bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which Psychological Factors Are Involved in the Onset and/or Persistence of Musculoskeletal Pain? An Umbrella Review of Systematic Reviews and Meta-Analyses of Prospective Cohort Studies
Authors: Martinez-Calderon Javier , Flores-Cortes Mar , Morales-Asencio Jose Miguel , Luque-Suarez Alejandro 
Published: May 2020

Objective:
The objective of this study was to summarize the current status of knowledge about the longitudinal association between vulnerability or protective psychological factors and the onset and/or persistence of musculoskeletal (MSK) pain.

Methods:
PubMed, CINAHL, PsycINFO, PubPsych, Scopus, Web of Science, gray literature, and manual screening of references were searched from inception to June 15, 2019. Systematic reviews with or without meta-analysis that explored the longitudinal association between psychological factors and the onset and/or persistence of MSK pain were identified. The AMSTAR-2 tool was used to assess the risk of bias.

Results:
Fifty-nine systematic reviews that included 286 original research studies were included, with a total of 249,657 participants (127,370 with MSK pain and 122,287 without MSK pain at baseline). Overall, our results found that exposure to many psychological vulnerability factors such as depression, anxiety, psychological distress, and fear, among others, may increase the risk of the onset and persistence of MSK pain across time. In addition, our results also showed that a range of psychological factors considered to be “protective” such as self-efficacy beliefs, better mental health, active coping strategies, or favorable expectations of recovery may reduce the risk of the onset and persistence of MSK pain. However, all these systematic reviews were evaluated to have critically low confidence based on the AMSTAR-2 tool, indicating that findings from these reviews may be informative, but should be interpreted with caution.

Discussion:
The large number of methodological flaws found across reviews gives rise to a call to action to develop high-quality systematic reviews in this field.
Internal Version Compared With Pushing for Delivery of Cephalic Second Twins
Authors: Pauphilet Victoire , Goffinet François , Seco Aurélien , Azria Elie , Cordier Anne-Gaël , Deruelle Philippe , Kayem Gilles , Rozenberg Patrick , Sananès Nicolas , Sénat Marie-Victoire , Sentilhes Loic , Vayssière Christophe , Winer Norbert , Korb Diane , Schmitz Thomas ,   for the JUmeaux MODe d'Accouchement (JUMODA) Study Group and the Groupe de Recherche en Obstétrique et Gynécologie (GROG)
Published: May 2020

OBJECTIVE:
To assess neonatal morbidity and mortality according to whether cephalic second twins were born after internal version followed by total breech extraction or after instructions to push. We hypothesized that interval version would result in shorter intertwin delivery intervals and lower cesarean delivery rates for the second twin and therefore better neonatal outcomes.

METHODS:
These planned analyses of the JUMODA (JUmeaux MODe d'Accouchement) cohort, a national prospective population-based study of twin deliveries, examined births of cephalic second twins after vaginal birth of the first twin at or after 32 weeks of gestation. The internal version group of second twins born in breech presentation after obstetric maneuvers was compared with the pushing group, comprising those born in cephalic presentation. The primary outcome was a composite of neonatal morbidity and mortality. Multivariate modified Poisson regression models were used to control for potential confounders.

RESULTS:
Of 2,256 cephalic second twins, 487 (21.6%) were born in breech presentation after internal version and total breech extraction and 1,769 (78.4%) in cephalic presentation after pushing. Composite neonatal morbidity and mortality was not lower in the internal version (17/487 [3.5%]) compared with the pushing group (38/1,769 [2.1%]; adjusted relative risk [aRR] 1.73 [95% CI 0.98–3.05]), although median [quartile 1–quartile 3] intertwin delivery intervals were shorter (5 [4–8] vs 8 [5–12] minutes, P<.001) and the cesarean delivery rate for the second twin lower (5/487 [1.0%] vs 66/1,769 [3.7%], P=.002). Subgroup analyses showed no difference between groups at or after 37 weeks of gestation but higher composite neonatal morbidity and mortality after internal version before 37 weeks (14/215 [6.5%] vs 26/841 [3.1%]; aRR 2.18 [95% CI 1.15–4.13]). Secondary analyses according to center expertise in the overall population and stratified by gestational age yielded concordant results.

CONCLUSION:
Although our sample size precluded a robust assessment for small differences in outcomes between groups, internal version followed by total breech extraction of cephalic second twins was not associated with better neonatal outcomes than pushing.
Neonatal Seizures Among Low-Risk Pregnancies at Term
Authors: Doty Morgen S. , Chen Han-Yang , Chauhan Suneet P. 
Published: May 2020

OBJECTIVE:
To examine risk factors and adverse outcomes for neonatal–maternal dyads among low-risk pregnancies at term with subsequent neonatal seizures.

METHODS:
United States vital statistics data sets were used for this retrospective study. Inclusion criteria were low-risk women (without hypertensive disease or diabetes) with nonanomalous singleton pregnancies, who delivered after labor at 37–41 weeks of gestation. The primary composite neonatal adverse outcome included 5-minute Apgar score less than 5, assisted ventilation longer than 6 hours, and neonatal death. A secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used, with adjusted relative risk (aRR) and 95% CI reported.

RESULTS:
Of 19.76 million live births during the study interval, 11.7 million (59.4%) met inclusion criteria. The rate of neonatal seizures after low-risk pregnancies delivered at term was 0.2 per 1,000 live births. The maternal risks factors associated with neonatal seizures included no prenatal care, smoking during pregnancy, being overweight or obese, and gestational age of 41 weeks. The strongest risk factors for neonatal seizures were chorioamnionitis (relative risk [RR] 5.04, 95% CI 4.40–5.77; aRR 3.27, 95% CI 2.84–3.76) and route of delivery, with operative vaginal (RR 3.62, 95% CI 3.20–4.09; aRR 3.02, 95% CI 2.66–3.43) and cesarean (RR 4.13, 95% CI 3.81–4.48; aRR 3.14, 95% CI 2.86–3.45) higher than spontaneous vaginal. Compared with neonates without seizures, those with seizures had higher risk of composite neonatal adverse outcome (RR 64.55, 95% CI 61.83–67.39; aRR 37.09, 95% CI 35.20–39.08). Compared with women who delivered neonates without seizures, those who delivered neonates with seizures had higher risk of composite maternal adverse outcome (RR 16.27, 95% CI 13.66–19.37; aRR 9.70, 95% CI 8.15–11.53).

CONCLUSION:
We identified modifiable maternal risk factors associated with neonatal seizures among low-risk pregnancies at term. Though infrequent, neonatal seizures are associated with higher risk of adverse outcomes in neonatal–maternal dyads.
Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in the Elderly: A Cost-Effectiveness Analysis
Authors: Yong Taylor M. , Austin Daniel C. , Molloy Ilda B. , Kunkel Samuel T. , Jevsevar David S. , Gitajn Ida L. 
Published: May 2020

Objective:
To evaluate the cost-effectiveness of screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in low-demand elderly patients.

Methods:
We constructed a Markov decision model using a low-demand, 80-year-old patient as the base case. Costs, health-state utilities, mortality rates, and transition probabilities were obtained from published literature. The simulation model was cycled until all patients were deceased to estimate lifetime costs and quality-adjusted life years (QALYs). The primary outcome was the incremental cost-effectiveness ratio with a willingness-to-pay threshold set at $100,000 per QALY. We performed sensitivity analyses to assess our parameter assumptions.

Results:
For the base case, hemiarthroplasty was associated with greater quality of life (2.96 QALYs) compared with screw fixation (2.73 QALYs) with lower cost ($23,467 vs. $25,356). Cost per QALY for hemiarthroplasty was $7925 compared with $9303 in screw fixation. Hemiarthroplasty provided better outcomes at lower cost, indicating dominance over screw fixation.

Conclusions:
Hemiarthroplasty is a cost-effective option compared with screw fixation for the treatment of nondisplaced femoral neck fractures in the low-demand elderly. Medical comorbidities and other factors that impact perioperative mortality should also be considered in the treatment decision.

Level of Evidence:
Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Compartment Syndrome: Evaluation of Skeletal Muscle Ischemia and Physiologic Biomarkers in Controlled Conditions Within Ex Vivo Isolated Muscle Bundles
Authors: Tatman Lauren M. , Upchurch Weston J. , Scholz Natalie , Wagstrom Emily , Smith Lauren L. , Bechtold Joan E. , Schmidt Andrew H. , Iaizzo Paul A. 
Published: May 2020

Objectives:
To identify potential physiologic markers of muscle ischemia to serve as diagnostic indicators of compartment syndrome. We hypothesize that muscle bundles in hypoxic conditions will elicit decreases in potential hydrogen (pH) and increases in lactate and potassium that correlates with decreased muscle twitch forces.

Methods:
We performed an ex vivo evaluation of individual skeletal muscle bundles obtained from a swine's diaphragm that were exposed to hypoxic conditions and compared with control groups. Over a 4-hour period, we evaluated the following parameters for each muscle bundle: muscle twitch forces and levels of potassium, lactate, and pH. Comparisons between the hypoxic and control groups were calculated at each time point using the 2-tailed Wilcoxon rank sum test for nonparametric data. Longitudinal associations between biomarkers and muscle twitch forces were tested using repeated measures analyses.

Results:
The hypoxic group elicited more significant decreases in normalized muscle twitch forces than the control group at all time points (0.15 g vs. 0.55 g at 4 hours, P < 0.001). Repeated measures analyses of the hypoxic group demonstrated a statistically significant association between potassium, lactate, and normalized peak force over the course of time. Potassium demonstrated the strongest association with a 1 mmol/L unit increase in potassium associated with a 2.9 g decrease in normalized peak force (95% confidence interval −3.3 to −2.4, P < 0.001). The pH of all muscle baths increased over the course of time at similar rates between the study groups.

Conclusions:
This study used an ex vivo ischemic skeletal muscle model as a representation for pathophysiologic pathways associated with compartment syndrome. In this experimental approach we were unable to evaluate the pH of the muscle bundles due to continuous applied gassing. Our findings support further evaluations of potassium and lactate levels as potential diagnostic markers.
Accuracy of the Gutter Position in Cervical Double-door Laminoplasty Using Intraoperative Computed Tomography Navigation and the Factors Associated With C5 Palsy
Authors: Kudo Hitoshi , Wada Kanichiro , Kumagai Gentaro , Tanaka Sunao , Asari Toru , Araki Ryo , Takeuchi Kazunari , Yokoyama Toru , Ishibashi Yasuyuki 
Published: May 2020

Study Design:
This was a prospective study.

Objective:
This study aimed to investigate the accuracy of the gutter position after cervical double-door laminoplasty (LP) using intraoperative computed tomography (CT) navigation and the factors associated with C5 palsy.

Summary of Background Data:
There were some reports in which the gutter position and the width of decompression in cervical LP were associated with C5 palsy; however, there were few reports about the accuracy of the gutter position.

Materials and Methods:
Thirty-three patients treated with cervical LP were enrolled. We marked our targeted gutter position on the lamina with a high-speed drill using intraoperative CT navigation and performed the LP procedure. The accuracy of the gutter position was evaluated with a postoperative CT scan. We measured the angle of the opened lamina (AOL), the proportion of the distance between the gutters and the distance of transverse diameter of spinal canal (PGSC) with a postoperative CT scan and spinal cord posterior shifting (SCPS) with preoperative and postoperative magnetic resonance imaging scans. We investigated the incidence of C5 palsy and analyzed AOL, PGSC, and SCPS between the C5 palsy (+) and (−) groups.

Results:
The accuracy of all gutter positions was 78.4% (182/232). The accuracy of the gutter position at the right C4 and right C7 was lower than that at the other levels. The AOL in all cases was ~60 degrees. The PGSC was 90.1%–97.2%. The SCPS at C5 was the largest with 2.2 mm. C5 palsy occurred in 3 of 33 patients (9.1%). There were no significant differences in the AOL, PGSC, or SCPS between the 2 groups.

Conclusions:
The accuracy of the gutter position using intraoperative CT navigation was good. The incidence of C5 palsy was higher in this study than in the previous reports.
The Impact of Step-Down Unit Care on Patient Outcomes After ICU Discharge
Authors: Lekwijit Suparerk , Chan Carri W. , Green Linda V. , Liu Vincent X. , Escobar Gabriel J. 
Published: May 2020

Objectives:
To examine whether and how step-down unit admission after ICU discharge affects patient outcomes.

Design:
Retrospective study using an instrumental variable approach to remove potential biases from unobserved differences in illness severity for patients admitted to the step-down unit after ICU discharge.

Setting:
Ten hospitals in an integrated healthcare delivery system in Northern California.

Patients:
Eleven-thousand fifty-eight episodes involving patients who were admitted via emergency departments to a medical service from July 2010 to June 2011, were admitted to the ICU at least once during their hospitalization, and were discharged from the ICU to the step-down unit or the ward.

Interventions:
None.

Measurements and Main Results:
Using congestion in the step-down unit as an instrumental variable, we quantified the impact of step-down unit care in terms of clinical and operational outcomes. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6–4.1%). We did not find statistically significant effects on other outcomes. For ICU patients with higher illness severity, we found that availability of step-down unit care was associated with an absolute decrease in in-hospital mortality of 2.5% (95% CI, 2.3–2.6%), a decrease in remaining hospital length-of-stay of 1.1 days (95% CI, 1.0–1.2 d), and a decrease in the likelihood of ICU readmission within 5 days of 3.6% (95% CI, 3.3–3.8%).

Conclusions:
This study shows that there exists a subset of patients discharged from the ICU who may benefit from care in an step-down unit relative to that in the ward. We found that step-down unit care was associated with statistically significant improvements in patient outcomes especially for high-risk patients. Our results suggest that step-down units can provide effective transitional care for ICU patients.
Development of Persistent Respiratory Morbidity in Previously Healthy Children After Acute Respiratory Failure*
Authors: Keim Garrett , Yehya Nadir , Spear Debbie , Hall Mark W. , Loftis Laura L. , Alten Jeffrey A. , McArthur Jennifer , Patwari Pallavi P. , Freishtat Robert J. , Willson Douglas F. , Straumanis John P. , Thomas Neal J. ,   for the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: May 2020

Objectives:
Acute respiratory failure is a common reason for admission to PICUs. Short- and long-term effects on pulmonary health in previously healthy children after acute respiratory failure requiring mechanical ventilation are unknown. The aim was to determine if clinical course or characteristics of mechanical ventilation predict persistent respiratory morbidity at follow-up.

Design:
Prospective cohort study with follow-up questionnaires at 6 and 12 months.

Setting:
Ten U.S. PICUs.

Patients:
Two-hundred fifty-five children were included in analysis after exclusion for underlying chronic disease or incomplete data. One-hundred fifty-eight and 130 children had follow-up data at 6 and 12 months, respectively.

Interventions:
None.

Measurements and Main Results:
Pulmonary dysfunction at discharge a priori defined as one of: mechanical ventilation, supplemental oxygen, bronchodilators or steroids at 28 days or discharge. Persistent respiratory morbidity a priori defined as a respiratory PedsQL, a pediatric quality of life measure, greater than or equal to 5 or asthma diagnosis, bronchodilator or inhaled steroids, or unscheduled clinical evaluation for respiratory symptoms. Multivariate backward stepwise regression using Akaike information criterion minimization determined independent predictors of these outcomes. Pulmonary dysfunction at discharge was present in 34% of patients. Positive bacterial respiratory culture predicted pulmonary dysfunction at discharge (odds ratio, 4.38; 95% CI, 1.66–11.56). At 6- and 12-month follow-up 42% and 44% of responders, respectively, had persistent respiratory morbidity. Pulmonary dysfunction at discharge was associated with persistent respiratory morbidity at 6 months, and persistent respiratory morbidity at 6 months was strongly predictive of 12-month persistent respiratory morbidity (odds ratio, 18.58; 95% CI, 6.68–52.67). Positive bacterial respiratory culture remained predictive of persistent respiratory morbidity in patients at both follow-up points.

Conclusions:
Persistent respiratory morbidity develops in up to potentially 44% of previously healthy children less than or equal to 24 months old at follow-up after acute respiratory failure requiring mechanical ventilation. This is the first study, to our knowledge, to suggest a prevalence of persistent respiratory morbidity and the association between positive bacterial respiratory culture and pulmonary morbidity in a population of only previously healthy children with acute respiratory failure.
Cutaneous Adenosquamous Carcinoma of the Scalp With Intestinal Phenotype
Authors: Alomran Husain , Cruel Thierry , Harrou Olivier , Kanitakis Jean , Balme Brigitte 
Published: May 2020

Abstract:
Cutaneous adenosquamous carcinoma is a mixed, squamous and glandular, rare malignant tumor of the skin characterized by a mixed, squamous, and glandular differentiation. Few cases of this tumor have been so far reported, and even fewer have been thoroughly studied by immunohistochemistry. We report here an exceptional case of cutaneous adenosquamous carcinoma which showed immunohistochemically features of intestinal differentiation, namely because of the expression of keratin 20 and CDX2, a marker of gastrointestinal tumors.
Beyond Developmental Supports for a Child Refugee
Authors: Moore Jessica A. , Scharf Rebecca J. , Malik Fatima , Nyp Sarah S. 
Published: May 2020

CASE:
Zahid is a 10-year-old boy who moved to the United States 18 months ago with his parents and 3 younger siblings. He and his family are refugees from Syria. Zahid was born in Syria after an uncomplicated pregnancy and delivery. Zahid's parents first became concerned about Zahid's development when he was 9 months old because he had not started cooing or babbling and did not respond to his name. At 3 years, a doctor in Syria expressed concern that Zahid may have autism spectrum disorder; however, his parents did not know what symptoms triggered the concern and believed his behavior was because of his ongoing exposure to trauma.
Zahid underwent a full evaluation 1 year ago in the United States and was found to meet the criteria for autism spectrum disorder. Coaching was provided to his parents in obtaining appropriate educational support for their son, and a referral was placed for applied behavior analysis (ABA) to be provided by an organization in the community. After several meetings between the parents and school administration, an Individualized Education Program was initiated. Despite acceptance into a community-based ABA program, Zahid has not begun the intervention because of transportation difficulties. In-home ABA was offered but was refused by the family.
The family is under significant stress. Zahid is nonverbal and has displayed behaviors affecting safety, including wandering/eloping and turning on kitchen appliances resulting in a kitchen fire. Zahid's mother completed high school, and his father completed sixth grade. Both parents speak limited English, and neither is employed. The family receives financial support through the government, but this will be ending soon. Zahid's father is concerned that employment outside of the home will further limit his ability to transport Zahid to necessary appointments. Zahid's mother does not drive. Zahid's father requests that the physician provide a letter requesting exemption from requirements to participate in work or training programs because of Zahid's needs. How would you respond to this overwhelmed father?
Evaluation of Extrapolation Methods to Predict Trough Concentrations to Guide Therapeutic Drug Monitoring of Oral Anticancer Drugs
Authors: Janssen Julie M. , Dorlo Thomas P.C. , Beijnen Jos H. , Huitema Alwin D.R. 
Published: May 2020

Background:
For oral anticancer drugs, trough concentration (Cmin) is usually used as a target in therapeutic drug monitoring (TDM). Recording of Cmin is highly challenging in outpatients, in whom there is typically a variability in sample collection time after dosing. Various methods are used to estimate Cmin from the collected samples. This simulation study aimed to evaluate the performance of 3 different methods in estimating the Cmin of 4 oral anticancer drugs for which TDM is regularly performed.

Methods:
Plasma concentrations of abiraterone, dabrafenib, imatinib, and pazopanib at a random time (Ct,sim) and at the end of the dosing interval (Cmin,sim) were simulated from population pharmacokinetic models including 1000 patients, and the values were converted into simulated observed concentrations (Ct,sim,obs and Cmin,sim,obs) by adding a residual error. From Ct, sim,obs, Cmin was predicted (Cmin,pred) by the Bayesian estimation (method 1), taking the ratio of the Ct,sim,obs and typical population concentration and multiplying this ratio with the typical population value of Cmin,sim (method 2), and log-linear extrapolation (method 3). Target attainment was assessed by comparing Cmin,pred with the proposed pharmacokinetic targets related to efficacy and calculating the positive predictive and negative predictive values.

Results:
The mean relative prediction error and root mean squared relative prediction error results showed that method 3 was out-performed by method 1 and 2. Target attainment was adequately predicted by all 3 methods (the respective positive predictive value of method 1, 2, and 3 was 92.1%, 92.5%, and 93.1% for abiraterone; 87.3%, 86.9%, and 99.1% for dabrafenib; 79.3%, 79.3%, and 75.9% for imatinib; and 72.5%, 73.5%, and 67.6% for pazopanib), indicating that dose adjustments were correctly predicted.

Conclusions:
Both method 1 and 2 provided accurate and precise individual Cmin,pred values. However, method 2 was easier to implement than method 1 to guide individual dose adjustments in TDM programs.