bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Four-Step Technique for Creating Individual Double-Eyelid Crease Shapes: A Free-Style Design
Authors: Suo Linlang , Li Jiaqi , Fu Rao , Xie Yun , Huang Ru-Lin 
Published: June 2020

Background:
Double-eyelid blepharoplasty is the most frequently performed aesthetic surgery in the Asian population. However, the epicanthal fold has been a conundrum limiting the outcomes of Asian blepharoplasty. Furthermore, with the blending of Western and Asian cultures, patients have individual standards of beauty for the upper eyelids. Here, we developed a four-step technique to form infold or outfold double-eyelid creases to satisfy individual patient requirements.

Methods:
The medical records of patients who simultaneously underwent double-eyelid blepharoplasty and epicanthoplasty using this four-step technique from January of 2017 to January of 2019 were reviewed. The results were grouped by preoperative patient requirements for eyelid crease shapes. The rate of meeting patient expectations in each group was evaluated by two independent observers. Preoperative and postoperative photographs were collected, complications were identified, and postoperative results were assessed.

Results:
In total, 285 consecutive patients were included in this study, with a mean follow-up period of 9 months. Of the 285 patients, 207 requested infold eyelid creases, and 190 (92 percent) procedures met patient expectations; and 78 patients requested outfold eyelid creases, and 69 (87 percent) procedures met patient expectations. A high rate of satisfaction with the final eyelid crease shape and resulting scarring was noted in both patient groups. The revision rate was 3 percent. No severe complications were observed.

Conclusion:
The four-step technique is a simple, flexible, and effective method for creating infold or outfold double-eyelid creases according to individual patient requirements and should be considered a routine method for patients who request double eyelids.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Personality Traits and Traumatic Outcome Symptoms in Registered Nurses in the Aftermath of a Patient Safety Incident
Authors: Stovall Mady C. , Firkins Jenny , Hansen Lissi , Dieckmann Nathan F. , van Ryn Michelle 
Published: June 2020

Objectives
The purpose of this study was to investigate the relationship between personality traits (perfectionism and neuroticism) and the traumatic outcomes of reexperiencing, avoidance, and alcohol abuse severity of registered nurses (RNs) who have been involved with a patient safety incident (PSI). We hypothesized that higher scores for perfectionism and neuroticism would predict higher reexperiencing and avoidance symptoms in RNs in the aftermath of a PSI. Also, RNs with higher perfectionism and neuroticism sum scores would be more likely to abuse alcohol.

Methods
A descriptive, correlational study design was used to characterize the relationships of personality traits and potential traumatic outcomes of RNs in the aftermath of a PSI. The Almost Perfect Scale—Revised, Neuroticism Scale, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, and Alcohol Use Disorders Identification Test—Consumption measures were administered to RNs licensed in Oregon and New York.

Results
Perfectionist-discrepancy personality traits (P < 0.01) were the strongest predictors for reexperiencing symptoms and neuroticism (P < 0.05) was the strongest predictor for avoidance symptoms, when controlling for sociodemographics and experience. We found a negative linear relationship between perfectionism-order and alcohol abuse severity (β = −0.15, P < 0.01; confidence interval, −0.24 to 0.05).

Conclusions
This study demonstrated a statistically significant relationship between perfectionism-discrepancy and reexperiencing as well as between neuroticism and reexperiencing and avoidance, each explaining 4% of variance of their model. The results add to the nurse second victim literature by validating 2 posttraumatic stress disorder symptoms in RNs in the aftermath of a PSI. Registered nurses with perfectionism-order were less likely to abuse alcohol.
Single Versus Multiple Arterial Revascularization in Patients With Reduced Renal Function
Authors: Hayatsu Yukihiro , Ruel Marc , Bader Eddeen Anan , Sun Louise 
Published: June 2020

Objective:
To compare the long-term outcomes of MAR versus SAR in patients with renal insufficiency.

Summary of Background Data:
Previous studies have been insufficiently powered to address whether MAR confers long-term benefit over SAR in patients with renal dysfunction who require CABG.

Methods:
We conducted retrospective cohort study in Ontario, Canada of patients who underwent isolated CABG (n = 23,406). The primary outcome was MACE, defined as the composite of stroke, myocardial infarction, and repeat revascularization. We compared patients by matching them on the propensity to have received SAR versus MAR, within groups with preoperative glomerular filtration rate (GFR) ≥60 mL/min/1.73 m2; GFR between 30 and 60; and GFR <30.

Results:
In patients with GFR ≥60, the use of MAR versus SAR was associated with a lower rate of MACE [hazard ratio (HR) 0.87 (0.80–0.94)], and a lower rate of long-term mortality [HR 0.87 (0.79–0.97)]. In those with GFR between 30 and 60, MAR was not associated with a difference in MACE [HR 1.04 (0.87–1.26)], and a lower rate of long-term mortality [HR 0.75 (0.65–0.87)] was observed. In those with GFR <30, MAR was not associated with a difference in outcomes.

Conclusions:
MAR versus SAR does not correlate with a difference in MACE amongst patients with GFR between 30 and 60 and better survival raises the possibility of indication bias. Furthermore, MAR did not confer a benefit in those with severely reduced renal function. These data suggest that the potential long-term benefits of using MAR in CABG patients with renal insufficiency may be offset by competing health risks.
Assessment of Technical Skills in Axillary Lymph Node Dissection
Authors: Muthuswamy Keerthini , Fisher Rebecca , Mavroveli Stella , Petrou Fotis , Khawar Sabrina , Amlani Ashik , Hanna George B. , Hadjiminas Dimitri J. , Thiruchelvam Paul T. R. , Leff Daniel R. 
Published: June 2020

Objective:
A simulator to enable safe practice and assessment of ALND has been designed, and face, content and construct validity has been investigated.

Summary and Background Data:
The reduction in the number of ALNDs conducted has led to decreased resident exposure and confidence.

Methods:
A cross-sectional multicenter observational study was carried out between July 2017 and August 2018. Following model development, 30 surgeons of varying experience (n = “experts," n = 11 “senior residents," and n = 10 “junior residents”) were asked to perform a simulated ALND. Face and content validity questionnaires were administered immediately after ALND. All ALND procedures were retrospectively assessed by 2 attending breast surgeons, blinded to operator identity, using a video-based assessment tool, and an end product assessment tool.

Results:
Statistically significant differences between groups were observed across all operative subphases on the axillary clearance assessment tool (P < 0.001). Significant differences between groups were observed for overall procedure quality (P < 0.05) and total number of lymph nodes harvested (P < 0.001). However, operator grade could not be distinguished across other end product variables such as axillary vein damage (P = 0.864) and long thoracic nerve injury (P = 0.094). Overall, participants indicated that the simulator has good anatomical (median score >7) and procedural realism (median score >7).

Conclusions:
Video-based analysis demonstrates construct validity for ALND assessment. Given reduced ALND exposure, this simulation is a useful adjunct for both technical skills training and formative Deanery or Faculty administered assessments.
Comparing Clinician Consensus Recommendations to Patient-reported Opioid Use Across Multiple Hospital Systems
Authors: Robinson Kortney A. , Thiels Cornelius A. , Stokes Sean , Duncan Sarah , Feranil Mario , Fleishman Aaron , Cook Charles H. , Nathanson Larry A. , Huang Lyen C. , Habermann Elizabeth B. , Brat Gabriel A. 
Published: June 2020

Objective: :
We compare consensus recommendations for 5 surgical procedures to prospectively collected patient consumption data. To address local variation, we combined data from multiple hospitals across the country.

Summary of Background Data:
One approach to address the opioid epidemic has been to create prescribing consensus reports for common surgical procedures. However, it is unclear how these guidelines compare to patient-reported data from multiple hospital systems.

Methods:
Prospective observational studies of surgery patients were completed between 3/2017 and 12/2018. Data were collected utilizing post-discharge surveys and chart reviews from 5 hospitals (representing 3 hospital systems) in 5 states across the USA. Prescribing recommendations for 5 common surgical procedures identified in 2 recent consensus reports were compared to the prospectively collected aggregated data. Surgeries included: laparoscopic cholecystectomy, open inguinal hernia repair, laparoscopic inguinal hernia repair, partial mastectomy without sentinel lymph node biopsy, and partial mastectomy with sentinel lymph node biopsy.

Results:
Eight hundred forty-seven opioid-naïve patients who underwent 1 of the 5 studied procedures reported counts of unused opioid pills after discharge. Forty-one percent did not take any opioid medications, and across all surgeries, the median consumption was 3 5 mg oxycodone pills or less. Generally, consensus reports recommended opioid quantities that were greater than the 75th percentile of consumption, and for 2 procedures, recommendations exceeded the 90th percentile of consumption.

Conclusions:
Although consensus recommendations were an important first step to address opioid prescribing, our data suggests that following these recommendations would result in 47%–56% of pills prescribed remaining unused. Future multi-institutional efforts should be directed toward refining and personalizing prescribing recommendations.
Drain Placement After Uncomplicated Hepatic Resection Increases Severe Postoperative Complication Rate
Authors: Arita Junichi , Sakamaki Kentaro , Saiura Akio , Konishi Masaru , Sakamoto Yoshihiro , Hashimoto Masaji , Sano Tsuyoshi , Uesaka Katsuhiko , Kokudo Norihiro , Yamanaka Takeharu , Shimada Kazuaki 
Published: June 2020

Objective:
To assess the clinical impact of a no-drain policy after hepatic resection.

Summary of Background Data:
Previous randomized controlled trials addressing no-drain policy after hepatic resection seem inconclusive because they did not adopt appropriate study design to validate its true clinical impact.

Methods:
This unblinded, randomized controlled trial was done at 7 Japanese institutions. Patients undergoing hepatic resection without biliary reconstruction were randomized to either D group or ND group. When the risk of postoperative bile leakage or hemorrhage were considered high, the patients were excluded during the operation. Primary endpoint was the postoperative complication of C-D grade 3 or higher within 90 postoperative days. A noninferiority of ND group to D group was assessed, and if it was confirmed, a superiority was assessed.

Results:
Between May 2015 and July 2017, a total of 400 patients were finally included in the per-protocol set analysis: 199 patients in D group and 201 patients in ND group. Intraoperatively, 37 patients were excluded from the final enrollment because of high risk of bile leakage or hemorrhage. Postoperative complication rate of C-D grade 3 or higher was 8.0% (16/199) in the D group and 2.5% (5/201) in the ND group. The risk difference was −5.5% (95% confidence interval: −9.9% to −1.2%) and fulfilled the prescribed noninferiority margin of 4%. No postoperative mortality was experienced in both groups. Bile leakage was diagnosed in 8.0% (16/199) of the D group and none in the ND group (P < 0.001). In none of the subgroups classified based on 8 potentially relevant factors, drain placement was favored in terms of C-D grade 3 or higher complication.

Conclusions:
Drains should not be placed after uncomplicated hepatic resections.
Fresh whole blood from walking blood banks for patients with traumatic hemorrhagic shock: A systematic review and meta-analysis
Authors: Naumann David N. , Boulton Adam J. , Sandhu Amrit , Campbell Kieran , Charlton William , Gurney Jennifer M. , Martin Matthew J. , Scorer Tom , Doughty Heidi 
Published: June 2020

BACKGROUNDWhole blood is optimal for resuscitation of traumatic hemorrhage. Walking Blood Banks provide fresh whole blood (FWB) where conventional blood components or stored, tested whole blood are not readily available. There is an increasing interest in this as an emergency resilience measure for isolated communities and during crises including the coronavirus disease 2019 pandemic. We conducted a systematic review and meta-analysis of the available evidence to inform practice.METHODSStandard systematic review methodology was used to obtain studies that reported the delivery of FWB (PROSPERO registry CRD42019153849). Studies that only reported whole blood from conventional blood banking were excluded. For outcomes, odds ratios (ORs) and 95% confidence interval (CI) were calculated using random-effects modeling because of high risk of heterogeneity. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system.RESULTSTwenty-seven studies published from 2006 to 2020 reported >10,000 U of FWB for >3,000 patients (precise values not available for all studies). Evidence for studies was “low” or “very low” except for one study, which was “moderate” in quality. Fresh whole blood patients were more severely injured than non-FWB patients. Overall, survival was equivalent between FWB and non-FWB groups for eight studies that compared these (OR, 1.00 [95% CI, 0.65–1.55];p= 0.61). However, the highest quality study (matched groups for physiological and injury characteristics) reported an adjusted OR of 0.27 (95% CI, 0.13–0.58) for mortality for the FWB group (p< 0.01).CONCLUSIONThousands of units of FWB from Walking Blood Banks have been transfused in patients following life-threatening hemorrhage. Survival is equivalent for FWB resuscitation when compared with non-FWB, even when patients were more severely injured. Evidence is scarce and of relative low quality and may underestimate potential adverse events. Whereas Walking Blood Banks may be an attractive resilience measure, caution is still advised. Walking Blood Banks should be subject to prospective evaluation to optimize care and inform policy.LEVEL OF EVIDENCESystematic/therapeutic, level 3.
Pain across traumatic injury groups: A National Institute on Disability, Independent Living, and Rehabilitation Research model systems study
Authors: Amtmann Dagmar , Bamer Alyssa M. , McMullen Kara , Gibran Nicole S. , Hoffman Jeanne M. , Bombardier Charles H. , Carrougher Gretchen J. 
Published: June 2020

BACKGROUND
Pain is a common problem after traumatic injury. We describe pain intensity and interference at baseline and 1 year postinjury in burn, traumatic brain injury (TBI), and spinal cord injury (SCI) survivors and compare them with the general population (GP). We tested a custom Patient Reported Outcomes Measurement Information System (PROMIS) pain interference short form developed for use in trauma populations.

METHODS
We administered a pain intensity numerical rating scale and custom PROMIS pain interference short forms at baseline and/or 1 year postinjury from participants (≥18 years) at three Model System projects (burn, TBI, and SCI). Scores were compared across injury groups and pain intensity levels, and to the GP. Reliability and floor and ceiling effects of the custom PROMIS pain measures were calculated.

RESULTS
Participants (burn, 161; TBI, 232; SCI, 134) responded to the pain intensity and/or pain interference measures at baseline (n = 432), 1 year (n = 288), or both (n = 193). At baseline, pain interference and intensity were both significantly higher in all three groups than in the GP (all p < 0.01). At 1 year, average pain intensity in SCI and burn (p < 0.01) participants was higher than the GP, but only SCI participants reported higher pain interference (p < 0.01) than the GP. Half of all participants reported clinically significant pain interference (55 or higher) at baseline and one third at 1 year. Reliability of the custom pain interference measure was excellent (>0.9) between T-scores of 48 and 79.

CONCLUSION
The custom pain interference short forms functioned well and demonstrated the utility of the custom PROMIS pain interference short forms in traumatic injury. Results indicate that, for many people with burn, TBI and SCI, pain remains an ongoing concern long after the acute injury phase is over. This suggests a need to continue to assess pain months or years after injury to provide better pain management for those with traumatic injuries.

LEVEL OF EVIDENCE
Epidemiologic/Therapeutic study, level IV.
Dizziness and Vertigo: The Skillful Examination
Authors: Shemesh Ari A. , Gold Daniel R. 
Published: June 2020

Background:
The visual, ocular motor and vestibular systems have intimate neural and close anatomical relationship that dictates their assessment in a patient with dizziness and vertigo.

Results:
Recognition of the pearls and pitfalls of a targeted clinical examination HINTS/HINTS “Plus” allows the clinician to probe at the bedside the most crucial hypothesis in a patient with acute isolated vestibular syndrome, “Is this a stroke?”

Conclusion:
By applying a methodical approach to examination of patients with dizziness and vertigo, localization of the offending lesion, management, and even elucidation of the underlying diagnosis is feasible.
Role of Ocular Ultrasonography to Distinguish Papilledema From Pseudopapilledema
Authors: Kohli Anita A. , Pistilli Maxwell , Alfaro Cesar , Ross Ahmara G. , Jivraj Imran , Bagchi Sheila , Chan Jessie , May Dionne , Liu Grant T. , Shindler Kenneth S. , Tamhankar Madhura A. 
Published: June 2020

Background:
We prospectively evaluated the sensitivity and specificity of ocular ultrasonography (OUS) to distinguish papilledema from pseudopapilledema.

Methods:
Forty-nine study participants, with optic disc elevation, underwent neuro-ophthalmic evaluation, OUS, fundus photography, and optical coherence tomography (OCT) of the optic nerve head at the initial and follow-up visits (≤6 months apart). Participants were classified as having papilledema if there was a change in optic nerve appearance on fundus photographs, as determined by a masked observer, between initial and follow-up visits ≤6 months apart. OUS was considered positive when the optic nerve sheath width was >3.3 mm and the 30° test was positive. Ocular ultrasonographic findings were correlated in patients who had papilledema vs patients who had pseudopapilledema. In a subanalysis, OUS findings were also correlated with change in peripapillary retinal nerve fiber layer thickness on OCT of the optic nerve head between initial and follow-up visits.

Results:
OUS was 68% (17/25) sensitive for papilledema and 54% (13/24) specific for pseudopapilledema. When using OCT parameters to define papilledema, the sensitivity of OUS to diagnose papilledema decreased to 62%. Positive OUS correlated with elevated opening pressure on lumbar puncture and with signs of increased intracranial pressure on MRI.

Conclusion:
OUS alone was less sensitive in diagnosing papilledema than previously thought. Therefore, OUS may not be helpful in distinguishing between papilledema and pseudopapilledema.
Optic Nerve Angle in Idiopathic Intracranial Hypertension
Authors: Chen Benson S. , Asnafi Solmaz , Lin Mung Y. , Bruce Beau B. , Lock Jane H. , Sharma Rahul A. , Newman Nancy J. , Biousse Valérie , Saindane Amit M. 
Published: June 2020

Background:
The tortuosity of the optic nerve can be quantified radiologically by measuring the angle of optic nerve deformation (the “optic nerve angle” [ONA]). In patients with idiopathic intracranial hypertension (IIH), lowering the intracranial pressure (ICP) to a normal range by lumbar puncture leads to straightening of the optic nerve and an increase in the measured sagittal ONA on MRI. It is uncertain whether there is any correlation between ONA and cerebrospinal fluid (CSF) opening pressure or visual function.

Methods:
Retrospective study of patients with and without IIH who had MRI of the brain followed by lumbar puncture with CSF opening pressure within 24 hours of MRI. Before LP and within 24 hours of MRI of the brain, all patients with IIH had neuro-ophthalmologic assessment including visual acuity, Humphrey Visual Field (HVF), and fundus photography. Sagittal ONA was measured on multiplanar T2-SPACE images on a DICOM viewer. Papilledema on the fundus photographs was graded using the Frisén scale.

Results:
Fifty-four patients with IIH and 30 unmatched controls were included. The IIH group was 6.3 years younger (95% CI 2.4–10.3, P = 0.002), had 8.7 kg/m2 higher body mass index (4.9–12.5, P < 0.001), and 26.3% more women (P = 0.011) compared with controls. In both eyes, the ONA was significantly smaller in patients with IIH by 12° compared with controls (7°–17°, P < 0.00001). In the IIH group, no correlation between ONA and the CSF opening pressure was present in either eye (right eye r = 0.19, P = 0.15; left eye r = 0.18, P = 0.19) The ONA did not correlate with logarithm of the minimum angle of resolution visual acuity (right eye r = 0.26, P = 0.063; left eye r = 0.15, P = 0.27), HVF mean deviation (right eye r = 0.0059, P = 0.97; left eye r = −0.069, P = 0.63), or Frisén grade (Spearman's rho right eye 0.058, P = 0.67; left eye 0.14, P = 0.30).

Conclusions:
The ONA is significantly smaller in patients with IIH compared to controls, but does not correlate with CSF opening pressure, severity of papilledema, or visual function. The ONA may be useful in identifying patients with raised ICP, but not necessarily those with a poor visual prognosis.