bluuebunny/crossref_metadata_2025_split huggingface dataset:
Misuse of Tramadol in the United States: An Analysis of the National Survey of Drug Use and Health 2002-2017
Authors: Reines Scott A , Goldmann Bonnie , Harnett Mark , Lu Lucy 
Published: June 2020

Objective: To analyze the rates of misuse - that is, use in any way not directed by a doctor - of products containing oral tramadol, a Schedule IV opioid, from the National Survey of Drug Use and Health (NSDUH), as compared to comparator Schedule II opioids (morphine, oxycodone, and hydrocodone) and alprazolam, a commonly prescribed Schedule IV controlled substance in the U.S. Methods: The NSDUH is a congressionally mandated household survey that collects information on tobacco, alcohol, and drug use, mental health and other health-related issues in the US. A cross-sectional surveillance study design was used to examine lifetime and past year misuse of oral tramadol and comparators of interest among NSHUH respondents aged 12 years or older. Based on when particular data were available, the past-year misuse analysis includes NSDUH data from 2015 to 2017, and the lifetime misuse analysis includes NSDUH data from 2002 to 2014. Results: In 2015 to 2017, past-year misuse of oral tramadol was approximately 4% of the total number of prescriptions, versus 7% to 8% for all of the comparators when adjusted for drug availability. In 2002 to 2014, lifetime misuse of oral tramadol remained at 1.5% or less over the 13-year period, and was lower than reported for hydrocodone (6%) and oxycodone (4%), respectively. Comparison of oral tramadol and alprazolam showed misuse of tramadol was also much lower than alprazolam. Too few reports of tramadol misuse by injection (n = 7) were reported, versus 570, 1096, and 32 reports of injection of morphine, oxycodone, and hydrocodone, respectively, during the 16-year analysis period to allow for any population-based estimation. Only morphine has an intravenous formulation available and tramadol was not available as an intravenous formulation in the U.S. during that time period. Conclusions: This analysis shows a low prevalence of oral tramadol misuse, relative to other commonly prescribed opioids, in a nationally representative sample of noninstitutionalized US residents. Estimates of reported oral tramadol misuse have remained relatively stable over time and are substantially lower than those reported for comparators when adjusted for prescription volume. Reports of oral tramadol misuse are also much less than alprazolam, another Schedule IV drug.
Single Tertiary Care Center Outcomes After Lower Extremity Cadaveric Vein Bypass for Limb Salvage
Authors: Singh Kuldeep , Juneja Amandeep , Bajaj Tushar , Voto Christian , Schor Jonathan , Zia Saqib , Deitch Jonathan 
Published: June 2020

Objective: Cadaveric saphenous vein (CV) conduits are used in rare instances for limb salvage in patients without autogenous veins although long-term outcome data are scarce. This study was designed to evaluate the outcomes of CV bypass in patients with threatened limbs. Methods: We retrospectively reviewed the charts from 2010 to 2017 of 25 patients who underwent 30 CV allografts for critical limb ischemia and acute limb ischemia. Patient charts were reviewed for demographics, comorbidities, smoking status, indications for bypass, and outcomes. Primary outcomes included graft patency, major amputation rates, and mortality. Secondary outcomes measured included infection rates, 30-day major adverse cardiac events (MACE) and major adverse limb events (MALE). Statistical analysis was performed using time series and Kaplan-Meier survival curves. Results: A total of 30 limbs received CV lower extremity bypasses (20 males, 10 female), and the average age was 68 ± 4 years. Primary patency rates were 71%, 42%, and 28% at 3, 6, and 12 months, respectively. Assisted primary patency rates were 78%, 56%, and 37% at 3, 6, and 12 months, respectively. Secondary patency rates were 77%, 59%, and 28% at 3, 6, and 12 months, respectively. Minor amputations, defined as amputations below the transmetatarsal level occurred in 5 (20%) patients. Wound infection occurred in 8 (32%) patients which was managed with local wound care and no patients required an extraanatomic bypass for limb salvage. Thirty-day MALE occurred in 7 (23.3%) patients. We had no 30-day mortality or MACE. The average graft length was 64.2 ± 8 cm with an average graft diameter of 3.9 ± 2 mm. Amputation-free survival and overall survival at 12 months were 20 (68%) and 21 (84%), respectively. Conclusions: Cadaveric saphenous vein allograft may be used as a bypass conduit as a viable surgical option before limb amputation. Despite the poor patency rates, the limb salvage rates of cadaveric vein grafts demonstrate that this alternate conduit may be considered when no autogenous vein is available.
Low skill fibreoptic intubation using i-gel™ and air-Q™ in simulated difficult airways: A randomised study in manikin and in patients
Authors: Sim Jacqueline Xiu Ling , Liew Geoffrey Haw Chieh , Abdullah Hairil , Wong Theodore Gar Ling , Wong Patrick 
Published: June 2020

Background: Fibreoptic intubation via a supraglottic device (SAD) is ‘low skill fibreoptic intubation’ (LSFOI). ‘Standard’ second generation SADs (i-gelTM) have a gastric port. ‘Specialised’ second generation SADs (air-QTM) are designed to facilitate LSFOI and have wider ventilation ports. Our hypothesis was that performance of LSFOI differs between i-gelTM and air-QTM in a manikin with a simulated difficult airway. Methods: Our primary outcome was fibreoptic intubation success rate. Our secondary outcomes included SAD insertion and LSFOI times. A difficult airway was simulated by applying a hard cervical collar to a manikin. Anaesthetists performed LSFOI serially using both SADs in a random sequence. In the manikin study, 80 anaesthetists were recruited. To test the robustness of the conclusion from our manikin study, we repeated the study in 22 anaesthetised patients. Patients were fitted with the same cervical collar and randomly allocated to either devices. We used McNemar’s statistical test to analyse our primary outcome of successful intubations and paired nominal data. A Wilcoxon signed-ranks test was used to analyse nonparametric paired data and a Mann–Whitney U test was used for unpaired data analysis where appropriate. A p-value of <0.05 was considered statistically significant. Results: In the manikin study, the i-gelTM was superior to the air-QTM for successful tracheal intubation (98.8% vs 83.8%, respectively; p=0.002) and LSFOI times (34.0 s vs 36.0 s, respectively; p=0.012). In the patient study, LSFOI success rates were not significantly different between i-gelTM and air-QTM (100% vs 91.6%, respectively; p=0.545) but intubation times were shorter (52.5 s vs 60.0 s, respectively; p=0.036). Conclusion: In conclusion, we obtained LSFOI success rates for the i-gelTM or air-QTM of 98.8% and 83.8% respectively in a manikin; and 100% and 91.6% respectively in patients. It is in fact ‘low skill’ as many participants were successful despite no prior experience with LSFOI. The i-gelTM is superior for LSFOI compared with the air-QTM. This is despite being a ‘standard’ second generation SAD as compared to a ‘specialised’ second generation SAD (air-QTM). Trial Registration: The manikin and patient studies were conducted after being approved by the SingHealth Centralised Institutional Review Board (CRB reference number 2014/2039 and 2016/2069, respectively). The patient study was registered at ClinicalTrials.gov (ID: NCT02663843).
Optimising implementation of European guidelines on cardiovascular disease prevention in clinical practice: what is needed?
Authors: Uchmanowicz Izabella , Hoes Arno , Perk Joep , McKee Gabrielle , Svavarsdóttir Margrét Hrönn , Czerwińska-Jelonkiewicz Katarzyna , Janssen Arne , Oleksiak Anna , Dendale Paul , Graham Ian M 
Published: June 2020

Abstract
Cardiovascular disease is a model example of a preventable condition for which practice guidelines are particularly important. In 2016, the joint task force created by the European Society of Cardiology (ESC) together with 10 other societies released the new version of the European guidelines on cardiovascular disease prevention. To facilitate the implementation of the ESC guidelines, a dedicated prevention implementation committee has been established within the European Association of Preventive Cardiology. The paper will first explore potential barriers to the guidelines’ implementation. It then develops a discussion that seeks to inform the future development of the committee’s work, including a new definition of the guidelines’ stakeholders (health policy-makers, healthcare professionals and health educators, patient organisations, entrepreneurs and the general public), future activities within four specific areas: strengthening awareness of the guidelines among stakeholders; supporting organisational changes to facilitate the guidelines’ implementation; motivating stakeholders to utilise the guidelines; and present ideas on new implementation strategies. Providing multifaceted cooperation between healthcare professionals, healthcare management executives and health policy-makers, the novel approach proposed in this paper should contribute to a wider use of the 2016 ESC guidelines and produce desired effects of less cardiovascular disease morbidity and mortality. Furthermore, the solutions presented within the paper may constitute a benchmark for the implementation of practice guidelines in other medical disciplines.
Descriptive study of discharge medications in pediatric patients
Authors: Nguyen Thao T , Bergeron Erica , Lewis Teresa V , Miller Jamie L , Hagemann Tracy M , Neely Stephen , Johnson Peter N 
Published: June 2020

Background: Limited studies have evaluated medications in children discharged from hospitals. Knowledge of the number of medications and dosage forms could provide a baseline to establish a medication discharge prescription program. Objectives: To identify the median number of discharge prescriptions per patient. Secondary objectives included an evaluation of the dosage formulations and frequency, and comparisons of the prevalence of unrounded medication doses between service type (medical vs surgical) and physician provider level (trainees vs attendings). Methods: This retrospective study included children <18 years receiving >1 discharge prescription during 4 selected months over a 1-year time frame. Comparisons were made via Pearson’s chi-square tests, Fisher’s Exact tests, and Kruskal–Wallis nonparametric rank tests as appropriate with a priori p value of <0.05. Results: A total of 852 patients were evaluated, with most (78.8%) on a medical service. The median (interquartile range) number of new medications at discharge was 2 (1–3), with the median total number of discharge medications of 3 (2–6). There was no difference in the net change of the median number of home medications stopped and new medications started between service types. The majority (72.2%) received >1 oral liquid medications. There was no difference in prescribing rates per service type and provider level. There was a difference in the number of unrounded doses between trainees versus attendings, 17.8% versus 9.5%, p = 0.048. Conclusion: Patients were discharged on a median of three medications, and most received >1 oral liquid medications. These data can be used to target children who would benefit from medication discharge prescription programs.
A cross-sectional study of the portrayal of childhood speech and language disorders in YouTube videos
Authors: Bellon-Harn Monica L , Manchaiah Vinaya , Shashikanth Shriya 
Published: June 2020

Purpose This study examined meta-data, source, type of informational content, understandability, and actionability of YouTube content related to speech and/or language disorders. Method The 100 most widely viewed videos related to children with speech and/or language disorders were obtained. Meta-data and sources of each upload were identified. Type of informational content within the videos was analyzed. The Patient Education Material Assessment Tool for Audiovisual Materials was used to assess understandability and actionability. Results A significant difference between video source groups was found for length of video, thumbs-up, and thumbs-down, but not for number of views. The YouTube videos related to speech and/or language disorders covered a range of issues, although a majority of the content focused on signs/symptoms and treatment. Videos had close-to-adequate understandability (i.e. 68%), although poor actionability scores (i.e. 32%) were noted. Videos uploaded by professionals were superior to other upload sources in understandability, but no difference was noted between video source for actionability. Conclusions Study insights about meta-data, source, type of informational content, understandability, and actionability of YouTube videos may help professionals understand the nature of online content related to speech and/or language disorders. Study implications and recommendations for further research are discussed.
Partial Rotator Cuff Repair With Superior Capsular Reconstruction Using the Biceps Tendon Is as Effective as Superior Capsular Reconstruction Using a Tensor Fasciae Latae Autograft in the Treatment of Irreparable Massive Rotator Cuff Tears
Authors: Kocaoglu Baris , Firatli Goktug , Ulku Tekin Kerem 
Published: June 2020

Background: Several treatment options are available for stable massive rotator cuff tears, including partial repair with or without tissue augmentation, tendon transfer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and effectiveness of partial rotator cuff repair with SCR using the long head of the biceps tendon (PRCR-SCRB) and SCR with a tensor fasciae latae autograft (SCRTF) for the treatment of rotator cuff tears with severe fatty degeneration. The hypothesis of this study was that SCRTF would be superior to PRCR-SCRB in functional and anatomic outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 26 consecutive patients with massive and fatty degenerative rotator cuff tears were treated surgically. Patients were divided into either the PRCR-SCRB group (n = 14) or SCRTF group (n = 12). Functional outcomes were assessed at final follow-up, and the acromiohumeral distance (AHD) was measured. Results: All functional scores significantly improved in both groups at final follow-up. The PRCR-SCRB group showed better overall outcomes in terms of the visual analog scale for pain; American Shoulder and Elbow Surgeons score; and Quick Disabilities of the Arm, Shoulder and Hand, but these differences were not statistically significant. Better outcomes were found for only the AHD for the PRCR-SCRB group without statistical significance ( P = .4). No statistical difference was found in terms of retear rate. Conclusion: PRCR-SCRB had comparable outcomes and improvement in AHD compared with SCRTF without the need for additional graft harvesting.
Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks
Authors: Kennie-Kaulbach Natalie , Cormier Rachel , Kits Olga , Reeve Emily , Whelan Anne Marie , Martin-Misener Ruth , Burge Fred , Burgess Sarah , Isenor Jennifer E. 
Published: June 2020

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.
Young adult outcomes of childhood prophylaxis for severe hemophilia A: results of the Joint Outcome Continuation Study
Authors: Warren Beth Boulden , Thornhill Dianne , Stein Jill , Fadell Michael , Ingram J. David , Funk Sharon , Norton Kristi L. , Lane Heidi D. , Bennett Carolyn M. , Dunn Amy , Recht Michael , Shapiro Amy , Manco-Johnson Marilyn J. 
Published: June 2020

Abstract
The Joint Outcome Study (JOS), a randomized controlled trial, demonstrated that children with severe hemophilia A (HA) initiating prophylactic factor VIII (FVIII) prior to age 2.5 years had reduced joint damage at age 6 years compared with those treated with episodic FVIII for bleeding. The Joint Outcome Continuation Study (JOS-C) evaluated early vs delayed prophylaxis effects on long-term joint health, following JOS participants to age 18 years in an observational, partially retrospective study. Index joint magnetic resonance imaging (MRI) scores of osteochondral (OC) damage (primary outcome), joint physical examination scores, and annualized rates of joint/other bleeding episodes (secondary outcomes) were collected. Thirty-seven of 65 JOS participants enrolled in JOS-C, including 15 randomized to prophylaxis at mean age 1.3 years (“early prophylaxis”); 18 initially randomized to episodic treatment, starting “delayed prophylaxis” at mean age 7.5 years; and 4 with high-titer inhibitors. At JOS-C exit, MRI OC damage was found in 77% of those on delayed and 35% of those on early prophylaxis for an odds ratio of OC damage, in the delayed vs early prophylaxis group, of 6.3 (95% confidence interval, 1.3, 29.9; P = .02). Annualized bleeding rates were higher with delayed prophylaxis (mean plus or minus standard deviation, 10.6 ± 6.6 vs 3.5 ± 2.1; P &lt; .001), including when only comparing time periods on prophylaxis (6.2 ± 5.3 vs 3.3 ± 1.9; P &lt; .05). In severe HA, early initiation of prophylaxis provided continued protection against joint damage throughout childhood compared with delayed initiation, but early prophylaxis was not sufficient to fully prevent damage. This trial was registered at www.clinicaltrials.gov as #NCT01000844.
Novel mouse model resistant to irreversible BTK inhibitors: a tool identifying new therapeutic targets and side effects
Authors: Estupiñán H. Yesid , Bouderlique Thibault , He Chenfei , Berglöf Anna , Gupta Dhanu , Saher Osama , Daza Cruz Miguel Ángel , Peña-Perez Lucia , Yu Liang , Zain Rula , Karlsson Mikael C. I. , Månsson Robert , Smith C. I. Edvard 
Published: June 2020

AbstractPharmacological inhibitors of Bruton tyrosine kinase (BTK) have revolutionized treatment of B-lymphocyte malignancies and show great promise for dampening autoimmunity. The predominant BTK inhibitors tether irreversibly by covalently binding to cysteine 481 in the BTK catalytic domain. Substitution of cysteine 481 for serine (C481S) is the most common mechanism for acquired drug resistance. We generated a novel C481S knock-in mouse model and, using a battery of tests, no overt B-lymphocyte phenotype was found. B lymphocytes from C481S animals were resistant to irreversible, but sensitive to reversible, BTK inhibitors. In contrast, irreversible inhibitors equally impaired T-lymphocyte activation in mice, mimicking the effect of treatment in patients. This demonstrates that T-lymphocyte blockage is independent of BTK. We suggest that the C481S knock-in mouse can serve as a useful tool for the study of BTK-independent effects of irreversible inhibitors, allowing for the identification of novel therapeutic targets and pinpointing potential side effects.
Association between apolipoprotein B XbaI polymorphisms and coronary heart disease: A meta-analysis
Authors: Feng Ya Yun , Chen Lu Yang , Liu Yang , Luo Meng , Yang Tian Tian , Hu Yu Hao , Chang Jing , Mao Min 
Published: June 2020

AbstractBackgroundTo evaluate the association between apolipoprotein B gene polymorphism and coronary heart disease in some populations at home and abroad by means of meta-analysis.MethodsUsing the strict exclusion criteria for primary screening of the literature and applying the Hardy-Weinberg equilibrium to test the genetic balance of the selected literature. The corresponding models were selected according to the results of the heterogeneity test. The Begg’s test and Egger’s test were used to evaluate publication bias, and meta-analysis was performed using Stata 12.0.ResultsThe study included twelve articles. In the literature, a total of 1596 patients with coronary heart disease and 1431 controls.Meta-analysis results showed no statistical value in the following three genetic models: allelic comparison (a vs A,P = 0.811,OR = 0.95, 95%CI = 0.62–1.46), recessive genetic models (aa vs Aa/AA,P = 0.86,OR = 0.94, 95%CI = 0.45–1.96), or dominant genetic models (aa/Aa vs AA,P = 0.73,OR = 0.92, 95%CI = 0.58–1.47). Subgroup analysis based on ethnicity showed allelic comparison (a vs A,P = 0.464,OR = 1.32, 95%CI = 0.63–2.78), recessive genetic models (aa vs Aa/AA,P = 0.422,OR = 1.52, 95%CI = 0.55–4.21), and dominant genetic models (aa/Aa vs AA,P = 0.551,OR = 1.26, 95%CI = 0.58–2.73) in Asians, allelic comparison (a vs A,P = 0.410,OR = 0.79, 95%CI = 0.45–1.39), recessive genetic models (aa vs Aa/AA,P = 0.041,OR = 0.75,95%CI = 0.57–0.99),dominant genetic models (aa/Aa vs AA,P = 0.385,OR = 0.75, 95%CI = 0.40–1.43) in Caucasian;ConclusionThe ApoB(apolipoprotein B) XbaI locus is not a risk factor when it comes to the development of coronary heart disease in the domestic and international populations included in this paper. In Caucasians, people carrying the aa genotype may be less susceptible to CHD (coronary heart disease). The results of recessive genetic models have to take the effect of heterogeneity and sample sizes into account. Further research may require a larger and more rigorous research design.