bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of Patient-Specific Characteristics and Competing Risks to Tailor the Duration of Surveillance Imaging After Surgery for Renal Cell Carcinoma
Authors: Merrill Suzanne B. , Alzubaidi Ahmad N. , Schaefer Eric , Master Viraj , Patil Dattatraya , Allen Glenn O. , Abel E. Jason , Raman Jay D. 
Published: March 2024

Purpose:
The appropriate duration of follow-up after surgical resection of renal cell carcinoma (RCC) remains incompletely defined. To better inform on this time line, we investigate when an individual's risk of RCC recurrence becomes less significant than their risk of non-RCC death.

Materials and Methods:
We identified 1672 patients who underwent surgery for M0 RCC between 1999 and 2018. Patients were stratified by pathologic stage, histology, age, and Eastern Cooperative Oncology Group (ECOG) performance status. Cumulative incidence functions were estimated for RCC recurrence and non-RCC death using Fine and Gray models. Follow-up durations were estimated as the time point at which the cumulative incidence of non-RCC death exceeded that of RCC recurrence.

Results:
At a median follow-up of 2.1 years (IQR 0.6-5.1 years), a total of 272 recurrences (16.3%) and 234 non-RCC deaths (14.0%) occurred. The fitted model showed significant associations of stage with RCC recurrence and of age and ECOG with non-RCC death. For 50-year-old patients with pT1aN0-x clear cell and ECOG 0, the incidence of non-RCC death exceeded that of recurrence after 4.4 years. However, if such patients had an ECOG status of 1 or 2 to 4, the incidence of non-RCC death exceeded that of recurrence at 30 days, suggesting that routine oncologic surveillance may not be necessary. Alternatively, regardless of ECOG status, the incidence of non-RCC death failed to exceed that of recurrence for >13.9 years in all patients age 50 with > pT3aN0-x clear cell thereby suggesting longer surveillance than currently recommended.

Conclusion:
Modeling competing risks of RCC recurrence and non-RCC death provide patient-specific estimates when follow-up may be reasonably discontinued.
Measuring the PULSE of Nursing
Authors: Mann Charles , Montoya Lorraine , Taylor Joey , Barton Glenn 
Published: March 2024

Background:
Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

Problem:
A mechanism to continuously monitor the impact of this staffing change was not available.

Approach:
Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

Outcomes:
The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

Conclusion:
The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.
Evaluating Sepsis Bundle Compliance as a Predictor for Patient Outcomes at a Community Hospital
Authors: Lawrence John R. , Lee Ben Seiyon , Fadahunsi Adetokunbo I. , Mowery Bernice D. 
Published: March 2024

Background:
Clinicians are encouraged to use the Centers for Medicare & Medicaid Services early management bundle for severe sepsis and septic shock (SEP-1); however, it is unclear whether this process measure improves patient outcomes.

Purpose:
The purpose of this study was to evaluate whether compliance with the SEP-1 bundle is a predictor of hospital mortality, length of stay (LOS), and intensive care unit LOS at a suburban community hospital.

Methods:
A retrospective observational study was conducted.

Results:
A total of 577 patients were included in the analysis. Compliance with the SEP-1 bundle was not a significant predictor for patient outcomes.

Conclusions:
SEP-1 compliance may not equate with quality of health care. Efforts to comply with SEP-1 may help organizations develop systems and structures that improve patient outcomes. Health care leaders should evaluate strategies beyond SEP-1 compliance to ensure continuous improvement of outcomes for patients experiencing sepsis.
The L-Shaped Zygomatic Reduction with Oblique or Vertical Resection: Which One Is the Optimal Choice?
Authors: He Yingyou , Wang Yu , Al-Watary Mohammed Qasem , Wang Yumo , Wu Yifan , Li Xiang , Ye Bin , Li Jihua 
Published: March 2024

Background:
This study aimed to investigate the optimal surgical techniques in reduction malarplasty by comparing the difference between the L-shaped osteotomy with vertical and oblique bone resection.

Methods:
A total of 120 patients who visited the authors’ department for L-shaped osteotomy with either vertical (group I) or oblique bone resection (group II) from 2015 to 2021 were reviewed retrospectively. The preoperative and postoperative spiral computed tomographic data were analyzed. The preoperative computed tomographic data were also used to simulate the virtual and model surgery.

Results:
The results showed that a broken bridge–like structure with a bony gap of 2.86 ± 1.03 mm at the zygomatic arch root was observed in group I, and a mortice-and-tenon joint structure with a bone overlap of 2.28 ± 0.58 mm was formed in group II. The zygoma in group I displaced significantly in the vertical direction and horizontal direction during the follow-up. Simultaneously, the incidence of complications was higher in group I. In the mechanism analysis through virtual and model surgery, the zygomatic segment was shifted anteriorly and inferiorly in group I, and a bony gap was detected at the zygomatic arch root. Conversely, a superior and posterior movement was performed in group II and it maintained the zygomatic complex integral with bone overlap at the zygomatic arch root on repositioning.

Conclusion:
This study suggested that L-shaped osteotomy with oblique bone resection could be the optimal choice for reducing zygomatic prominence.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Predictive Power of Dependence and Clinical-Social Fragility Index and Risk of Fall in Hospitalized Adult Patients: A Case-Control Study
Authors: Cioce Marco , Grassi Simone , Borrelli Ivan , Grassi Vincenzo Maria , Ghisellini Renato , Nuzzo Carmen , Zega Maurizio , Laurenti Patrizia , Raponi Matteo , Rossi Riccardo , Boccia Stefania , Moscato Umberto , Oliva Antonio , Vetrugno Giuseppe 
Published: March 2024

Objectives
Accidental falls are among the leading hospitals’ adverse events, with incidence ranging from 2 to 20 events per 1.000 days/patients. The objective of this study is to assess the relationship between in-hospital falls and the score of 3 DEPendence and Clinical-Social Fragility indexes.

Methods
A monocentric case-control study was conducted by retrieving data of in-hospital patients from the electronic health records.

Results
Significant differences between the mean scores at the hospital admission and discharge were found. The BRASS scale mean (SD) values at the admission and at the discharge were also significantly higher in cases of in-hospital falls: at the admission 10.2 (±7.7) in cases versus 7.0 (±8.0) in controls (P = 0.003); at the discharge 10.0 (±6.4) versus 6.7 (±7.5) (P = 0.001). Barthel index mean (SD) scores also presented statistically significant differences: at the admission 60.3 (±40.6) in cases versus 76.0 (±34.8) in controls (P = 0.003); at discharge 51.3 (±34.9) versus 73.3 (±35.2) (P = 0.000).
Odds ratios were as follows: for Barthel index 2.37 (95% CI, 1.28–4.39; P = 0.003); for Index of Caring Complexity 1.45 (95% CI, 0.72–2.91, P = 0. 255); for BRASS index 1.95 (95% CI, 1.03–3.70, P = 0.026). With BRASS index, the area under the curve was 0.667 (95% CI, 0.595–0.740), thus indicating a moderate predictive power of the scale.

Conclusions
The use of only Conley scale—despite its sensitivity and specificity—is not enough to fully address this need because of the multiple and heterogeneous factors that predispose to in-hospital falls. Therefore, the combination of multiple tools should be recommended.
A Case Report of Craniofacial Intraosseous Xanthoma in a Patient Seeking Facial Feminization Surgery
Authors: Nguyen Nghiem , Lee James , Liu Yuan 
Published: March 2024

Background
Fibrous dysplasia (FD) is a benign developmental disorder of the bone that causes normal skeletal tissue to be replaced by excess fibrous tissue and poorly differentiated osteoblasts. Intraosseous xanthomas are benign intraosseous tumor growths characterized microscopically by the presence of lipid-laden foamy histiocytes, often with cortical expansion or disruption. Although FD commonly occurs in craniofacial bones, primary intraosseous xanthomas of the skull or facial skeleton are extremely rare. Although 2 distinct conditions, each may be difficult to differentiate on CT imaging when occurring in the facial skeleton.

Methods
We report a case of an incidental finding on craniofacial CT of a frontal bone lesion originally thought to be FD. The finding was in a 55-year-old transgender woman who was assigned male at birth before receiving multiprocedural facial feminization surgery.

Results
The clinical features, radiological findings, and treatment are discussed. Postoperatively, the patient had no sequelae secondary to facial feminization surgery or to the orbital lesion biopsy procedure. Bone graft appeared stable on CT imaging, although FD did not appear to resolve completely.

Conclusions
Diagnosis of such lesions is challenging and may require both radiographic and histopathologic assessment. As in the case of this patient, intraosseous xanthomas may also be misdiagnosed as other benign lesions such as FD. In most known cases, surgical intervention leads to complete resolution without recurrence of the lesion.
Free Tissue Transfer for Reconstruction After Bilateral Skin Sparing Mastectomy—A Systematic Review
Authors: Bucher Florian , Vogt Peter M. , Krezdorn Nicco , Dastagir Khaled 
Published: March 2024

Background
Breast cancer is the most commonly diagnosed malignant neoplasia in females worldwide. Overall survival and patients' choice for bilateral mastectomy have increased. It is therefore important to offer breast reconstructive procedures to improve patient quality of life and self-esteem. The aim of this systematic literature review is to quantify the outcome and sustainability of bilateral breast reconstruction using autologous, vascularized free tissue transfer.

Methods
A systematic literature review of PubMed, Cochrane, and the Web of Science databases was performed. A total of 5879 citations were identified, and 12 studies met the inclusion criteria.

Results
A total of 1316 patients were included, with a mean age of 47.2 years. Overall, 32.5% of patients experienced a complication after breast reconstruction. If reported, 7.45% of patients experienced major complications, while 20.7% had minor complications.
The following flaps were used for breast reconstruction, in order of reducing frequency: DIEP (45.45%), TRAM (22.73%), SIEA (9.09%), SGAP (9.09%), TUG (4.55%), TMG (4.55%), and LD/MLD (4.55%).

Conclusions
Current studies indicate that bilateral breast reconstruction using autologous, vascularized free tissue transfer is a safe procedure for postmastectomy reconstruction and offers stable long-term results. This is particularly in comparison to implant-based breast reconstruction.
Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers
Authors: Singh Neeraj , Lentine Krista L. , Fleetwood Vidya A. , Woodside Kenneth J. , Odorico Jon , Axelrod David , Alhamad Tarek , Maher Kennan , Xiao Huiling , Fridell Jonathan , Kukla Aleksandra , Pavlakis Martha , Shokouh-Amiri Hosein M. , Zibari Gazi , Cooper Matthew , Parsons Ronald F. 
Published: March 2024

Background.
Pancreas transplant biopsy practices for the diagnosis of rejection or other pathologies are not well described.

Methods.
We conducted a survey of staff at US pancreas transplant programs (March 22, 2022, to August 22, 2022) to assess current program practices and perceptions about the utility and challenges in the performance and interpretation of pancreas allograft biopsies.

Results.
Respondents represented 65% (76/117) of active adult pancreas transplant programs, capturing 66% of recent pancreas transplant volume in the United States. Participants were most often nephrologists (52%), followed by surgeons (46%), and other staff (4%). Pancreas allograft biopsies were performed mostly by interventional radiologists (74%), followed by surgeons (11%), nephrologists (8%), and gastroenterologists (1%). Limitations in the radiologist’s or biopsy performer’s comfort level or expertise to safely perform a biopsy, or to obtain sufficient/adequate samples were the two most common challenges with pancreas transplant biopsies. Pancreas transplant biopsies were read by local pathologists at a majority (86%) of centers. Challenges reported with pancreas biopsy interpretation included poor reliability, lack of reporting of C4d staining, lack of reporting of rejection grading, and inconclusive interpretation of the biopsy. Staff at a third of responding programs (34%) stated that they rarely or never perform pancreas allograft biopsies and treat presumed rejection empirically.

Conclusions.
This national survey identified significant variation in clinical practices related to pancreas allograft biopsies and potential barriers to pancreas transplant utilization across the United States. Consideration of strategies to improve program experience with percutaneous pancreas biopsy and to support optimal management of pancreas allograft rejection informed by histology is warranted.
Sequential Normothermic Regional Perfusion and End-ischemic Ex Situ Machine Perfusion Allow the Safe Use of Very Old DCD Donors in Liver Transplantation
Authors: Torri Francesco , Balzano Emanuele , Melandro Fabio , Maremmani Paolo , Bertini Pietro , Lo Pane Paolo , Masini Matilde , Rotondo Maria Isabella , Babboni Serena , Del Turco Serena , Antonelli Stefano , De Tata Vincenzo , Biancofiore Giandomenico , Guarracino Fabio , Paolicchi Aldo , De Simone Paolo , Basta Giuseppina , Ghinolfi Davide ,   for the DCDNet Study Group
Published: March 2024

Background.
In Italy, 20 min of continuous, flat-line electrocardiogram are required for death declaration. Despite prolonged warm ischemia time, Italian centers reported good outcomes in controlled donation after circulatory death (cDCD) liver transplantation by combining normothermic regional and end-ischemic machine perfusion (MP). The aim of this study was to evaluate the safety and feasibility of the use of septuagenarian and octogenarian cDCD donors with this approach.

Methods.
All cDCD older than 70 y were evaluated during normothermic regional perfusion and then randomly assigned to dual hypothermic or normothermic MP.

Results.
In the period from April 2021 to December 2022, 17 cDCD older than 70 y were considered. In 6 cases (35%), the graft was not considered suitable for liver transplantation, whereas 11 (65%) were evaluated and eventually transplanted. The median donor age was 82 y, being 8 (73%) older than 80. Median functional warm ischemia and no-flow time were 36 and 28 min, respectively. Grafts were randomly assigned to ex situ dual hypothermic oxygenated MP in 6 cases (55%) and normothermic MP in 5 (45%). None was discarded during MP. There were no cases of primary nonfunction, 1 case of postreperfusion syndrome (9%) and 2 cases (18%) of early allograft dysfunction. At a median follow-up of 8 mo, no vascular complications or ischemic cholangiopathy were reported. No major differences were found in terms of postoperative hospitalization or complications based on the type of MP.

Conclusions.
The implementation of sequential normothermic regional and end-ischemic MP allows the safe use of very old donation after circulatory death donors.
Silymarin (Milk Thistle) Treatment of Adults With Gambling Disorder: A Double-Blind, Placebo-Controlled Trial
Authors: Grant Jon E. , Driessens Corine , Chamberlain Samuel R. 
Published: March 2024

Objective
Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder.

Methods
Forty-three individuals (18 [41.9%] women; mean age=49.61 [±13.1] years) with gambling disorder entered an 8-week, double-blind, placebo-controlled study. Dosing of silymarin ranged from 150 to 300 mg twice a day. The primary outcome measure was the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS). Secondary outcome measures comprised the Gambling Symptom Assessment Scale and measures of depression and anxiety. Outcomes were examined using mixed-effect models.

Results
Silymarin did not statistically differentiate from the placebo on any of the outcome measures of interest, in terms of treatment group×time interactions. There was a robust response in the placebo group (57% reduction on the PG-YBOCS), and on average there was a 56% reduction in YBOCS score for the milk thistle.

Conclusions
The findings of this study do not support the use of silymarin/milk thistle in the treatment of gambling disorder but highlight the large placebo response seen in gambling disorder. Treatment interventions for gambling disorder need to better understand and address the placebo response.

Trial Registration

ClinicalTrials.gov identifier: NCT02337634
Collaborative Approach Toward Transplant Candidacy for Obese Patients with End-Stage Renal Disease
Authors: Levy Shauna , Attia Abdallah , Omar Mahmoud , Langford Nicole , Vijay Adarsh , Jeon Hoonbae , Galvani Carlos , Killackey Mary T , Paramesh Anil S 
Published: March 2024

BACKGROUND:
An elevated BMI is a major cause of transplant preclusion for patients with end-stage renal disease (ESRD). This phenomenon exacerbates existing socioeconomic and racial disparities and increases the economic burden of maintaining patients on dialysis. Metabolic bariatric surgery (MBS) in such patients is not widely available. Our center created a collaborative program to undergo weight loss surgery before obtaining a kidney transplant.

STUDY DESIGN:
We studied the outcomes of these patients after MBS and transplant surgery. One hundred eighty-three patients with ESRD were referred to the bariatric team by the transplant team between January 2019 and June 2023. Of these, 36 patients underwent MBS (20 underwent Roux-en-Y gastric bypass and 16 underwent sleeve gastrectomy), and 10 underwent subsequent transplantation, with another 15 currently waitlisted. Both surgical teams shared resources, including dieticians, social workers, and a common database, for easy transition between teams.

RESULTS:
The mean starting BMI for all referrals was 46.4 kg/m2 and was 33.9 kg/m2 at the time of transplant. The average number of hypertension medications decreased from 2 (range 2 to 4) presurgery to 1 (range 1 to 3) postsurgery. Similarly, hemoglobin A1C levels improved, with preoperative averages at 6.2 (range 5.4 to 7.6) and postoperative levels at 5.2 (range 4.6 to 5.8) All transplants are currently functioning, with a median creatinine of 1.5 (1.2 to 1.6) mg/dL (glomerular filtration rate 46 [36.3 to 71]).

CONCLUSIONS:
A collaborative approach between bariatric and transplant surgery teams offers a pathway toward transplant for obese ESRD patients and potentially alleviates existing healthcare disparities. ESRD patients who undergo MBS have unique complications to be aware of. The improvement in comorbidities may lead to superior posttransplant outcomes.
Preventing functional decline in hospitalized older adults in medical ward: a best practice implementation project
Authors: Chen Chia-Te , Tung Heng-Hsin , Chen Chi-Wen , Yang Yea-Ru , Wang Jiun-Ling , Chang Chia-Ming , Chen Yen-Chin , Liang Shih-Hsin , Fan Chia-Hao 
Published: March 2024

ABSTRACT

Introduction and objectives:
Functional decline frequently occurs in older adults in hospitals. The aim of this project was to promote evidence-based strategies for physical activity to prevent functional decline in hospitalized older adults in a medical center in southern Taiwan.

Methods:
This project was guided by the JBI Evidence Implementation Framework. Seven audit criteria were derived from a JBI evidence summary and a baseline audit involving 25 nurses and 30 hospitalized older adults was conducted to compare current practice with best practice recommendations. The JBI Getting Research into Practice (GRiP) approach was used to identify barriers to implementation, and strategies were developed to overcome those barriers. A follow-up audit was conducted to measure any changes in compliance.

Results:
After implementing the strategies, the pass rate of nursing staff improved in the physical activity knowledge test, rising from 56% to 88%. Compliance of nursing staff with providing physical activity instructions using evidence-based guidelines to hospitalized older adults reached 80%. The incidence of functional decline among hospitalized older adults decreased from 36.7% to 20%.

Conclusions:
The results of this best practice implementation project suggest that initiating physical activity as early as possible for hospitalized older adults once their medical condition has stabilized can help prevent functional decline.

Spanish abstract:

http://links.lww.com/IJEBH/A171
Prevention and management of enteral nutrition-related diarrhea among adult inpatients: a best practice implementation project
Authors: Zhang Xinyue , Du Meijie , He Mei , Wang Mei , Jiang Mengyao , Cai Yue , Cui Mengying , Wang Ying 
Published: March 2024

ABSTRACT

Introduction:
Diarrhea, the most common complication for patients during enteral nutrition, poses a range of risks and care burdens. Medical staff are aware of the importance of proactively preventing and managing enteral nutrition-related diarrhea. However, clinical prevention and management methods are not standardized, and the scientific basis and effectiveness of these methods need to be further verified.

Objectives:
This project aimed to promote evidence-based practices for the prevention and management of enteral nutrition-related diarrhea among adult inpatients in a public tertiary hospital in China.

Methods:
This project was guided by the JBI Evidence Implementation Framework and used the JBI Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tools. Twelve audit criteria were developed to conduct a baseline audit to measure compliance with best practices. A barrier analysis was conducted, and strategies were implemented to overcome the barriers. The project was finalized with a follow-up audit to determine any changes in compliance with best practices.

Results:
The overall compliance rate for the audit criteria increased from 27.37% at baseline to 89.62% in the follow-up audit, with six criteria achieving a compliance rate of 100%.

Conclusions:
The implementation of evidence-based practices can effectively narrow the gap between current practice and best practice. This project improved the ability of medical staff to prevent and manage enteral nutrition-related diarrhea, as well as promoting evidence-based practice in the hospital.

Spanish abstract:

http://links.lww.com/IJEBH/A168