dong Rak 
Published: June 2015

ObjectivesThis study aimed to evaluate the correlation of sonoelastographic features between ruptured and unruptured epidermal cysts.MethodsWe performed a prospective survey of 27 patients with clinically suspected epidermal cysts diagnosed by excisional biopsy with prebiopsy sonography and real‐time sonoelastography. We statistically evaluated the correlation between elastographic and histopathologic features. To measure the relative hardness on elastography, the Rinside/Routside ratio was used to show the ratio of the elasticity inside and outside the cyst, where the random value R was defined as the median red pixel intensity/(median red pixel intensity + median green pixel intensity + median blue pixel intensity).ResultsOnly 24 of the 27 patients were enrolled. Among the 24 diagnosed epidermal cysts, 13 were unruptured cysts, and 11 were ruptured cysts based on histopathologic examination. There was no correlation between sonographically and histopathologically measured cyst diameters. The Rinside/Routside ratio was significantly higher in unruptured cysts than ruptured cysts (mean ± SD, 1.16 ± 0.15 versus 1.04 ± 0.13; P = .047). All values below the cutoff point were considered to indicate ruptured cysts, and the cutoff value was set to 1.0919, which afforded sensitivity of 83.3% and specificity of 66.7%.ConclusionsReal‐time sonoelastography is able to detect differences in tissue elasticity between ruptured and unruptured epidermal cysts. This study shows the utility of real‐time sonoelastography, which has important implications for treatment planning.
Interobserver Reliability of Quantitative Muscle Sonographic Analysis in the Critically Ill Population
Authors: Sarwal Aarti , Parry Selina M. , Berry Michael J. , Hsu Fang-Chi , Lewis Marc T. , Justus Nicholas W. , Morris Peter E. , Denehy Linda , Berney Sue , Dhar Sanjay , Cartwright Michael S. 
Published: June 2015

ObjectivesThere is growing interest in the use of quantitative high‐resolution neuromuscular sonography to evaluate skeletal muscles in patients with critical illness. There is currently considerable methodological variability in the measurement technique of quantitative muscle analysis. The reliability of muscle parameters using different measurement techniques and assessor expertise levels has not been examined in patients with critical illness. The primary objective of this study was to determine the interobserver reliability of quantitative sonographic measurement analyses (thickness and echogenicity) between assessors of different expertise levels and using different techniques for selecting the region of interest.MethodsWe conducted a cross‐sectional observational study in neurocritical care and mixed surgical‐medical intensive care units from 2 tertiary referral hospitals.ResultsTwenty diaphragm and 20 quadriceps images were evaluated. Images were obtained by using standardized imaging acquisition techniques. Quantitative sonographic measurements included muscle thickness and echogenicity analysis (either by the trace or square technique). All images were analyzed twice independently by 4 assessors of differing expertise levels. Excellent interobserver reliability was obtained for all measurement techniques regardless of expertise level (intraclass correlation coefficient, >0.75 for all comparisons). There was less variability between assessors for echogenicity values when the square technique was used for the quadriceps muscle and the trace technique for the diaphragm.ConclusionsExcellent interobserver reliability exists regardless of expertise level for quantitative analysis of muscle parameters on sonography in the critically ill population. On the basis of these findings, it is recommended that echogenicity analysis be performed using the square technique for the quadriceps and the trace technique for the diaphragm.
Utility of Targeted Neonatal Echocardiography in the Management of Neonatal Illness
Authors: Harabor Andrei , Soraisham Amuchou Singh 
Published: June 2015

ObjectivesTo describe the impact of targeted neonatal echocardiography on management of neonatal illness in a tertiary perinatal center neonatal intensive care unit (NICU).MethodsWe conducted a retrospective analysis of consecutive targeted neonatal echocardiographic studies that were performed over an 18‐month period in a regional perinatal center NICU in Canada. All studies were performed with a cardiovascular ultrasound machine and transducer and read on a workstation with storage and analysis software. Reporting was done on a standardized document, and any management change resulting from targeted neonatal echocardiography was documented.ResultsA total of 303 consecutive targeted neonatal echocardiographic studies were performed on 129 neonates. The mean gestational age ± SD was 27.8 ± 4.3 weeks (range, 23–41 weeks), and the mean birth weight ± SD was 1196 ± 197 g (range, 490– 4500 g). The median number of studies per neonate was 2 (range, 1–8), with most repeated studies for a patent ductus arteriosus (PDA). The most common indication for echocardiography was assessment of a PDA (52.1%), followed by early global hemodynamic assessment of very low birth weight (16.2%) and pulmonary hypertension (12.2%). Of the 303 studies, 126 (41.5%) resulted in management changes. The contribution to management was significantly related to the timing of echocardiography. Around half of the echocardiographic examinations during first the week of life resulted in management changes, compared to 22% of studies after 1 week of age (P = .002). Patent ductus arteriosus management accounted for almost half of the interventions.ConclusionsTargeted neonatal echocardiography is a valuable tool in the NICU and can contribute substantially to hemodynamic management in the first week of life, PDA management in the first 2 weeks of life, and cases of hypotension or shock at any time during the hospital stay.
Cardiovascular System Sonographic Evaluation Algorithm
Authors: De León-Luis Juan , Bravo Coral , Gámez Francisco , Ortiz-Quintana Luis 
Published: June 2015

ObjectivesTo evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra‐aortic areas, in the second trimester of pregnancy (19–22 weeks).MethodsWe performed a cross‐sectional study of pregnant women with healthy fetuses (singleton and twin pregnancies) attending our center from March to August 2011. The extended fetal cardiovascular system was evaluated by following the new algorithm, a sequential acquisition of axial views comprising the following (caudal to cranial): I, portal sinus; II, ductus venosus; III, hepatic veins; IV, 4‐chamber view; V, left ventricular outflow tract; VI, right ventricular outflow tract; VII, 3‐vessel and trachea view; VIII, thy‐box; and IX, subclavian arteries. Interobserver agreement on the feasibility and exploration time was estimated in a subgroup of patients. The feasibility and exploration time were determined for the main cohort. Maternal, fetal, and sonographic factors affecting both features were evaluated.ResultsInterobserver agreement was excellent for all views except view VIII; the difference in the mean exploration time between observers was 1.5 minutes (95% confidence interval, 0.7–2.1 minutes; P < .05). In 184 fetuses (mean gestational age ± SD, 20 ± 0.6 weeks), the feasibility of all views was close to 99% except view VIII (88.7%). The complete feasibility of the algorithm was 81.5%. The mean exploration time was 5.6 ± 4.2 minutes. Only the occiput anterior fetal position was associated with a lower frequency of visualization and a longer exploration time (P < .05).ConclusionsThe cardiovascular system sonographic evaluation algorithm is a reproducible and feasible approach for exploration of the extended fetal cardiovascular system in a second‐trimester scan. It can be used to explore these areas in normal and abnormal conditions and provides an integrated image of extended fetal cardiovascular anatomy.
Saline Flush Test
Authors: Gekle Robert , Dubensky Laurence , Haddad Stephanie , Bramante Robert , Cirilli Angela , Catlin Tracy , Patel Gaurav , D'Amore Jason , Slesinger Todd L. , Raio Christopher , Modayil Veena , Nelson Mathew 
Published: June 2015

ObjectivesResuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. The purpose of this study was to determine whether dynamic sonographic visualization of a saline flush in the right side of the heart after central venous catheter placement could serve as a more rapid confirmatory study for above‐the‐diaphragm catheter placement.MethodsA consecutive prospective enrollment study was conducted in the emergency departments of 2 major tertiary care centers. Adult patients of the study investigators who required an above‐the‐diaphragm central venous catheter were enrolled during the study period. Patients had a catheter placed with sonographic guidance. After placement of the catheter, thoracic sonography was performed. The times for visualization of the saline flush in the right ventricle and sonographic exclusion of ipsilateral pneumothorax were recorded. Chest radiography was performed per standard practice.ResultsEighty‐one patients were enrolled; 13 were excluded. The mean catheter confirmation time by sonography was 8.80 minutes (95% confidence interval, 7.46–10.14 minutes). The mean catheter confirmation time by chest radiograph availability for viewing was 45.78 minutes (95% confidence interval, 37.03–54.54 minutes). Mean sonographic confirmation occurred 36.98 minutes sooner than radiography (P< .001). No discrepancy existed between sonographic and radiographic confirmation.ConclusionsConfirmation of central venous catheter placement by dynamic sonographic visualization of a saline flush with exclusion of pneumothorax is an accurate, safe, and more efficient method than confirmation by chest radiography. It allows the central line to be used immediately, expediting patient care.
Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery
Authors: Karamnov Sergey , Sarkisian Natalia , Wollborn Jakob , Justice Samuel , Fields Kara , Kovacheva Vesela P. , Osho Asishana A. , Sabe Ashraf , Body Simon C. , Muehlschlegel Jochen D. 
Published: August 2024

ImportanceThere are limited data on the association of sex with the incidence of postoperative atrial fibrillation (poAF) and subsequent long-term mortality after cardiac surgery.ObjectiveTo evaluate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ by sex.Design, Setting, and ParticipantsThis retrospective cohort study was conducted at 2 tertiary care centers in Massachusetts from January 1, 2002, until October 1, 2016, with follow-up until December 1, 2022. Adult (aged &amp;gt;20 years) women and men undergoing coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, and combined procedures with cardiopulmonary bypass were examined using medical records. Patients who had data on poAF were included in data analyses.ExposuresSex and poAF.Main Outcomes and MeasuresPrimary outcomes were the incidence of poAF and all-cause mortality. poAF was defined as any atrial fibrillation detected on electrocardiogram (EKG) during the index hospitalization in patients presenting for surgery in normal sinus rhythm. Data on poAF were obtained from EKG reports and supplemented by information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. All-cause mortality was assessed via hospital records. The hypotheses were formulated prior to data analysis.ResultsAmong 21 568 patients with poAF data (mean [SD] age, 66.5 [12.4] years), 2694 of 6601 women (40.8%) and 5805 of 14 967 men (38.8%) developed poAF. In a multivariable logistic regression model, women had lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P &amp;lt; .001). During the follow-up study period, 1294 women (50.4%) and 2376 men (48.9%) in the poAF group as well as 1273 women (49.6%) and 2484 men (51.1%) in the non-poAF group died. Cox proportional hazards analysis found that the association between poAF and mortality was significantly moderated (ie, effect modified) by sex. Compared with same-sex individuals without poAF, men with poAF had a 17% higher mortality hazard (hazard ratio [HR], 1.17; 95% CI, 1.11-1.25; P &amp;lt; .001), and women with poAF had a 31% higher mortality hazard (HR, 1.31; 95% CI, 1.21-1.42; P &amp;lt; .001).Conclusions and RelevanceIn this retrospective cohort study of 21 568 patients who underwent cardiac surgery, women were less likely to develop poAF than men when controlling for other relevant characteristics; however, women who did develop poAF had a higher risk of long-term mortality than men who developed poAF. This observed elevated risk calls for a tailored approach to perioperative care in women undergoing cardiac surgery.
Household Firearm Ownership and Firearm Mortality
Authors: Morral Andrew R. , Agniel Denis , Smart Rosanna , Schell Terry L. 
Published: August 2024

ImportanceCausal associations between household firearm ownership rates (HFRs) and firearm mortality rates are not well understood.ObjectiveTo assess the population-level temporal sequencing of firearm death rates and HFRs.Design, Setting, and ParticipantsThis cohort study used autoregressive cross-lagged models to analyze HFRs, firearm suicide rates, and firearm homicide rates in the US from 1990 to 2018. The suicide analyses included 16 demographic subgroups of adults, defined by study year, state, sex, race and ethnicity, marital status, and urbanicity. The homicide analyses consisted of adult subgroups living in urban or rural areas. Data analysis was conducted from March to December 2023.ExposuresFirearm mortality rates and HFRs.Main Outcomes and MeasuresFirearm homicide and suicide rates with HFRs as the exposure, and HFR with mortality as the exposure.ResultsA total of 10 416 observations of 16 demographic subgroups by state and 2-year periods were included in the suicide analyses, while 1302 observations from 2 demographic subgroups by state and 2-year period were included in the homicide analysis. At baseline, the mean (SD) rate per 100 000 population across strata was 7.46 (7.21) for firearm suicides and 3.32 (2.13) for firearm homicides. The mean (SD) baseline HFR was 36.9% (20.2%) for firearm suicides and 36.9% (14.8%) for firearm homicides. Higher HFR preceded increases in suicide rates: demographic strata with equal firearm suicide rates but which differ by 18.6 percentage points on HFR (1 SD) would be expected to have firearm suicide rates that diverged by 0.19 (95% CI, 0.15-0.23) deaths per 100 000 population per period. With these differences accumulated over 8 years, firearm suicide rates in subgroups with the highest decile HFR would be expected to have 1.93 (95% CI, 1.64-2.36) more suicides per 100 000 population than strata with lowest decile HFR, a difference of 25.7% of the overall firearm suicide rate in 2018 and 2019. Firearm suicide rates had a smaller magnitude of association with subsequent changes in HFR: strata with equal HFRs but which differ by 1 SD in firearm suicide rates had minimal subsequent change in HFRs (−0.02 [95% CI, −0.04 to 0.01] percentage points). A 1-SD difference in HFRs was associated with little difference in next-period overall firearm homicides rates (0.03 [95% CI, −0.02 to 0.08] per 100 000 population), but a 1-SD difference in homicide rates was associated with a decrease in HFR (−0.09 [95% CI, −0.16 to −0.04] percentage points).Conclusions and RelevanceThis cohort study found an association between high HFRs and subsequent increases in rates of firearm suicide. In contrast, higher firearm homicide rates preceded decreases in HFRs. By demonstrating the temporal sequencing of firearm ownership and mortality, this study may help to rule out some theories of why gun ownership and firearm mortality are associated at the population level.
Assessing Psychosocial Risk and Resilience to Support Readiness for Gene Therapy in Sickle Cell Disease
Authors: Hardy Steven J. , Crosby Lori E. , Porter Jerlym S. , Sil Soumitri , Valrie Cecelia R. , Jonassaint Charles R. , Bediako Shawn M. , Andrews Clayton , Rivera Maria , Woolford Teonna , Coleman-Cowger Victoria H. 
Published: August 2024

ImportanceThe introduction of gene therapies into the clinical care landscape for individuals living with sickle cell disease (SCD) represents a momentous achievement with the potential to rewrite the story of the world’s most prevalent heritable blood disorder. This disease, which was first described in 1910 and did not see a US Food and Drug Administration–approved therapeutic until 1998, is poised to be among the first to realize the promise of gene therapy and genome editing. However, the future of these treatments now rests on how evidence of safety, outcomes, and acceptance in clinical practice unfolds in SCD. Furthermore, historic injustices involving the exploitation of individuals from minoritized racial and ethnic groups in medical contexts necessitate extreme care in ensuring readiness among individuals with SCD considering genetic therapies.ObjectiveTo address a gap in resources focused on patient readiness for gene therapy.Evidence ReviewThe Cure Sickle Cell Initiative organized the Patient Readiness and Resilience Working Group in September 2020. Membership was comprised of behavioral health clinicians and scientists with expertise in SCD, adults with lived experience with SCD, and a caregiver. Over 2 years, the working group developed consensus recommendations and created resources to guide implementation of pregene therapy patient readiness assessments. Recommendations centered on strategies to enhance delivery of education about gene therapy and assess knowledge and understanding, interest and motivation, and psychosocial risk and resilience factors.FindingsFive goals of a pregene therapy patient readiness assessment were identified: (1) gathering information about a patient’s understanding of and perceived readiness for gene therapy; (2) encouraging an open dialogue; (3) providing a conceptualization of psychosocial factors that may influence participation in gene therapy; (4) identifying patient strengths that can be used to promote psychosocial well-being before, during, and after gene therapy; (5) identifying and addressing psychosocial risks.Conclusions and RelevancePatient readiness and psychosocial factors will have tangible implications for the success of gene therapy at individual and collective levels. Health care institutions, industry, payers, policymakers, and clinicians all shoulder responsibility for ensuring that patients with SCD are adequately prepared for gene therapy and supported in ways that optimize readiness and access. Resources described here may be leveraged as a guide to support implementation of pregene therapy assessments of patient readiness and resilience in SCD.