bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midazolam versus morphine in acute cardiogenic pulmonary edema patients with and without atrial fibrillation: findings from the MIMO trial
Authors: Domínguez-Rodríguez Alberto , Hernandez-Vaquero Daniel , Suero-Mendez Coral , Burillo-Putze Guillermo , Gil Victor , Calvo-Rodriguez Rafael , Piñera-Salmeron Pascual , Llorens Pere , Martín-Sánchez Francisco J. , Abreu-Gonzalez Pedro , Miró Òscar ,   for the MIMO (MIdazolam versus MOrphine) Trial Investigators
Published: February 2023

Background and importance
The MIMO clinical trial showed that patients with acute cardiogenic pulmonary edema (ACPE) treated with midazolam had fewer serious adverse events than those treated with morphine. Atrial fibrillation (AF) is a common comorbidity in heart failure and affects patient’s outcome.

Objective
The primary endpoint of this substudy is to know if AF modified the reduced risk of serious adverse events in the midazolam arm compared to morphine. The first secondary endpoint is to know if AF modified the reduced risk of serious adverse events or death at 30 days in the midazolam arm. The second secondary objective of this substudy is to analyze whether AF modified the reduced risk of midazolam against morphine on the total number of serious adverse events per patient.

Design
We conducted a secondary analysis of the MIMO trial. Patients more than 18 years old clinically diagnosed with ACPE and with dyspnea and anxiety were randomized (1:1) at emergency department arrival to receive either intravenous midazolam or morphine.

Outcome measures and analysis
In this post hoc analysis, we calculated the relative risk (RR) of serious adverse events in patients with and without AF. Calculating the Cochran-Mantel-Haenszel interaction test, we evaluated if AF modified the reduced risk of serious adverse events in the midazolam arm compared to morphine.

Main results
One hundred eleven patients (median = 78.9 years; IQR, 72.3–83.7; women, 52.2%) were randomized in the MIMO trial, 55 to receive midazolam and 56 to morphine. All randomized patients received the assigned drug and there were no losses to follow-up. Forty-four patients (39.6%) had AF. In the AF group, the RR for the incidence of serious adverse events in the midazolam versus morphine arm was 0.42 (95% CI, 0.14–1.3). In the group without AF, the RR was 0.46 (95% CI, 0.21–1). The presence of AF did not modify the reduced risk of serious adverse events in the midazolam arm compared with morphine (P for interaction = 0.88).

Conclusion
This post hoc analysis of the MIMO trial suggests that the reduced risk of serious adverse events in the midazolam group compared to morphine is similar in patients with and without AF.
Statin Use and Delirium Risk: An Updated Systematic Review and Meta-Analysis
Authors: Chang Ya-Hui , Wang Jian-Ying , Peng Tzu-Rong , Lian Jia-Haur , Lee Ming-Chia , Chen Hui-Ming 
Published: February 2023

Background:
Findings on the association of statin use with delirium risk are inconsistent.

The Study Question:
Is statin use associated with delirium risk?

Study Design:
We searched PubMed, the Cochrane Library, and the EMBASE database, limiting the search to human patients and articles in English published until December 31, 2021. The effect size and 95% confidence interval (CI) were defined as the odds ratio (OR) and 95% CI, respectively, to indicate the difference in the incidence of delirium between statin use and nonuse groups. A random-effects model was selected in the case of high heterogeneity of study populations. We used funnel plots, Egger test, Duval and Tweedie trim-and-fill approach, and the classic fail-safe N to assess publication bias.

Results:
Of a total of 264 identified studies, 13 were selected for the qualitative review—4 RCTs and 9 observational cohort studies. Statin use was not associated with low delirium risk (pooled OR, 0·82; 95% CI, 0·64–1·04; P = 0·09). Substantial statistical heterogeneity was observed (I
2, 90%). Visual inspection of the funnel plot of ORs from the studies revealed symmetry. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, we assigned the evidence a rating of C and a weak recommendation for this review.

Conclusions:
Statin use is not associated with delirium risk. More comprehensive RCTs are required to confirm the results.
Chronic Illness in Children and Foregone Care Among Household Adults in the United States
Authors: Narm Koh Eun , Wen Jenny , Sung Lily , Dar Sofia , Kim Paul , Olson Brady , Schrager Alix , Tsay Annie , Himmelstein David U. , Woolhandler Steffie , Shure Natalie , McCormick Danny , Gaffney Adam 
Published: February 2023

Background:
Childhood chronic illness imposes financial burdens that may affect the entire family.

Objective:
The aim was to assess whether adults living with children with 2 childhood chronic illnesses—asthma and diabetes—are more likely to forego their own medical care, and experience financial strain, relative to those living with children without these illnesses.

Research Design:
2009–2018 National Health Interview Survey.

Subjects:
Adult-child dyads, consisting of one randomly sampled child and adult in each family.

Measures:
The main exposure was a diagnosis of asthma or diabetes in the child. The outcomes were delayed/foregone medical care for the adult as well as family financial strain; the authors evaluated their association with the child’s illness using multivariable logistic regressions adjusted for potential confounders.

Results:
The authors identified 93,264 adult-child dyads; 8499 included a child with asthma, and 179 a child with diabetes. Families with children with either illness had more medical bill problems, food insecurity, and medical expenses. Adults living with children with each illness reported more health care access problems. For instance, relative to other adults, those living with a child with asthma were more likely to forego/delay care (14.7% vs. 10.2%, adjusted odds ratio: 1.27; 95% CI: 1.16–1.39) and were more likely to forego medications, specialist, mental health, and dental care. Adults living with a child with diabetes were also more likely to forego/delay care (adjusted odds ratio: 1.76; 95% CI: 1.18–2.64).

Conclusions:
Adults living with children with chronic illnesses may sacrifice their own care because of cost concerns. Reducing out-of-pocket health care costs, improving health coverage, and expanding social supports for families with children with chronic conditions might mitigate such impacts.
The Impact of Reimbursement for Non–Face-to-Face Chronic Care Management on Comprehensive Metabolic Biomarkers Among Multimorbid Patients With Type 2 Diabetes
Authors: Shao Yixue , Stoecker Charles , Hong Dongzhe , Nauman Elizabeth , Fonseca Vivian , Hu Gang , Bazzano Alessandra N. , Fort Daniel , Kabagambe Edmond K. , Shi Lizheng 
Published: February 2023

Aims:
We evaluated the impact of reimbursement for non–face-to-face chronic care management (NFFCCM) on comprehensive metabolic risk factors among multimorbid Medicare beneficiaries with type 2 diabetes in Louisiana.

Materials and Methods:
We implemented a propensity score method to obtain comparable treatment (n=1501 with NFFCCM) and control (n=17,524 without NFFCCM) groups. Patients with type 2 diabetes were extracted from the electronic health records stored in REACHnet. The study period was from 2013 to February 2020. The comprehensive metabolic risk factors included the primary outcome of glycated hemoglobin (HbA1c) (as the primary outcome) and the secondary outcomes of body mass index (BMI), systolic blood pressure (BP), and low-density lipoprotein cholesterol.

Results:
Receiving any NFFCCM was associated with improvement in all outcomes measures: a reduction in HbA1c of 0.063% (95% CI: 0.031%–0.094%; P<0.001), a reduction in BMI of 0.155 kg/m2 (95% CI: 0.029–0.282 kg/m2; P=0.016), a reduction in systolic BP of 0.816 mm Hg (95% CI: 0.469–1.163 mm Hg; P<0.001), and a reduction in low-density lipoprotein cholesterol of 1.779 mg/dL (95% CI: 0.988 2.570 mg/dL; P<0.001). Compared with the control group, the treatment group had 1.6% more patients with HbA1c <7% (95% CI: 0.3%–2.9%; P=0.013).

Conclusions:
Patients with diabetes in Louisiana receiving NFFCCM experienced better control of HbA1c, BMI, BP, and low-density lipoprotein outcomes.
Stigma and Barriers in Health Care Among a Sample of Transgender and Gender-Diverse Active Duty Service Members
Authors: Johnson Nia , Pearlman Arielle T. , Klein David A. , Riggs David , Schvey Natasha A. 
Published: February 2023

Background:
Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness.

Methods:
We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank.

Results:
Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P=0.03), anxiety (β=0.21, P=0.03), stress (β=0.30, P=0.001), and poorer overall mental health (β=−0.23, P=0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician.

Conclusions:
Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.
The relationship between tumor mean standard uptake value (SUVmax) in preoperative PET/computed tomography and prognostic risk groups in endometrial cancer
Authors: Bese Tugan , Bicer Elifnur , Tetikli Kosuk Asli , Akovali Burak , Turan Hasan , Kabasakal Levent , Demirkiran Fuat 
Published: February 2023

Objective
Our aim in this study was to determine the relationship between tumor mean standard uptake value (SUVmax) value in preoperative PET/computed tomography (CT) and prognostic risk groups in cases with endometrial cancer.

Methods
A total of 368 patients operated on for endometrial cancer were evaluated in the study. The SUVmax value of endometrial primary tumor of the patients screened within 30 days of operation, was compared with prognostic parameters and risk groups. P value <0.05 was considered significant for all tests.

Results
A statistically significant relationship was found between the mean SUVmax value and risk groups (P < 0.001), grade (P < 0.001), stage (P < 0.001), myometrial invasion of the tumor (P < 0.001), cervical involvement (P = 0.002), lymphovascular space invasion (LVSI) (P < 0.001), lymph node metastasis (P < 0.001), tumor size (P < 0.001), lymph node involvement in PET/CT (P < 0.001). There was no significant relationship found between the histologic type of tumor and the mean SUVmax value (P = 0.113). Cutoff SUVmax value for endometrial cancer tumor tissue, which will be used to determine the possible lymph node metastasis, was accepted as 19 as a result of the ROC analysis. The risk of lymph node metastasis was found 4.74 times (confidence interval, 2.510–8.977) higher in patients with SUVmax value above cutoff 19 (P < 0.001). Considering risk groups, it was observed that patients with mean SUVmax value above 19 were in intermediate-high and high risk group, 2.3 times more than those in low and intermediate risk group (P < 0.001). As a result of logistic regression analysis, in determining intermediate-high and high-risk groups, histological type (P < 0.001), myometrial invasion (P = 0.003), cervical invasion (CI) (P < 0.001), grade (P = 0.018) and SUVmax value (P = 0.028) had statistically significant importance.

Conclusion
The higher the mean SUVmax value in the endometrial cancer tumor tissue in preoperative PET/CT in patients with endometrial cancer, the higher the risk group of the patients.
State-of-the-art: septal perforation repair
Authors: Garaycochea Octavio , Santamaría-Gadea Alfonso , Alobid Isam 
Published: February 2023

Purpose of review
To provide a comprehensive overview of the evolution of the different techniques described for the surgical repair of nasal septal perforation, and a surgical decision-making algorithm for its surgical treatment.

Recent findings
Septal perforation surgery has evolved and improved in recent years. It has gone from being an avoided or discouraged surgical procedure to a procedure with success rates of >90%. Nowadays, there is no standard approach or single technique. The different techniques described include unilateral random pattern flaps, interposition grafts, unilateral pedicle septal local flaps, free mucosal grafts and bilateral random patter flaps. The incidence of success is higher in pediculated septal flaps such as the anterior ethmoidal artery flap or the greater palatine artery pedicled flap combined with additional techniques.

Summary
Nowadays, surgical closure of septal perforation is possible and should be an option to consider in symptomatic patients without response to medical treatment. The surgical approach that we recommend when planning the surgical closure of nasal septum (or nasoseptal) perforation is based on the osseocartilaginous support and the location of the defect.
Splenic Stiffness Is the Best Predictor of Clinically Significant Varices in Children With Portal Hypertension
Authors: Upadhyay Piyush , Khanna Rajeev , Sood Vikrant , Lal Bikrant Bihari , Patidar Yashwant , Alam Seema 
Published: February 2023

Background and Aims:We studied splenic stiffness measurement (SSM) by transient elastography (TE) and portal hemodynamics parameters (PHDp) on Doppler as predictors of clinically significant varices (CSV) in children.Methods:All children of 6 months to 18 years of age with portal hypertension (PHT) (chronic liver disease, CLD and non‐cirrhotic portal hypertension, NCPH) were enrolled. TE for spleen (SSM) and liver (liver stiffness measurement, LSM) and PHDp by Doppler ultrasonography were measured. Noninvasive indices for PHT were calculated. CSV were defined as esophageal varices ≥grade 2 and/or gastric varix. Binary logistic regression analysis (LRA) and receiver operating characteristic statistics were applied.Results:A total of 150 (120 CLD and 30 NCPH) children formed the study cohort. Prevalence of CSV was higher in NCPH than CLD [73.3% vs 53.3%, Odd’s ratio (OR) 2.369, P = 0.04]. On LRA, SSM was found to be the only independent predictor of CSV in children with CLD [OR 1.19 (95% Confidence Interval (CI) 1.018–1.16), P = 0.000] as well as in NCPH [OR 1.088 (95% CI 1.018–1.16), P = 0.013]. This model improved prediction of CSV in CLD from 52.5% to 83.9% and in NCPH from 73.3% to 86.7%. In children with CLD, SSM at a cut‐off ≥27.6 kPa and in NCPH, SSM at a cut‐off ≥29.5 kPa predicted CSV. In children with CLD, SSM correlated with LSM (R = 0.610, P <0.001) and with noninvasive PHT indices except aspartate aminotransferase‐to‐platelet ratio index.Conclusion:SSM is the best noninvasive predictor of CSV in childhood CLD and NCPH and can be used as screening test for endoscopy in children with PHT.
Evaluating Transition Readiness
Authors: Huang Jeannie S. , Cruz Rusvelda , Kruth Robin , Parker Jacob 
Published: February 2023

Objective:Determination of transitional readiness is an essential component of delivery of transition services to adolescents and young adults with chronic diseases, including those with inflammatory bowel disease (IBD). To date, this has been performed using the transition checklist (TC). However, clinical experience suggests the validity of the checklist may not be ideal. We sought to evaluate the validity of the TC among adolescents and young adults with IBD (AYA IBD).Methods:We evaluated the validity of the TC compared with a skills‐based practicum (TKSP) in a cross‐sectional study using a real‐world clinical cohort of AYA IBD. Extent of concordance between TC and TKSP was assessed using confusion matrices and calculation of Matthews correlation coefficients.Results:Concordance between self‐reported TC answers and TKSP performance varied based on skill/knowledge base assessed, ranging from 81.3% for mastery of knowing one’s medical condition to 39.2% for mastery of knowing one’s medication schedule and 29.3% for mastery of knowing how to refill medications. Matthews correlation coefficients were closer to random prediction than perfect correlation for all skills/knowledge tested.Conclusions:Self‐reported TC answers lack sufficient concordance with TKSP performance. Our findings suggest that a TKSP should be performed to assess for transition readiness and to identify individual AYA IBD patient needs during the transition process.
Prevalence and Etiologies of Renal and Urinary Manifestations in a Large Cohort of Children With Inflammatory Bowel Disease
Authors: Cordesse Anne , Delbet Jean‐Daniel , Lemoine Anaïs , Dubern Béatrice , Tounian Patrick , Lemale Julie 
Published: February 2023

Background and objectives:Renal and/or urinary manifestations (RUM) have been reported in pediatric patients with inflammatory bowel disease (IBD) but their incidence is unknown. The aims of this study were to assess the prevalence and causes of these manifestations in children with IBD and determine the causal link with 5‐aminosalicylic acid (5‐ASA) treatment.Methods:A retrospective observational study was performed with children with diagnosis of IBD. All children with RUM during follow‐up and/or impaired renal function [estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2] were identified.Results:Of 228 included patients, 9 (3.9%) had a RUM during follow‐up [follow‐up: 5 years (1–12 years)] at a median age of 16 years (8–17 years). It concerned 7 of 171 patients with Crohn disease and 2 of 57 with ulcerative colitis. Seven patients were taking 5‐ASA at the time of the RUM. Only 1 of them had an iatrogenic renal complication related to this treatment. Patients with RUM had a more severe disease with increased anti‐tumor necrosis factor‐α use (P = 0.031), more abscesses (P = 0.003), and a higher rate of digestive surgery (P = 0.04). For the whole cohort, a significant decrease in eGFR was found during follow‐up (121 vs 107 mL/min/1.73 m2, P < 0.001). At the end of follow‐up, 38 of 202 (19%) patients had an eGFR < 90 mL/min/1.73 m2.Conclusion:In children with IBD, RUM can occur, independently of treatment with 5‐ASA. During follow‐up, a significant decrease in eGFR was observed. We suggest monitoring renal function in all patients with IBD.
Length of Bowel Rest Does Not Predict Gastrojejunostomy Tube‐Associated Intussusception Recurrence
Authors: Abebe Abel Tsehay , Worede Fikadu , Elsingergy Mohamed , Cahill Anne Marie , Acord Michael R. 
Published: February 2023

Objectives:One potential treatment for gastrojejunostomy (GJ) tube‐related intussusception is bowel rest, whereby the GJ tube is replaced with a gastrostomy tube. The aim of this study was to determine whether bowel rest length was associated with decreased risk of re‐intussusception.Methods:Pediatric patients with GJ tube‐related intussusceptions were identified during the study period of January 1, 2010 and August 1, 2021. Records were reviewed for demographics, symptoms, need for central access to initiate parenteral nutrition, and length of stay. Comparison was made between patients with intussusception recurrence within 30 days and those without. Those undergoing earlier replacement, defined as the first quartile of rest time, or 72 hours, were then compared to longer periods of bowel rest.Results:Forty‐six intussusceptions were included, with a median age of 2.8 years (interquartile range, IQR: 1.4–4.1) and weight of 12 kg (IQR: 8.9–15.4). All patients diagnosed as outpatient (54.3%) required hospital admission and 9 of 46 (19.6%) required central access. There were 7 recurrences (15.2%). There was no difference in recurrence based on time of bowel rest (5 days in those without vs 6 days in those with, P = 0.30) nor a difference in recurrence with <72 hours of bowel rest compared to >72 hours (1/15, 6.7% vs 6/31, 19.3%). Patients undergoing earlier exchange had a shorter median length of hospital stay (3 vs 8.5 days, P = 0.003).Conclusion:Length of bowel rest was not associated with recurrent GJ tube‐related intussusceptions. If bowel rest is utilized, <72 hours may be sufficient to decrease length of hospital stay.
Inter and Intraobserver Variation in Interpretation of Fecal Loading on Abdominal Radiographs
Authors: Yallanki Narendra , Small‐Harary Lesley , Morganstern Jeffrey , Tobin Michelle , Milla Lucia , Chawla Anupama 
Published: February 2023

Objectives:The current gold standard for the diagnosis of functional constipation is the ROME IV criteria. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) guidelines do not support the use of abdominal X‐rays in establishing the diagnosis of constipation. Despite these recommendations, abdominal radiography is frequently performed to diagnose constipation. The objective of our study is to evaluate inter and intraobserver variation in interpretation of fecal loading on abdominal radiographs.Methods:Electronic records of 100 children seen in the emergency room for gastrointestinal symptoms who had an abdominal radiograph performed were included. Four physicians from each specialty including gastroenterology, radiology, and emergency medicine interpreted the radiographs independently. Initially, subjective interpretations, followed by interpretations for intraobserver variation were obtained. Subsequently, all physicians were trained and asked to score the X‐rays objectively using Barr and Blethyn scoring systems. Consistency between inter and intraobserver ratings of radiographic interpretation was evaluated using the Kappa coefficient (k) which ranges from 0 (no agreement) to 1.0 (perfect agreement).Results:For subjective interpretations, k values showed a fixed margin k of 0.18 indicating poor agreement among 12 observers. Intraobserver k to look for reproducibility showed significant variability ranging from 0.08 (poor) to 0.61 (fair) agreement. Objective scoring results for Blethyn showed a k of 0.14 indicating poor agreement among 12 providers.Conclusions:Reliability and reproducibility of X‐rays for diagnosis and grading of constipation is questionable given poor to fair agreement for both inter and intraobserver comparisons. Our study supports the current recommendation of ESPGHAN and NASPGHAN to not use abdominal X‐rays to diagnose constipation.