bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Electronic Communication of Medication Discontinuation (CancelRx) on Medication Safety: A Pilot Study
Authors: Pitts Samantha I. , Yang Yushi , Woodroof Taylor , Mollenkopf Nicole L. , Wang Nae-Yuh , Thomas Bridgette A. , Chen Allen R. 
Published: April 2022

Objectives
This study aimed to evaluate the impact of electronic communication of medication discontinuation from prescribers to pharmacies (CancelRx) on medication safety.

Methods
We used electronic health record (EHR) data to identify medications that were e-prescribed from a pilot practice to a health system pharmacy and subsequently discontinued before or after CancelRx implementation (January 16–April 15, 2018 versus 2019). We matched these EHR data to pharmacy management software data to identify medications that were sold to patients in the 6 months after discontinuation. As a surrogate for unintended cancellation, we also identified medications refilled within 120 days of discontinuation. We conducted a medical record review to identify documentation of prescriber intent to discontinue these medications.

Results
CancelRx implementation prevented prescriptions from being sold after discontinuation in the EHR (42 of 392 [10.7%] versus 0 of 387 [0.0%], P < 0.0001), but only 15 of 42 (35.7%) had documented intent to discontinue the medication (15 of 392, or 3.8% overall). There was a nonsignificant increase in the proportion of discontinued medications reordered within 120 days (10.0% versus 12.7%, P = 0.23). Medical record review of reordered prescriptions after CancelRx implementation found that 10 of 49 (10 of 387, or 2.6% overall) might have been unintentionally canceled.

Conclusions
Implementation of CancelRx eliminated the sale of e-prescribed medications after discontinuation in the EHR but might result in the unintentional cancellation of some prescriptions. Strategies to increase situational awareness of providers and pharmacy staff, including increased visibility of CancelRx, clear distinctions between active and expired prescriptions, and transmission of the reason for discontinuation, might reduce the risk of unintentional cancellations.
Patient Safety Issues From Information Overload in Electronic Medical Records
Authors: Nijor Sohn , Rallis Gavin , Lad Nimit , Gokcen Eric 
Published: April 2022

Background and Objective
Electronic health records (EHRs) have become ubiquitous in medicine and continue to grow in informational content. Little has been documented regarding patient safety from the resultant information overload. The objective of this literature review is to better understand how information overload in EHR affects patient safety.

Methods
A literature search was performed using the Transparent Reporting of Systematic Reviews and Meta-Analyses standards for literature review. PubMed and Web of Science were searched and articles selected that were relevant to EHR information overload based on keywords.

Results
The literature search yielded 28 articles meeting the criteria for the study. Information overload was found to increase physician cognitive load and error rates in clinical simulations. Overabundance of clinically irrelevant information, poor data display, and excessive alerting were consistently identified as issues that may lead to information overload.

Conclusions
Information overload in EHRs may result in higher error rates and negatively impact patient safety. Further studies are necessary to define the role of EHR in adverse patient safety events and to determine methods to mitigate these errors. Changes focused on the usability of EHR should be considered with the end user (physician) in mind. Federal agencies have a role to play in encouraging faster adoption of improved EHR interfaces.
Texas Hospitals' Perspectives About NICU Performance Measures: A Mixed-Methods Study
Authors: Doherty Julie R. , Schaefer Andrew , Goodman David C. 
Published: April 2022

Background and Objectives:
This study was conducted to assess Texas hospital leaders' perspectives about neonatal intensive care (NICU) performance measures.

Methods:
We conducted an explanatory mixed-methods study. First, we sent a survey and a copy of the Dartmouth Atlas of Neonatal Intensive Care to clinical and administrative leaders of 150 NICUs in Texas. We asked respondents to review the chapter that reported Texas-specific results and respond to a variety of open and closed-ended questions about the overall usefulness of the report. Second, we conducted semistructured qualitative interviews with a subset of survey respondents to better understand their perspectives.

Results:
The survey had a 50% hospital response rate. Respondents generally found the report to be interesting and useful, and 87.7% of all respondents reported being in favor of receiving future reports with their own hospital's data benchmarked against anonymous peers. All of the specific measures in the Atlas were found to be of interest and valuable, with NICU admissions and special care days rating among the most interesting and useful. In the semistructured interviews, respondents expressed that a report with performance data would serve as a mechanism to drive change by identifying opportunities for improvement.

Conclusion:
Texas hospital NICU leaders are interested in routinely receiving more information about their own NICU's performance anonymously benchmarked against their peers. This would facilitate a greater understanding of a unit's functionality, as well as accelerate clinically appropriate quality improvement initiatives, which together have the potential to deliver better newborn care at lower costs for all Texans.
Accuracy of the Simplified HOSPITAL Score to Predict Nonelective Readmission in a Brazilian Tertiary Care Public Teaching Hospital
Authors: Pivatto Júnior Fernando , Helena Dias Pereira dos Santos Ulbrich Ana , Gheno Jociele , Antônio Fisch Marco , Cristina Petry Roberta , da Silva Nunes Thaise , Wajner André 
Published: April 2022

Background and Objectives:
Predictive models to identify patients at high risk of readmission have gained the attention of health care teams, which have focused the strategies to reduce unnecessary readmissions on the “at-risk” patients. The HOSPITAL score includes 7 predictor variables with a C-statistic of 0.70 or more when applied to international datasets. Its simplified version retains a C-statistic at around the same level, but only incipient external validation has been attempted to date. The primary objective of this study was to evaluate the prognostic accuracy of the simplified HOSPITAL score to predict nonelective hospital readmissions in a tertiary care public teaching hospital in Brazil.

Methods:
We used a retrospective cohort that included all patients discharged from the internal medicine service of a Brazilian tertiary care public teaching hospital in 2018. We excluded patients who died before index discharge, were transferred to another institution, left against medical advice, or were readmitted electively. We calculated the simplified HOSPITAL score for each admission, and admissions were divided into low (0-4 points) or high risk (≥ 5 points) of nonelective 30-day readmission. We estimated accuracy, area under the receiver operating characteristic curve (AUC), and observed/expected (O/E) readmission ratio; the latter using the mid-P exact test with Miettinen's modification at a 95% confidence interval (CI). A P value < .05 was considered significant.

Results:
A total of 4472 hospital discharges were analyzed during the study period after application of the exclusion criteria. The nonelective 30-day readmission rate was 14.0% (n = 625). Of all patients discharged, 3173 (71.0%) were considered to be at low risk and 1299 (29.0%) at high risk of readmission according to the simplified HOSPITAL score. The AUC was 0.68 (95% CI: 0.66-0.71; P < .001). The nonelective 30-day readmission rate was 9.2% in the low-risk group (expected: 9.2%; O/E: 1.0 [95% CI: 0.89-1.12]) and 25.7% in the high-risk group (expected: 27.2%; O/E: 0.95 [95% CI: 0.85-1.05]) (P < .001). At a cut-off of 5 points, the score had a sensitivity of 53.4%, specificity of 74.9%, positive predictive value of 25.7%, and negative predictive value (NPV) of 90.8%.

Conclusions:
The parameters of the score were almost identical to the original study, with better applicability to exclude low-risk patients given its high NPV. Additional adjustments are still needed for better applicability in daily clinical practice.
Fully Automatic Quantitative Measurement of 18F-FDG PET/CT in Thymic Epithelial Tumors Using a Convolutional Neural Network
Authors: Han Sangwon , Oh Jungsu S. , Kim Yong-il , Seo Seung Yeon , Lee Geun Dong , Park Min-Jae , Choi Sehoon , Kim Hyeong Ryul , Kim Yong-Hee , Kim Dong Kwan , Park Seung-Il , Ryu Jin-Sook 
Published: April 2022

ObjectivesThe aim of this study was to develop a deep learning (DL)–based segmentation algorithm for automatic measurement of metabolic parameters of18F-FDG PET/CT in thymic epithelial tumors (TETs), comparable performance to manual volumes of interest.Patients and MethodsA total of 186 consecutive patients with resectable TETs and preoperative18F-FDG PET/CT were retrospectively enrolled (145 thymomas, 41 thymic carcinomas). A quasi-3D U-net architecture was trained to resemble ground-truth volumes of interest. Segmentation performance was assessed using the Dice similarity coefficient. Agreements between manual and DL-based automated extraction of SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and 63 radiomics features were evaluated via concordance correlation coefficients (CCCs) and linear regression slopes. Diagnostic and prognostic values were compared in terms of area under the receiver operating characteristics curve (AUC) for thymic carcinoma and hazards ratios (HRs) for freedom from recurrence.ResultsThe mean Dice similarity coefficient was 0.83 ± 0.34. Automatically measured SUVmax(slope, 0.97; CCC, 0.92), MTV (slope, 0.94; CCC, 0.96), and TLG (slope, 0.96; CCC, 0.96) were in good agreement with manual measurements. The mean CCC and slopes were 0.88 ± 0.06 and 0.89 ± 0.05, respectively, for the radiomics parameters. Automatically measured SUVmax, MTV, and TLG showed good diagnostic accuracy for thymic carcinoma (AUCs: SUVmax, 0.95; MTV, 0.85; TLG, 0.87) and significant prognostic value (HRs: SUVmax, 1.31 [95% confidence interval, 1.16–1.48]; MTV, 2.11 [1.09–4.06]; TLG, 1.90 [1.12–3.23]). No significant differences in the AUCs or HRs were found between automatic and manual measurements for any of the metabolic parameters.ConclusionsOur DL-based model provides comparable segmentation performance and metabolic parameter values to manual measurements in TETs.
Metastasis From Clear Cell Renal Cell Carcinoma Mimicking Well-Differentiated Pancreatic Neuroendocrine Tumor at 18F-FDG and 68Ga-DOTATOC PET/CT
Authors: Guglielmo Priscilla , Pesella Fiammetta , Sartorello Alida , El Khouzai Badr , Berti Sara , Muccioli Simona , Gregianin Michele 
Published: April 2022

Abstract
Dual-tracer PET/CT with both 18F-FDG and 68Ga-DOTA–conjugated peptides is currently used in clinical routine for characterizing pNET (pancreatic masses suspicious for neuroendocrine tumor). We describe here the case of a 81-year-old man with a pancreatic lesion showing high 68Ga-DOTATOC uptake and mild 18F-FDG avidity, thus suggesting a well-differentiated pNET, which resulted at endoscopic ultrasound-guided fine-needle aspiration to be a clear cell renal cell carcinoma metastasis. In fact, the patient had right nephrectomy for clear cell renal cell carcinoma 27 years earlier. This case puts light on the role of PET/CT with 68Ga-DOTATOC in imaging RCC, a field which deserves to be further explored.
Perirenal Infiltration of Signet Ring Cell Colon Carcinoma Shown by 68Ga-FAPI PET/CT
Authors: Güzel Yunus , Kaplan İhsan , Kepenek Ferat , Söğütçü Nilgün , Kömek Halil 
Published: April 2022

Abstract
A soft tissue lesion surrounding the left kidney was detected in 18F-FDG PET/CT performed with suspicion of recurrence in a patient who was operated for descending colon cancer and showed mild FDG uptake. Intense fibroblast activation protein-specific inhibitor (FAPI) uptake in the perirenal soft tissue was observed in 68Ga-FAPI-04 PET/CT. Tru-cut biopsy of the left perirenal lesion revealed signet ring cell colon carcinoma metastasis. This case demonstrated that 68Ga-FAPI-04 PET/CT could be a promising radiopharmaceutical for the evaluation of signet ring cell colon carcinomas.
18F-FES PET/CT for Characterization of Brain and Leptomeningeal Metastasis in Double Primary Cancer Patient
Authors: Lee Yeongjoo , Yoo Ie Ryung , Ha Seunggyun 
Published: April 2022

Abstract
The clinical value of 16α-18F-fluoro-17 β-estradiol (18F-FES) PET in breast cancer has been widely investigated because it can visualize estrogen receptor–expressing lesions. This relatively new radiotracer adds clinical values by characterization of metastasis in double primary cancer. It also has advantage in finding small brain lesions, which has no background brain activity. Here, we present 18F-FES PET findings of brain and leptomeningeal metastases in a patient with breast and lung malignancy.
Prognostic Significance of Small Pulmonary Vessel Alteration Measured by Chest Computed Tomography in Connective Tissue Diseases With Pulmonary Arterial Hypertension
Authors: Zhang Yue , Zhang Ning , Sun Xiaoxuan , Liu Qingwen , Yuan Xiaohan , Wang Qiang , Zhou Lei 
Published: April 2022

Background:
Pulmonary arterial hypertension (PAH) is characterized by structural alterations of pulmonary vessels. Few studies have explored the clinical significance of quantitative assessment of pulmonary small vessels by chest computed tomography (CT). Our aim was to assess whether the prognosis of connective tissue diseases (CTD)-PAH patients could be assessed through pulmonary small vessels measured by chest CT.

Methods:
In all, 42 CTD-PAH patients diagnosed based on right heart catheterization were retrospectively investigated. All patients underwent a chest CT within 1 month before and after right heart catheterization examination. Main pulmonary artery (MPA) and the cross-sectional area of small pulmonary vessels <5 mm2as a percentage of total lung area (%CSA<5) were measured. The primary endpoint was a composite clinical worsening endpoint.

Results:
After a median follow-up time of 30.5 (interquartile range, 8.5 to 45.25) months, endpoint events occurred in 16 (38.1%) patients after 19.5 (interquartile range, 10.0 to 45.5) months. Cox univariate proportional hazard analysis showed that pulmonary vascular resistance, MPA diameter, and %CSA<5were associated with the end point. A combination of MPA diameter and %CSA< 5was the independent risk factor for the prognosis (hazard ratio, 2.180 [95% confidence interval, 1.405-3.383],P=0.001). Kaplan-Meier analysis showed that CTD-PAH patients satisfying %CSA< 5of <0.382 and MPA >36.75 mm had the highest risk of experiencing the endpoint.

Conclusion:
Among the pulmonary vascular indicators measured by chest CT, in addition to MPA, %CSA< 5may be a potential independent risk factor for poor long-term prognosis in Chinese CTD-PAH patients.
Computed Tomography Pulmonary Angiography Utilization in the Emergency Department During the COVID-19 Pandemic
Authors: Schulz Kathryn , Mao Lu , Kanne Jeffrey 
Published: April 2022

Purpose:
To determine if computed tomography pulmonary angiography (CTPA) ordering increased significantly during the COVID-19 pandemic in an emergency department (ED) setting; if positive findings for pulmonary embolism (PE) increased to the same degree; and whether COVID-positive patients have a higher incidence of PE than COVID-negative patients at ED presentation.

Materials and Methods:
We conducted a retrospective review of CTPA performed in our ED between June and December in 2019 and 2020. We collected data on patient demographics, symptoms, COVID-19 status, lab and imaging results, and risk factors for PE. We used a Wilcoxon rank sum to analyze quantitative variables and χ2 or Fisher test for categorical variables. We used logistic regression to identify predictive factors for PE.

Results:
CTPA ordering increased from 432 studies in 2019 to 699 in 2020 (+61.8%, P<0.0001), but detection rates for PE remained stable (11.3% vs. 10.2%, P=0.61). In 2020, 10 of 91 COVID-positive patients undergoing CTPA had positive studies. On regression analysis, COVID-19 was not a significant predictor of PE at ED presentation (odds ratio 1.029, 95% confidence interval: 0.959-1.103). COVID-positive patients were more likely to have nondiagnostic imaging (7.7% vs. 2.5% [COVID-negative] and 0.8% [not tested], P=0.007).

Conclusions:
While CTPA ordering increased significantly during the pandemic, our positivity rate remained stable, suggesting that this increase was appropriate. COVID-positive patients who underwent CTPA in the ED did not have a higher incidence of PE than other patients. Clinicians should use clinical judgment to weigh the likelihood of PE against the risk of nondiagnostic results when determining whether to expose COVID-positive patients to high-dose radiation and contrast with CTPA on initial presentation.
Mortality of adolescents with isolated traumatic brain injury does not vary with type of level I trauma center
Authors: Sheff Zachary T. , Engbrecht Brett W. , Rodgers Richard , Jacobson Lewis E. , Smith Jodi L. 
Published: April 2022

BACKGROUND
Pediatric patients with isolated severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTCs) have lower mortality than those treated at adult trauma centers (ATCs) or mixed trauma centers (MTCs). The primary objective of this study was to determine if adolescent patients (15–17 years) with isolated severe TBI also benefited from treatment at PTCs.

METHODS
This was a cross-sectional analysis using a national sample of adolescent trauma patients obtained from the American College of Surgeons' Trauma Quality Program Participant Use Files for 2013 to 2017 (n = 3,524). Mortality, the primary outcome variable, was compared between Level I PTCs, ATCs, and MTCs using multiple logistic regression controlling for patient characteristics and injury severity. Secondary outcomes included discharge disposition, utilization of craniotomy, intensive care unit (ICU) utilization, ICU length of stay (LOS), and hospital LOS.

RESULTS
Prior to adjustment, patients treated at ATCs (odds ratio [OR], 2.76; p = 0.032) and MTCs (OR, 2.36; p = 0.070) appeared to be at greater risk of mortality than those treated at PTCs. However, after adjustment, this difference disappeared (ATC OR, 1.21; p = 0.733; MTC OR, 0.95; p = 0.919). Patients treated at ATCs and MTCs were more severely injured than those treated at PTCs and more likely to be admitted to an ICU (ATC OR, 2.12; p < 0.001; MTC OR, 1.91; p < 0.001). No other secondary outcome differed between center types.

CONCLUSION
Adolescent patients with isolated severe TBI treated at ATCs and MTCs had similar mortality risk as those treated at PTCs. The difference in injury severity across center types warrants additional research.

LEVEL OF EVIDENCE
Prognostic/Epidemiological; Level III.
Infection Risk in the First Year After ABO-incompatible Kidney Transplantation: A Nationwide Prospective Cohort Study
Authors: Hirzel Cédric , Projer Lea , Atkinson Andrew , Surial Bernard , Mueller Nicolas J. , Manuel Oriol , Mombelli Matteo , van Delden Christian , Hirsch Hans H. , Boggian Katia , Walti Laura N. , Sidler Daniel , Hadaya Karine , Dickenmann Michael , Müller Thomas F. , Binet Isabelle , Golshayan Déla , Huynh-Do Uyen ,   Swiss Transplant Cohort Study (STCS)
Published: April 2022

Background.
ABO-incompatible (ABOi) kidney transplantation (KT) expands the kidney donor pool and may help to overcome organ shortage. Nonetheless, concerns about infectious complications associated with ABOi-KT have been raised.

Methods.
In a nationwide cohort (Swiss Transplant Cohort Study), we compared the risk for infectious complications among ABOi and ABO-compatible (ABOc) renal transplant recipients. Infections needed to fulfill rigorous, prespecified criteria to be classified as clinically relevant. Unadjusted and adjusted competing risk regression models were used to compare the time to the first clinically relevant infection among ABOi-KT and ABOc-KT recipients. Inverse probability weighted generalized mixed-effects Poisson regression was used to estimate incidence rate ratios for infection.

Results.
We included 757 living-donor KT recipients (639 ABOc; 118 ABOi) and identified 717 infection episodes. The spectrum of causative pathogens and the anatomical sites affected by infections were similar between ABOi-KT and ABOc-KT recipients. There was no significant difference in time to first posttransplant infection between ABOi-KT and ABOc-KT recipients (subhazard ratio, 1.24; 95% confidence interval [CI], 0.93-1.66; P = 0.142). At 1 y, the crude infection rate was 1.11 (95% CI, 0.93-1.33) episodes per patient-year for ABOi patients and 0.94 (95% CI, 0.86-1.01) for ABOc-KT recipients. Inverse probability weighted infection rates were similar between groups (adjusted incidence rate ratio, 1.12; 95% CI, 0.83-1.52; P = 0.461).

Conclusions.
The burden of infections during the first year posttransplant was high but not relevantly different in ABOi-KT and ABOc-KT recipients. Our results highlight that concerns regarding infectious complications should not affect the implementation of ABOi-KT programs.
Malignancies in Deceased Organ Donors: The Spanish Experience
Authors: Mahíllo Beatriz , Martín Silvia , Molano Esteban , Navarro Aurora , Castro Pablo , Pont Teresa , Andrés Amado , Galán Juan , López Montserrat , Oliver Eva , Martínez Adolfo , Mosteiro Fernando , Roque Rebeca , Pérez-Redondo Marina , Cid-Cumplido Manuela , Ballesteros María A. , Daga Domingo , Quindós Brígida , Sancho Micaela , Royo-Villanova Mario , Bernabé Esther , Muñoz Raúl , Chacón José Ignacio , Coll Elisabeth , Domínguez-Gil Beatriz 
Published: April 2022

Background.
To better define the risk of malignancy transmission through organ transplantation, we review the Spanish experience on donor malignancies.

Methods.
We analyzed the outcomes of recipients of organs obtained from deceased donors diagnosed with a malignancy during 2013–2018. The risk of malignancy transmission was classified as proposed by the Council of Europe.

Results.
Of 10 076 utilized deceased donors, 349 (3.5%) were diagnosed with a malignancy. Of those, 275 had a past (n = 168) or current (n = 107) history of malignancy known before the transplantation of organs into 651 recipients. Ten malignancies met high-risk criteria. No donor-transmitted cancer (DTC) was reported after a median follow-up of 24 (interquartile range [IQR]: 19–25) mo. The other 74 donors were diagnosed with a malignancy after transplantation. Within this group, 64 donors (22 with malignancies of high or unacceptable risk) whose organs were transplanted into 126 recipients did not result in a DTC after a median follow-up of 26 (IQR: 22–37) mo, though a prophylactic transplantectomy was performed in 5 patients. The remaining 10 donors transmitted an occult malignancy to 16 of 25 recipients, consisting of lung cancer (n = 9), duodenal adenocarcinoma (n = 2), renal cell carcinoma (n = 2), extrahepatic cholangiocarcinoma (n = 1), prostate cancer (n = 1), and undifferentiated cancer (n = 1). After a median follow-up of 14 (IQR: 11–24) mo following diagnosis, the evolution was fatal in 9 recipients. In total, of 802 recipients at risk, 16 (2%) developed a DTC, which corresponds to 6 cases per 10 000 organ transplants.

Conclusions.
Current standards may overestimate the risk of malignancy transmission. DTC is an infrequent but difficult to eliminate complication.