bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of cytoreductive surgery in the era of immunotherapy
Authors: Isali Ilaha , Braun Avery , Bukavina Laura , Psutka Sarah P. 
Published: September 2022

Purpose of review
The benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI + TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap.

Recent findings
Data from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited.

Summary
Although the optimal selection criteria and timing for CN remains to be established for patients with mRCC in the immunotherapy era, the available body of evidence underscores the importance of careful patient selection. Ongoing prospective studies, such as Cyto-KIK, PROBE, and NORDIC-SUN, will better define the role of CN in the rapidly evolving treatment landscape for mRCC.
Adrenal functional imaging – which marker for which indication?
Authors: Werner Rudolf A. , Hartrampf Philipp E. , Schirbel Andreas , Hahner Stefanie 
Published: September 2022

Purpose of review
In recent years, a broad spectrum of molecular image biomarkers for assessment of adrenal functional imaging have penetrated the clinical arena. Those include positron emission tomography and single photon emission computed tomography radiotracers, which either target glucose transporter, CYP11B enzymes, C-X-C motif chemokine receptor 4, norepinephrine transporter or somatostatin receptors. We will provide an overview of key radiopharmaceuticals and determine their most relevant clinical applications, thereby providing a roadmap for the right image biomarker at the right time for the right patient.

Recent findings
Numerous radiotracers for assessment of adrenal incidentalomas ([18F]FDG; [123I]IMTO/IMAZA), ACC ([123I]IMTO/IMAZA; [18F]FDG; [68Ga]PentixaFor), pheochromocytomas and paragangliomas ([123I]mIBG; [18F]flubrobenguane; [18F]AF78; [68Ga]DOTATOC/-TATE), or primary aldosteronism ([11C]MTO, [68Ga]PentixaFor) are currently available and have been extensively investigated in recent years. In addition, the field is currently evolving from adrenal functional imaging to a patient-centered adrenal theranostics approach, as some of those radiotracers can also be labeled with ß-emitters for therapeutic purposes.

Summary
The herein reviewed functional image biomarkers may not only allow to increase diagnostic accuracy for adrenal gland diseases but may also enable for achieving substantial antitumor effects in patients with adrenocortical carcinoma, pheochromocytoma or paraganglioma.
Pancreatitis in the Complex Care Population: Presentation, Incidence, and Severity
Authors: Hawa Kathryn , Corker Lisa , Hornung Lindsey , Noritz Garey , Gariepy Cheryl , Shaikhkhalil Ala , Abu-El-Haija Maisam 
Published: September 2022

Objectives:
To describe the incidence and presentation of pancreatitis in Children with Medical Complexity (CMC) while evaluating severity of disease and outlining risk factors.

Methods:
This was a retrospective chart review between January 2010 and December 2019 of patients seen in the complex care clinic at Nationwide Children’s Hospital (NCH) and Cincinnati Children’s Hospital Medical Center (CCHMC). Data collected included sex, underlying diagnosis, family history of pancreatitis, type of pancreatitis, signs/symptoms, abdominal imaging, severity of attack, and presence of various risk factors associated with pancreatitis. Severity and diagnosis of pancreatitis was determined based on North American Society for Pediatric Gastroenterology, Hepatology and Nutrition criteria.

Results:
One hundred and twelve patients from both institutions were included, 62% from NCH, median age 11.5 [interquartile range (IQR): 5–16 years], 50% male. Most patients were less than 18 years of age with a median age of 8 years (IQR: 4–13 years). Underlying diagnoses included seizures (67%), cerebral palsy/spastic quadriplegia (65%), diabetes (3.6%), and mitochondrial disease (3%). Majority of patients were found to have multiple underlying diagnoses (88%). Incidence of pancreatitis for both institutions was 336 of 100,000 patients/year which is significantly higher than the general pediatric population (P < 0.0001). Majority of first episodes of pancreatitis were mild (82%) with abdominal pain as the predominant symptom (50%). Adult patients were more likely to have pancreatitis related to medication use than pediatric patients (70% vs 38%, respectively P = 0.007).

Conclusions:
Individuals in the CMC population at our institutions have a high incidence of pancreatitis with unique risk factors compared to the general pediatric/young adult populations.
Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy
Authors: Lin Yufen , Bailey Donald E. , Xiao Canhua , Hammer Marilyn , Paul Steven M. , Cooper Bruce A. , Conley Yvette P. , Levine Jon D. , Kober Kord M. , Miaskowski Christine 
Published: September 2022

Background
Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life.

Objectives
Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics.

Methods
Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses.

Results
Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function.

Conclusions
Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers.

Implications for Practice
Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
Effectiveness of a Multimodal Nursing Intervention on Quality of Sleep, Fatigue, and Level of Depression Among Indonesian Patients With Gynecological Cancer
Authors: Erfina Erfina , Nurmaulid Nurmaulid , Hariati Suni , Andriani Andriani , McKenna Lisa 
Published: September 2022

Background
The use of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important in providing holistic care. However, limited studies have reported on integrating nonpharmacological interventions to improve physical and psychological symptoms of women with gynecological cancer.

Objective
The aim of this study was to examine the effect of a multimodal nursing intervention (MNI) on sleep quality, fatigue, and level of depression among Indonesian women with gynecological cancer.

Methods
The quasi-experimental nonequivalent group design involved 50 patients in 2 groups and used convenience sampling. An experimental group (n = 25) received MNI including progressive muscle relaxation and a counseling session; the control group received routine hospital care (n = 25). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), depression levels by the Beck Depression Inventory-II, and fatigue by the Piper Fatigue Scale (PFS). Pretest data were collected after 3 days of hospital admission; posttest data were gathered after the intervention.

Results
The PSQI (P = .000), Beck Depression Inventory-II (P = .008), and PFS (P = .000) changed significantly in the intervention group; the PSQI (P = .000) and PFS (P = .000) in the control group changed significantly. The PSQI (P = .00) and PFS (P = .000) scores differed significantly between the 2 groups before and after the intervention. The effect size of the MNI for difference scores before and after the intervention was medium effect size.

Conclusions
The role of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important to providing holistic care.

Implication for Practice
Gynecology nurses can lead the implementation of MNI to decrease patient fatigue and depression and to increase sleep quality.
Capturing patient-reported outcomes: paper versus electronic survey administration
Authors: Nguyen Mai P. , Rivard Rachael L. , Blaschke Breanna , Vang Sandy , Schroder Lisa K. , Cole Peter A. , Cunningham Brian P. 
Published: September 2022

Abstract

Objective: To compare the capture rates and costs of paper patient-reported outcomes (pPRO) administered in-clinic and electronic PROs (ePRO) collected through emails and texts.

Design: Retrospective review.

Setting: Level 1 trauma center.

Patients/Participants: The pPRO program enrolled 2164 patients for postsurgical follow-up in 4 fracture types: ankle, distal radius, proximal humerus, and implant removal from 2012 to 2017. The ePRO program enrolled 3096 patients in 13 fracture types from 2018 to 2020. Among the patients enrolled in the ePRO program, 1296 patients were matched to the 4 original fracture types and time points.

Main Outcome Measures: PRO capture rates in 4 fracture types by matched time point and estimated cost of each program per enrolled patient.

Results: At first follow-up, pPRO provided a higher capture rate than ePRO for 3 of 4 fracture types except for implant removal (P < 0.05). However, at 6-month and 1-year follow-ups, ePRO demonstrated statistically significant higher capture rates when compared with pPRO for all applicable modules (P < 0.05). The average cost for the pPRO program was $171 per patient versus $56 per patient in the ePRO program. Patients were 1.19 times more likely to complete ePRO compared with pPRO (P = 0.007) after controlling for age, sex, fracture type, and time point.

Conclusion: The electronic PRO service has improved long-term capture rates compared with paper PROs, while minimizing cost. A combined program that includes both in-clinic and out of clinic effort may be the ideal model for collection of PROs.

Level of Evidence: Level 3.
Comparison of Bedside and Video-Based Capillary Refill Time Assessment in Children
Authors: Nickel Amanda J. , Hunter Ryan Brandon , Jiang Shen , Boulet John R. , Hanks Jasmine , Napolitano Natalie , Nadkarni Vinay M. , Nishisaki Akira 
Published: September 2022

Objectives
Capillary refill time (CRT) to assess peripheral perfusion in children with suspected shock may be subject to poor reproducibility. Our objectives were to compare video-based and bedside CRT assessment using a standardized protocol and evaluate interrater and intrarater consistency of video-based CRT (VB-CRT) assessment. We hypothesized that measurement errors associated with raters would be low for both standardized bedside CRT and VB-CRT as well as VB-CRT across raters.

Methods
Ninety-nine children (aged 1–12 y) had 5 consecutive bedside CRT assessments by an experienced critical care clinician following a standardized protocol. Each CRT assessment was video recorded on a black background. Thirty video clips (10 with bedside CRT < 1 s, 10 with CRT 1–2 s, and 10 with CRT > 2 s) were randomly selected and presented to 10 clinicians twice in randomized order. They were instructed to push a button when they visualized release of compression and completion of a capillary refill. The correlation and absolute difference between bedside and VB-CRT were assessed. Consistency across raters and within each rater was analyzed using the intraclass correlation coefficient (ICC). A Generalizability study was performed to evaluate sources of variation.

Results
We found moderate agreement between bedside and VB-CRT observations (r = 0.65; P < 0.001). The VB-CRT values were shorter by 0.17 s (95% confidence interval, 0.09–0.25; P < 0.001) on average compared with bedside CRT. There was moderate agreement in VB-CRT across raters (ICC = 0.61). Consistency of repeated VB-CRT within each rater was moderate (ICC = 0.71). Generalizability study revealed the source of largest variance was from individual patient video clips (57%), followed by interaction of the VB-CRT reviewer and patient video clip (10.7%).

Conclusions
Bedside and VB-CRT observations showed moderate consistency. Using video-based assessment, moderate consistency was also observed across raters and within each rater. Further investigation to standardize and automate CRT measurement is warranted.
Reducing Admission for Anaphylaxis in a Pediatric Emergency Department Using a Clinical Decision Support Tool
Authors: Wolpert Katherine H. , Kestle Rebecca , Weaver Nicholas , Huynh Kelly , Yoo Minkyoung , Nelson Richard , Lane Roni D. 
Published: September 2022

Introduction:
Anaphylaxis is a life-threatening condition necessitating emergent management. However, the benefits of prolonged observation and indications for hospitalization are not well established. Through the implementation of a disposition-focused clinical decision support tool (CDST), this quality improvement initiative aimed to reduce hospitalization for low-risk patients presenting to the pediatric emergency department (PED) with anaphylaxis from 49% to ≤12% within 12 months of implementation.

Methods:
The intervention included patients 18 years and younger of age presenting with anaphylaxis to the PED. A multidisciplinary team identified a 2006 evidence-based guideline as a significant contributor to hospitalization. The updated guideline incorporated a disposition-focused CDST that stratified patients as low-risk or high-risk and recommended discharge of low-risk patients after a 4-hour observation period. The primary outcome measure was the percentage of low-risk patients hospitalized. Balancing measures included low-risk patient 72-hour return rate and PED length of stay for all comers. Secondary outcomes included a focused cost analysis.

Results:
Fifty-three children preintervention and 43 children postintervention presenting with anaphylaxis met low-risk criteria. Postimplementation, hospitalization of low-risk patients decreased from 49% to 7% (P < 0.0001). No low-risk patients returned in 72 hours for an anaphylaxis-related concern (P = 0.83). The median PED length of stay increased from 189 to 193 minutes (P < 0.0001). The median cost per low-risk encounter decreased by $377 (P = 0.013).

Conclusions:
After implementing an evidence-based disposition-focused CDST, hospitalization of low-risk patients presenting to the PED with anaphylaxis significantly decreased without an increase in 72-hour returns. In addition, patient encounters demonstrated cost savings.
A prospective study of clinical outcomes of HIV-associated and HIV-negative Kaposi sarcoma in Uganda
Authors: Phipps Warren , Adams Scott V. , Mooka Peter , Kafeero James , Sekitene Semei , Mubiru Dennis , Nankoma Janet , Namirembe Constance , Okoche Lazarus , Namubiru Elizabeth B. , Kayemba Shadiah , Baker Kelsey K. , Redman Mary W. , Casper Corey , Orem Jackson , Warren Edus H. 
Published: September 2022

Objective:
Improved understanding of the effect of HIV infection on Kaposi sarcoma (KS) presentation and outcomes will guide development of more effective KS staging and therapeutic approaches. We enrolled a prospective cohort of epidemic (HIV-positive; HIV+KS) and endemic (HIV-negative; HIV−KS) KS patients in Uganda to identify factors associated with survival and response.

Methods:
Adults with newly diagnosed KS presenting for care at the Uganda Cancer Institute (UCI) in Kampala, Uganda, between October 2012 and December 2019 were evaluated. Participants received chemotherapy per standard guidelines and were followed over 1 year to assess overall survival (OS) and treatment response.

Results:
Two hundred participants were enrolled; 166 (83%) had HIV+KS, and 176 (88%) were poor-risk tumor (T1) stage. One-year OS was 64% (95% confidence interval [CI] 57–71%), with the hazard of death nearly threefold higher for HIV+KS (hazard ratio [HR] = 2.93; P = 0.023). Among HIV+KS, abnormal chest X-ray (HR = 2.81; P = 0.007), lower CD4+ T-cell count (HR = 0.68 per 100 cells/μl; P = 0.027), higher HIV viral load (HR = 2.22 per log10 copies/ml; P = 0.026), and higher plasma Kaposi sarcoma-associated herpesvirus (KSHV) copy number (HR = 1.79 per log10 copies/ml; P = 0.028) were associated with increased mortality. Among HIV−KS, factors associated with mortality included Karnofsky score <70 (HR = 9.17; P = 0.045), abnormal chest X-ray (HR = 8.41; P = 0.025), and higher plasma KSHV copy number (HR = 6.21 per log10 copies/ml; P < 0.001).

Conclusions:
Although survival rates were better for HIV
−
KS than HIV+KS, the high mortality rate seen in both groups underscores the urgent need to identify new staging and therapeutic approaches. Factors associated with mortality, including high plasma KSHV, may serve as important targets of therapy.
A prospective study on adverse childhood experiences and HIV-related risk among adolescents in Malawi
Authors: Kidman Rachel , Breton Etienne , Behrman Jere , Kohler Hans-Peter 
Published: September 2022

Objective:
Adverse childhood experiences have been robustly associated with poor sexual health in later life. In low-income countries, there is growing evidence that children experience greater adversity than those in higher income countries. Research suggests this may contribute to later sexual risk taking and HIV infection, though most studies to date have been cross-sectional.

Design:
We use longitudinal data on adolescents to examine the temporal relationship between adversity and HIV-related behavioral and biological outcomes.

Methods:
We interviewed 1878 adolescents living in Malawi in 2017–2018 (age 10–16) and again in 2021 (age 13–20). Adolescents completed the Adverse Childhood Experience – International Questionnaire. HIV-risk was assessed through both behavioral (e.g. condom use) and biological (HIV and herpes simplex virus 2 [HSV2] infection) outcomes. ordinary least squares (OLS) and logistic multivariate regression models are used to explore associations between adversity and HIV risk.

Results:
In longitudinal analyses, adverse childhood experiences (ACEs) were significantly associated with intimate partner violence and girls’ behavioral risk scores only. HIV incidence was too low to model; there were no significant associations with HSV2. In cross-sectional analyses, ACEs were additionally associated with an early sexual debut, lack of condom use, a greater number of sexual partnerships, and sexually transmitted infection symptoms.

Conclusions:
Our findings emphasize the importance of collecting prospective data: results from longitudinal and cross-sectional analyses drew qualitatively different conclusions. Cross-sectional analyses may not be accurate representations of longitudinal processes. However, they suggest that recent adversity and distress drives HIV-related behavior, perhaps more than early adversity. Interventions that combat emotional abuse or peer violence during adolescence could potentially reduce HIV risk.
Brief Report: HIV Infection Does Not Explain Higher Nicotine Metabolism in People Living With HIV
Authors: Arens Yotam , Bilker Warren B. , Han Xiaoyan , Plankey Michael , Ware Deanna , Friedman M. Reuel , D'Souza Gypsyamber , Stosor Valentina , Shoptaw Steven , Schnoll Robert A. , Tyndale Rachel F. , Ashare Rebecca , Gross Robert 
Published: September 2022

Background:
Smoking contributes to significant morbidity and mortality in people with HIV. People with HIV have relatively high nicotine metabolism rates, as measured by the nicotine metabolite ratio (NMR, 3-hydroxycotinine/cotinine). A higher NMR is associated with difficulty quitting smoking. We hypothesized that HIV infection might upregulate nicotine metabolism.

Setting:
A retrospective study of male current smokers in the Multicenter AIDS Cohort Study who HIV seroconverted between 1985 and 1993.

Methods:
Eligibility included having plasma stored before and after confirmed HIV seroconversion and current tobacco use. Samples were selected from the closest available visits before (median 3.3 months) and after (median 9.4 months) seroconversion. Antiretroviral therapy use was exclusionary. Cotinine and 3-hydroxycotinine were measured using liquid chromatography–tandem mass spectrometry. We compared NMR from plasma pre-HIV and post-HIV infection using signed-rank tests. We targeted a sample size of 71 pairs to achieve 80% power to detect a 0.1 unit increase in NMR with P = 0.05.

Results:
We analyzed paired samples from 78 participants; the median age was 34.5 years [interquartile range (IQR 29–40 years)]. The median NMR pre-HIV and post-HIV was 0.45 (IQR 0.32–0.54) and 0.46 (IQR 0.34–0.56), respectively. The median change in NMR postseroconversion was +0.01 (IQR −0.05, +0.09), P = 0.25. Stratification of median change in NMR by timing between samples or time since HIV seroconversion did not alter this finding.

Conclusions:
Acquiring HIV had no measurable effect on NMR. We postulate that upregulation of the NMR may be due to direct pharmacologic effects of HIV medications or metabolic changes in response to HIV infection.