bluuebunny/crossref_metadata_2025 huggingface dataset:
Generalizability of Randomized Clinical Trial Outcomes for Diabetes Control Resulting From Bariatric Surgery
Authors: Livingston Edward H. , Zelicha Hila , Dutson Erik P. , Li Zhaoping , Maciejewski Matthew L. , Chen Yijun
Published: April 2024

Objective:

To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control.

Background:

Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world. There is a need to assess how the results of RCTs generalize to all contemporary patient populations undergoing treatments.

Methods:

All patients undergoing sleeve gastrectomy at University of California Los Angeles (UCLA) between January 8, 2018 and May 19, 2023 had their baseline characteristics, weight change, and diabetes control compared with those enrolled in the surgical treatment and medications potentially eradicate diabetes efficiently (STAMPEDE) and diabetes surgery study (DSS) RCTs of bariatric surgery’s effect on diabetes control. Weight loss and diabetes control were compared between UCLA patients who did and did not fit the entry criteria for these RCTs.

Results:

Only 65 (17%) of 387 patients with diabetes fulfilled the eligibility criteria for STAMPEDE, and 29 (7.5%) fulfilled the criteria for DSS due to being older, having higher body mass index, and lower HbA1c. UCLA patients experienced slightly less weight loss than patients in the RCTs but had similar diabetes control. The 313 (81%) patients not eligible for study entry into either RCT had similar long-term diabetes control as those who were eligible for the RCTs.

Conclusions:

Even though only a very small proportion of patients undergoing bariatric surgery met the eligibility criteria for the 2 major RCTs, most patients in this contemporary cohort had similar outcomes. Diabetes outcomes from STAMPEDE and DSS generalize to most patients undergoing bariatric surgery for diabetes control.
The Intermalleolar Method for Intraoperative Rotational Assessment of the Tibia – A Prospective Clinical Validation Study
Authors: Roberts Michael S. , Conroy Jordan P. , DeSarno Michael , Blankstein Michael , Hahn Jesse C. , Bartlett Craig S. , Schottel Patrick C.
Published: April 2024

OBJECTIVES:

To determine the accuracy of the intermalleolar method, an intraoperative fluoroscopic method for assessing tibial rotation in patients undergoing intramedullary nail fixation for tibial shaft fractures, by comparing it to the gold standard, computed tomography (CT).

METHODS:

Design: Prospective cohort study

Setting:

Academic Level 1 trauma center

Patient Selection Criteria:

Consecutive patients, age 18 years and older, with unilateral tibial shaft fractures who underwent intramedullary fixation from September, 2021 to January, 2023.

Outcome Measures and Comparisons:

Intraoperatively, tibial rotation measurements were performed using the intermalleolar method on both the uninjured and injured limbs. Postoperatively, patients underwent bilateral low-dose lower extremity rotational CT scans. CT measurements were made by four blinded observers. Mean absolute rotational differences and standard errors were calculated to compare the injured and uninjured limbs. Subgroup analysis was performed assessing accuracy relating to injured versus uninjured limbs, BMI, AO/OTA fracture pattern, tibial and fibular fracture location, and distal articular fracture extension requiring fixation.

RESULTS:

Of the 20 tibia fractures, the mean patient age was 43.4 years. The intermalleolar method had a mean absolute rotational difference of 5.1 degrees (SE 0.6, range 0 – 13.7) compared to CT. Sixty percent (24/40) of the measurements were within 5 degrees, 90% (36/40) of the measurements were within 10 degrees, and 100% (40/40) were within 15 degrees of the CT. No patients were revised for malrotation postoperatively.

CONCLUSION:

The intermalleolar method is accurate and consistently provides intraoperative tibial rotation measurements within 10 degrees of the mean CT measurement for adult aged patients undergoing intramedullary nail fixation for unilateral tibial shaft fractures. This method may be employed in the operating room to accurately quantify tibial rotation and assist with intraoperative rotational corrections.

LEVEL OF EVIDENCE:

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Comparison of different interposition techniques after surgical resection of tarsal coalitions in children: a systematic review
Authors: Spaans Anne J. , Korbee Susanne E. , Simoens Nathalie C. , van Bergen Christiaan J.A.
Published: April 2024

In the surgical treatment of tarsal coalitions, it is unclear whether interposition material should be used to prevent recurrence. The aim of this review was to systematically examine the results of different interposition tissues after surgical resection of tarsal coalitions in children. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent investigators systematically searched electronic databases (PubMed, Embase, Cochrane) and included original articles reporting outcomes of tarsal coalition resection. The quality of included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Out of 294 articles, 21 studies examining 436 patients (581 feet), were included. The mean age was 12.2 years (range 7–18). There were 153 talocalcaneal, 425 calcaneonavicular, 2 naviculocuboidal, and 1 naviculocuneiform coalitions. The mean follow-up time was 58 months (range 12–276). In 96 feet, solely resection was performed. Resection and interposition were performed with muscle/tendon (n = 178), fat graft (n = 176), other material (n = 36), or a combination of interposition techniques (n = 95). Eighteen studies reported on recurrence, which was found in 45 of 485 feet (9%). The highest recurrence (17%) was described after muscle/tendon interposition for calcaneonavicular coalitions. However, a statistical comparison could not be performed. The included studies were diverse and the scientific quality was generally low (MINORS mean 7, range 3–20). Coalition resection with various interposition techniques results in low recurrence rates. It is unclear which interposition material shows the best results.
Surgery for Spinal Stenosis in Achondroplasia: Causes of Reoperation and Reduction of Risks
Authors: Hariharan Arun R. , Nugraha Hans K. , Huser Aaron J. , Feldman David S.
Published: April 2024

Background:

Individuals with achondroplasia are prone to symptomatic spinal stenosis requiring surgery. Revision rates are thought to be high; however, the precise causes and rates of reoperation are unknown. The primary aim of this study is to investigate the causes of reoperation after initial surgical intervention in individuals with achondroplasia and spinal stenosis. In addition, we report on surgical techniques aimed at reducing the risks of these reoperations.

Methods:

A retrospective review was conducted over an 8-year period of all patients with achondroplasia at a single institution that serves as a large referral center for patients with skeletal dysplasias. Patients with achondroplasia who underwent spinal surgery for stenosis were identified and the need for revision surgery was studied. Data collected included demographic, surgical, and revision details. Fisher exact test was used to determine if an association existed between construct type and the need for revisions.

Results:

Thirty-three of the 130 (22%) patients with achondroplasia required spinal stenosis surgery. Twenty-four individuals who met the criteria were selected for analysis. The initial spine surgery was at an average age of 18.7 years (SD: 10.1 y). Nine patients (38%) required revision surgeries, and 3 required multiple revisions. Five of 9 (56%) of the revisions had primary surgery at an outside institution. Revision surgeries were due to caudal pseudarthrosis (the distal instrumented segment) (8), proximal junctional kyphosis (PJK) (7), and new neurological symptoms (7). There was a significant association found between construct type and the need for revision (P=0.0111). The pairwise comparison found that short fusions were significantly associated with the need for revision compared with the interbody group (P=0.0180). PJK was associated with short fusions when compared with the long fusion group (P=0.0294) and the interbody group (P=0.0300). Caudal pseudarthrosis was associated with short fusions when compared with the interbody group (P=0.0015). Multivariate logistic regression found long fusion with an interbody was predictive of and protective against the need for revision surgery (P=0.0246). To date, none of the initial cases that had long fusions with caudal interbody required a revision for distal pseudarthrosis.

Conclusions:

In patients with achondroplasia, the rate of surgery for spinal stenosis is 22% and the risk of revision is 38% and is primarily due to pseudarthrosis, PJK, and recurrent neurological symptoms. Surgeons should consider discussing spinal surgery as part of the patient’s life plan and should consider wide decompression of the stenotic levels and long fusion with the use of an interbody cage at the caudal level in all patients to reduce risks of revision.

Level of Evidence:

Level IV—Retrospective case series.
Postoperative Patient Portal Messaging Is Associated With Return to the Emergency Department After Lumbar Spine Surgery
Authors: Chua Theresa L. , Lucaciu Andreea R. , Jeffers Tierney R. , Fogel Harold A. , Hershman Stuart H. , Bernstein David N. , Tobert Daniel G.
Published: April 2024

Study Design.

Retrospective study.

Objective.

To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) postoperatively and emergency department (ED) visits within 90 days of surgery.

Summary of Background Data.

Secure patient messaging through electronic patient portals has grown over recent years. Despite its frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery.

Materials and Methods.

This study was approved by our Institutional Review Board. Inclusion criteria were adults who underwent single-stage lumbar spine surgery between January 2016 and June 2023. Patients with incomplete information, multistage surgeries, and those who died within 90 days of surgery were excluded. Patient sociodemographic, surgical, hospital readmission, and patient-provider engagement data were collected.

Results.

A total of 13,135 patients were included. A total of 1711 patients (13%) had a postoperative ED visit, and 4791 patients (36%) used the patient portal to send a message after surgery. Sending a postoperative patient message after undergoing lumbar spine surgery was associated with an increased likelihood of having an ED visit that does not lead to readmission (1.29 [1.10–1.53], P = 0.002). Patients with high school degrees were more likely to have an ED visit without readmission (1.33 [1.08–1.65], P = 0.008).

Conclusion.

Patients at a higher risk of presenting to the ED postoperatively should be identified and may benefit from additional counseling and access to the care team virtually to limit unnecessary healthcare utilization. Focusing on patients who reach out via EPP messaging postoperatively may be a good target patient group to address first. Future research is needed to investigate the possible health literacy and other socioeconomic barriers affecting these patients so that appropriate, more cost-effective resources can be utilized to avoid clinically unnecessary and costly ED visits.
First-Line Respiratory Support for Children With Hematologic Malignancy and Acute Respiratory Failure
Authors: Asif Hassaan , McNeer Jennifer L. , Ghanayem Nancy S. , Cursio John F. , Kane Jason M.
Published: April 2024

OBJECTIVES:

To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV.

DESIGN:

Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019.

SETTING:

One hundred thirteen North American PICUs participating in VPS.

PATIENTS:

Two thousand four hundred eighty children 0–21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2% (p < 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, p < 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, p < 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, p < 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia.

CONCLUSIONS:

For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM.
One-Year Recovery Among Survivors of Prolonged Severe COVID-19: A National Multicenter Cohort
Authors: Makam Anil N. , Burnfield Judith , Prettyman Ed , Nguyen Oanh Kieu , Wu Nancy , Espejo Edie , Blat Cinthia , Boscardin W. John , Ely E. Wesley , Jackson James C. , Covinsky Kenneth E , Votto John ,   for the Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) Study
Published: April 2024

OBJECTIVES:

Understanding the long-term effects of severe COVID-19 illness on survivors is essential for effective pandemic recovery planning. Therefore, we investigated impairments among hospitalized adults discharged to long-term acute care hospitals (LTACHs) for prolonged severe COVID-19 illness who survived 1 year.

DESIGN:

The Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) study was a national, multicenter, prospective longitudinal cohort study.

SETTING AND PATIENTS:

We included hospitalized English-speaking adults transferred to one of nine LTACHs in the United States between March 2020 and February 2021 and completed a survey.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Validated instruments for impairments and free response questions about recovering. Among 282 potentially eligible participants who provided permission to be contacted, 156 (55.3%) participated (median age, 65; 38.5% female; 61.3% in good prior health; median length of stay of 57 d; 77% mechanically ventilated for a median of 26 d; 42% had a tracheostomy). Approximately two-thirds (64%) had a persistent impairment, including physical (57%), respiratory (49%; 19% on supplemental oxygen), psychiatric (24%), and cognitive impairments (15%). Nearly half (47%) had two or more impairment types. Participants also experienced persistent debility from hospital-acquired complications, including mononeuropathies and pressure ulcers. Participants described protracted recovery, attributing improvements to exercise/rehabilitation, support, and time. While considered life-altering with 78.7% not returning to their usual health, participants expressed gratitude for recovering; 99% returned home and 60% of previously employed individuals returned to work.

CONCLUSIONS:

Nearly two-thirds of survivors of among the most prolonged severe COVID-19 illness had persistent impairments at 1 year that resembled post-intensive care syndrome after critical illness plus debility from hospital-acquired complications.
Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study*
Authors: Henríquez-Beltrán Mario , Vaca Rafaela , Benítez Iván D. , González Jessica , Santisteve Sally , Aguilà Maria , Minguez Olga , Moncusí-Moix Anna , Gort-Paniello Clara , Torres Gerard , Labarca Gonzalo , Caballero Jesús , Barberà Carme , Torres Antoni , de Gonzalo-Calvo David , Barbé Ferran , Targa Adriano D. S.
Published: April 2024

OBJECTIVES:

To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context.

DESIGN:

Observational, prospective study.

SETTING:

Single-center study.

PATIENTS:

Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The cohort was composed of 260 patients (69.2% males), with a median (quartile 1–quartile 3) age of 61.5 years (52.0–67.0 yr). The median length of ICU stay was 11.0 days (6.00–21.8 d), where 56.2% of the patients required invasive mechanical ventilation (IMV). The Pittsburgh Sleep Quality Index (PSQI) revealed that 43.1% of the cohort presented poor sleep quality 12 months after hospital discharge. Actigraphy data indicated an influence of the disease severity on the fragmentation of the circadian rest-activity rhythm at the 3- and 6-month follow-ups, which was no longer significant in the long term. Still, the length of the ICU stay and the duration of IMV predicted a higher fragmentation of the rhythm at the 12-month follow-up with effect sizes (95% CI) of 0.248 (0.078–0.418) and 0.182 (0.005–0.359), respectively. Relevant associations between the PSQI and the Hospital Anxiety and Depression Scale (rho = 0.55, anxiety; rho = 0.5, depression) as well as between the fragmentation of the rhythm and the diffusing lung capacity for carbon monoxide (rho = –0.35) were observed at this time point.

CONCLUSIONS:

Our findings reveal a great prevalence of critical survivors presenting poor sleep quality 12 months after hospital discharge. Actigraphy data indicated the persistence of circadian alterations and a possible impact of the disease severity on the fragmentation of the circadian rest-activity rhythm, which was attenuated at the 12-month follow-up. This altogether highlights the relevance of considering the sleep and circadian health of critical survivors in the long term.
Early Experience With Biologically Effective Dose-Comparable Short-Course Whole Brain Radiation Therapy for Metastatic Intracranial Disease
Authors: McClelland Shearwood
Published: April 2024

Background:

For inpatients with metastatic intracranial disease burden exceeding established guidelines for stereotactic radiosurgery (SRS), the standard of care involves whole brain radiation therapy (WBRT), typically administered as a 2-week course of treatment with biologically effective dose (BED) of 60 Gy. However, shorter course WBRT provides theoretical advantages in quality of life and decreasing systemic therapy delay. This retrospective study evaluates our early experience with BED-comparable short-course WBRT (23 Gy in 5 fractions; BED=58.3 Gy) for metastatic intracranial disease.

Methods:

Over a recent 2-month timeframe, 3 inpatients with intracranial disease burden exceeding SRS guidelines were administered BED-comparable short-course WBRT. Due to the high intracranial disease burden, 23 Gy was chosen over 20 Gy for 5-fraction WBRT due to the desire to optimally mimic the durability of the classic 30 Gy in 10 fraction treatment regimen.

Results:

The mean age at treatment was 65.7 years, the mean Karnofsky Performance Status (KPS) was 60, and the mean number of intracranial metastases was 20.3. The mean duration between inpatient Radiation Oncology consultation and the start of WBRT (following CT radiation therapy simulation) was 6.7 days. All patients completed WBRT no later than 2 weeks from the initial inpatient consultation.

Conclusions:

For inpatients with intracranial metastatic disease burden exceeding established SRS guidelines, BED-comparable short-course WBRT administered to 23 Gy in 5 fractions (4.6 Gy/fraction) is safe and efficacious. Given previous literature indicating that nearly half of the patients prescribed traditional 2-week WBRT die without completing treatment, BED-comparable WBRT represents an attractive and promising WBRT alternative in this patient population.
One-Year Safety Evaluation of New Hyaluronic Acid Fillers (YYS Series): A Prospective, Multicenter, Observational Study
Authors: Park Su Jung , Yoo Kwang Ho
Published: April 2024

BACKGROUND

With the continuous increasing availability of new filler products, each hyaluronic acid filler brand has distinctive pharmacokinetics, which may be associated with different complications. Therefore, the long-term safety of new generations of fillers should be evaluated.

OBJECTIVE

This prospective, multicenter, observational, postmarketing study (ClinicalTrials.gov identifier: NCT04738019) aimed to investigate the incidence of delayed-onset nodules and adverse reactions after the injection of new hyaluronic acid fillers (YYS series) into the facial skin.

METHODS

Subjects scheduled to receive an injection YYS series filler were followed up for 52 weeks. The authors aimed to determine the incidence of a self-reported delayed-onset nodule—a visible or palpable nodule or mass at the injection site that was detected beyond the 14th day following the injection—during the 1-year follow-up period.

RESULTS

Among the 1,022 subjects who received an injection of the YYS series, the incidences of delayed-onset nodules were 0% for YYS 360, YYS 540, and YYS 720. A 0.21% incidence (1 delayed hypersensitivity reaction) of a delayed-onset adverse reaction was noted for YYS 720, although none were reported for YYS 360 and YYS 540.

CONCLUSION

In this study, a notably low frequency of adverse reactions associated with the YYS series was observed.
A Systematic Review of the Epidemiology, Clinical Characteristics, Treatment, and Outcomes for Desmoplastic Trichoepithelioma: Underscoring Mohs Micrographic Surgery in Management
Authors: Nanda Rahul , Srivastava Divya , Nijhawan Rajiv I.
Published: April 2024

BACKGROUND

Desmoplastic trichoepithelioma (DTE) is an uncommon benign adnexal tumor that histologically may mimic malignant tumors including basal cell carcinoma and microcystic adnexal carcinoma.

OBJECTIVE

To present a systematic review of the epidemiology, clinical characteristics, treatment, and outcome data on DTEs, with emphasis on comparing Mohs micrographic surgery (MMS) with other treatments.

METHODS

Using the OVID platform, MEDLINE and Embase were searched from inception for studies providing original data on DTEs.

RESULTS

A total of 338 cases of DTE from 61 articles were included. No recurrence/persistence (0%) was reported following MMS (n = 24, mean follow-up of 41.9 months), 13.1% with standard excision (n = 38, mean follow-up 16.9 months), and 2.1% for electrosurgery/cautery (n = 49, follow-up 3–72 months). 100% recurrence/persistence for imiquimod (n = 2) and liquid nitrogen (n = 4) were identified. In patients who underwent biopsy only, there was a 12.5% recurrence/persistence (n = 32, mean follow-up 16.5 months). Overall, duration of follow-up varied from 2 months to 6 years for the various management strategies.

CONCLUSION

Data are limited regarding DTE outcomes. In this review, surgical modalities, specifically MMS, had the lowest rates of recurrence/persistence compared with other options. Given that most lesions are found on cosmetically sensitive locations, MMS seems to be the optimal management strategy for actively managing DTEs.
Reporting and Description of Research Methodology in Studies Estimating Effects of Firearm Policies
Authors: Rencken Camerin A. , Schleimer Julia P. , Miller Matthew , Swanson Sonja A. , Rowhani-Rahbar Ali
Published: April 2024

Background:

Evidence about which firearm policies work, to what extent, and for whom is hotly debated, perhaps partly because variation in research methodology has produced mixed and inconclusive effect estimates. We conducted a scoping review of firearm policy research in the health sciences in the United States, focusing on methodological considerations for causal inference.

Methods:

We identified original, empirical articles indexed in PubMed from 1 January 2000 to 1 September 2021 that examined any of 18 prespecified firearm policies. We extracted key study components, including policy type(s) examined, policy operationalization, outcomes, study setting and population, study approach and design, causal language, and whether and how authors acknowledged potential sources of bias.

Results:

We screened 7733 articles and included 124. A plurality of studies used a legislative score as their primary exposure (n = 39; 32%) and did not examine change in policies over time (n = 47; 38%). Most examined firearm homicide (n = 51; 41%) or firearm suicide (n = 40; 32%) as outcomes. One-third adjusted for other firearm policies (n = 41; 33%). Three studies (2%) explicitly mentioned that their goal was to estimate causal effects, but over half used language implying causality (n = 72; 58%). Most acknowledged causal identification assumptions of temporality (n = 91; 73%) and exchangeability (n = 111; 90%); other assumptions were less often acknowledged. One-third of studies included bias analyses (n = 42; 34%).

Conclusions:

We identified a range of methodologic approaches in firearm policy research in the health sciences. Acknowledging the imitations of data availability and quality, we identify opportunities to improve causal inferences about and reporting on the effects of firearm policies on population health.
Poor ovarian response classification systems in the clinical setting – time for an update?
Authors: Reig Andres , Seli Emre
Published: April 2024

Purpose of review

Poor ovarian response (POR) remains a key challenge to the success of assisted reproductive technology. Here, we offer a comprehensive review of the two main classification systems for POR, discussing their promises and pitfalls, evaluating their performance, and exploring potential avenues for improving upon these definitions of POR.

Recent findings

The Bologna criteria represented the first meaningful attempt to create a universal POR definition. Subsequently, the POSEIDON classification system was published to provide a more nuanced view of POR, classifying patients into four groups based on age and ovarian reserve markers. A recent study evaluated the likelihood of achieving at least one euploid embryo for transfer and found that, indeed, these classification systems are effective predictors of this outcome.

While these criteria provide an effective counseling tool, several limitations – not considering underlying conditions, selecting somewhat arbitrary cutoffs, and evaluating the number of oocytes retrieved regardless of maturity – highlight the importance of improving upon these systems to create a more useful tool to more accurately predict ovarian response for clinical and research purposes.

In the era of personalized medicine, it is time to reconsider whether diagnostic criteria for a continuous metric such as ovarian response should be based on meeting all-or-nothing thresholds for specific parameters.
Socioecological factors influencing physical activity engagement for women across the menopausal transition: a systematic review
Authors: Casey Meghan , Dabkowski Elissa , de Gracia Ma Regina L. , Moore Kathleen A. , Kennedy Gerard A. , Porter Joanne E. , Nasstasia Yasmina , Alvarenga Marlies E.
Published: April 2024

Importance

Physical activity during menopause can be effective in reducing the physiological changes associated with reproductive aging that increase risks for noncommunicable diseases, yet many women do not meet the recommendations for physical activity.

Objective

This study aimed to synthesize factors influencing physical activity for women across menopausal transition phases using a socioecological approach.

Evidence Review

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to systematically search 10 databases between 2001 and 2021. A comprehensive search strategy was used to identify studies on physical activity of women in various stages of menopause. A socioecological model was used to categorize the reported barriers and enablers.

Findings

Twenty studies met the inclusion criteria. The findings highlight several intrapersonal barriers such as existing health complaints versus enablers such as awareness of the health benefits of physical activity during menopause. Ensuring women's safety, preventing injury, and enhancing exercise self-efficacy were important components of programs. Social support was also an important enabler of women's engagement in activities.

Conclusions and Relevance

Several barriers and enablers were identified and can inform practitioners and future interventions to encourage physical activity among women in various stages of menopause. For instance, when encouraging physical activity during menopause, practitioners should consider other health complaints, safety, and injury prevention while discussing the benefits of physical activity related to managing menopausal symptoms. There was a lack of theoretically informed studies exploring the barriers and enablers to physical activity for women in various stages of menopause; thus, research designs may not have fully accounted for influences. Future research that combines socioecological and individual theories of behavior is needed to comprehensively understand the complexity of physical activity among women across the menopausal transition.
Analysis of Major and Minor Pedicles in Flap Perfusion by Computational Fluid Dynamics
Authors: Izadpanah Amin , Jansen David A. , Alt Eckhard U. , Izadpanah Reza
Published: April 2024

Background:

Type 2 muscle flaps are characterized by major and minor pedicles, such that the minor pedicle is unreliable, and the major pedicle is a requirement for the success of the flap. The role of the minor pedicle, beyond the decreased caliber and decreased vascular territory in comparison to the major pedicle, is poorly understood. We sought to model the fluid dynamics of a model flap containing a major and minor pedicle to understand differences between the pedicles and the implications on perfusion.

Methods:

We first generated a computer-assisted design model of a type 2 flap with a major and minor pedicle. We then performed computational fluid dynamics to analyze velocities and flow within the pedicles and flap.

Results:

In our investigation, we found that the flow velocity within the major pedicle was higher than the minor pedicle, indicative of decreased resistance to flow. Concomitantly, we found decreased pressures within the major pedicle, reflecting decreasing resistance to flow. Interestingly, we found increased kinematic viscosity in flap areas supplied by the minor pedicle, suggesting decreased flow rates and increased resistance.

Conclusions:

We identified that the major pedicle has increased flow velocity, decreased resistance, and decreased kinematic viscosity, suggesting its dominance in maintaining flap perfusion. Our study also identifies computational fluid dynamics as a powerful tool in studying flap perfusion dynamics.
Incidence of liver cancer in young adults according to the Global Burden of Disease database 2019
Authors: Danpanichkul Pojsakorn , Aboona Majd B. , Sukphutanan Banthoon , Kongarin Siwanart , Duangsonk Kwanjit , Ng Cheng Han , Muthiah Mark D. , Huang Daniel Q. , Seko Yuya , Díaz Luis Antonio , Arab Juan Pablo , Yang Ju Dong , Chen Vincent L. , Kim Donghee , Noureddin Mazen , Liangpunsakul Suthat , Wijarnpreecha Karn
Published: April 2024

Background and Aims:

The worldwide burden of cancer is increasing in younger populations. However, the epidemiology of primary liver cancer remains understudied in young adults compared to other cancer forms.

Approach and Results:

This study analyzed data from the Global Burden of Disease study between 2010 and 2019 to assess the age-standardized incidence, mortality, and disability-adjusted life years associated with primary liver cancer in the young (15–49 y), stratified by region, nation, sociodemographic index, and sex. The study found a global estimate of 78,299 primary liver cancer cases, 60,602 deaths, and 2.90 million disability-adjusted life years in the young population. The Western Pacific region exhibited the highest burden in 2019, showing the most significant increase compared to other regions between 2010 and 2019. More than half of the countries worldwide have undergone an increase in primary liver cancer incidence rates in young adults. Around 12.51% of deaths due to primary liver cancer occur in young individuals. Throughout the study period, there was a significant decline in primary liver cancer mortality due to most etiologies, except for metabolic dysfunction–associated steatotic liver disease-attributable primary liver cancer (annual percentage change + 0.87%, 95% CI: 0.70%–1.05%) and alcohol-attributable primary liver cancer (annual percentage change + 0.21%, 95% CI: 0.01%–0.42%). The limitations of the Global Burden of Disease database include reliance on the quality of primary data and possible underestimation of alcohol consumption.

Conclusions:

Over the past decade, there has been a marked increase in the burden of primary liver cancer, especially that originating from steatotic liver disease. This trend calls for the development of urgent and comprehensive strategies to mitigate this rising burden globally.
SPONTANEOUS RESOLUTION OF SUBFOVEAL PERFLUOROCARBON: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: A Hermosa , JI Vela , I Loscos-Giménez , A Verdú , D Rego-Lorca
Published: April 2024

Purpose:

To report a case of spontaneous resolution of subfoveal perfluorocarbon liquid (sPFCL). Methods: A 72-year-old male presented with poor vision in the left eye for two months. Ophthalmic examination revealed a visual acuity of counting fingers at 40 cm, pseudophakia, and rhegmatogenous retinal detachment in the left eye. The patient underwent 23G pars plana vitrectomy associated with a scleral buckle and silicone oil. Postoperatively, a retained sPFCL bubble was observed on OCT image. Results: Postoperatively, the sPFCL bubbles disappeared spontaneously by a full-thickness macular hole. Four weeks after surgery, the macular hole was closed, and visual acuity improved with preservation of foveal depression. Conclusion: Because spontaneous resolution rarely occurs, retinal surgeons prefer early evacuation of sPFCL. Herein, we report a new case of spontaneously resolved sPFCL and discuss the mechanisms for its resolution reported in the literature.
Breaking Barriers in Behavioral Change: The Potential of Artificial Intelligence-Driven Motivational Interviewing
Authors: Abid Areeba , Baxter Sally L.
Published: April 2024

Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma, where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is motivational interviewing (MI), a collaborative and patient-centered counseling approach that has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure the accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven motivational interviewing has the potential to offer significant improvements in adherence and should be further explored to maximally leverage the potential of artificial intelligence for our patients.
Repeatability of Online Circular Contrast Perimetry Compared to Standard Automated Perimetry
Authors: Meyerov Joshua , Chen Yang , Busija Lazar , Green Catherine , Skalicky Simon E.
Published: April 2024

Précis:

Online circular contrast perimetry provides visual field assessment on any computer or tablet with no extra hardware. It has good test repeatability and reliability that is comparable with standard automated perimetry. It holds promise for use in disease screening and surveillance to expand the provision of glaucoma care.

Purpose:

To evaluate the repeatability of online circular contrast perimetry (OCCP) compared to standard automated perimetry (SAP) in normal participants and patients with stable glaucoma over 18 weeks.

Methods:

Thirty-six participants (13 normal controls and 23 patients with open angle glaucoma) were recruited. OCCP and SAP perimetry tests were performed twice at baseline, then at 6, 12, and 18 weeks. Global perimetric indices were compared between perimetry types and analyzed for short-term and intermediate-term repeatability.

Results:

There were no statistically significant changes over time for both OCCP and SAP across all groups for mean deviation (MD), pattern standard deviation, and visual index/visual field index (P>0.05). Test-retest intraclass correlation coefficients (ICCs) for OCCP MD were excellent at baseline (0.98, 95% CI: 0.89–0.99) and good at 18 weeks (0.88, 95% CI: 0.51–0.98). SAP test-retest ICCs were excellent at baseline (0.94, 95% CI: 0.70–0.99) and 18 weeks (0.97, 95% CI: 0.84–0.99). Inter-test ICCs were good, ranging from 0.84 to 0.87. OCCP testing time was shorter than SAP (5:29 ± 1:24 vs. 6:00 ± 1:05, P<0.001). OCCP had similar false-positive (3.84 ± 3.32 vs. 3.66 ± 4.53, P=0.48) but lower false-negative (0.73 ± 1.52 vs. 4.48 ± 5.00, P<0.001) and fixation loss responses (0.91 ± 1.32 vs. 2.02 ± 2.17, P<0.001).

Conclusions:

OCCP allows visual field assessment on any computer screen with no additional hardware. It demonstrated good repeatability and reliability with similar performance indices to SAP in both the short term and intermediate term. OCCP has the potential to be utilized as a glaucoma screening and surveillance tool for in-clinic and at-home testing, expanding the provision of care.
Pediatric chronic pain grading: a revised classification of the severity of pediatric chronic pain
Authors: Grothus Susanne , Sommer Ariane , Stahlschmidt Lorin , Hirschfeld Gerrit , Höfel Lea , Linder Roland , Zernikow Boris , Wager Julia
Published: April 2024

In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; Mage = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (Mage = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
Can Slow Personalized Titration Using C-Reactive Protein Monitoring Decrease the High Rates and Mortality of Clozapine-Associated Myocarditis Seen in Some Countries? A Call for Research
Authors: de Leon Jose
Published: April 2024

Purpose/Background

The hypothesis that slower personalized titration may prevent clozapine-associated myocarditis and decrease the disproportion incidence of 3% found in Australia was not described in a recent Australian article in this journal.

Methods

Six countries in addition to Australia have published information suggesting a similar incidence of clozapine-associated myocarditis. On September 19, 2023, PubMed searches were updated for articles from the United States, Korea, Japan, Canada, New Zealand, and Turkey.

Findings/Results

An incidence of 3.5% (4/76) was found in a US hospital, but US experts were the first to propose that clozapine-associated myocarditis may be a hypersensitivity reaction associated with rapid titration and possibly preventable. Koreans and Japanese are of Asian ancestry and need lower minimum therapeutic doses for clozapine than patients of European ancestry. A 0.1% (2/1408) incidence of myocarditis during clozapine titration was found in a Korean hospital, but pneumonia incidence was 3.7% (52/1408). In 7 Japanese hospitals, 34% (37/110) of cases of clozapine-associated inflammation were found during faster titrations (based on the official Japanese titration) versus 13% (17/131) during slower titrations (based on the international titration guideline for average Asian patients). Recent limited studies from Canada, New Zealand, and Turkey suggest that slower personalized titration considering ancestry may help prevent clozapine-associated myocarditis.

Implications/Conclusions

Other countries have very limited published data on clozapine-associated myocarditis. Based on a recent Australian case series and these non-Australian studies, the author proposes that Australia (and other countries) should use slow personalized titration for clozapine based on ancestry and c-reactive protein monitoring.
Responsible Development of Emerging Technologies
Authors: Schulte Paul A. , Leso Veruscka , Iavicoli Ivo
Published: April 2024

Objectives

This paper identifies approaches to the responsible development of emerging technologies to secure worker safety and health.

Methods

A retrospective analysis was used to describe the history of the responsible development of worker protection from engineered nanomaterials. Lessons from that history were extended and applied to emerging technologies and illustrated in three examples: advanced manufacturing, synthetic biology, and artificial intelligence.

Results

The same principles used to underpin responsible development of nanotechnology can be applied to emerging technologies. Five criterion actions were identified that embody these principles.

Conclusion

Responsible development of emerging technologies requires anticipating hazards and risks and ethical issues attendant to them. Occupational and environment health specialists are often called upon to provide guidance on emerging technologies and the approach described here can serve as a basis for that guidance.
The Psychosocial, Organizational, and Environmental Stressors Experienced by Food Service Workers in a Hospital Setting During the COVID-19 Pandemic
Authors: Kent Karen Butcher , Zhang Ying , Roemer Enid Chung , Davis Meghan F. , Safeer Richard , Mojica Angelo , Goetzel Ron Z.
Published: April 2024

Objective

To identify stressors faced by hospital food service workers amid the COVID-19 pandemic and effective interventions mitigating these stressors. Methods: In this cross-sectional study, we conducted surveys (n = 305) and interviews (n = 9) in the summer and fall of 2022 with employees in hospital settings to determine the psychosocial, organizational, and environmental stressors they faced during the COVID-19 pandemic and interventions that improved health and well-being. Findings: The main stressors reported were fear of infection, increased work demands and schedule unpredictability, and financial insecurity. Employee well-being was bolstered by regular, clear, bidirectional communication; a sense of community and purpose; benefits like paid sick leave and health insurance coverage; and organizational policies that included masking and vaccine requirements demonstrating commitment to protecting worker health. Conclusion: Organizations can play a critical role in guarding the health, well-being, and resilience of frontline workers.
Effects of Occupational Noise Exposure on Hearing Loss
Authors: Zhou Zhi , Lang Ling , Xie Juan
Published: April 2024

Objective

To assess regulatory effect of Mediterranean diet for occupational noise exposure and hearing loss. Methods: This cross-sectional study included 4757 individuals. Weighted logistic regression model was adopted to explore the association of occupational noise exposure and Mediterranean diet with hearing loss, and regulatory effects of the Mediterranean diet for the relationship of occupational noise exposure and hearing loss. Results: Occupational noise exposure was associated with an increased odds of hearing loss. Under low adherence to the Mediterranean diet, the occupational noise exposure group was related to increased odds of hearing loss. Under high adherence to the Mediterranean diet, no significant difference was observed between occupational noise exposure and hearing loss, and adjusted effect size was reduced accordingly. Conclusion: Mediterranean diet may moderate this relationship of occupational noise exposure and hearing loss to some degree.