bluuebunny/crossref_metadata_2025_split huggingface dataset:
One Size Doesn’t Fit All for Wellness: Residents’ Perception of Wellness Programming
Authors: Winkel Abigail , Palmer James , Morgan Helen , Mahany Erica , Dow Margaret , Woodland Mark 
Published: October 2019

PURPOSE:
To investigate which wellness interventions have the most meaning for a modern cohort of OB/GYN residents.

BACKGROUND:
The 2017 CREOG Resident Survey found significant associations between the learning environment and wellness. The primary analysis indicated that PGY-1's prioritized wellness, and that a sense of wellness decreased with each PGY level. In order to explore whether developmental stage influenced how wellness initiatives were perceived, we performed a secondary analysis of the survey to determine how residents at different PGY levels perceived wellness interventions.

METHODS:
A six-item survey on wellness was administered before the 2017 CREOG exam. IRB exemption was obtained. Participation was voluntary and anonymous, linked only to PGY level. A mixed-methods analysis of the data was performed. Descriptive statistics were analyzed with Microsoft Excel 2010. Mann-Whitney U tests were used to explore differences between PGY-levels. Thematic analysis of text responses was performed.

RESULTS:
Among the 5855 residents, 4,753 answered questions regarding wellness programming (81% RR). Significant differences existed between year of training and perceived effectiveness for several initiatives. PGY1 residents valued peer mentorship (p=0.003) and strategic napping (p<0.001) more than senior residents, while PGY3 residents emphasized faculty mentoring (p=.005). Regardless of training Level, residents prioritized the same three activities: wellness days to address personal needs, team-building retreats, and facilitated exercise programs.

DISCUSSION:
OBGYN residents perceive some wellness activities as valuable throughout training, while the importance of others may vary based on resident year. Most programs do not yet provide the wellness programs (retreats, facilitated exercise, personal time) that OBGYN residents identify as most effective.
Mentoring millennials for nursing leadership
Authors: Bittner Aubrey 
Published: October 2019

Abstract:
As baby boomers continue to retire and millennials become the leading generation in the nursing workforce, nurse leaders must promote professional development and leadership opportunities for millennials moving forward. This article describes challenges and opportunities across the multigenerational nursing workforce along with suggestions on how to remove barriers and align with millennial nurses to provide meaningful mentorship and promote understanding and a positive work environment.
Differential expression and role of S100 proteins in chronic rhinosinusitis
Authors: Sumsion Jorgen S. , Pulsipher Abigail , Alt Jeremiah A. 
Published: October 2019

Purpose of review
Immune system modulators have been under investigation to help elucidate the underlying pathophysiologies of chronic rhinosinusitis (CRS). Psoriasin (S100A7) and calgranulins (S100A8, S100A9, and S100A12) are S100 proteins that have been studied for their immune-mediating responses to pathogens within the context of CRS. This review highlights the expression patterns and proposed roles of S100 proteins in CRS with (CRSwNP) and without (CRSsNP) nasal polyps.

Recent findings
Elevated levels of S100A7 and S100A12 were measured in the sinonasal tissues of patients with CRSsNP compared with CRSwNP and controls. S100A12 expression in CRSsNP was significantly correlated to disease severity. Contrastingly, increased S100A8, S100A9, and S100A8/A9 levels were demonstrated in the nasal polyp tissues of patients with CRSwNP compared with those in inferior turbinate and uncinate tissues of patients with CRSsNP and controls.

Summary
The reported differential expression patterns and activities of psoriasin and calgranulins suggest that S100 proteins exert unique and concerted roles in mediating immunity in different subtypes of CRS. These studies will enable further investigations focused on understanding the immune-modulating mechanisms of S100 proteins in different inflammatory signaling pathways and disease phenotypes of CRS toward the pursuit of identifying new biomarkers and targets for improved outcomes.
Pain monitor: reality or fantasy in ambulatory patients
Authors: Farhang Borzoo , Mathews Donald M. 
Published: October 2019

Purpose of review
In an unconscious patient, there can be significant challenges to monitoring nociception and proper dosing of analgesic medications. The traditional measures of intraoperative nociception have poor sensitivity and specificity with little predictive value in postoperative outcomes such as postoperative pain, opioid-induced side effects, length of stay or incidence of opioid use disorder. To date, several monitoring modalities are in development to establish objective measures of the balance between nociception and analgesia with the goal of guiding anesthesiologists and improve patient outcomes. In this review, some of the most promising monitoring modalities are discussed with the most recent findings.

Recent findings
Multiple modalities are beginning to demonstrate utility compared with traditional care. Most, but not all, of these studies show decreased intraoperative opioid use and some show lower pain scores and opioid requirements in the postanesthesia care unit.

Summary
Recent evidence points to promising efficacy for these monitoring modalities; however, this field is in its infancy. More investigation is required to demonstrate differences in outcome compared with traditional care, and these differences need to be of sufficient import to achieve widespread adoption.
Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity after Noncardiac Surgery
Authors: Turan Alparslan , Artis Amanda S. , Hanline Cecelia , Saha Partha , Maheshwari Kamal , Kurz Andrea , Devereaux P. J. , Duceppe Emmanuelle , Patel Ameen , Tiboni Maria , Ruetzler Kurt , Pearse Rupert , Chan Matthew T. V. , Wu William K. K. , Srinathan Sadeesh , Garg Amit X. , Sapsford Robert , Sessler Daniel I. 
Published: October 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Low 25-hydroxyvitamin D is associated with cardiovascular, renal, and infectious risks. Postsurgical patients are susceptible to similar complications, but whether vitamin D deficiency contributes to postoperative complications remains unclear. We tested whether low preoperative vitamin D is associated with cardiovascular events within 30 days after noncardiac surgery.

Methods
We evaluated a subset of patients enrolled in the biobank substudy of the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, who were at least 45 yr with at least an overnight hospitalization. Blood was collected preoperatively, and 25-hydroxyvitamin D was measured in stored samples. The primary outcome was the composite of cardiovascular events (death, myocardial injury, nonfatal cardiac arrest, stroke, congestive heart failure) within 30 postoperative days. Secondary outcomes were kidney injury and infectious complications.

Results
A total of 3,851 participants were eligible for analysis. Preoperative 25-hydroxyvitamin D concentration was 70 ± 30 nmol/l, and 62% of patients were vitamin D deficient. Overall, 26 (0.7%) patients died, 41 (1.1%) had congestive heart failure or nonfatal cardiac arrest, 540 (14%) had myocardial injury, and 15 (0.4%) had strokes. Preoperative vitamin D concentration was not associated with the primary outcome (average relative effect odds ratio [95% CI]: 0.93 [0.85, 1.01] per 10 nmol/l increase in preoperative vitamin D, P = 0.095). However, it was associated with postoperative infection (average relative effect odds ratio [95% CI]: 0.94 [0.90, 0.98] per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.005) and kidney function (estimated mean change in postoperative estimated glomerular filtration rate [95% CI]: 0.29 [0.11, 0.48] ml min-1 1.73 m-2 per 10 nmol/l increase in preoperative vitamin D, P adjusted value = 0.004).

Conclusions
Preoperative vitamin D was not associated with a composite of postoperative 30-day cardiac outcomes. However, there was a significant association between vitamin D deficiency and a composite of infectious complications and decreased kidney function. While renal effects were not clinically meaningful, the effect of vitamin D supplementation on infectious complications requires further study.
Simulation Training for Operative Vaginal Delivery Among Obstetrics and Gynecology Residents
Authors: Bligard Katherine H. , Lipsey Kim L. , Young Omar M. 
Published: October 2019

OBJECTIVE:
To perform a systematic review of the literature on the effect of simulation training of operative vaginal delivery on learner technique and knowledge, operator comfort, and patient-centered outcomes.

DATA SOURCES:
MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, ERIC, The Cochrane Library, and ClinicalTrials.gov were searched from inception through April 2017. The search criteria used MeSH terms (“simulation training,” “high fidelity simulation training,” “teaching,” “obstetrical extraction,” “obstetrical forceps,” “vaginal delivery,” “clinical competence,” and “internship and residency”).

METHODS OF STUDY SELECTION:
A total of 30,813 articles were reviewed for inclusion. Studies detailing operative vaginal delivery simulation using forceps or vacuums and reporting health care provider or patient outcomes were eligible.

TABULATION, INTEGRATION, AND RESULTS:
All studies were independently reviewed by two investigators for inclusion. Only eight articles assessed the effect of simulation on trainee skill and comfort or patient outcomes and were included. Four were pretest–posttest studies, two were cross-sectional studies, one was a case–control study, and one was a cohort study. No randomized trials were identified. Simulation was associated with improved forceps placement accuracy and generated force during extraction, as well as increased operator knowledge and comfort with operative vaginal delivery. Additionally, simulation had no association with forceps failure rates, but there was an association with decreased rates of maternal lacerations and neonatal injury. The quality of the included studies was assessed with the Medical Education Research Study Quality Instrument, with a median score of 9.75 (range 9.0–13.5), indicating low-to-moderate quality.

CONCLUSION:
The available evidence suggests that improved technique, comfort, knowledge, and patient outcomes are associated with operative vaginal delivery simulation, but additional studies are required to further characterize such benefits for both forceps and vacuum.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42018087343.
Common and rare forms of vasculitis associated with Sjögren's syndrome
Authors: Argyropoulou Ourania D. , Tzioufas Athanasios G. 
Published: October 2019

Purpose of review
Although uncommon, systemic vasculitis is one of the most severe extraglandular manifestations of primary Sjögren's syndrome (pSS) accounting for the increased morbidity and mortality of the disease. This review aims to describe major previous and recent reports regarding the clinical presentation, prognosis and treatment of systemic vasculitis associated with pSS.

Recent findings
Both older and recent pSS cohort studies performed over the past several and recent years, have clearly shown that cryoglobulinaemic vasculitis is the most frequent type of systemic vasculitis accompanying pSS. Antineutrophil cytoplasmic antibody-associated, large and medium vessel vasculitis are described only in sporadic cases. In addition to the overt clinical manifestations of cryoglobulinaemic vasculitis, type II cryoglobulinaemia, glomerulonephritis and purpura have been correlated with increased risk for B-cell non-Hodgkin lymphoma (NHL) in pSS.

Summary
pSS is characterized by autoreactive B and T-cell infiltrates around the epithelial structures of the affected organs, as well as, B-cell hyperreactivity. The latter, is attested by the increased production of autoantibodies, directed against many different organ and nonorgan self-antigens. Vasculitis is a significant and potentially life-threatening complication of the disease depending on the size, localization, histologic type and the pathogenetic mechanisms of the inflammatory process. The potentially irreversible tissue damage, as well as the increased risk for NHL development, prompts the need for early diagnosis and treatment of cryoglobulinaemic vasculitis in pSS.
Unpicking observational relationships between hip shape and osteoarthritis: hype or hope?
Authors: Faber Benjamin G. , Frysz Monika , Tobias Jon H. 
Published: October 2019

Purpose of reviewTo review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application.Recent findingsRecent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation being identified, such as a wider femoral neck and larger lesser trochanter, in association with HOA. Furthermore, this method has formed the basis of genetic studies identifying novel genetic influences on hip shape, several of which are shared with known genetic risk factors for HOA.SummaryShared genetic influences of hip shape and HOA raise the possibility that hip shape plays a casual role in the development of HOA, justifying preventive approaches aiming to combat these adverse consequences.
Delay in Flap Coverage Past 7 Days Increases Complications for Open Tibia Fractures: A Cohort Study of 140 North American Trauma Centers
Authors: Pincus Daniel , Byrne James P. , Nathens Avery B. , Miller Anna N. , Wolinsky Philip R. , Wasserstein David , Ravi Bheeshma , Jenkinson Richard J. 
Published: October 2019

Objectives:
To measure time to flap coverage after open tibia fractures and assess whether delays are associated with inpatient complications.

Design:
Retrospective cohort study.

Setting:
One forty level I and II trauma centers in Canada and the United States.

Patients/Participants:
Adult patients (≥16 years) undergoing surgery for (1) an open tibia (including ankle) fracture and (2) a soft-tissue flap during their index admission between January 1, 2012, and December 31, 2015, were eligible for inclusion.

Exposure:
Time from hospital arrival to definitive flap coverage (in days).

Main outcome measurements:
The primary outcome was a composite of the following complications occurring during the index admission: (1) deep infection, (2) osteomyelitis, and/or (3) amputation. The primary analysis compared complications between early and delayed coverage groups (≤7 and >7 days, respectively) after matching on propensity scores. We also used logistic regression with time to flap coverage as a continuous variable to examine the impact of the duration of delay on complications.

Results:
There were 672 patients at 140 centers included. Of these, 412 (61.3%) had delayed coverage (>7 days). Delayed coverage was associated with a significant increase in complications during the index admission after matching (16.7% vs. 6.2%, P < 0.001, number needed to harm = 10). Each additional week of delay was associated with an approximate 40% increased adjusted risk of complications (adjusted odds ratio 1.44, 95% confidence interval 1.13–1.82, for each week coverage was delayed, P = 0.003).

Conclusion:
This is the first multicenter study of flap coverage for tibia fractures in North America. Complications rose significantly when flap coverage was delayed beyond 7 days, consistent with current guideline recommendations. Because the majority of patients did not have coverage within this timeframe, initiatives are required to improve care for patients with these injuries.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Underlying Mental Illness and Psychosocial Factors Are Predictors of Poor Outcomes After Proximal Humerus Repair
Authors: Belayneh Rebekah , Haglin Jack , Lott Ariana , Kugelman David , Konda Sanjit , Egol Kenneth A. 
Published: October 2019

Objectives:
(1) To assess the correlation of psychosocial factors and long-term outcomes of proximal humerus fractures all in surgical repair; (2) to identify specific psychosocial factors with favorable and unfavorable outcomes; and (3) to assess the correlation between DSM-V mental health diagnoses and long-term Disabilities of Arm, Shoulder, and Hand (DASH) scores.

Design:
Prospective cohort study.

Setting:
Academic medical center.

Patients:
Patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board–approved registry. One hundred eighty-five proximal humerus fractures of 247 met inclusion criteria.

Intervention:
Surgical repair of proximal humerus fractures.

Main Outcome Measure:
All patients were prospectively followed up and assessed for clinical and functional outcomes at latest follow-up visit (mean = 24.8 months) using the DASH questionnaires along with ranges of motion and pain level. Psychosocial factors at 3 months were obtained from the DASH survey.

Results:
Concomitant diagnosis of depressed mood (P = 0.001), anxiety (P < 0.0005), low energy level (P = 0.003), and fatigue (P = 0.001) correlated significantly with poorer outcome. All 6 psychosocial factors correlated directly and significantly with pain at latest follow-up (P < 0.0005). Multiple regression analysis revealed that the strongest predictor of the overall DASH score was the extent of interference with social life (P = 0.001).

Conclusion:
Analysis demonstrated that psychological and social factors at 3 months postoperatively have a strong correlation with negative long-term (>1 year) outcomes after proximal humerus fixation. Clinicians may offer psychological support and encourage social support to these patients postoperatively to improve pain and treatment outcomes.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Complications and Mortality Rates Following Surgical Management of Extradural Spine Tumors in New York State
Authors: Williams Devin M. , Thirukumaran Caroline P. , oses Jalea T. , Mesfin Addisu 
Published: October 2019

Study Design.
Database analysis.

Objective.
To evaluate complications and mortality in patients undergoing surgical management of extradural spinal tumors in New York State.

Summary of Background Data.
Metastatic spine surgery has a high rate of complications but most studies are limited to single institutions.

Methods.
The Statewide Planning and Research Cooperative System was used to identify patients with extradural spinal tumors undergoing surgery in New York State from 2006 to 2015. Bivariate and multivariate logistic regression analyses were used to estimate outcomes.

Results.
Four thousand seven hundred sixty-seven patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications were higher in males compared with females (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.05–1.52, P = 0.01), and patients on Medicaid compared with patients on private insurance (OR: 1.42; 95% CI: 1.03–1.96, P = 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03–2.13, P value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03–2.09, P = 0.04), have higher odds of complications compared with high-volume hospitals and nonteaching hospitals. Multivariate analysis showed higher odds of mortality within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01–1.03, P value = 0.001), low-volume hospitals compared with high-volume hospitals (OR: 1.36; 95% CI: 1.09–1.79, P value = 0.02), hospitals with low bed size compared with high bed size (OR: 1.43; 95% CI: 1.12–1.83, P value = 0.01), and urban hospitals compared with rural hospitals (OR: 3.04; 95% CI: 2.03–4.56, P value = 0.001).

Conclusion.
Low-volume hospitals are associated with complications and mortality in patients with metastatic spine disease.

Level of Evidence: 3
Conservative Versus Operative Treatment of Stable Thoracolumbar Burst Fractures in Neurologically Intact Patients
Authors: Pehlivanoglu Tuna , Akgul Turgut , Bayram Serkan , Meric Emre , Ozdemir Mustafa , Korkmaz Murat , Sar Cuneyt 
Published: October 2019

Study Design.
Nonrandomized, retrospective, comparative, and single-center trial.

Objective.
The aim of this study is to compare the long-term clinical and radiographic results of thoracolumbar burst fractures in neurologically intact patients, treated surgically or nonsurgically with the aim to optimize their management.

Summary of Background Data.
There is an ongoing controversy regarding the treatment of thoracolumbar burst fractures (TLBF) (A3, A4) in neurologically intact patients. Surgical treatment as well as conservative treatment methods are advised to this specific group of patients, while contrasting results exist in the literature.

Methods.
Forty-five neurologically intact patients with TLBF (A3 or A4) (2010–2016) were included. Twenty-one patients with a mean age of 34.3 and a mean follow-up period of 63.1 months were treated surgically with short segment posterior fixation (group 1), while 24 patients with a mean age of 45.7 and a mean follow-up period of 67.1 months were treated conservatively (group 2) with thoracolumbosacral orthesis.

Results.
At the final follow-up groups 1 and 2 had an average segmental kyphosis of 4.09°/11.65° (P = 0.027), an average loss of kyphosis of 2.04°/4.03° (P = 0.038), an average loss of anterior/posterior vertebral body height of %12.89/%2.84/%17.94/%7.62 (P = 0.027/ P = 0.03), a median JOA score of (16.6/16.75) (P = 0.198), a median ODI score of (11.7/12.1) (P = 0.25), a median VAS score of (1.9/2.3) (P = 0.3), SF-36 PCS of (56.74/56.67) (P = 0.25), SF-36 MCS of (55.47/55.5) (P = 0.3), mean durations of hospital stay of 9–11 days (P = 0.3), respectively.

Conclusion.
While there is an ongoing controversy regarding the management of stable thoracolumbar burst fractures in neurologically intact patients in the literature, this study concluded that surgical management of stable thoracolumbar burst fractures in neurologically intact patients provided better radiolographic outcomes, despite the result, that the difference between surgically and nonsurgically treated patients in terms of clinical outcome parameters and quality of life was not statistically significant.

Level of Evidence: 3