bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Transfer for Hand and Upper Extremity Injuries: Diagnostic Accuracy at the Time of Referral
Authors: Amador Ricardo O. , Wilkens Suzanne , Gottlieb Rachel , Sood Ravi F. , Cetrulo Curtis L. , Chen Neal C. , Eberlin Kyle R. 
Published: July 2020

Background:
Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral.

Methods:
Adult patients transferred from outside facilities to the authors’ Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified. Patient- and injury-related information was prospectively collected at the time of referral before patient transfer, and again following diagnostic evaluation by a hand surgeon at the authors’ institution.

Results:
Sixty-three patients were transferred to the authors’ hand surgery service from outside facilities after direct contact with the on-call fellow. Most patients were referred by emergency medicine physicians [n = 47 (76 percent)], followed by midlevel emergency department providers (physician assistant or nurse practitioner) [n = 12 (19 percent)] or hand surgeons [n = 3 (5 percent)]. Six patients were transferred directly from a Level I trauma center. Twenty-one transferred patients (33 percent) had an inaccurate diagnosis at the time of referral. Factors associated with an inaccurate diagnosis included trauma level of the referring hospital and diagnoses of infection or dysvascularity.

Conclusions:
The diagnostic accuracy for hand injuries transferred from outside facilities by means of provider-to-provider communication is imperfect, and some injuries are misdiagnosed. Hand surgeons should continue to improve the triage and transfer process for patients with acute hand surgery injuries.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Nonsyndromic Craniosynostosis Is Associated with Increased Risk for Psychiatric Disorders
Authors: Tillman Karin K. , Höijer Jonas , Ramklint Mia , Ekselius Lisa , Nowinski Daniel , Papadopoulos Fotios C. 
Published: July 2020

Background:
Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis.

Methods:
The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders.

Results:
Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders.

Conclusions:
Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors).

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
A Comprehensive Review of Surgical Treatment of Migraine Surgery Safety and Efficacy
Authors: Hatef Daniel A. , Gutowski Karol A. , Culbertson Gary R. , Zielinski Marta , Manahan Michele A. 
Published: July 2020

Background:Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature.Methods:A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed.Results:Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery.Conclusions:Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.
Low Complication Rates Using Closed-Incision Negative-Pressure Therapy for Panniculectomies: A Single-Surgeon, Retrospective, Uncontrolled Case Series
Authors: Patel Ashraf A. , Wilcox Kailyn , Bhinder Jasmine , Reiser Julia , Upadhyaya Prashant 
Published: July 2020

Background:
Panniculectomies are associated with high complication rates (43 to 70 percent), particularly in patients with obesity, smoking, and diabetes mellitus. Closed-incision negative-pressure therapy can be used postoperatively to support healing by promoting angiogenesis and decreasing tension. The authors hypothesized that using it with panniculectomies would minimize complications, and that a longer duration of therapy would not increase the incidence of complications. The authors also evaluated whether closed-incision negative-pressure therapy malfunction was associated with complications.

Methods:
This retrospective, uncontrolled case series analyzed 91 patients who underwent panniculectomies managed with closed-incision negative-pressure therapy performed by a single surgeon from 2014 to 2018. Patients were followed for 6 months; therapy duration and malfunction were recorded. Patients were placed into therapy duration groups (2 to 7, 8 to 10, or >10 days). Complications managed conservatively were minor and major if they required intervention. Odds ratios were performed with 95 percent confidence intervals and p values.

Results:
Mean follow-up was 225.1 days and mean closed-incision negative-pressure therapy duration was 10.5 days. Major complications were reported in five patients (5.5 percent), infections in four (4.4 percent), dehiscence in two (2.2 percent), and seroma in four (4.4 percent). Patients with malfunction [n = 16 (17.6 percent)] were more likely to experience complications (OR, 3.3; p = 0.043). No significant increase in complications was found with therapy duration longer than 10 days, but potentially there is an increased risk of infection (OR, 4.0; p = 0.067).

Conclusions:
Although high complication rates have been associated with panniculectomies, the authors’ results show that low complication rates can be achieved with closed-incision negative-pressure therapy. Randomized controlled trials need to be conducted evaluating different therapy systems and the optimal duration of therapy with panniculectomies.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Development and Evaluation of the Taxonomy of Trauma Leadership Skills–Shortened for Observation and Reflection in Training
Authors: Leenstra Nico F. , Jung Oliver C. , Cnossen Fokie , Jaarsma A. Debbie C. , Tulleken Jaap E. 
Published: July 2020

Introduction
Trauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training.

Methods
In 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised.

Results
The resultant “TTLS–Shortened for Observation and Reflection in Training” was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors.

Conclusions
The TTLS–Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.
Nonfluent Primary Progressive Aphasia
Authors: Mahendra Nidhi , Tadokoro Ashlyn 
Published: July 2020

Purpose:
Nonfluent primary progressive aphasia (nfvPPA) is an established language-led dementia and a known variant of frontotemporal degeneration. The purpose of this article is to report the trajectory of a single case, AC, diagnosed with nfvPPA. We describe a range of interventions offered to AC over 3 years that aimed to support her communicative function, social participation, sense of identity, and emotional well-being. We offer reflections on how these interventions align with palliative care principles, highlighting their value for guiding communication and life participation interventions for persons with nfvPPA.

Method:
This study used a longitudinal analysis of impairment progression, traditional outcome measures, patient-reported outcome measures, and narrative description to report on patient and family response to interventions.

Results:
Individual and group interventions are critical for addressing the progressive communication impairments and life participation restrictions for persons affected by nfvPPA. Palliative care principles have intuitive appeal for informing the selection of intervention approaches while focusing on managing symptoms, upholding patient autonomy and dignity, and enhancing quality of life throughout the course of rapidly progressive conditions like primary progressive aphasia.

Discussion/Conclusion:
Speech–language pathologist-led interventions, grounded in palliative care principles, can optimize communicative function and quality of life for persons with nfvPPA.
Modeling Control, Lockdown & Exit Strategies for COVID-19 Pandemic in India
Authors: Barman Madhab , Nayak Snigdhashree , Yadav Manoj K. , Raha Soumyendu , Mishra Nachiketa 
Published: July 2020

AbstractCOVID-19–a viral infectious disease–has quickly emerged as a global pandemic infecting millions of people with a significant number of deaths across the globe. The symptoms of this disease vary widely. Depending on the symptoms an infected person is broadly classified into two categories namely, asymptomatic and symptomatic. Asymptomatic individuals display mild or no symptoms but continue to transmit the infection to other-wise healthy individuals. This particular aspect of asymptomatic infection poses a major obstacle in managing and controlling the transmission of the infectious disease. In this paper, we attempt to mathematically model the spread of COVID-19 in India under various intervention strategies. We consider SEIR type epidemiological models, incorporated with India specific social contact matrix representing contact structures among different age groups of the population. Impact of various factors such as presence of asymptotic individuals, lockdown strategies, social distancing practices, quarantine, and hospitalization on the disease transmission is extensively studied. Numerical simulation of our model is matched with the real COVID-19 data of India till May 15, 2020 for the purpose of estimating the model parameters. Our model with zone-wise lockdown is seen to give a decent prediction for July 20, 2020.
SARS-CoV-2, SARS-CoV-1 and MERS-CoV viral load dynamics, duration of viral shedding and infectiousness – a living systematic review and meta-analysis
Authors: Cevik Muge , Tate Matthew , Lloyd Ollie , Maraolo Alberto Enrico , Schafers Jenna , Ho Antonia 
Published: July 2020

ABSTRACTBackgroundViral load kinetics and the duration of viral shedding are important determinants for disease transmission. We aim i) to characterize viral load dynamics, duration of viral RNA, and viable virus shedding of SARS-CoV-2 in various body fluids and ii) to compare SARS-CoV-2 viral dynamics with SARS-CoV-1 and MERS-CoV.MethodsMedline, EMBASE, Europe PMC, preprint servers and grey literature were searched to retrieve all articles reporting viral dynamics and duration of SARS-CoV-2, SARS-CoV-1 and MERS-CoV shedding. We excluded case reports and case series with < 5 patients, or studies that did not report shedding duration from symptom onset. PROSPERO registration: CRD42020181914.FindingsSeventy-nine studies on SARS-CoV-2, 8 on SARS-CoV-1, and 11 on MERS-CoV were included. Mean SARS-CoV-2 RNA shedding duration in upper respiratory tract, lower respiratory tract, stool and serum were 17.0, 14.6, 17.2 and 16.6 days, respectively. Maximum duration of SARS-CoV-2 RNA shedding reported in URT, LRT, stool and serum were 83, 59, 35 and 60 days, respectively. Pooled mean duration of SARS-CoV-2 RNA shedding was positively associated with age (p=0.002), but not gender (p = 0.277). No study to date has cultured live virus beyond day nine of illness despite persistently high viral loads. SARS-CoV-2 viral load in the upper respiratory tract appears to peak in the first week of illness, while SARS-CoV-1 and MERS-CoV peak later.ConclusionAlthough SARS-CoV-2 RNA shedding in respiratory and stool can be prolonged, duration of viable virus is relatively short-lived. Thus, detection of viral RNA cannot be used to infer infectiousness. High SARS-CoV-2 titers are detectable in the first week of illness with an early peak observed at symptom onset to day 5 of illness. This review underscores the importance of early case finding and isolation, as well as public education on the spectrum of illness. However, given potential delays in the isolation of patients, effective containment of SARS-CoV-2 may be challenging even with an early detection and isolation strategy.FundingNo funding was received.
A Bayesian Framework for Estimating the Risk Ratio of Hospitalization for People with Comorbidity Infected by the SARS-CoV-2 Virus
Authors: Gao Xiang , Dong Qunfeng 
Published: July 2020

AbstractEstimating the hospitalization risk for people with certain comorbidities infected by the SARS-CoV-2 virus is important for developing public health policies and guidance based on risk stratification. Traditional biostatistical methods require knowing both the number of infected people who were hospitalized and the number of infected people who were not hospitalized. However, the latter may be undercounted, as it is limited to only those who were tested for viral infection. In addition, comorbidity information for people not hospitalized may not always be readily available for traditional biostatistical analyses. To overcome these limitations, we developed a Bayesian approach that only requires the observed frequency of comorbidities in COVID-19 patients in hospitals and the prevalence of comorbidities in the general population. By applying our approach to two different large-scale datasets in the U.S., our results consistently indicated that cardiovascular diseases carried the highest hospitalization risk for COVID-19 patients, followed by diabetes, chronic respiratory disease, hypertension, and obesity, respectively.Significance StatementWe developed a novel Bayesian approach to estimate the hospitalization risk for people with comorbidities infected with the SARS-CoV-2 virus. Our results indicated that cardiovascular diseases carried the highest hospitalization risk for COVID-19 patients, followed by diabetes, chronic respiratory disease, hypertension, and obesity, respectively.
30-day mortality and morbidity in COVID-19 versus influenza: A population- based study
Authors: Nersesjan Vardan , Amiri Moshgan , Christensen Hanne , Benros Michael E. , Kondziella Daniel 
Published: July 2020

AbstractBackgroundAs of July 2020, COVID-19 has caused 500,000 deaths worldwide. However, large-scale studies of COVID-19 mortality and new-onset comorbidity compared to influenza and individuals tested negative for COVID-19 are lacking. We aimed to investigate COVID-19 30-day mortality and new-onset comorbidity compared to individuals with negative COVID-19 test results and individuals tested for influenza.Methods and findingsThis population-based cohort study utilized electronic health records covering roughly half (n=2,647,229) of Denmark’s population, with nationwide linkage of microbiology test results and death records. All individuals ≥18 years tested for COVID-19 and individuals tested for influenza were followed from November 1, 2017 to June 30, 2020. The main outcome was 30-day mortality after a test for either COVID-19 or influenza. Secondary outcomes were major comorbidity diagnoses 30-days after the test for either COVID-19 or influenza. In total, 224,639 individuals were tested for COVID-19. Among inpatients positive for COVID-19, 356 of 1657 (21%) died within 30 days, which was a 3.0 to 3.1-fold increased 30-day mortality rate, when compared to influenza and COVID-19-negative inpatients (all p<0.001). For outpatients, 128 of 6,263 (2%) COVID-19-positive patients died within 30 days, which was a 5.5 to 6.9-fold increased mortality rate compared to influenza and COVID-19-negative patients, respectively (all p<0.001). Compared to hospitalized patients with influenza, new-onset ischemic stroke, diabetes and nephropathy occurred more frequently in inpatients with COVID-19 (all p<0.05).ConclusionsIn this population-based study comparing COVID-19 with influenza, COVID-19 was associated with increased rates of major systemic and vascular comorbidity and substantially higher mortality, which is likely even higher than the stated 3.0 to 5.5-fold increase owing to more extensive testing for COVID-19.
Association of olfactory dysfunction with hospitalization for COVID-19: a multicenter study in Kurdistan
Authors: Zobairy Hosna , Shamsoddin Erfan , Rasouli Mohammad Aziz , Khodlan Nasrollah Veisi , Moradi Ghobad , Zareie Bushra , Teymori Sara , Asadi Jalal , Sofi-Mahmudi Ahmad , Sedaghat Ahmad R 
Published: July 2020

AbstractObjectiveTo evaluate the association of olfactory dysfunction (OD) with hospitalization for COVID-19.Study DesignMulti-center cohort study.SettingEmergency departments of thirteen COVID-19-designed hospitals in Kurdistan province, Iran.Subjects and MethodsPatients presenting with flu-like symptoms who tested positive by RT-PCR for COVID-19 between May 1st and 31st, 2020. At the time of presentation and enrollment, patients were asked about the presence of OD, fever, cough, shortness of breath, headache, rhinorrhea and sore throat. The severity of OD was assessed on an 11-point scale from 0 (none) to 10 (anosmia). Patients were either hospitalized or sent home for outpatient care based on standardized criteria.ResultsOf 203 patients, who presented at a mean of 6 days into the COVID-19 disease course, 25 patients (12.3%) had new OD and 138 patients (68.0%) were admitted for their COVID-19. Patients admitted for COVID-19 had a higher prevalence of all symptoms assessed, including OD (p<0.05 in all cases), and OD identified admitted patients with 84.0% sensitivity and 34.3% specificity. On univariate logistic regression, hospitalization was associated with OD (odds ratio [OR] = 2.47, 95%CI: 1.085–6.911, p=0.049). However, hospitalization for COVID-19 was not associated with OD (OR=3.22, 95% CI: 0.57–18.31, p=0.188) after controlling for confounding demographics and comorbidities.ConclusionOD may be associated with hospitalization for (and therefore more severe) COVID-19. However, this association between OD and COVID-19 severity is more likely driven by patient characteristics linked to OD, such as greater numbers of COVID-19 symptoms experienced or high-risk comorbidities.
Does sampling saliva increase detection of SARS-CoV-2 by RT-PCR? Comparing saliva with oro-nasopharyngeal swabs
Authors: Akgun Dogan Ozlem , Kose Betsi , Agaoglu Nihat Bugra , Yildiz Jale , Alkurt Gizem , Demirkol Yasemin Kendir , Irvem Arzu , Dinler Doganay Gizem , Doğanay Levent 
Published: July 2020

AbstractThe gold standard method in the diagnosis of SARS-CoV-2 infection is the detection of viral RNA in nasopharyngeal sample by RT-PCR. Recently, saliva samples has been suggested as an alternative due to being fast, reliable and non-invasive, rather than nasopharyngeal samples. We compared RT-PCR results in nasopharyngeal, oro-nasopharyngeal and saliva samples of COVID-19 patients. 98 of 200 patients were positive in RT-PCR analysis performed before the hospitalization. In day 0, at least one sample was positive in 67% of 98 patients. Positivity rate was 83% for both oro-nasopharyngeal and nasopharyngeal samples, while it was 63% for saliva samples (p<0.001). On day 5, RT-PCR was performed in 59 patients, 34% had at least one positive result. The positivity rate was 55% for saliva and nasopharyngeal samples, while it was 60% for oro-nasopharyngeal samples. Our study shows that the sampling saliva does not increase the sensitivity of RT-PCR tests at early stages of infection. However, on 5th day, viral RNA detection rates in saliva were similar to nasopharyngeal and oro-nasopharyngeal samples. In conclusion, we suggest that, in patients receiving treatment, virus presence in saliva, in addition to the standard samples, is important to determine the isolation period and to control the transmission.