bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of a Multifaceted Tertiary Pediatric Hospital’s Antimicrobial Stewardship Service
Authors: Goff Zoy , Abbotsford Joanne , Yeoh Daniel K. , Bowen Asha C. , Campbell Anita J. , Foley David A. , Ford Timothy J. , Hazelton Briony , Thu Le Huong , McLeod Charlie , Ware Benjamin , Snelling Thomas , Blyth Christopher C. 
Published: September 2022

Background:
Antimicrobials are the most commonly prescribed drug class in children. Overuse through inappropriate prescribing is a key driver of antimicrobial resistance and is recognized as one of the top 10 threats to global health by the World Health Organization.

Methods:
A prospective observational cohort study was performed following implementation of a multifaceted Antimicrobial Stewardship (AMS) program (January 2014 to December 2020). Data were collected on AMS and “handshake” ward rounds from patient information sources and directly from clinicians responsible for patient care. Primary outcomes include appropriateness of therapy (drug, dose, antimicrobial spectrum, duration and route), compliance with prescribing guidelines, antimicrobial expenditure, use of high-priority antimicrobials and duration of hospitalization. We compared outcomes across 3 time periods; January 2014–December 2015, January 2016–December 2017 and January 2018–December 2020.

Results:
The appropriateness of individual antimicrobial orders improved across the study periods from 6111/7040 (79.4%) in the first 2 years following implementation of the AMS program to 17,819/19,229 (92.3%) in the latter period. Guideline compliance increased from 5426/7700 (70.5%) to 17,822/19,316 (92.3%). A reduction in overall antimicrobial expenditure (34% reduction, equivalent to $12.52 per bed day) and a decrease in antifungal expenditure (37% reduction, equivalent to $5.56 per bed day) was observed across the time periods.

Conclusions:
This study quantifies a comprehensive pediatric AMS program’s sustained impact on reducing inappropriate antimicrobial use and expenditure and improving compliance with guidelines. The effectiveness of these interventions has been demonstrated and should be considered by institutions seeking to improve rational antimicrobial use in children.
Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery
Authors: Mayer-Xanthaki Christoph F. , Hirnschall Nino , Pregartner Gudrun , Gabriel Maximilian , Falb Thomas , Sommer Michael , Haas Anton 
Published: September 2022

Purpose:
To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery.

Setting:
Department of Ophthalmology Graz, Graz, Austria.

Design:
Single-center, retrospective cohort study.

Methods:
The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations.

Results:
ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078).

Conclusions:
According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.
Predictive Model for Quality of Life in Patients With Heart Failure
Authors: Park Ju-Kyung , Ahn Jeong-Ah , Hayman Laura L. , Park Jin-Sun , Kim Chun-Ja 
Published: September 2022

Background
Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF).

Objectives
In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF.

Methods
Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography.

Results
Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (β = 0.186, P = .004, and β = −0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress.

Conclusions
These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.
Utility of a Handheld Blood Ketone Meter as a Postmortem Indicator of Diabetic Ketoacidosis
Authors: Mitchell Caris , McCleskey Brandi 
Published: September 2022

Abstract
When investigating a death potentially due to diabetic ketoacidosis (DKA), it is challenging to assess the glucose level in the blood, but β-hydroxybutyrate, the most prevalent ketone body in the blood, is relatively stable after death. The aim of this project is to prove that a commercially available ketone meter can be used on postmortem blood samples to aid the diagnosis of DKA in a novel setting (during coroner/medical examiner examination). Samples with acetone detected via gas chromatography were chosen retrospectively to determine whether the meter could detect ketones in postmortem blood (proof-of-concept). In all of the thawed samples, the meter detected an elevated ketone level. Samples were then obtained in a prospective manner to include those with a possible cause of death from DKA along with controls. We correctly identified 16 cases in which death was due to DKA with use of the ketone manner. The ketone levels ranged from 2.6 to 5.4 mmol/L in those cases. The diagnosis was confirmed with a greatly elevated vitreous glucose concentration or glycated hemoglobin concentration. Detecting the presence of ketones while in the autopsy suite allowed for more accurate preliminary diagnoses and utilization of resources.
Opioid Co-Prescribing with Sedatives After Implant-Based Breast Reconstruction
Authors: Santosa Katherine B. , Wang Christine S. , Hu Hsou-Mei , Mullen Connor R. , Brummett Chad M. , Englesbe Michael J. , Bicket Mark C. , Myers Paige L. , Waljee Jennifer F. 
Published: September 2022

Background:
Skeletal muscle relaxants (SMR) and benzodiazepines are thought to mitigate against postoperative muscle contraction. The Centers for Disease Control and the Food and Drug Administration warn against co-prescribing opioids with SMR/benzodiazepines due to increased risks of overdose and death. We evaluated the frequency of co-prescribing of opioids with SMRs/benzodiazepines after implant-based reconstruction.

Methods:
We examined healthcare claims to identify women (18-64 years old) who underwent implant-based breast reconstruction (IBBR) between January 2008 and June 2019 to determine the frequency of co-prescribing and associated factors. We determined factors associated with co-prescribing of opioids and SMRs/benzodiazepines, and the impact on opioid refills within 90 days of reconstruction.

Results:
86.7% (7,574) of women who had IBBR filled an opioid prescription peri-operatively. Of these, 27.7% of women filled opioids and benzodiazepines, 14.4% filled opioids and SMRs, and 2.4% filled opioids, benzodiazepines, and SMRs. Risk factors for co-prescribing opioids and benzodiazepines include use of acellular dermal matrix, immediate reconstruction, and history of anxiety. Women who filled opioids and SMRs, opioids and benzodiazepines, and opioids with SMRs and benzodiazepines were significantly more likely to refill opioid prescriptions, even when controlling for preoperative opioid exposure.

Conclusions:
Nearly half of women filled an opioid prescription with a benzodiazepine, SMR, or both after IBBR. Co-prescribing of opioids with SMRs may potentiate opioid use after surgery and should be avoided given the risks of sedation. Identifying strategies that avoid sedatives to manage pain following breast reconstruction is critical to mitigate high-risk prescribing practices.
Clinical Evaluation of Safety and Efficacy of Radio-Frequency Assisted Lipolysis (RFAL) on Breast Envelope and Nipple-Areolar Complex (NAC) Position
Authors: Unger Jacob G. , Agochukwu-Nwubah Nneamaka , Theodorou Spero , Maxwell G. Patrick 
Published: September 2022

Background/Purpose:
Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics and weight loss is a common complaint amongst women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy and safety of radiofrequency assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis.

Methods:
This was a single center (Maxwell Aesthetics) study of female desiring tightening of the breast envelope and elevation of the nipple areolar complex (NAC). Each patient underwent 1 treatment with RFAL in the operating room. RFAL was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at: 6 weeks, 3 months, 6 months and 12 months via manual and 3D computer generated measurements (Vectra).

Results:
10 female patients were enrolled. Ages ranged from 23-54. Follow up was 12 months. Data was captured for seven measurements from the nipple longitudinally at five time points. The sternal notch to the nipples (SN-N) distance, nipple to inframammary fold (N-IMF) and nipple to nipple (N-N), improved statistically at 6- week follow-up ,which persisted through the 12-month follow-up (p<0.05). Patient questionnaires revealed moderate to excellent satisfaction.

Conclusions:
Radiofrequency assisted Lipolysis with a bipolar device to deliver RF energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally-invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction.
“Restylane® Lyft for aesthetic shaping of the nasal dorsum and radix - A randomized, no-treatment control, multi-center study”
Authors: Wang Xiaojun , Li Bi , Li Qin 
Published: September 2022

Background:
Hyaluronic acid fillers are widely used in non-surgical rhinoplasty.

Methods:
We performed a no-treatment control, multi-center, 12-month follow-up study to evaluate efficacy and safety of Restylane® Lyft (Galderma Aesthetics, Sweden) in shaping the nasal dorsum and radix. Assignment to Restylane Lyft or no-treatment control was randomized (3:1). The Restylane Lyft group received ≤1 mL Restylane Lyft on Day 1; the control group was offered ≤1 mL Restylane Lyft at Month 6. Both groups were offered re-treatment (≤0.5 mL Restylane Lyft) at Month 12. Outcome assessments included blinded evaluation of 3D photography measurements of change in volume (primary endpoint; Month 6) and elevation of the nasal dorsum and radix, aesthetic improvement, adverse events (AEs) and diary-reported injection-site reactions.

Results:
132 Chinese subjects were enrolled. The Restylane Lyft group had a greater increase in volume of the nasal dorsum and radix than the no-treatment control (mean difference at Month 6: 0.71 mL [95% confidence interval: 0.59-0.83; p<0.001]). Restylane Lyft was also more effective than no-treatment control in achieving an elevation of the nasal dorsum and radix. The increase in volume and elevation persisted up to 12 months after injection, and was supported by clinical assessments of aesthetic improvement. Treatment-related AEs were mild-to-moderate, non-serious and resolved during the study. Injection-site reactions were mostly mild-to-moderate, and resolved within one week.

Conclusions:
Restylane Lyft injection was effective for aesthetic shaping of the nasal dorsum and radix and achieved aesthetic improvement for up to 12 months with an acceptable safety profile.
Added Value of Magnetic Resonance Over Computed Tomography in Distinguishing Nonneoplastic Complex Thymic Cysts From Malignant Cystic Thymic Neoplasms
Authors: Madan Rachna , Phillips William W. , Colson Yolonda L. , Hammer Mark Morris 
Published: September 2022

Purpose
The aim of the study was to evaluate cystic thymic masses by using computed tomography (CT) and magnetic resonance (MR) scoring systems to differentiate nonneoplastic thymic cysts from cystic thymic neoplasms.

Methods
This retrospective multisite study included adult patients who underwent CT and MR imaging of the chest between 2007 and 2020 with any of the following impressions on cross-sectional imaging studies: “thymic mass with cystic component,” “unilocular or multilocular cystic thymic lesion,” “complex thymic cyst,” “thymic cyst with hemorrhage.” Two blinded radiologists reviewed and recorded specific imaging features as well as overall impressions on both CT and MR using a Likert scale scoring system. Data were analyzed, and diagnostic accuracy of CT and MR was compared using areas under the receiver operating characteristic curves (AUC).

Results
Fifty-six patients were included, of which 45 (80%) had benign masses. Total of 21 patients (38%) had indeterminate scores on CT of which 3 (14%) were malignant, while only 6 (11%) had indeterminate scores on MR and 1 was malignant. Magnetic resonance scoring system (AUC, 0.95) performed better than CT scoring system (AUC, 0.86) in distinguishing benign versus malignant lesions (P = 0.06). Lack of enhancement within the mass was completely predictive of benign etiology (P < 0.001). Wall thickness of an enhancing cyst was predictive of malignancy, with AUC 0.93.

Conclusions
Magnetic resonance yielded higher specificity allowing a larger number of lesions to be confidently assigned a benign diagnosis. This could help in averting unnecessary follow-up, biopsies, or surgery. The authors recommend follow-up imaging with MR for prevascular masses, even those appearing “solid” on CT.
Distinguishing Intrathyroid Parathyroid Adenoma from Colloid Nodules and Papillary Thyroid Carcinomas Using Multiphasic Multidetector Computed Tomography
Authors: Debnam J. Matthew , Chi T. Linda , Kwon Michael , Sun Jia , Schellingerhout Dawid , Golant Brandon T. , Ahmed Salmaan , Perrier Nancy D. , Vu Thinh 
Published: September 2022

Objective
The aim of the study is to determine whether multiphase multidetector computed tomography (4D-MDCT) can differentiate between intrathyroid parathyroid adenomas (ITPAs), colloid nodules, and papillary thyroid carcinoma (PTC).

Methods
We studied 22 ITPAs, 22 colloid nodules, and 11 PTCs in 55 patients. Hounsfield unit (HU) values of the nodules were measured on 4D-MDCT in the precontrast, arterial, venous, and delayed phases. Raw HU values, phase with peak enhancement, and washout percentages between the phases were evaluated.

Results
Regardless of size, all ITPAs (22/22) showed peak enhancement in the arterial phase, which was significantly greater than both colloid nodules (15/22) and PTC (6/11, P = 0.002); thus, nodules with peak enhancement in the venous or delayed phase were not ITPAs (specificity = 1). For nodules with peak enhancement in the arterial phase, the percentage washout in the arterial-to-venous phases separated ITPAs from PTC and colloid nodules (P < 0.001) with greater than or equal to 23.95% loss of HU value implying IPTA (area under curve, 0.79). This left a subset of colloid nodules or PTC that either peaked in the venous or delayed phase or had an arterial-to-venous phase washout of less than 23.95%. From this subset, PTC measuring 1 cm or greater could be separated from colloid based on HU values in the arterial phase with a cutoff HU value less than 81.4 for PTC (area under curve, 0.72) and an HU value greater than 164.5 suggested colloid.

Conclusions
Intrathyroid parathyroid adenomas can be distinguished from colloid nodules and PTC by peak enhancement in the arterial phase and rapid washout. A subset of colloid and PTC measuring 1 cm or greater can be separated using arterial phase HU values.
A 3-Dimensional Evaluation of Bone Density in Alveolar Cleft Grafting Methods: Bone Substitutes Versus Autologous Bone
Authors: Bianchi Alberto , Cicciù Marco , Ruggiero Federica , Crimi Salvatore , Amadori Sara , Bassi Massimo , Gurrera Giorgio , Marchetti Claudio 
Published: September 2022

Introduction:
Secondary alveolar cleft repair using autologous bone graft is currently the gold standard in treating residual alveolar clefts. Despite its effectiveness, this technique is still burdened by several withdrawals, mostly related to donor site morbidity. To decrease disadvantages for patients, numerous attempts in the literature regarding bone substitutes have been described. The aim of this study is to compare the viability of bovine-based replacement bone material with respect of autologous bone graft in alveolar cleft reconstruction, through 3-dimensional alveolar cleft segmentation and bone density evaluation from preoperative and postoperative cone-beam computed tomography.

Patients and Methods:
A retrospective cohort study of 10 patients who underwent surgical procedure for alveolar cleft grafting at Sant’Orsola Malpighi University Hospital of Bologna from December 2012 to December 2016 was undertaken. Five patients received autologous bone graft and 5 a bovine bone substitute graft. Preoperative and immediate postoperative orthopanoramic x-rays were recorded. Cone-beam computed tomography scans have recorded both pre and postoperatively. Volumetric evaluation on 3-dimensional cone-beam computed tomography images was performed.

Results:
Alveolar clefts repaired using substitute bovine bone/biological membrane scaffold had a mean fill of 69.00% of total cleft volume, while this figure was of 67.07% with autologous bone grafting. The immediate postoperative course and subsequent discharge were uneventful for both groups, with a difference in timing. The cost of substitute bovine bone was offset by cost savings associated with a reduction in operative and postoperative and hospitalization time.

Conclusions:
Bone substitutes showed to be a promising solution in alveolar cleft grafting.
Textbook Outcome as a Quality Metric in Living and Deceased Donor Kidney Transplantation
Authors: Schenk Austin D , Logan April J , Sneddon Jeffrey M , Faulkner Daria , Han Jing L , Brock Guy N , Washburn William K 
Published: September 2022

BACKGROUND:
Quality in kidney transplantation is measured using 1-year patient and graft survival. Because 1-year patient and graft survival exceed 95%, this metric fails to measure a spectrum of quality. Textbook outcomes (TO) are a composite quality metric offering greater depth and resolution. We studied TO after living donor (LD) and deceased donor (DD) kidney transplantation.

STUDY DESIGN:
United Network for Organ Sharing data for 69,165 transplant recipients between 2013 and 2017 were analyzed. TO was defined as patient and graft survival of 1 year or greater, 1-year glomerular filtration rate of greater than 40 mL/min, absence of delayed graft function, length of stay of 5 days or less, no readmissions during the first 6 months, and no episodes of rejection during the first year after transplantation. Bivariate analysis identified characteristics associated with TO, and covariates were incorporated into multivariable models. Five-year conditional survival was measured, and center TO rates were corrected for case complexity to allow center-level comparisons.

RESULTS:
The national average TO rates were 54.1% and 31.7% for LD and DD transplant recipients. The hazard ratio for death at 5 years for recipients who did not experience TO was 1.92 (95% CI 1.68 to 2.18, p ≤ 0.0001) for LD transplant recipients and 2.08 (95% CI 1.93 to 2.24, p ≤ 0.0001) for DD transplant recipients. Center-level comparisons identify 18% and 24% of centers under-performing in LD and DD transplantation. High rates of TO do not correlate with transplantation center volume.

CONCLUSION:
Kidney transplant recipients who experience TO have superior long-term survival. Textbook outcomes add value to the current standards of 1-year patient and graft survival.
Delay to Surgery for Patients with Symptomatic Cholelithiasis: Retrospective Analysis of an Administrative California Database after Discharge from the Emergency Department
Authors: Shenoy Rivfka , Kirkland Patrick , Jackson Nicholas J , DeVirgilio Michael , Zingmond David , Maggard-Gibbons Melinda , Russell Marcia M 
Published: September 2022

BACKGROUND:
Timely receipt of surgery should be available for all patients. Few studies have examined differences in the treatment of symptomatic cholelithiasis (SC), a common surgical problem, based on race/ethnicity or insurance status. This study aimed to identify differences in repeat emergency department (ED) use and wait time to cholecystectomy for SC.

STUDY DESIGN:
Patients discharged from the ED with SC between July 1, 2016, and December 31, 2017, were identified from California administrative databases and followed for 1 year. Repeat ED use and wait time to elective and nonelective cholecystectomy after ED discharge were examined using logistic and negative binomial regression models.

RESULTS:
The final cohort analyzed 13,596 patients who underwent cholecystectomy within 1 year from index ED visit for SC. In adjusted analysis, non-Hispanic Black patients had higher odds for repeat ED use for biliary-related conditions before elective surgery and experienced longer waits for cholecystectomy (across several measures of wait times) compared with non-Hispanic White patients. Similar findings were seen for Medicaid and self-pay compared with privately insured patients. For example, self-pay patients had more than double the odds of experiencing repeat ED use while waiting for elective cholecystectomy compared with privately insured patients (adjusted odds ratio 2.49, 95% CI 1.88–3.31).

CONCLUSION:
Patients with SC receiving cholecystectomy within 1 year from index ED visit were more likely to have repeat ED use and longer waits to surgery based on their race/ethnicity and insurance status, even after adjusting for other measures of access. We identify a vulnerable population at risk for differences in treatment for a common surgical pathology.