bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010–13
Authors: Kourlaba Georgia , Kourkouni Eleni , Spyridis Nikos , Gerber Jeffrey S. , Kopsidas John , Mougkou Katerina , Lourida Athanasia , Zaoutis Theoklis E. 
Published: April 2015

Abstract

Objectives
The objectives of this study were to provide a nationally representative analysis of antibiotic prescribing in outpatient paediatrics and to assess overall and class-specific antibiotic costs in Greece.

Methods
Data on antibiotic prescriptions for patients aged ≤19 years old between July 2010 and June 2013 in Greece were extracted from the IMS Health Xponent database. Antibiotics were grouped into narrow- and broad-spectrum agents. The number of prescribed antibiotics and census denominators were used to calculate prescribing rates. The total costs associated with prescribed antibiotics were calculated.

Results
More than 7 million antibiotics were prescribed during the study period, with an annual rate of 1100 antibiotics/1000 persons. Prescribing rates were higher among children aged &lt;10 years old. Acute respiratory tract infections (ARTIs) accounted for 80% of prescribed antibiotics, with acute otitis media (22.3%), acute tonsillitis (19.5%) and acute bronchitis/bronchiolitis (13.9%) being the most common clinical diagnoses. Cephalosporins (32.9%), penicillins (32.3%) and macrolides (32.1%) were the most commonly prescribed antibiotic classes. The majority (90.4%) of antibiotics were broad spectrum. Antibiotic expenditures totalled ∼€50 million.

Conclusions
Broad-spectrum antibiotic prescribing is common in outpatient paediatric patients. These data provide important targets to inform the development of an outpatient antimicrobial stewardship programme targeting specific practices, providers and conditions.
Solving the interoperability challenge of a distributed complex patient guidance system: a data integrator based on HL7’s Virtual Medical Record standard
Authors: Marcos Carlos , González-Ferrer Arturo , Peleg Mor , Cavero Carlos 
Published: April 2015

Abstract
Objective We show how the HL7 Virtual Medical Record (vMR) standard can be used to design and implement a data integrator (DI) component that collects patient information from heterogeneous sources and stores it into a personal health record, from which it can then retrieve data. Our working hypothesis is that the HL7 vMR standard in its release 1 version can properly capture the semantics needed to drive evidence-based clinical decision support systems.
Materials and Methods To achieve seamless communication between the personal health record and heterogeneous data consumers, we used a three-pronged approach. First, the choice of the HL7 vMR as a message model for all components accompanied by the use of medical vocabularies eases their semantic interoperability. Second, the DI follows a service-oriented approach to provide access to system components. Third, an XML database provides the data layer.
Results The DI supports requirements of a guideline-based clinical decision support system implemented in two clinical domains and settings, ensuring reliable and secure access, high performance, and simplicity of integration, while complying with standards for the storage and processing of patient information needed for decision support and analytics. This was tested within the framework of a multinational project (www.mobiguide-project.eu) aimed at developing a ubiquitous patient guidance system (PGS).
Discussion The vMR model with its extension mechanism is demonstrated to be effective for data integration and communication within a distributed PGS implemented for two clinical domains across different healthcare settings in two nations.
Readability of patient discharge instructions with and without the use of electronically available disease-specific templates
Authors: Mueller Stephanie K , Giannelli Kyla , Boxer Robert , Schnipper Jeffrey L 
Published: April 2015

Abstract
Objective Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge.
Materials and Methods We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based “discharge module,” which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0–100 scale, with higher scores indicating greater readability) and the Flesch–Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis).
Results Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P &lt; .001) and lower FKGL scores (5.6 vs. 7.6, P &lt; .001), compared to clinician-generated discharge instructions.
Discussion The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient’s specific discharge diagnosis.
Conclusions Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
Measles in Canada Between 2002 and 2013
Authors: De Serres Gaston , Desai Shalini , Shane Amanda , Hiebert Joanne , Ouakki Manale , Severini Alberto 
Published: April 2015

AbstractBackground.  In 1994, Canada committed to eliminate measles by the year 2000. This report presents the epidemiology of measles in Canada between 2002 and 2013 and its implications in sustaining measles elimination.Methods.  Cases included individuals reported to the Canadian Measles and Rubella Surveillance System with confirmed measles.Results.  In Canada, 1171 cases of measles were reported between 2002 and 2013 (incidence 0.29 cases per 100 000 population). The annual number of cases ranged from 6 to 752. The majority of cases were unvaccinated (63%) or had an unknown vaccination status (19%). The median age of cases was 14.4 years (range, &lt;1 to 63 years) globally and 14 years when excluding the 2011 outbreak in Quebec where 68% of the 678 cases were 10 to 19 years old. With the exclusion of this outbreak, the incidence was highest in infants (1.0 per 100 000), lower but fairly similar between 1 and 19 years of age (0.2 to 0.4 per 100 000), and there was a substantial decline between 20 and 39 years of age (0.1 per 100 000). There was a significant trend towards a greater annual number of importations over the period. Although importations resulted in no transmission sustained for ≥12 months, 5 chains of transmission had &gt;30 cases. The effective reproductive number between 2002 and 2013 was estimated at 0.86 (95% confidence interval, .81–.92).Conclusions.  Canada has maintained elimination between 2002 and 2013, but additional efforts are needed to reduce the proportion of unimmunized individuals and respond to importation events.
Congenital Parvovirus B19 Infection: Persistent Viremia and Red Blood Cell Aplasia
Authors: Nadimpalli Sruti S. , Miller Russell S. , Kamath Vasudeva M. , Farkouh Christiana R. , Nhan-Chang Chia-Ling , Rathe Jennifer A. , Collins Amélie , Duchon Jennifer M. , Neu Natalie , Simpson Lynn L. , Ratner Adam J. 
Published: April 2015

Abstract
We describe a case of fetal parvovirus B19 infection resulting in preterm birth and leading to hydrops fetalis requiring multiple in utero transfusions. The infant developed chronic postnatal anemia responsive to intravenous immunoglobulin therapy. Serum viral load decreased after immunoglobulin treatment but remained detectable for over 1 year.
Histoplasmosis-Induced Hemophagocytic Syndrome: A Case Series and Review of the Literature
Authors: Townsend Jennifer Leigh , Shanbhag Satish , Hancock John , Bowman Kathryn , Nijhawan Ank E. 
Published: April 2015

AbstractBackground.  Histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) is a relatively rare disorder for which data are limited regarding optimal treatment and clinical outcomes in adults. We describe the clinical features, treatment, and outcomes of patients with histoplasmosis-associated HLH at our institution.Methods.  We performed a retrospective chart review of all inpatients at Parkland Hospital diagnosed with HLH associated with Histoplasma capsulatum from 2003 to 2013.Results.  Eleven cases of histoplasmosis-associated HLH over this time period were identified. Nine of eleven cases were males (82%). Nine of these patients had human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), 1 was a renal transplant patient on immunosuppressants, and the other had no documented immunocompromise. The most common HLH criteria were splenomegaly (n = 10), fever (n = 10), and ferritin &gt;500 ng/dL (n = 9). Urine Histoplasma antigen was positive in every patient tested (n = 9 of 9), and most antibodies for Histoplasma were positive if checked (n = 4 of 5). A majority of patients received liposomal amphotericin B (n = 9) with an average treatment duration of 11 days, and 5 patients also received prednisone, intravenous immunoglobulin (IVIG), or both. Overall, 5 patients died within 30 days (45.5%), and 7 patients died within 90 days (63.6%). Of the 5 patients that received immunosuppression, 4 died (80%), whereas in the group not given additional immunosuppression (n = 5), 2 died (40%).Conclusions.  Histoplasmosis-associated HLH among adults is a lethal disease of highly immunocompromised patients, especially patients with HIV/AIDS. Clinical features such as splenomegaly, elevated ferritin, and cytopenias should prompt evaluation for HLH in this population. Further data are needed to define the role of immunosuppression, IVIG, and highly active antiretroviral therapy in treating this condition.
Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia Increases Delirium after Cardiac Surgery
Authors: Saager Leif , Duncan Andra E. , Yared Jean-Pierre , Hesler Brian D. , You Jing , Deogaonkar Anupa , Sessler Daniel I. , Kurz Andrea 
Published: April 2015

AbstractAbstract
Intraoperative hyperinsulinemic–normoglycemia augments the risk of delirium after cardiac surgery, but not its severity.

Background:
Postoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. Therefore, the authors sought to determine the effect of tight intraoperative glucose control using a hyperinsulinemic–normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery.

Methods:
The authors enrolled 198 adult patients having cardiac surgery in this randomized, double-blind, single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic–normoglycemic clamp (target blood glucose, 80 to 110 mg/dl) or standard therapy (conventional insulin administration with blood glucose target, <150 mg/dl). Delirium was assessed using a comprehensive delirium battery. The authors considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention) and either 3 (disorganized thinking) or 4 (altered consciousness).

Results:
Patients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26 of 93 vs. 15 of 105; relative risk, 1.89; 95% CI, 1.06 to 3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy.

Conclusion:
Intraoperative hyperinsulinemic–normoglycemia augments the risk of delirium after cardiac surgery, but not its severity.
Growth Arrest Following ACL Reconstruction With Hamstring Autograft in Skeletally Immature Patients: A Review of 4 Cases
Authors: Shifflett Grant D. , Green Daniel W. , Widmann Roger F. , Marx Robert G. 
Published: April 2015

Background:
Anterior cruciate ligament (ACL) tears are becoming more common in the skeletally immature population as participation in high-risk sports continues to grow. This presents a challenge for the treating surgeon as ACL reconstruction in this patient set has the added aim of preservation of the growth plate anatomy. The purpose of this investigation is to report on 4 patients who developed growth arrest following ACL reconstruction and offer a review of the available literature.

Methods:
Four skeletally immature patients (2 male and 2 female) were identified who underwent ACL reconstruction at mean age of 14.2 years (range, 13.5 to 14.8 y) and developed growth arrests. Bone ages at the time of reconstruction were 14 and 16 years for the boys and 13 years 6 months and 14 years for the girls. All patients had a transphyseal reconstruction with a hamstring autograft. Standard postoperative care was provided including clinical and radiographic follow-up at regular intervals. Clinically significant postoperative physeal arrest was confirmed on MRI or CT scan. Detailed chart review examined demographics, operative variables, and postoperative subjective and objective clinical measures.

Results:
Two patients developed tibial recurvatum; 2 patients developed genu valgum. Three patients required further surgery. One patient underwent distal femoral–guided growth procedure, 2 underwent proximal tibial epiphysiodesis, and 1 patient was skeletally mature at presentation and did not require deformity correction.

Conclusions:
This report of 4 patients demonstrates that growth arrest following ACL reconstruction in skeletally immature patients is a real concern and highlights the importance of careful preoperative evaluation and discussion with patients and family members. We routinely obtain long-leg AP and lateral hip-to-ankle films on skeletally immature patients before performing an ACL reconstruction and then at 6 and 12 months postoperatively or every 6 months until the growth plates are closed to assess leg lengths and lower extremity alignment.

Level of Evidence:
Level IV—therapeutic study, case series.
Changing Pattern of Femoral Deformity During Growth in Polyostotic Fibrous Dysplasia of the Bone: An Analysis of 46 Cases
Authors: Ippolito Ernesto , Valentini Matteo Benedetti , Lala Roberto , De Maio Fernando , Sorge Roberto , Farsetti Pasquale 
Published: April 2015

Background:
In polyostotic fibrous dysplasia (PFD) affecting the femur, 6 types of stable femoral deformities have been identified, ranging from the mild type 1 to the most severe type 6. The purpose of our study was to identify the type of deformity present at diagnosis in children with PFD affecting the femur, and to investigate possible changes in the original type with growth.

Methods:
Twenty-seven children affected by either PFD or McCune-Albright syndrome, with 46 affected femurs, were consecutively observed from 1994 to 2010. Radiographs of the pelvis and femurs were taken at diagnosis, and afterward at regular intervals of 6 to 12 months depending on the clinical evolution of each case. Radiographs of the femurs taken at 3 and 7 years after diagnosis were selected to assess the evolution of the femoral deformity. Deformities were classified according to the femoral shape, neck-shaft angle value, and the presence of shepherd’s crook deformity evaluated on AP radiographs.

Results:
The average age of the patients at diagnosis was 5 years (range, 2 to 11 y). At diagnosis, 30 femurs were type 1; 12, type 2; 1, type 3; 1, type 4; and 2, type 5. Three years later, 39% of the femurs had maintained the original deformity present at diagnosis, whereas only 13% did so 7 years after diagnosis.
Predictors of change to a more severe type were: younger age at diagnosis, McCune-Albright syndrome, rapid spreading of fibrodysplastic tissue from the trochanteric area to the proximal femoral shaft, cortical thinning of the proximal femur, calcar osteolysis, and presence of an intertrochanteric cystic-like lesion eroding the calcar.

Conclusions:
In children with PFD affecting the femur, 61% of the femoral deformity present at diagnosis switched to a more severe type of deformity within 3 years from diagnosis, whereas 87% either shifted to a more severe type of deformity or already had corrective surgery within 7 years after diagnosis.

Level of evidence:
Level IV.
Guided Growth of the Proximal Femur for Hip Displacement in Children With Cerebral Palsy
Authors: Lee Wei-Chun , Kao Hsuan-Kai , Yang Wen-E. , Ho Pei-Chi , Chang Chia-Hsieh 
Published: April 2015

Background:
Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement.

Methods:
This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer’s migration percentage (MP) and the head-shaft angle (HSA).

Results:
Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (P<0.01) and to 162.7 degrees at 2 years postoperatively. The screw was usually backed out from the femoral epiphysis in the second postoperative year, and no radiologic bony bar or other surgical complications occurred.

Conclusions:
The immediate postoperative improvement of MP was the result of soft-tissue release. From postoperative 3 months to 2 years, the HSA was reduced by 10.6 degrees and the MP further improved by 8.7%. Less surgical dissection, faster recovery of motion, and less comorbidity than varus osteotomy make guided growth surgery a treatment option for coxa valga in spastic hip displacement in nonambulant cerebral palsy children.

Level of Evidence:
Level IV—therapeutic, case series.
What’s New in the Management of Neuromuscular Scoliosis
Authors: Brooks Jaysson T. , Sponseller Paul D. 
Published: April 2015

Background:
Patients with neuromuscular scoliosis (NMS) can pose treatment challenges related to medical comorbidities and altered spinopelvic anatomy. We reviewed the recent literature regarding evaluation and management of NMS patients and explored areas where further research is needed.

Methods:
We searched the PubMed database for all papers related to the treatment of NMS published from January 1, 2011 through July 31, 2014, yielding 70 papers.

Results:
A total of 39 papers contributed compelling new findings. Steroid treatment has been most promising in patients with Duchenne muscular dystrophy, leading to a significantly lower death rate, better pulmonary function, and longer independent ambulation. Growing rods in early-onset NMS were shown to result in significant improvements in major Cobb angles and pelvic obliquity, with low complication rates in patients with spinal muscular atrophy but high infection rates in those with cerebral palsy. Early reports of magnetic growing rods in NMS patients are favorable. Intraoperative neural monitoring is variable in this patient population; however, use of transcranial motor-evoked potentials in NMS patients seems to be safe. Blood loss is the highest in NMS patients when compared with all other diagnostic categories. However, tranexamic acid seems to significantly lower intraoperative blood loss. In a multicenter study, patients diagnosed with NMS had the highest surgical-site infection rate at 13.1%. Best-practice guidelines have been created regarding prevention of infection in NMS patients. Preoperative nutritional optimization and postoperative nutritional supplementation seem to help with lowering the infection rate in these patients.

Conclusions:
There have been major advances in the management of NMS patients, but many challenges remain. Further multicenter studies and randomized clinical trials are needed, particularly in the areas of infection prophylaxis, nutritional optimization, improvement in intraoperative neural monitoring, and prevention of proximal junctional kyphosis.

Level of Evidence:
Level 4—literature review.
Building Genomic Analysis Pipelines in a Hackathon Setting with Bioinformatician Teams: DNA-seq, Epigenomics, Metagenomics and RNA-seq
Authors: Busby Ben , Dillman Allissa , Simpson Claire L. , Fingerman Ian , Yun Sijung , Kristensen David M. , Federer Lisa , Shah Naisha , LaFave Matthew C. , Jimenez-Barron Laura , Pande Manjusha , Luo Wen , Miller Brendan , Mayden Cem , Chandramohan Dhruva , Fletez-Brant Kipper , Bible Paul W. , Nowoshilow Sergej , Chan Alfred , Galvez Eric JC , Chignell Jeremy , Paulson Joseph N. , Kandpal Manoj , Yoon Suhyeon , Asaki Esther , Nellore Abhinav , Stine Adam , Sanders Robert , Becker Jesse , Lesko Matt , Abzug Mordechai , Yaschenko Eugene 
Published: April 2015

AbstractWe assembled teams of genomics professionals to assess whether we could rapidly develop pipelines to answer biological questions commonly asked by biologists and others new to bioinformatics by facilitating analysis of high-throughput sequencing data. In January 2015, teams were assembled on the National Institutes of Health (NIH) campus to address questions in the DNA-seq, epigenomics, metagenomics and RNA-seq subfields of genomics. The only two rules for this hackathon were that either the data used were housed at the National Center for Biotechnology Information (NCBI) or would be submitted there by a participant in the next six months, and that all software going into the pipeline was open-source or open-use. Questions proposed by organizers, as well as suggested tools and approaches, were distributed to participants a few days before the event and were refined during the event. Pipelines were published on GitHub, a web service providing publicly available, free-usage tiers for collaborative software development (https://github.com/features/). The code was published athttps://github.com/DCGenomics/with separate repositories for each team, starting with hackathon_v001.