Conflict with children, psychological depression, and problematic internet use among Chinese older adults: The moderating effect of sociability and living situation.

Introduction: Problematic internet use among the elderly is an emerging area as previous studies focused more among the young people. Only a few studies focused on problematic internet use at the level of individual characteristics of older adults or on mitigating factors at the level of the older adult's family, ignoring family-level disruptive factors.

Objective: The purpose of study is to investigate the relationship between conflict with children and problematic internet use among the elderly, as well as the mediating mechanisms and boundary conditions of the relationship.

Boosted Chemical Protective Properties Using Interface Constructed between TiCT MXene and Natural Rubber.

Rubbers are extensively applied in chemical protective clothing (CPC) due to their eye-catching anti-penetration of chemicals. However, their impermeability, particularly that of natural rubber (NR), is unsatisfactory. In this work, we demonstrate the facile construction of TiCT MXene/NR interface using a plant-scale and feasible method combining latex mixing, emulsion flocculation, and flat-plate vulcanisation.

Managing the value Co-creation of peer service providers in the sharing economy: The perspective of customer incivility.

Previous studies have discussed the preconditions for peer service providers participation in value co-creation from the perspective of the platforms or the peer service providers themselves. However, little attention has been paid to the influence of customers. In the sharing economy, however, customers interact closely with peer service providers, and they have a major influence on the attitudes and behaviours of peer service providers.

Achieving an optimal textbook outcome following pancreatic resection: The impact of surgeon specific experience in achieving high quality outcomes.

Background: The interplay of patient-, procedural, and provider-level factors on the ability to achieve a textbook outcome(TO) remain poorly defined.

Methods: The Medicare Standard Analytical Files from 2013 to 2017 were used to identify beneficiaries who underwent pancreatic surgery. Multivariable logistic regression with mixed effects was used to examine the role of the individual surgeon relative to patient- and procedural-factors to achieve a TO.

Intraoperative hypotension is associated with persistent acute kidney disease after noncardiac surgery: a multicentre cohort study.

Background: Whilst intraoperative hypotension is associated with postoperative acute kidney injury (AKI), the link between intraoperative hypotension and acute kidney disease (AKD), defined as continuing renal dysfunction for up to 3 months after exposure, has not yet been studied.

Methods: We conducted a retrospective multicentre cohort study using data from noncardiac, non-obstetric surgery extracted from a US electronic health records database. Primary outcome was the association between intraoperative hypotension, at three MAP thresholds (≤75, ≤65, and ≤55 mm Hg), and the following two AKD subtypes: (i) persistent (initial AKI incidence within 7 days of surgery, with continuation between 8 and 90 days post-surgery) and (ii) delayed (renal impairment without AKI within 7 days, with AKI occurring between 8 and 90 days post-surgery).

Clinical Data Prediction Model to Identify Patients With Early-Stage Pancreatic Cancer.

Purpose: Pancreatic cancer is an aggressive malignancy with patients often experiencing nonspecific symptoms before diagnosis. This study evaluates a machine learning approach to help identify patients with early-stage pancreatic cancer from clinical data within electronic health records (EHRs).

Materials And Methods: From the Optum deidentified EHR data set, we identified early-stage (n = 3,322) and late-stage (n = 25,908) pancreatic cancer cases over 40 years of age diagnosed between 2009 and 2017.

Postoperative Hypotension and Adverse Clinical Outcomes in Patients Without Intraoperative Hypotension, After Noncardiac Surgery.

Background: Postoperative hypotension (POH) is associated with major adverse events. However, little is known about the association of blood pressure thresholds and outcomes in postoperative patients without intraoperative hypotension (IOH) on the general-care ward. We evaluated the association of POH with major adverse cardiac or cerebrovascular events (MACCE) in patients without IOH.

Postoperative hypotension in patients discharged to the intensive care unit after non-cardiac surgery is associated with adverse clinical outcomes.

Background: The postoperative period is critical for a patient's recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (≤ 75, ≤ 65 and ≤ 55 mmHg), in the absence of intraoperative hypotension (≤ 65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery.

Inter-surgeon variability is associated with likelihood to undergo minimally invasive hepatectomy and postoperative mortality.

Introduction: Minimally invasive liver surgery (MILS) has been increasingly adopted in clinical practice; yet, inter-surgeon variability in operative approach (MILS vs. open), as well as the impact of providers on the likelihood of undergoing MILS have not been well characterized.

Methods: The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent hepatectomy between 2013 - 2017.

Intraoperative Hypotension Is Associated With Adverse Clinical Outcomes After Noncardiac Surgery.

Background: Intraoperative hypotension (IOH) occurs frequently during surgery and may be associated with organ ischemia; however, few multicenter studies report data regarding its associations with adverse postoperative outcomes across varying hemodynamic thresholds. Additionally, no study has evaluated the association between IOH exposure and adverse outcomes among patients by various age groups.

Methods: A multicenter retrospective cohort study was conducted between 2008 and 2017 using intraoperative blood pressure data from the US electronic health records database to examine postoperative outcomes.

The impact of individual surgeon on the likelihood of minimal invasive surgery among Medicare beneficiaries undergoing pancreatic resection.

Background: The objective of the current study was to evaluate the impact of the individual surgeon on the use of minimally invasive pancreatic resection.

Methods: The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent pancreatic resection between 2013 and 2017. The impact of patient- and procedure-related factors on the likelihood of minimally invasive pancreatic resection was investigated.

Racial Differences in the Use of Aortic Valve Replacement for Treatment of Symptomatic Severe Aortic Valve Stenosis in the Transcatheter Aortic Valve Replacement Era.

Background Aortic valve replacement (AVR) is a life-saving treatment for patients with symptomatic severe aortic valve stenosis. We sought to determine whether transcatheter AVR has resulted in a more equitable treatment rate by race in the United States. Methods and Results A total of 32 853 patients with symptomatic severe aortic valve stenosis were retrospectively identified via Optum's deidentified electronic health records database (2007-2017).

The Association Between Patient Satisfaction and Patient-Reported Health Outcomes.

Objective: Although patient satisfaction is increasingly used to rate hospitals, it is unclear how patient satisfaction is associated with health outcomes. We sought to define the relationship of self-reported patient satisfaction and health outcomes.

Design: Retrospective cross-sectional analysis using regression analyses and generalized linear modeling.

Clinical practice and outcomes of palliative radiation therapy in pediatric oncology patients: An international comparison of experiences from two distinct countries and health care systems.

Background And Purpose: This study describes clinical outcomes of palliative radiation therapy (RT) for children treated in distinct health-care environments-the US where there is advanced integration of palliative resources and Brazil, a country in the process of developing provisions for pediatric palliative care.

Methods And Materials: Palliative RT cases of pediatric oncology patients aged ≤21-years from 2010 to 2016 in two Brazil-based and one US-based (Johns Hopkins Hospital, JHH) academic centers were reviewed in this study.

Results: Eighty-eight pediatric patients were treated to 131 lesions with palliative RT.

A Multi-institutional International Analysis of Textbook Outcomes Among Patients Undergoing Curative-Intent Resection of Intrahepatic Cholangiocarcinoma.

Importance: Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care.

Objective: To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma.

Design, Setting, And Participants: This cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015.

Local referrals as a strategy for increasing value of surgical care among medicare patients undergoing liver and pancreatic surgery.

Background: The focus of the current Medicare payment reform is to increase value - i.e. improve health care quality while lowering costs.

Textbook Outcomes Among Medicare Patients Undergoing Hepatopancreatic Surgery.

Objective: To define and test "Textbook Outcome" (TO)-a composite measure for healthcare quality-among Medicare patients undergoing hepatopancreatic resections. Hospital variation in TO and Medicare payments were analyzed.

Background: Composite measures of quality may be superior to individual measures for the analysis of hospital performance.

Hot spotting surgical patients undergoing hepatopancreatic procedures.

Background: The burden of health care spending in the United States is a major concern, as health care costs have exponentially increased during the last three decades. The objective of the current study was to investigate the degree of cost-concentration among Medicare patients undergoing liver and pancreatic surgery.

Methods: Medicare claims data from 2013 to 2015 were used to identify patients undergoing elective liver and pancreatic resections.

Procedure-Specific Volume and Nurse-to-Patient Ratio: Implications for Failure to Rescue Patients Following Liver Surgery.

Background: The effect of various hospital characteristics on failure to rescue (FTR) after liver surgery has not been well examined. We sought to examine the relationship between hospital characteristics and FTR after liver surgery.

Methods: The 2013-2015 Medicare-Provider Analysis and Review (MEDPAR) database was used to identify Medicare beneficiaries who underwent liver surgery.

Differences in Physician Compensation Between Men and Women at United States Public Academic Radiation Oncology Departments.

Purpose: A pay gap between men and women has been identified in many medical specialties. However, radiation oncology has been excluded from most analyses. This study sought to determine whether such a disparity exists among physicians in US public academic radiation oncology departments.

Variation in the cost-of-rescue among medicare patients with complications following hepatopancreatic surgery.

Background: The relationship of expenditures related to rescuing patients from complications and hospital quality has not been well characterized. We sought to examine the relationship between payments for treating post-operative complications after liver and pancreas surgery and hospital quality.

Methods: A retrospective cohort study of patients who underwent hepatopancreatic surgery was performed using claims data from 2013 to 2015 in the Medicare Provider Analysis and Review (MEDPAR) database.

Population level outcomes and costs of single stage colon and liver resection versus conventional two-stage approach for the resection of metastatic colorectal cancer.

Background: The objective of the current study was to compare outcomes among patients combined colon (CR) and liver resection (LR) for the treatment of simultaneous colorectal liver metastasis (CRLM) versus patients undergoing two-stage CR and LR.

Methods: Patients undergoing surgery for CRLM between 2004 and 2014 were identified using the Nationwide Inpatient Sample (NIS). Propensity-score matching was used to compare patients undergoing CR + LR with patients undergoing two-stage CR and LR.

Preoperative Intensity Modulated Radiation Therapy Compared to Three-Dimensional Conformal Radiation Therapy for High-Grade Extremity Sarcomas in Children: Analysis of the Children's Oncology Group Study ARST0332.

Purpose: For pediatric patients with large, high-grade, extremity nonrhabdomyosarcoma soft-tissue sarcomas, preoperative radiation therapy (RT) provides the opportunity for smaller radiation fields and tumor shrinkage resulting in less extensive surgery. The potential disadvantage is an increased risk of wound complications after surgery compared with rates after postoperative chemoradiation. We assessed the impact of preoperative RT technique on target coverage in relationship to dose to skin and adjacent joints to determine whether acute wound complications and late musculoskeletal injury might be influenced by treatment technique.

Readmission after pancreatic resection: causes, costs and cost-effectiveness analysis of high versus low quality hospitals using the Nationwide Readmission Database.

Background: Objectives were to determine the causes of readmission and assess the cost-effectiveness of high (HQ) and low quality (LQ) hospitals in performing pancreatic resection, by using readmission rates as the measure of quality.

Methods: We identified 53,572 pancreatic resection cases from National Readmission Database from 2010 through 2014. Hospitals were risk adjusted and ranked based on readmission.