bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Adjustment of ICD-10-CM Coded Potential Inpatient Complications Using Administrative Data
Authors: Korvink Michael , Gunn Laura H. , Molina German , Hayes Tracy , Selves Esther , Duan Michael , Martin John 
Published: May 2023

Objective:
To risk-adjust the Potential Inpatient Complication (PIC) measure set and propose a method to identify large deviations between observed and expected PIC counts.

Data Sources:
Acute inpatient stays from the Premier Healthcare Database from January 1, 2019 to December 31, 2021.

Study Design:
In 2014, the PIC list was developed to identify a broader set of potential complications that can occur as a result of care decisions. Risk adjustment for 111 PIC measures is performed across 3 age-based strata. Using patient-level risk factors and PIC occurrences, PIC-specific probabilities of occurrence are estimated through multivariate logistic regression models. Poisson Binomial cumulative mass function estimates identify deviations between observed and expected PIC counts across levels of patient-visit aggregation. Area under the curve (AUC) estimates are used to demonstrate PIC predictive performance in an 80:20 derivation-validation split framework.

Data collection/Extraction methods:
We used N=3,363,149 administrative hospitalizations between 2019 and 2021 from the Premier Healthcare Database.

Principal Findings:
PIC-specific model predictive performance was strong across PICs and age strata. Average area under the curve estimates across PICs were 0.95 (95% CI: 0.93–0.96), 0.91 (95% CI: 0.90–0.93), and 0.90 (95% CI: 0.89–0.91) for the neonate and infant, pediatric, and adult strata, respectively.

Conclusions:
The proposed method provides a consistent quality metric that adjusts for the population’s case mix. Age-specific risk stratification further addresses currently ignored heterogeneity in PIC prevalence across age groups. Finally, the proposed aggregation method identifies large PIC-specific deviations between observed and expected counts, flagging areas with a potential need for quality improvements.
Postoperative surgical complications after pediatric kidney transplantation in low weight recipients (<15 kg): a systematic review
Authors: Prudhomme Thomas , Mesnard Benoit , Abbo Olivier , Banuelos Beatriz , Territo Angelo 
Published: May 2023

Purpose of review
Kidney transplantation in low-weight recipients (<15 kg) is a challenging surgery with special characteristics. We proposed to perform a systematic review to determine the postoperative complication rate and the type of complications after kidney transplantation in low-weight recipients (<15 kg). The secondary objectives were to determine graft survival, functional outcomes, and patient survival after kidney transplantation in low-weight recipients.

Methods
A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline and Embase databases were searched to identify all studies reporting outcomes on kidney transplantation in low-weight recipients (<15 kg).

Results
A total of 1254 patients in 23 studies were included. The median postoperative complications rate was 20.0%, while 87.5% of those were major complications (Clavien ≥3). Further, urological and vascular complications rates were 6.3% (2.0–11.9) and 5.0% (3.0–10.0), whereas the rate of venous thrombosis ranged from 0 to 5.6%. Median 10-year graft and patient survival were 76 and 91.0%.

Summary
Kidney transplantation in low-weight recipients is a challenging procedure complicated by a high rate of morbidity. Finally, pediatric kidney transplantation should be performed in centers with expertise and multidisciplinary pediatric teams.
Overview of pregnancy in solid-organ transplantation
Authors: Yenebere Priya , Doraiswamy Mohankumar , Gundroo Aijaz 
Published: May 2023

Purpose of review
Pregnancy in solid organ transplantation (SOT) is a very complex part of transplant medicine wherein there is scarce information available in the literature. Solid organ transplant recipients often have comorbidities, such as hypertension and diabetes, which add additional risk to a pregnancy.

Recent findings
We present this review article on the various aspects of different types of immunosuppressant medications used in pregnancy with added inputs on contraception and fertility after transplant. We described the antepartum and postpartum considerations and discussed the adverse effects of the immunosuppressive medications. Maternal and fetal complications of each SOT have been also discussed in this article.

Summary
This article will serve as the primary review articles for the use of immunosuppressive medications during pregnancy with consideration during pregnancy after SOT.
Establishment of Nurse Case Manager Role in a Pediatric Orthopedic Team
Authors: Bourque Maryanne , McCarraher Elizabeth A. 
Published: May 2023

Purpose/Objectives:
Incorporating a nurse case manager (NCM) directly into a pediatric orthopedic department was implemented to address gaps in processes that had previously led to common delays in discharge planning. The orthopedic NCM works within an interdisciplinary team and provides guidance and support for both elective and emergent pediatric admissions. Applying continuous improvement techniques, the NCM role included the review of existing processes and determination of root causes of delays. This article describes some of the unique challenges and new processes included in the NCM role in the pediatric orthopedic setting, several solutions created and implemented to address identified delays, and statistical results of anticipatory discharge planning.

Primary Practice Setting:
An NCM role was initiated in the orthopedic department at a quaternary-level freestanding pediatric hospital.

Findings/Conclusions:
After interdisciplinary planning and implementation, the NCM role was established within the orthopedic department to facilitate timely, efficient, safe, and sustained discharges of patients. Success was realized through decreased denials and decreased number of avoidable inpatient days. Once rapport was established and streamlined work was developed, a retrospective review of length of stay was conducted to compare time periods prior to and after embedding this position. Changes in discharge planning processes positively affected the average length of stay for patients managed by the NCM. Cost savings are found in decreased avoidable inpatient days, decreased number of denials of inpatient medical necessity, and improved progression of care, which resulted in timely transitions and discharges. The effects of a consignment process and web-based ordering of durable medical equipment were also evaluated. Although this process in and of itself did not seem to impact length of stay, it did foster an improvement in team satisfaction around discharge readiness.

Implications for Case Management:
Pediatric orthopedic service teams benefit from the role of the NCM when there is interdisciplinary involvement and a focus on streamlining processes from preadmission through transition of care. Further study in a concurrent design will shed light on other factors that impact length of stay, such as specific diagnoses and medical complexity. Average length of stay is an effective metric for services with a high percentage of elective admissions but may not be as dependable for teams that do not have prescribed lengths of stay. Study with a specific focus around those factors that impact both team and family satisfaction is also indicated.
Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients*
Authors: Kanno Koji , Fujiwara Naoki , Moromizato Takuhiro , Fujii Shuichi , Ami Yuki , Tokushige Akihiro , Ueda Shinichiro 
Published: May 2023

OBJECTIVES:
We performed our standard air leak, leak percentage, and cuff leak percentage tests in pediatric patients intubated with microcuff pediatric tracheal tubes (MPTTs) just before extubation. We examined the association between test findings and the subsequent occurrence of post-extubation laryngeal edema (PLE).

DESIGN:
Prospective, single-center, observational study.

SETTING:
PICU (June 1, 2020 to May 31, 2021).

PATIENTS:
Pediatric patients intubated and scheduled for extubation during the day shift in the PICU.

INTERVENTIONS:
Multiple pre-extubation leak tests were performed on each patient immediately before extubation. In our center, the standard leak test is positive if a leak is audible at 30 cm H2O applied pressure with the MPTT cuff deflated. Two other tests were calculated in the pressure control-assist control ventilator mode using the following formulas: leak percentage with deflated cuff = (inspiratory tidal volume [Vt]–expiratory Vt) × 100/inspiratory Vt; cuff leak percentage = (expiratory Vt with inflated cuff–expiratory Vt with deflated cuff) × 100/expiratory Vt with inflated cuff.

MEASUREMENTS AND MAIN RESULTS:
The diagnostic criteria for PLE was made by at least two healthcare professionals and included upper airway stricture with stridor-requiring nebulized epinephrine. Eighty-five pediatric patients (< 15 yr) who had been intubated for at least 12 hours using the MPTT were included. Positive rates for the standard leak, leak percentage (cutoff 10%), and cuff leak percentage (cutoff 10%) tests were 0.27, 0.20, and 0.64, respectively. The standard leak, leak percentage, and cuff leak tests showed sensitivities of 0.36, 0.27, and 0.55, respectively; and specificities of 0.74, 0.81, and 0.35, respectively. PLE occurred in 11 of 85 patients (13%), and there were no instances of needing reintubation.

CONCLUSIONS:
The pre-extubation leak tests in current practice for intubated pediatric patients in the PICU all lack diagnostic accuracy for PLE.
Clinical and Analytic Accuracy of Simultaneously Acquired Hemoglobin Measurements: A Multi-Institution Cohort Study to Minimize Redundant Laboratory Usage
Authors: Dziorny Adam C. , Jones Chloe , Salant Jennifer A. , Kubis Sherri , Zand Martin S. , Wolfe Heather A. , Srinivasan Vijay 
Published: May 2023

OBJECTIVES:Frequent diagnostic blood sampling contributes to anemia among critically ill children. Reducing duplicative hemoglobin testing while maintaining clinical accuracy can improve patient care efficacy. The objective of this study was to determine the analytical and clinical accuracy of simultaneously acquired hemoglobin measurements with different methods.DESIGN:Retrospective cohort study.SETTING:Two U.S. children’s hospitals.PATIENTS:Children (< 18 yr old) admitted to the PICU.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:We identified hemoglobin results from complete blood count (CBC) panels paired with blood gas (BG) panels and point-of-care (POC) devices. We estimated analytic accuracy by comparing hemoglobin distributions, correlation coefficients, and Bland-Altman bias. We measured clinical accuracy with error grid analysis and defined mismatch zones as low, medium, or high risk-based on deviance from unity and risk of therapeutic error. We calculated pairwise agreement to a binary decision to transfuse based on a hemoglobin value. Our cohort includes 49,004 ICU admissions from 29,926 patients, resulting in 85,757 CBC-BG hemoglobin pairs. BG hemoglobin was significantly higher (mean bias, 0.43–0.58 g/dL) than CBC hemoglobin with similar Pearson correlation (R2) (0.90–0.91). POC hemoglobin was also significantly higher, but of lower magnitude (mean bias, 0.14 g/dL). Error grid analysis revealed only 78 (< 0.1%) CBC-BG hemoglobin pairs in the high-risk zone. For CBC-BG hemoglobin pairs, at a BG hemoglobin cutoff of greater than 8.0 g/dL, the “number needed to miss” a CBC hemoglobin less than 7 g/dL was 275 and 474 at each institution, respectively.CONCLUSIONS:In this pragmatic two-institution cohort of greater than 29,000 patients, we show similar clinical and analytic accuracy of CBC and BG hemoglobin. Although BG hemoglobin values are higher than CBC hemoglobin values, the small magnitude is unlikely to be clinically significant. Application of these findings may reduce duplicative testing and decrease anemia among critically ill children.
Autologous Breast Reconstruction Success Rates in Hypercoagulable Patients
Authors: Egan Katie G , Elver Ashlie A , Birney Jalee M , Nazir Niaman , Butterworth James A , Lai Eric C 
Published: May 2023

Introduction:
Hypercoagulable disorders may adversely affect microsurgical outcomes, including increased flap failure and complication rates. Outcomes specific to autologous breast reconstruction patients are not well described.

Methods:
A retrospective review was performed of autologous breast reconstructions between 2009 to 2020. Patients with either a thrombophilic disorder diagnosis or a previous thrombotic event were identified. The analysis compared perioperative complications and flap success rates.

Results:
In this series, 23 thrombophilic disorder patients underwent 39 flaps, and 78 thrombotic event patients underwent 126 flaps, compared to 815 control patients who underwent 1300 flaps. In logistic regression models, a thrombophilic disorder diagnosis was an independent predictor of early total flap loss (OR 8.42 [1.59-44.47], p=.01), late partial flap loss (OR 3.9 [1.0-15.22], p=.05), and delayed healing (OR 2.26 [1.02-5.04], p=.04). Thrombotic event history trended towards an association only with late partial flap loss (p=.057). Flap salvage rates (25%) and flap success rates (92.3%) were statistically lower in thrombophilic disorder patients but normal in thrombotic event patients.

Conclusion:
A microsurgical breast reconstruction is a reasonable option for hypercoagulable patients. No increased risk of flap complications is associated with a previous thrombotic event; however, thrombophilic disorders carry an increased risk.
Double-Blinded Randomized Control Trial Comparing Liposomal Bupivacaine and Plain Bupivacaine in Transversus Abdominis Plane For Deep Inferior Epigastric Artery Perforator (DIEP) Flap Breast Reconstruction
Authors: Nguyen Lyly , Glassman Gabriella E. , Afshari Ashkan , Feng Xiaoke , Shastri Uma Devi , Kaoutzanis Christodoulos , McEvoy Matthew David , Bansal Vik , Canlas Christopher , Yao Julia , Higdon Kye , Perdikis Galen 
Published: May 2023

Background:
Pain control after autologous breast reconstruction is important for patient satisfaction and early recovery. Transversus Abdominis Plane (TAP) blocks are commonly used as part of an Enhanced Recovery After Surgery (ERAS) pathway for breast reconstruction. It is uncertain if liposomal bupivacaine used in TAP blocks offer additional advantages. This study aimed to compare the efficacy of liposomal bupivacaine versus plain bupivacaine for patients undergoing deep inferior epigastric perforator (DIEP) flap reconstruction.

Method:
This prospective, double-blinded, randomized controlled trial studied patients undergoing abdominally based autologous breast reconstruction between June 2019 to August 2020. Subjects were randomly assigned liposomal or plain bupivacaine, performed using ultrasound-guided TAP block technique. All patients were managed according to an ERAS protocol. Primary outcomes were postoperative narcotic analgesia required measured in oral morphine equivalents (OME) from postoperative day (POD) 1 to 7. Secondary outcomes included POD 1-7 pain Numeric Pain Scale (NPS), non-narcotic pain medication usage, time to first narcotic use, return of bowel function, and length of stay (LOS).

Results:
Sixty patients were enrolled, 30 received liposomal bupivacaine, while 30 received plain bupivacaine. There were no significant differences in demographics, daily OME narcotic use, non-narcotic pain medication use, time to narcotic use, NPS, time to bowel function, or LOS.

Conclusion:
Liposomal bupivacaine does not confer advantages over plain bupivacaine when used in TAP blocks for abdominally based microvascular breast reconstruction in patients under ERAS protocols and multimodal approaches for pain control.
Cathelicidin LL-37 expression in human breast implant capsules
Authors: Segreto Francesco , Carotti Simone , Marangi Giovanni Francesco , Francesconi Maria , Calia Eleonora , Cagli Barbara , Cimmino Andrea , Rossi Caterina , Morini Sergio , Persichetti Paolo 
Published: May 2023

Background:
Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling and clinical outcomes.

Methods:
The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin/eosin, Masson trichrome, immunohistochemistry and immunofluorescence for LL-37, CD68, α-SMA, Collagen type I and III, CD31 and TLR-4.

Results:
LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and 9 (31%) of the specimens, respectively. In 8 cases (27.5%) it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages (p<0.001). Moreover, LL-37 expression by macrophages of peri-expander capsules negatively correlated with the severity of capsular contracture on definitive implants (p=0.04).

Conclusions:
This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophages modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture.
The Effect of Daytime Surgical Hospitalists on Reducing Night Shift Physicians’ Workload
Authors: Jung Yoon Bin , Lee Kang Young 
Published: May 2023

Background
The shortage of doctors at night makes it difficult to execute complex tasks and deliver accurate decisions. Therefore, reducing the night shift physician’s workload is essential for patient safety. This study aimed to observe the effect of daytime surgical hospitalists on the reduction in night shift physicians’ workload by analyzing the volume of electronic orders generated at night for postoperative patients.

Methods
A total of 9328 hospitalized patients who underwent colorectal or gastrointestinal surgery for more than 120 minutes were reviewed retrospectively. This study reviewed the nighttime volume difference of electronic orders between patients cared for by a daytime surgical hospitalist and patients cared for by a resident. Multiple logistic regression analysis was performed to analyze the risk factors of nighttime orders during hospitalization (dichotomous end point). Negative binomial regression analysis was also performed to analyze the volume of electronic orders as countable data, and the incident rate ratio was estimated (count end point).

Results
The risk of the occurrence of nighttime electronic order for patients treated by a surgical hospitalist was lower than that of patients cared for by a resident (adjusted odds ratio, 0.616; 95% confidence interval, 0.558–0.682; P < 0.001). In the negative binomial regression analysis, the total volume of electronic orders at night was lower in patients cared for by a surgical hospitalist than in patients cared for by a resident (adjusted incident rate ratio, 0.653; 95% confidence interval, 0.623–0.685; P < 0.001).

Conclusions
The introduction of daytime surgical hospitalists is associated with the lower workload of night shift physicians.
Viral Hepatitis and Human Papillomavirus Vaccination During HIV Pre-Exposure Prophylaxis: Factors Associated With Missed Vaccination
Authors: Raccagni Angelo Roberto , Ceccarelli Daniele , Trentacapilli Benedetta , Galli Laura , Lolatto Riccardo , Canetti Diana , Bruzzesi Elena , Candela Caterina , Castagna Antonella , Nozza Silvia 
Published: May 2023

Background:We evaluated factors associated with lack of triple vaccination (hepatitis A virus [HAV], hepatitis B virus [HBV], and human papillomavirus [HPV]) among men who have sex with men using pre-exposure prophylaxis (PrEP).Setting:PrEP users at the San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017–2022).Methods:Participants were considered protected if (1) before PrEP access: positive serology (IgG-HAV+, hepatitis B surface antigen >10 mUI/mL) or vaccination history was recorded and (2) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received the following before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection, and HPV vaccination. χ2and Kruskal–Wallis tests were used to compare characteristics of those fully, partially, and not protected. Factors associated with the lack of triple vaccination were assessed by using multivariable logistic regression and classification tree analysis.Results:Overall, 473 men who have sex with men were considered: 146 (31%) were fully protected, 231 (48%) partially, and 96 (20%) were not. Daily-based PrEP users (fully: 93, 63.7%; partially: 107, 46.3%; and not protected: 40, 41.7%;P= 0.001) and those with a sexually transmitted infection at the first visit (43, 29.5%; 55, 23.8%; 15, 15.6%;P= 0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio = 0.47, 95% confidence interval = 0.31–0.70,P< 0.001). Classification tree analysis showed that among daily-based users, with sexually transmitted infection prior and at the first PrEP visit, there was a lower chance of lack of triple vaccination (P= 44%).Conclusions:Strategies targeting PrEP users at risk of missing HAV, HBV, and HPV vaccinations need to be implemented, focusing mostly on event-based users.
Renal Involvement of Immunoglobulin G4–Related Disease Presenting as a Solitary Hypermetabolic Mass Mimicking Renal Tumor on 18F-FDG PET/CT
Authors: Hu Guilan , Huo Li , Li Fang , Luo Yaping 
Published: May 2023

Abstract
A 62-year-old woman with a 5-year history of diabetes insipidus was found with a solitary renal mass in contrast-enhanced CT. 18F-FDG PET/CT showed a hypermetabolic mass in the right kidney. Besides, there was increased uptake in the pituitary stalk. The histopathological examination of renal biopsy confirmed the diagnosis of immunoglobulin G4–related disease. After treatment with prednisone and cyclophosphamide, there was obvious radiographic improvement of the renal lesion.