bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital at home: A change in the course of care
Authors: Gaillard Garrett , Russinoff Ian 
Published: February 2023

ABSTRACT
Acute care services in the United States are largely delivered in the hospital setting. Since the recent pandemic, acute care services in the hospital have become overwhelmed. An elderly population with comorbidities and lack of hospital capacity is leading to a “hospital without walls” approach to acute care. Hospital at Home (HaH) is a paradigm shift in the standard way to administer acute care. Model development coupled with innovations in telehealth and remote patient monitoring has led to HaH being considered a viable alternative to admitting patients to the hospital. Robust evidence suggests that HaH interventions are a new option for providers to assess, treat, and monitor patients. Outcomes equivalent to in-patient stays with no mortality difference makes this model a viable option for patient care outside of the hospital. An overall reduction in cost compared with an in-patient stay may be an economically viable option for overwhelmed hospital systems looking to care for their surrounding population. In this brief, we review some of the existing evidence and the growth of the HaH concept, and what it means for members of the interdisciplinary care team.
Cerebral Small Vessel Disease in Elderly Patients with Sudden Sensorineural Hearing Loss
Authors: Oussoren Fieke K. , van Leeuwen Roeland B. , Schermer Tjard R. , Poulsen Louise N. F. , Kardux Joost J. , Bruintjes Tjasse D. 
Published: February 2023

Background
The cause of sudden sensorineural hearing loss (SSNHL) is uncertain in a significant number of patients. A vascular etiology has been proposed because SSNHL increases the risk of developing a stroke. Cardiovascular risk factors can cause cerebral small vessel disease (CSVD). The presence of CSVD in turn raises the risk of stroke.

Aim
The aim of this study was to compare the presence of CSVD and cardiovascular risk factors in elderly patients with idiopathic SSNHL (iSSNHL) to a control cohort.

Method
Patients with iSSNHL of 50 years and older were compared with a control cohort with patients suspected of trigeminal neuralgia or vestibular paroxysmia. The primary outcome was the difference in the number of white matter hyperintensities using the ordinal Fazekas scale. Secondary outcomes were the presence of brain infarctions on MRI and the difference in cardiovascular risk factors.

Results
In the SSNHL cohort, Fazekas score 2 was most frequently seen compared with Fazekas 1 in the control cohort. The distribution of Fazekas scores did not differ significantly. The sum of the Fazekas scores were 13,925 and 14,042 for iSSNHL and controls, respectively (p = 0.908). Brain infarctions were seen in 8 patients with iSSNHL (n = 118) and in 13 patients in the control cohort (n = 118) (p = 0.361). None of the cardiovascular risk factors were more frequently seen in the iSSNHL cohort.

Conclusion
Patients with iSSNHL did not exhibit more CSVD on MRI than controls. This result is in contrast with previous literature demonstrating a higher risk of stroke in patients with iSSNHL than in controls. A prospective analysis with a larger study population is therefore warranted.
Real-world long-term effects on blood pressure and other cardiovascular risk factors for patients in digital therapeutics
Authors: Willis Michael , Darwiche Ghassan , Carlsson Martin , Nilsson Andreas , Wohlin Jonas , Lindgren Peter 
Published: February 2023

Purpose
Hypertension is a leading causeof premature death worldwide and a major public health problem. This study investigated the long-term effects (>1 year) of digital hypertension monitoring by home blood pressure (HBP) measurements in combination with individualized remote treatment via a Swedish Digital Therapeutics platform in a large patient population.

Methods
The primary endpoint, HBP, and exploratory endpoints, BMI, alcohol consumption, stress level, physical activity, and smoking, were assessed every 3 months for 540 and 360 days, respectively, in 7752 Swedish primary hypertension patients. Patients received individualized medical treatments and lifestyle advice via asynchronous text-based communication in an app. Changes from baseline in endpoints were calculated for the whole population and for subgroups defined by baseline SBP ≥135 (high SBP), 125–135 (suboptimal SBP), 115–125 (optimal SBP), and <115 mmHg (low SBP).

Results
After 360 days of treatment, the whole population showed a significant increase of 57% (from 37 to 58%) in the proportion of patients with controlled SBP (i.e. SBP of 115–135 mmHg). The largest reduction in SBP of 13.8 mmHg was observed for the high SBP subgroup, whereas for the low SBP subgroup, SBP increased by 13.4 mmHg. BP improved most in the first three months, and for both the high and low BP subgroups, the improvement continued during the 540-day study period. Significant beneficial changes were also observed for some exploratory endpoints including BMI and smoking.

Conclusions
In conclusion, the digital therapeutics platform was associated with significant improvement in BP control and associated risk factors, which were maintained over a longer period.
Atypical Causes of Gastroparesis
Authors: Szeto Lauren , Yazdian Aaron , Parkman Henry P. 
Published: February 2023

Background:
Gastroparesis is commonly attributed to idiopathic or diabetic causes.

Goals:
We aimed to describe atypical causes of gastroparesis and examine the clinical features and severity of delayed gastric emptying compared with idiopathic and diabetic causes.

Study:
Between 2018 and 2021, gastroparesis patients being evaluated at our tertiary care center completed a 4-hour gastric emptying scintigraphy and questionnaires assessing for gastrointestinal disorders, including patient assessment of upper gastrointestinal symptoms. Patients were divided into groups relating to gastroparesis cause: diabetic, postsurgical (PSGp), connective tissue (CTGp), neurological and idiopathic.

Results:
Two hundred fifty-six patients with delayed emptying on gastric emptying scintigraphy completed the questionnaires. Gastroparesis causes included 149 (58.2%) idiopathic, 60 (23.4%) diabetic, 29 (11.3%) postsurgical, 13 (5.1%) connective tissue, and 5 (2.0%) neurological. In each group, most patients were female and White. Gastric retention at 4 hours was significantly greater in patients with diabetic (39.3±25.7% P<0.001), postsurgical (41.3±24.0% P=0.002), and connective tissue gastroparesis (37.8±20.0% P=0.049) compared with patients with idiopathic gastroparesis (25.5±17.6%). In PSGp, diabetic and idiopathic causes, the main symptoms were early satiety and postprandial fullness, whereas in CTGp, bloating and abdominal distension were the predominant symptoms. Vomiting severity was significantly greater in patients with diabetes compared with idiopathic gastroparesis (2.9±1.9 vs. 2.1±1.8 P=0.006).

Conclusions:
Atypical causes contributed to gastroparesis in 47 of 256 (18.4%) patients with delayed gastric emptying. Gastric emptying was significantly more delayed in PSGp and CTGp patients. PSGp patients mainly experienced stomach fullness and early satiety, whereas CTGp patients had predominantly bloating and distension.
Integration of Cirrhosis Best Practices Into Electronic Medical Record Documentation Associated With Reduction in 30-Day Mortality Following Hospitalization
Authors: Sherman Zachary , Wahid Nabeel , Wagner Michael , Soltani Amin , Rosenblatt Russell , Fortune Brett , Lucero Catherine , Schoenfeld Emily , Brown Robert , Jesudian Arun 
Published: February 2023

Background:
Hospital admissions for patients with cirrhosis continue to increase. In New York City, 25% to 30% of hospitalized cirrhotics are readmitted within 30 days. Rehospitalization is associated with increased mortality, poor quality of life, and financial burden to patients, hospitals, and payers. Preventable readmissions are partially accounted for by a well-documented quality gap between evidence-based guidelines for cirrhosis management and real-world adherence to these recommendations.

Methods:
We performed a prospective cohort study that compared outcomes among cirrhotic patients admitted to 4 internal medicine teams over a 6-month period. An electronic medical record (EMR) note template that outlined best-practice measures for cirrhotics was developed. Inpatient providers on 2 teams were instructed to include it in daily progress notes and discharge summaries. The recommended practices included diagnostic paracentesis and diuretics for ascites, rifaximin, and lactulose for hepatic encephalopathy, beta blockers for esophageal varices, and antibiotic prophylaxis for spontaneous bacterial peritonitis. The remaining 2 teams continued the standard of care for cirrhotic patients. The primary outcome was 30-day readmissions. Secondary outcomes included in-hospital mortality, 30-day mortality, length of stay, and adherence to best-practice guidelines.

Results:
Over a 6-month period, 108 cirrhotic patients were admitted, 83 in the interventional group and 25 in the control group. MELD-Na scores on admission did not differ between the groups (20.1 vs. 21.1, P=0.56). Thirty-day readmissions were not significantly different between the interventional and control groups (19.3% vs. 24%, P=0.61). However, 30-day mortality was significantly lower in the interventional group (8.4% vs. 28%, P=0.01). There was no difference between the 2 groups in in-hospital mortality (4.8% vs. 0%, P=0.27), 90-day mortality (15.7% vs. 28.0%, P=0.17) or length of stay (10.2 vs. 12.6 d, P=0.34). Adherence to best-practice metrics was similar between the groups, except for rates of diagnostic paracentesis, which were higher in the interventional group (98% vs. 80%, P=0.01).

Conclusion:
Implementation of an EMR note template with cirrhosis best practices was associated with lower 30-day mortality and higher rates of diagnostic paracentesis among admitted patients with cirrhosis. These findings suggest that the integration of best-practice measures into the EMR may improve outcomes in hospitalized cirrhotic patients. Larger studies are required to validate these findings.
The Impact of Intermittent Fasting on Patients With Suspected Gastroesophageal Reflux Disease
Authors: Jiang Yan , Sonu Irene , Garcia Patricia , Fernandez-Becker Nielsen Q. , Kamal Afrin N. , Zikos Thomas A. , Singh Sundeep , Neshatian Leila , Triadafilopoulos George , Goodman Steven N. , Clarke John O. 
Published: February 2023

Goal:
The aim was to investigate the short-term impact of time restricted feeding on patients with suspected gastroesophageal reflux disease (GERD).

Background:
Lifestyle modifications are often suggested, but the role of diet in GERD is unclear. Intermittent fasting is popular in the media and has demonstrated potential benefits with weight loss and inflammatory conditions as well as alterations in gastrointestinal hormones.

Study:
Patients who were referred for 96-hour ambulatory wireless pH monitoring off proton pump inhibitor to investigate GERD symptoms were screened for eligibility. Patients were instructed to maintain their baseline diet for the first 2 days of pH monitoring and switch to an intermittent fasting regimen (16 consecutive hour fast and 8 h eating window) for the second 2 days. Objective measures of reflux and GERD symptom severity were collected and analyzed.

Results:
A total of 25 participants were analyzed. 9/25 (36%) fully adhered to the intermittent fasting regimen, with 21/25 (84%) demonstrating at least partial compliance. Mean acid exposure time on fasting days was 3.5% versus 4.3% on nonfasting days. Intermittent fasting was associated with a 0.64 reduction in acid exposure time (95% CI: −2.32, 1.05). There was a reduction in GERD symptom scores of heartburn and regurgitation during periods of intermittent fasting (14.3 vs. 9.9; difference of −4.46, 95% CI: −7.6,−1.32).

Conclusions:
Initial adherence to time restricted eating may be difficult for patients. There is weak statistical evidence to suggest that intermittent fasting mildly reduces acid exposure. Our data show that short-term intermittent fasting improves symptoms of both regurgitation and heartburn.
The Association Between Acidification Time on Wireless Motility Capsule and Gastroesophageal Reflux Disease
Authors: Rodriguez Steven J. , Blackett John W. , Jodorkovsky Daniela 
Published: February 2023

Background and Aims:
Gastric physiological characteristics such as fundus accommodation, gastric distention, emptying/transit time, and basal acid output may contribute to the pathogenesis of gastroesophageal reflux disease (GERD). Wireless motility capsule (WMC) uses pH data to determine gastric transit time but has not been used in the evaluation of GERD. Certain metrics such as acidification time, nadir pH, and gastric transit time may provide insight into the mechanisms of GERD related to gastric physiology, allowing WMC to be a complementary tool in the diagnosis of GERD. We aimed to determine whether pH data and transit time on WMC tests correlated with the presence of GERD on ambulatory reflux testing.

Study:
This was a retrospective study of 28 patients who had undergone both WMC and reflux testing via wireless pH or pH/impedance. Acidification time (time from capsule ingestion to pH<2), nadir postprandial pH, and gastric transit time were manually determined from the WMC capsule proprietary software. Spearman correlation was used to compare these metrics with gastric transit time, percent esophageal acid exposure, and DeMeester score.

Results:
Acidification time moderately correlated with gastric transit time, R: 0.44, P=0.02, but not nadir pH, percent esophageal acid exposure, or DeMeester score. Patients with an abnormal reflux test had a significantly longer median acidification time (135.5 vs. 78.5 min, P=0.021). After stratifying by patients with normal versus prolonged gastric transit time, there was a trend toward longer acidification time in patients with positive reflux testing in both groups, but this was not statistically significant. Patients with prolonged gastric transit time >300 minutes were not more likely to have a positive reflux test (38% vs. 35%, P=1).

Conclusions:
The acidification time on WMC was significantly longer in patients with proven GERD and acidification time positively correlated with gastric transit time. Larger studies are needed to determine whether WMC could be used as a complementary tool in investigating patients with GERD symptoms.
Safety and Efficacy of Endoscopic Full Thickness Resection of Upper Gastrointestinal Lesions Using a Full Thickness Resection Device
Authors: Bomman Shivanand , Klair Jagpal S. , Canakis Andrew , Muthusamy Arun Kumar , Nagra Navroop , Chandra Shruti , Shanmugam Meena , Perisetti Abhilash , Aggarwal Avin , Gavini Hemanth K. , Krishnamoorthi Rajesh 
Published: February 2023

Introduction:
Endoscopic full-thickness resection (EFTR) is a promising technique that allows for a minimally invasive resection of mucosal and submucosal lesions in the gastrointestinal (GI) tract. The data regarding the efficacy and safety of performing EFTR of upper GI lesions using a full-thickness resection device (FTRD) is limited. Hence, we performed a systematic review and meta-analysis of the studies that evaluated this technique.

Methods:
We performed a comprehensive systematic search of multiple electronic databases and conference proceedings that reported outcomes of EFTR using the FTRD system. The weighted pooled rates of technical success, complete (R0) resection, adverse events (AE), and residual or recurrent lesions were analyzed with 95% CI using the random effects model.

Results:
Eight studies with a total of 139 patients who underwent EFTR of upper GI lesions were included in the study. The pooled, weighted rate of technical success was 88.2% (95% CI: 81.4-92.7%, I
2: 0). The R0 resection rate was 70.7% (95% CI: 62.5-77.8%, I
2: 0). Overall AE rates were 22.1% (95% CI: 15.8-30.1%, I
2: 0), however, most of the AEs were minor. Of the patients who had follow-up endoscopies, the residual and/or recurrent lesion rate was 6.1% (95% CI: 2.4-14.4%, I
2: 0). Heterogeneity in the analysis was low.

Conclusions:
EFTR using the FTRD seems to be effective and safe with acceptable R0 resection rates and low recurrence rates. Further prospective studies are required to validate our results and to compare various modalities of endoscopic resection with this single-step EFTR device.
Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia
Authors: Barreyro Fernando Javier , Caronia Maria Virgina , Elizondo Karina , Sanchez Nicolas , Jordá Graciela , Schneider Adolfo , Zapata Pedro Dario 
Published: February 2023

Background:Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored.Aim:To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice.Materials and Methods:A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters,Helicobacter pylori(H. pylori),and duodenal histology were evaluated.Results:FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients wereH. pylori+. Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14;P<0.0001), adjusting for age, gender,H. pyloriand nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28;P<0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particularH. pylori−, was highly accurate for PDS with the area under the curve 0.731 compared withH. pylori+area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy.Conclusion:Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non-H. pyloriFD patients and could be a useful marker of treatment response.
Prevalence and Impact of Obesity in a Population-Based Cohort of Patients With Crohn’s Disease
Authors: Johnson Amanda M. , Harmsen William Scott , Aniwan Satimai , Tremaine William J. , Raffals Laura E. , Abu Dayyeh Barham K. , Loftus Edward V. 
Published: February 2023

Background:
Obesity is on the rise within the inflammatory bowel disease population. The impact obesity has on the natural history of Crohn’s disease (CD) is not well-understood. We aimed to describe the prevalence of obesity in a population-based cohort of newly diagnosed patients with CD, and the impact obesity had on disease phenotype and outcomes of corticosteroid use, hospitalization, intestinal resection, and development of fistulizing or penetrating disease.

Materials and Methods:
A chart review was performed on Olmsted County, Minnesota residents diagnosed with CD between 1970 and 2010. Data were collected on demographics, body mass index, CD location and behavior, CD-related hospitalizations, corticosteroid use, and intestinal resection. The proportion of individuals considered obese at the time of CD diagnosis was evaluated over time, and CD-associated complications were assessed with Kaplan-Meier survival analysis.

Results:
We identified 334 individuals diagnosed with CD between 1970 and 2010, of whom 156 (46.7%) were either overweight (27.8%) or obese (18.9%) at the time of diagnosis. The proportion of patients considered obese at the time of their diagnosis of CD increased 2-3 fold over the course of the study period. However, obesity did not have a significant impact on the future risk of corticosteroid use, hospitalization, intestinal resection, or development of penetrating and stricturing complications.

Conclusions:
Obesity is on the rise in patients with CD, although in this cohort, there did not appear to be any negative association with future CD-related outcomes. Further prospective studies, ideally including obesity measures such as visceral adipose tissue assessment, are warranted to understand the implications of the rising prevalence of obesity on CD outcomes.
Gastrointestinal-isolated Distress is Common in Alpha-gal Allergic Patients on Mammalian Meat Challenge
Authors: McGill Sarah K. , Levin Michael E. , Shaheen Nicholas J. , Cotton Cary C. , Platts-Mills Thomas A. , Commins Scott P. 
Published: February 2023

Background and Aims:
Alpha-gal allergy causes a delayed reaction to mammalian meats and has been reported worldwide. Patients with the allergy may present with isolated gastrointestinal (GI) symptoms, but this phenotype is poorly understood.

Methods:
We pooled and analyzed symptoms and demographics of patients from two prospective cohorts of patients with a diagnosis of alpha-gal allergy who reacted after eating mammalian meat under observation. We compared the characteristics of patients who demonstrated GI-isolated symptoms on a challenge with those who exhibited symptoms outside the GI tract (skin, respiratory, and circulatory).

Results:
Among the 91 children and adult alpha-gal allergic patients who exhibited symptoms after oral challenge with mammalian meat, 72.5% experienced GI distress with one or more GI symptoms, which was the most frequent class of symptoms, compared with skin changes in 57.1% and respiratory distress in 5.5%. The most common GI symptoms were abdominal pain (71%) and vomiting (22.0%). GI-isolated symptoms occurred in 37 patients (40.7%) who reacted, and those patients reacted more quickly than patients who exhibited systemic symptoms (median onset of symptoms in GI-isolated group 90 min vs 120 min) and were more likely to be children than adults (relative risk=1.94, 95% CI: 1.04-3.63).

Conclusions:
Isolated-GI distress occurred in 4 in every 10 alpha-gal allergic individuals who developed symptoms on oral food challenge with mammalian meat. Alpha-gal allergic patients, particularly children, may exhibit GI distress alone, and adult and pediatric gastroenterologists should be aware of the diagnosis and management of the allergy.