bluuebunny/crossref_metadata_2025 huggingface dataset:
III. REGIONAL ANESTHESIA Norepinephrine for the Prevention of Spinal-induced Hypotension During Cesarean Delivery Under Combined Spinal-epidural Anesthesia
Authors: Wei C. , Qian J. , Zhang Y. , Chang X. , Hu H. , Xiao F.
Published: February 2021

(Eur J Anaesthesiol. 2020;37:309–315)

Phenylephrine is considered the first-line therapy for the prevention of hypotension in obstetric anesthesia. However, phenylephrine may cause bradycardia and decreased maternal cardiac output. Norepinephrine has been proposed as an alternative to phenylephrine for treating or preventing hypotension during cesarean delivery. The primary goal of this study was to determine the effective dose (ED) of norepinephrine to prevent spinal-induced hypotension during cesarean delivery. The secondary aim was to examine adverse events and neonatal outcomes seen with various infusion rates of norepinephrine.
Clinical Characteristics and Intrauterine Vertical Transmissions Potential of COVID-19 Infection in 9 Pregnant Women: A Retrospective Review of Medical Records
Authors: Chen H. , Guo J. , Wang C. , Luo F. , Yu X. , Zhang W. , Li J. , Zhao D. , Xu D. , Gong Q. , Liao J. , Yang H. , Hou W. , Zhang Y.
Published: February 2021

(Lancet. 2020;395:809–815)

While the clinical characteristics, treatments, and outcomes of the 2019 novel coronavirus (COVID-19) pneumonia have been previously described, the clinical characteristics for pregnant COVID-19 patients are still emerging. Particularly of interest are whether pregnant patients will present differently than the general population, whether pregnant women will be more likely to die from COVID-19 or experience preterm labor while infected, whether vertical transmission is possible, and the risks for fetuses and neonates when mothers have COVID-19.This retrospective study examined clinical data from pregnant women with confirmed COVID-19 infection in Wuhan, China.
CE: A Nurse's Guide to COVID-19
Authors: Perkins Russell , Ingebretson Emily , Holifield Linda , Bergeron Amanda
Published: February 2021

To assist nurses caring for hospitalized adults with coronavirus disease 2019 (COVID-19), the authors synthesize evidence-based information on the disease, providing background on the epidemiology and history of severe acute respiratory syndrome coronavirus 2, the causative virus. They also discuss the risks for severe effects of the illness, the multiple signs and symptoms hospitalized adults with COVID-19 may manifest, and the precautions hospitals should take to keep health care providers and patients safe during the course of this pandemic.
QSEN in an Amazon World
Authors: Disch Joanne , Barnsteiner Jane
Published: February 2021

Quality and Safety Education for Nurses (QSEN) was launched in 2005 as a national nursing initiative aimed at preparing nurses with the competencies needed to continuously improve the quality and safety of the health care they provide. The six QSEN competencies—and the knowledge, skills, and attitudes that each entails—have served as a basis for significant curricular revision, more enlightened professional practice, relevant research, and health care system improvements. Since the launch of QSEN, new technologies have emerged, the range of care sites has broadened, new practice roles have emerged, and patients and families have become more active health care consumers. This article highlights these changes, considers Amazon as a powerful contemporary social force, examines the company's core values, and considers their relevancy to the six QSEN competencies. Essential new literacies and cognitive capacities are also identified. Lastly, the authors outline steps nurses can take to incorporate the QSEN competencies, along with the literacies and capacities, into their practice and organizations. Doing so is vital to delivering safe, high-quality care in this rapidly changing health care climate, and will enable nurses to claim their leadership and thrive professionally in an Amazon world.
Where Do We Go from Here?
Authors: Kennedy Maureen Shawn
Published: February 2021

What's next for nursing after the pandemic.
A COVID-19 Vaccination Challenge
Authors: Perkins Danielle EK
Published: February 2021

Increasing trust in Black communities is crucial.
New Guidelines for Prescribing Opioids to Children and Teens After Surgery
Authors: Halpern Lucy Wang
Published: February 2021

An emphasis on more responsible prescribing, improved parent education, and safer disposal of unused drugs.
Stronger Boxed Warning for Benzodiazepines
Authors: Aschenbrenner Diane S.
Published: February 2021

The boxed warning for drugs in the benzodiazepine class has been strengthened to further emphasize the risk of overdose and death, especially if combined with opioids, alcohol, or illicit drugs, and the risk of abuse, misuse, addiction, physical dependence, and withdrawal.
New Treatment for Hypereosinophilic Syndrome
Authors: Aschenbrenner Diane S.
Published: February 2021

Mepolizumab (Nucala) has been approved to treat hypereosinophilic syndrome.

Nurses should read the package insert for directions on how to reconstitute and administer the drug subcutaneously. Patient education will be needed regarding use of the autoinjector.
A Call to the CMS: Mandate Adequate Professional Nurse Staffing in Nursing Homes
Authors: Kolanowski Ann , Cortes Tara A. , Mueller Christine , Bowers Barbara , Boltz Marie , Bakerjian Deb , Harrington Charlene , Popejoy Lori , Vogelsmeier Amy , Wallhagen Margaret , Fick Donna , Batchelor Melissa , Harris Melodee , Palan-Lopez Ruth , Dellefield Mary , Mayo Ann , Woods Diana Lynn , Horgas Ann , Cacchione Pamela Z. , Carter Diane , Tabloski Patricia , Gerdner Linda
Published: February 2021

Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
Missing the Care in Health Care
Authors: Koch Amie M.
Published: February 2021

This article describes the case of a chronically ill patient whose care was grossly mismanaged as a result of the policies and practices of a dysfunctional health system. This case illustrates the importance of truly listening to patients and communicating effectively with colleagues within the health care system. It also discusses appropriate steps for the practice of patient-centered care, including a reevaluation of late arrival policies at hospitals and clinics.
Monitoring Equianalgesic Opioid Dosing
Authors: Curtis Mark , McPherson Mary Lynn , Swagger Stacy M. , Matzo Marianne
Published: February 2021

This series on palliative care is developed in collaboration with the Hospice and Palliative Nurses Association (HPNA; https://advancingexpertcare.org). The HPNA aims to guide nurses in preventing and relieving suffering and in giving the best possible care to patients and families, regardless of the stage of disease or the need for other therapies. The HPNA offers education, certification, advocacy, leadership, and research.
Are Consumer-Grade Masks Effective?
Authors: Rosenberg Karen
Published: February 2021

According to this study:

In many cases, the practical effectiveness of consumer-grade masks is nearly equivalent to or better than that of nonrespirator medical masks.
Scholarly Requirements and Support for Nursing Faculty Development and Career Advancement: A Nationwide Delphi Study
Authors: McPherson Sara , Reese Cynthia , Van Schyndel Jennie , Wendler M. Cecilia
Published: February 2021

AIM

The aim of the study was to better understand the scholarship requirements and support for nursing faculty as they work to advance their scholarship and careers.

BACKGROUND

Nursing faculty are often required to participate in teaching, service, and scholarship. New faculty often struggle with the scholarship component.

METHOD

A nationwide Delphi study was conducted, surveying deans and/or associate deans for research at master's and doctoral degree-granting institutions.

RESULTS

Scholarly requirements provided for faculty to enable development of scholarship were well defined: having a dedicated leader; funding support; a culture of scholarship; publications, presentations, and grant writing expectations; formal programs; mentors; and support.

CONCLUSION

This study provided a beginning understanding of important aspects of faculty support for scholarship and career development. More information is needed to determine if the support structures and activities described reach faculty and enhance career development.
Family Nurse Practitioner Students and Diagnostic Readiness Tests: Performances and Perceptions
Authors: Tankimovich Mariya
Published: February 2021

Nursing schools use diagnostic readiness tests (DRTs) to prepare family nurse practitioner (FNP) graduates to pass certification exams, but overall effectiveness estimates of DRTs are scant in the nursing literature. This pilot investigation used statistical analysis and Likert attitude scales with a convenience sample of FNP students to 1) discover any correlations between score results of two DRTs and 2) elicit test-takers’ perceptions of their effectiveness. Perceptions of effectiveness were sometimes less positive than statistical indicators of test effectiveness. Disconnects between effectiveness and student perceptions need further study to guarantee optimal employment of DRTs in FNP program curricula.
Helping persons with multiple chronic conditions overcome barriers to self-management
Authors: Jin Yuanyuan , Bratzke Lisa , Baumann Linda C.
Published: February 2021

The prevalence of multiple chronic conditions is growing dramatically, which complicates day-to-day self-management for patients. This article describes the features of multiple chronic conditions, an updated chronic care model, barriers to self-management, and strategies NPs can use to reduce or eliminate barriers to self-management in adults with multiple chronic conditions.
Understanding the most commonly billed diagnoses in primary care
Authors: Rogers Julia , Allen Jodi
Published: February 2021

Musculoskeletal pain is a common chief complaint in primary care and contributes to disability and a loss of independence. Musculoskeletal pain can be a diagnostic challenge for NPs. A thorough understanding of the pathophysiologic processes involved can help clinicians link the clinical manifestations and treatment for musculoskeletal injury causing pain.
COVID-19 and telehealth
Authors: Fant Catherine , Adelman Deborah S. , Summer Georgianne A.
Published: February 2021

Providing safe nonemergent care during the coronavirus disease 2019 (COVID-19) pandemic has been challenging for NPs. This article, the first of a three-part series, will overview telehealth and telemedicine and provide a brief history of the two. The benefits, challenges, and temporary changes due to COVID-19 will also be addressed.
A nurse staffing model for an unprecedented event
Authors: Cross Kimberly , Bradbury Alice , Burnham Nikki , Corbett-Carbonneau Denise , Peterson Kym , Phelan Cynthia , DeSanto-Madeya Susan
Published: February 2021

Lessons learned from one hospital's COVID-19 experience
Breast cancer and gynecologic risks in lesbian and bisexual women
Authors: Panganiban Jannelyn M. , O'Neil Jean
Published: February 2021

Lesbian and bisexual women may be at an increased risk for gynecologic infections and breast cancer due to a higher prevalence of factors such as obesity, smoking, and lower pregnancy rates. This article discusses the role of healthcare professionals in preventive screening for breast and gynecologic cancers and promoting healthy living in these patients by avoiding smoking, maintaining an ideal body weight, and limiting alcohol consumption.
Advice for aspiring nurse leaders
Authors: Bove Lisa Anne , Scott Melissa
Published: February 2021

Advice from current nurse leaders can offer valuable insight for aspiring leaders. This article discusses how the collective wisdom of practicing nurse leaders can assist new leaders as they transition into the role.
Omalizumab as an adjuvant in food allergen immunotherapy
Authors: Dantzer Jennifer A. , Wood Robert A.
Published: February 2021

Purpose of review

To review the most relevant studies in the rapidly advancing field of omalizumab as an adjunct to food allergen oral immunotherapy (OIT).

Recent findings

Clinical trials have primarily focused on milk, peanut, and multiallergen OIT combined with omalizumab. These studies suggest that omalizumab in addition to OIT can decrease the time required to reach maintenance OIT dosing and adverse events; however, serious adverse events did still occur. There is limited long-term data but available information suggests that individuals are at risk for increased reactivity after stopping omalizumab, and many discontinued treatment. There has been diversity in study designs, dosing, and populations.

The use of anti-IgE antibody as an adjunct to food allergen OIT has been an expanding area of research with several additional trials underway. Significant progress has been made in the past decades but further studies are needed to optimize protocols, improve safety and efficacy, and identify patients who will have the greatest benefit.
Biologicals for the prevention of anaphylaxis
Authors: Tanno Luciana Kase , Demoly Pascal
Published: February 2021

Purpose of review

To review the use of biological agents (BA) in the treatment of anaphylaxis in the view of the new knowledge in the field to support the quality of care and prevention.

Recent findings

Some BA, as a single medication or as combined therapy to food or venom immunotherapy, are effectively able to reduce most of the severe anaphylactic reactions.

Anaphylaxis is a recognized clinical emergency, which requires prompt identification and treatment. Several biologic therapies and new devices are emerging as a potential preventive treatment for anaphylaxis. However, adrenaline (epinephrine) is still the first-line treatment for any type of anaphylaxis. Biological drugs, such as omalizumab, whereas not US Food and Drug Administration (FDA) nor European Medicines Agency (EMA) approved for anaphylaxis, have been used as therapeutic adjuvants in the preventive treatment of anaphylaxis, but cost-effectiveness should be considered individually.
Machine Scoring of Medical Students’ Written Clinical Reasoning: Initial Validity Evidence
Authors: Cianciolo Anna T. , LaVoie Noelle , Parker James
Published: February 2021

Purpose

Developing medical students’ clinical reasoning requires a structured longitudinal curriculum with frequent targeted assessment and feedback. Performance-based assessments, which have the strongest validity evidence, are currently not feasible for this purpose because they are time-intensive to score. This study explored the potential of using machine learning technologies to score one such assessment—the diagnostic justification essay.

Method

From May to September 2018, machine scoring algorithms were trained to score a sample of 700 diagnostic justification essays written by 414 third-year medical students from the Southern Illinois University School of Medicine classes of 2012–2017. The algorithms applied semantically based natural language processing metrics (e.g., coherence, readability) to assess essay quality on 4 criteria (differential diagnosis, recognition and use of findings, workup, and thought process); the scores for these criteria were summed to create overall scores. Three sources of validity evidence (response process, internal structure, and association with other variables) were examined.

Results

Machine scores correlated more strongly with faculty ratings than faculty ratings did with each other (machine: .28–.53, faculty: .13–.33) and were less case-specific. Machine scores and faculty ratings were similarly correlated with medical knowledge, clinical cognition, and prior diagnostic justification. Machine scores were more strongly associated with clinical communication than were faculty ratings (.43 vs .31).

Conclusions

Machine learning technologies may be useful for assessing medical students’ long-form written clinical reasoning. Semantically based machine scoring may capture the communicative aspects of clinical reasoning better than faculty ratings, offering the potential for automated assessment that generalizes to the workplace. These results underscore the potential of machine scoring to capture an aspect of clinical reasoning performance that is difficult to assess with traditional analytic scoring methods. Additional research should investigate machine scoring generalizability and examine its acceptability to trainees and educators.
The IWill MCW Campaign: Individual Actions to Advance Gender Equity
Authors: Maurana Cheryl A. , Raymond John R. , Kerschner Joseph E. , Ellinas Elizabeth H.
Published: February 2021

Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW) stepped outside known approaches (e.g., women’s leadership plans and programming) to design and implement a strategic campaign that promotes gender equity through fostering change in systems and social norms. This campaign, IWill MCW (launched in 2019), emphasizes the power of individual responsibility for positive change. The IWill MCW campaign employs a 2-pronged approach. The first is the creation of personal call-to-action public pledges focused on 5 aspects of gender equity, along with the provision of supportive resources to reinforce positive change. The second is the use of those pledges to raise awareness of gender inequity in academic medicine by fostering meaningful dialogue meant to alter mental models of equity, relationships, and power dynamics. In the initial 6-week phase of the IWill MCW campaign, leaders reached out to all MCW faculty (2,002), staff (4,522), and learners (1,483) at multiple campuses. This outreach resulted in nearly 1,400 pledges, including 30% (n = 420) from men. The effort also engaged over 90% (n = 101) of members of MCW senior leadership teams. The feedback from the initial campaign has been positive. Lessons learned include realizing the importance of public pledges, engaging male allies, and following up. The authors suggest that the IWill MCW campaign provides a model for academic health centers to advance gender equity and shape an environment in which people of all genders can thrive.
From Diversity and Inclusion to Antiracism in Medical Training Institutions
Authors: Argueza Bianca R. , Saenz Samuel Ricardo , McBride Dannielle
Published: February 2021

The glaring racial inequities in the impact of the COVID-19 pandemic and the devastating loss of Black lives at the hands of police and racist vigilantes have catalyzed a global reckoning about deeply rooted systemic racism in society. Many medical training institutions in the United States have participated in this discourse by denouncing racism, expressing solidarity with people of color, and reexamining their diversity and inclusion efforts. Yet, the stagnant progress in recruiting, retaining, and supporting racial/ethnic minority trainees and faculty at medical training institutions is well documented and reflects unaddressed systemic racism along the academic pipeline. In this article, the authors draw upon their experiences as early-career physicians of color who have led and supported antiracism efforts within their institutions to highlight key barriers to achieving meaningful progress. They describe common pitfalls of diversity and inclusion initiatives and call for an antiracist approach to systems change. The authors then offer 9 recommendations that medical training institutions can implement to critically examine and address racist structures within their organizations to actualize racial equity and justice.
Reimagining Well-Being Initiatives in Medical Education: Shifting From Promoting Wellness to Increasing Satisfaction
Authors: Slavin Stuart
Published: February 2021

The well-being movement in medical education has been underway for over a decade. It seems appropriate to examine and evaluate these efforts to support the mental health needs of learners, faculty, and staff as medicine and medical education evolve in response to the COVID-19 pandemic and beyond.

To date, most interventions intended to promote well-being have focused on individual strategies rather than environmental drivers of distress, and the primary offerings have comprised strategies such as mindfulness, meditation, yoga, nutrition, exercise, and sleep. Responses to this programming from medical learners have primarily ranged from ambivalence to resentment, with many feeling that the programming failed to adequately address their particular needs and the challenges they were experiencing.

In this commentary, the author challenges the assumption that well-being per se should be the ideal target or goal. Learners and faculty may be better served by considering other goals—those that do not focus directly on well-being but that are instead foundational for well-being in that they directly address the challenges that students, residents, and faculty are facing. In other words, goals and associated interventions would focus on the experience of school and work rather than focusing primarily on encouraging healthy practices outside of school and work. The author proposes using the lens of satisfaction through which to view and assess progress toward well-being, increasing satisfaction within 3 interconnected domains: (1) school and/or work, (2) self, and (3) life in general. Attention to these domains may be more likely to produce improvements in well-being that have been sought for years but that remain elusive.
Adequacy of workforce – are there enough critical care doctors in the US-post COVID?
Authors: Hussain Rashid S. , Kataria Tripti C.
Published: February 2021

Purpose of review

The ICU is a complex ecosystem in which intensive care physicians, advanced practice providers (APPs), pharmacists, and respiratory therapists work in concert to take care of critically ill patients. The SARS COV2 pandemic highlighted weaknesses in the American healthcare system. This article explores the ability of American healthcare to adapt to this challenge.

Recent findings

With the COVID-19 pandemic, intensivists, and ventilators have been identified as the most critical components leading to shortages in ICU capacity. Anesthesiologists play a unique role in being able to provide ‘flex capacity’ with critical care staffing, space, and equipment (post-anesthesia care units, operating rooms, and ventilators). With the advent of APPs, intensive care physician staffing ratios may potentially be increased to cover patients safely in a physician-led team model. Tele-medicine expands this further and can allow hospital coordination for optimizing ICU bed use.

Although intensivists have been able to take care of the increased ICU caseload during the COVID-19 pandemic through recruiting other specialties, the question of what is the appropriate staffing model for the future is yet to be elucidated. Creating stronger multidisciplinary care teams that have the capacity to flex up critical care capacity may be the most prudent longer-term solution.
Enhanced Recovery After Surgery, Lean, and claims-based quality databases: how does it all make sense?
Authors: Shah Pranav R. , Leichtle Stefan , Spencer Paula
Published: February 2021

Purpose of review

Healthcare is rapidly evolving toward value-focused objectives, integrating outcomes and cost instead of simply volume. Concepts pertaining to Enhanced Recovery After Surgery (ERAS), Lean, and claims-based risk-adjusted databases can be used to optimize value, but the application of Lean principles and risk-adjusted outcomes is poorly described in perioperative medicine in perioperative medicine.

Recent findings

Lean management and process optimization tools allow the consistent application of a perioperative medical framework of ERAS to improve outcomes. Vizient risk-stratified outcomes are often used by hospitals to measure and compare quality.

Understanding administrative databases and Lean concepts for change management will allow the perioperative physician to better align medical concepts with health system tools for improving quality and reducing cost.
Gender pay disparity in anesthesiology
Authors: Hu Yaqi , Couser Deanna
Published: February 2021

Purpose of review

The purpose of this review is to look at the historical and current gender pay gap in healthcare, specifically in the field of anesthesiology, as well as discuss some of the reasons for the difference in compensation and its consequences. Future aims and directions to bridge the gap will also be explored.

Recent findings

Even though women have achieved equality in terms of admission to medical school and residency programs, disparities still exist in terms of compensation for equal or comparable work. However, institutional initiatives to close the pay gap have achieved success.

In order to improve the gender pay inequality, there needs to be continuous efforts on the institutional level for recognition of the disparity, initiation of programs for mentorship and sponsorship for female faculties, and continuous monitoring of the effect of the programs.
Procedural episode-based cost measures: anesthesia matters
Authors: Tolbert Coombs Alice A.
Published: February 2021

Purpose of review

Episode-based cost measures (EBCM) is a method of combining all services related to a defined episode of care, identified as either a procedure, acute illness or chronic disease, and providing expected cost for that episode or bundle of care. Procedural EBCM has become a major scheme for payment methodology and patient quality of care evaluation. Anesthesiologists need to know how EBCM can impact their clinical practice.

Recent finding

Centers for Medicare and Medicaid Services (CMS) pays physicians with fee-for-service payment for Clinical Episodes and, in 2020, the EBCM are increasing and currently, represents 4.5% of the total Medicare Part A and B spending [1]. With the recent changes in CMS, it is important, for anesthesia providers to know how cost attribution identifies the cost for all services and complications under anesthetic management.

EBCM can impact the anesthesiologist's quality performance, efficiencies measures, and payment. To preserve practice viability, anesthesiologists must understand how their compensation is impacted by services ordered. Anesthesiologists will increasingly be expected to improve quality and efficiencies in EBCM.
The Concept of Vulnerability Among Black and Latina Transgender Women in the United States
Authors: Webster Alicia
Published: February 2021

Although there is very little doubt that health disparities among transgender women remain prevalent in the United States, there has been very little research conducted regarding the unique experiences of Black and Latina transgender women. This article uses the Sinners and Victims Social Policy Model to delve into the historical foundations that have created these gaps in equity, while also reviewing current literature focusing on the distinct systemic racial and ethnic oppression of these communities. Results suggest that these historical and intersectional considerations are necessary to inform public policy, health care, and education. Future implications for research are discussed.
Family Satisfaction in the Adult Intensive Care Unit
Authors: Padilla Fortunatti Cristobal , De Santis Joseph P. , Munro Cindy L.
Published: February 2021

Admission of patients to an intensive care unit is often a stressful event for family members. In the context of patient- and family-centered care, family satisfaction is recognized as a quality indicator of intensive care unit care. However, family satisfaction has not been consistently used or conceptualized in the literature. A modified version of Walker and Avant's method for concept analysis was utilized to examine the concept of family satisfaction in the adult intensive care unit. Antecedents, attributes, consequences, and empirical referents of family satisfaction are presented and implications for practice, research, and policy.
Upstream Factors in Population Health
Authors: Distelhorst Karen S. , Graor Christine Heifner , Hansen Dana M.
Published: February 2021

The assessment of upstream factors is important in population-based nursing practice. The aim of this concept analysis is to enhance understanding of upstream factors and articulate a definition linked to the Conceptual Model for Nursing and Population Health. Upstream factors are thus defined as established conditions related to economic, social, and physical environments that occur outside the health care system, in the communities where people live, and contribute indirectly to the health outcomes for groups of individuals through multiple causal pathways. This concept analysis highlights the need for middle-range theory to guide nursing assessment and contributes to conceptual model evaluation.
Outcomes of surgical treatment of symptomatic bipartite patella in teenage athletes
Authors: Pan Tommy , Hennrikus William L.
Published: February 2021

Bipartite patella affects about 2% of people. Most cases are asymptomatic; however, some develop anterior knee pain during sports. When conservative treatment fails, surgery can be considered. This study reports the outcomes of fragment excision with or without lateral release in teenage athletes with symptomatic bipartite patella. The study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed. Patients were excluded if age >18 or had prior knee surgery. Data collected included age, gender, BMI, sports played, Saupe classification, conservative and surgical treatment, advanced imaging used, duration of follow-up, Lysholm Score and postoperative complications. Five teenage patients were studied. The average age was 15.6 years and BMI was 23. Sports played included basketball, football, track-and-field and soccer. All patients complained of anterior knee pain exacerbated by sports. All patients failed >6 months of conservative treatment. Saupe classification included four type III (superolateral) and one type II (lateral). Two patients had an MRI. Surgical treatment included two open excisions and three arthroscopic-assisted open excisions with lateral releases. The average Lysholm Score was 97. Postoperatively, all patients returned to presurgery sporting activity at an average of 9.8 weeks (range, 6–13 weeks). A 16-year-old male treated by open excision developed a postoperative wound infection. He was successfully treated with irrigation & debridement and antibiotics and returned to sports at 6 weeks. Symptomatic bipartite patella is an uncommon cause of anterior knee pain in adolescent athletes. When pain persists despite conservative care, fragment excision with or without lateral release resulted in excellent pain relief and return to full sporting activity in all cases.
The spectrum of tibial pseudarthrosis with constriction band syndrome in children
Authors: Naik Premal , Shah Hitesh , Gupta Parmanand
Published: February 2021

Constriction band syndrome (CBS) may be rarely associated with pseudarthrosis of tibia. Published literature includes only case reports. We evaluated the outcome of children with frank pseudarthrosis of the tibia with CBS and compared our results with other reported cases. We aimed to formulate a clinical classification of tibial involvement in CBS on the basis of the treatment guidelines. Seven patients with the presence of one or more constriction bands and radiological signs of tibial pseudarthrosis were included in the study. Eight reported cases of CBS with tibial involvement with management and follow-up details were reviewed. Only two tibial pseudarthrosis united spontaneously after the release of the constriction band. Two patients underwent simultaneous correction of tibial deformity and nailing with band release, one of which needed bone grafting for the pseudarthrosis union. Three patients subsequently needed an excision of tibial pseudarthrosis with nailing to achieve tibial union, two of them had autologous bone grafting along with nailing. Additional procedures were required for the correction of foot deformity and limb length discrepancy. Our findings were similar to the reported cases. The pseudarthrosis of the tibia with CBS does not always heal following band release. Additional surgeries may be required for persistent pseudarthrosis, limb length discrepancy and residual foot deformities. A functional and radiological classification is proposed for the treatment of tibial pseudarthrosis with CBS.
Risk Factors Associated with 90-day Readmissions Following Odontoid Fractures
Authors: von Glinski Alexander , Frieler Sven , Elia Christopher , Patchana Tye , Takayanagi Ariel , Arvind Varun , Pierre Clifford , Ishak Basem , Chapman Jens R. , Oskouian Rod J.
Published: February 2021

Study Design.

Nationwide Readmissions Database Study.

Objective.

The aim of this study was to investigate readmission rates and factors related to readmission after surgical and nonsurgical management of odontoid fractures.

Summary of Background Data.

Management of odontoid fractures, which are the most common isolated spine fracture in the elderly, continues to be debated. The choice between surgical or nonsurgical treatment has been reported to impact mortality and might influence readmission rates. Hospital readmissions represent a large financial burden upon our healthcare system. Factors surrounding hospital readmissions would benefit from a better understanding of their associated causes to lower health care costs

Methods.

A retrospective study was performed using the 2016 Healthcare Utilization Project (HCUP) Nationwide Readmission Database (NRD). Demographic information and factors associated with readmission were collected. Readmission rates, complications, length of hospital stay were collected. Patients treated operatively, nonoperatively, and patients who were readmitted or not readmitted were compared. Statistical analysis was performed using open source software SciPy (Python v1.3.0) for all analyses.

Results.

We identified 2921 patients who presented with Type II dens fractures from January 1, 2016 to September 30, 2016, 555 of which underwent surgical intervention. The readmission rate in patients who underwent surgery was 16.4% (91/555) and 29.4% (696/2366) in the nonoperative group. Hospital costs for readmitted and nonreadmitted patients were $353,704 and $174,922, and $197,099 and $80,715 for nonoperatively managed patients, respectively. Medicaid and Medicare patients had the highest readmission rate in both groups. Charlson and Elixhauser comorbidity indices were significantly higher in patients who were readmitted (P < 0.0001).

Conclusion.

We report an overall 90-day readmission rate of 16.4% and 29.4%, in operative and nonoperative management of type II odontoid fractures, respectively. In the face of a rising incidence of this fracture in the elderly population, an understanding of the comorbidities and age-related demographics associated with 90-day readmissions following both surgical and nonsurgical treatment are critical.

Level of Evidence: 3
Comparison of Zero-profile Anchored Spacer Versus Plate-and-Cage After 1-Level ACDF With Complete Uncinate Process Resection
Authors: Noh Sung Hyun , Park Jeong Yoon , Kuh Sung Uk , Chin Dong Kyu , Kim Keun Su , Cho Yong Eun , Kim Kyung Hyun
Published: February 2021

Study Design:

This is a retrospective study.

Objective:

The purpose of this study is to compare the zero-profile anchored spacer device (Zero-p) and traditional plate-and-cage implant (plate-and-cage) in anterior cervical discectomy and fusion (ACDF) with complete uncinate process resection (UPR) to treat 1-level cervical degenerative disk disease.

Summary of Background Data:

We retrospectively surveyed the data from all patients who underwent single-level ACDF with complete UPR between 2009 and 2013.

Patients and Methods:

In total, 80 patients participated in 3 years of follow-up. Among them, Zero-p (38 patients) and plate-and-cage (42 patients) approaches were used in ACDF with complete UPR. Clinical outcomes and radiographic results were compared between 2 groups and they were followed for 39.1±2.2 months.

Results:

Duration of operation, intraoperative blood loss, and length of hospitalization were significantly lower in the Zero-p group than the plate-and-cage group (P<0.001). The clinical outcomes of visual analog scale, neck disability index, and the Odom criteria were improved after operation in both groups. The fusion rates, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis, sellar turcica–C7 sagittal vertical axis, and spinocranial angle after single-level ACDF were not significantly different between the 2 groups. Subsidence occurred in 5 cases (13%) in the Zero-p group and 10 cases (37%) in the plate-and-cage group (P<0.05). The horizontal length of the Zero-p implant was longer than that of allograft bone. Fusion occurred in 37 cases (95%) of the Zero-p group and 40 cases (94%) in the plate-and-cage group.

Conclusions:

The Zero-p and plate-and-cage are effective when single-level ACDF with complete UPR was performed. Both groups showed good clinical outcomes, but Zero-p has more benefits than plate-and-cage such as lower duration of operation, intraoperative blood loss, length of hospitalization, and rate of subsidence compared with plate-and-cage. Surgeons should be aware of these results so that postoperative complications such as subsidence can be avoided.
Ameliorated Full-Endoscopic Transforaminal Decompression for L5–S1 Foraminal and Extraforaminal Stenosis
Authors: Yang Chang-Chen , Yeh Kuang-Ting , Liu Keng-Chang , Wu Wen-Tien
Published: February 2021

Study Design:

This is a retrospective review.

Objective:

To describe a modified surgical technique, full-endoscopic transforaminal decompression (FETD) in patients with L5–S1 foraminal stenosis or extraforaminal stenosis (EFS) and to detail the short-term results.

Summary of Background Data:

Performing FETD surgery for L5–S1 FS and EFS is challenging because of high iliac crests in most cases and the difficulty in accurately differentiating between FS and EFS by images preoperatively.

Material and Methods:

Patients who had solitary unilateral L5–S1 FS or EFS and had undergone FETD between October 2014 and December 2017 were included. In total, 22 patients underwent FETD for L5 root compressions at the L5–S1 levels. All patients were followed up for more than 1 year.

Results:

The mean visual analog scale score for back and leg pain, assessed preoperatively and at 12 months postoperatively, improved from 6.3±1.7 to 1.59±1.30 and from 7.29±0.78 to 1.41±1.20, respectively. The mean Oswestry Disability Index improved from 61.53% preoperatively to 15.8% at 12 months postoperatively. Neurovascular injury–related complications were absent in all these cases.

Conclusion:

Successful short-term clinical outcome is achievable using the ameliorated FETD technique for treating L5–S1 FS and EFS.
Clinical and Radiographic Outcomes Following Management of Benign Bone Lesions of the Hand With Calcium Phosphate Bone Cement
Authors: Jorgensen Anna , Johnson Jeremiah , Rodner Craig
Published: February 2021

Background:

Enchondromas are benign primary bone tumors that often occur in the hand. Surgical curettage is often indicated for symptomatic lesions, but controversy exists regarding whether and how best to fill the void. Autograft and allograft bone in addition to various types of plaster or cement are common means addressing the postexcision defect. This study reports long-term clinical and radiographic outcomes of excision with calcium phosphate bone cement (CPC) for benign bone lesions of the hand.

Methods:

This is a retrospective review of symptomatic benign bone lesions treated with curettage and CPC by a single surgeon with long-term follow-up. Following Institutional Review Board approval, consenting patients returned for postoperative research visits, during which radiographs were taken and functional outcome scores were measured.

Results:

Of the 7 patients who consented to participate, all initially presented with pain at the site of the tumor. Average follow-up time was over 6 years and overall functional outcome scores were good with early return to work. Cementation filled nearly the entire lesion on postoperative films and there were no postoperative fractures, infections, wound problems, or revision surgeries.

Conclusions:

This study reports good long-term radiographic and functional outcomes, without recurrences, in a series of patients with symptomatic benign bone lesions of the hand when treated with excision and CPC by a single surgeon.
Use of Machine Learning to Screen for Acute Respiratory Distress Syndrome Using Raw Ventilator Waveform Data
Authors: Rehm Gregory B. , Cortés-Puch Irene , Kuhn Brooks T. , Nguyen Jimmy , Fazio Sarina A. , Johnson Michael A. , Anderson Nicholas R. , Chuah Chen-Nee , Adams Jason Y.
Published: February 2021

Objectives:

To develop and characterize a machine learning algorithm to discriminate acute respiratory distress syndrome from other causes of respiratory failure using only ventilator waveform data.

Design:

Retrospective, observational cohort study.

Setting:

Academic medical center ICU.

Patients:

Adults admitted to the ICU requiring invasive mechanical ventilation, including 50 patients with acute respiratory distress syndrome and 50 patients with primary indications for mechanical ventilation other than hypoxemic respiratory failure.

Interventions:

None.

Measurements and Main Results:

Pressure and flow time series data from mechanical ventilation during the first 24-hours after meeting acute respiratory distress syndrome criteria (or first 24-hr of mechanical ventilation for non-acute respiratory distress syndrome patients) were processed to extract nine physiologic features. A random forest machine learning algorithm was trained to discriminate between the patients with and without acute respiratory distress syndrome. Model performance was assessed using the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value. Analyses examined performance when the model was trained using data from the first 24 hours and tested using withheld data from either the first 24 hours (24/24 model) or 6 hours (24/6 model). Area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value were 0.88, 0.90, 0.71, 0.77, and 0.90 (24/24); and 0.89, 0.90, 0.75, 0.83, and 0.83 (24/6).

Conclusions:

Use of machine learning and physiologic information derived from raw ventilator waveform data may enable acute respiratory distress syndrome screening at early time points after intubation. This approach, combined with traditional diagnostic criteria, could improve timely acute respiratory distress syndrome recognition and enable automated clinical decision support, especially in settings with limited availability of conventional diagnostic tests and electronic health records.
Hemophagocytic Lymphohistiocytosis in the Medical ICU: A Single-Institution Cohort Study on Acute Liver Failure and Mortality
Authors: Al Nasrallah Nawar , Al-Hader Ahmad , Samala Niharika , Sears Catherine R.
Published: February 2021

Objectives:

Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory disorder that is associated with high morbidity and mortality in the ICU. It has also been associated with acute liver failure.

Design:

Retrospective observational study.

Setting:

Tertiary-care medical ICU.

Patients:

Thirty-one patients critically ill with hemophagocytic lymphohistiocytosis.

Interventions:

None.

Measurements and Main Results:

We performed a comprehensive review of critically ill hemophagocytic lymphohistiocytosis patients admitted to a tertiary-care medical ICU from January 2012 to December 2018. Most patients presented with constitutional symptoms and elevated liver enzymes and thrombocytopenia were common upon hospital admission. ICU admission laboratory and clinical variables were used to calculate Acute Physiology and Chronic Health Evaluation II, hemophagocytic syndrome diagnostic score, and model for end-stage liver disease. Mean age of the cohort was 48.1 years, and 45% were male. The mortality rate was 65% at 28 days and 77% at 1 year. About 28-day survivors were younger, had lower mean Acute Physiology and Chronic Health Evaluation II score (16.5 vs 23.0; p = 0.004), and higher mean hemophagocytic syndrome diagnostic score (249.1 vs 226.0; p = 0.032) compared with nonsurvivors. Survivors were less likely to receive mechanical ventilation, renal replacement therapy, or vasopressor support and were more likely to receive chemotherapy for hemophagocytic lymphohistiocytosis. In this ICU cohort, 29% were diagnosed with acute liver failure, of whom only 22% developed acute liver failure early during their hospital stay. Acute liver failure was associated with a higher model for end-stage liver disease score upon hospital admission. Available histology in those that developed acute liver failure showed massive hepatic necrosis, or histiocytic or lymphocytic infiltrates.

Conclusions:

Patients admitted to the ICU with hemophagocytic lymphohistiocytosis have a high mortality. Those who survived had lower Acute Physiology and Chronic Health Evaluation scores, had higher hemophagocytic syndrome diagnostic scores, are more likely to receive hemophagocytic lymphohistiocytosis specific chemotherapy, and are less likely to have organ failure. Hemophagocytic lymphohistiocytosis can be associated with acute liver failure especially when model for end-stage liver disease score is elevated upon admission.