bluuebunny/crossref_metadata_2025_split huggingface dataset:
Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery
Authors: Neifert Sean N. , Lamb Colin D. , Gal Jonathan S. , Martini Michael L. , Nistal Dominic A. , Rothrock Robert J. , Gilligan Jeffrey , Maron Samuel Z. , Caridi John M. 
Published: April 2020

Study Design.
Retrospective study of a surgical cohort from a single, large academic institution.

Objective.
The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission.

Summary of Background Data.
One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay. No examinations of perioperative outcomes or cost have been performed.

Methods.
All patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) were queried from a single institution from January 1, 2008 to November 30, 2016. Patients undergoing surgery that started between 12:00 am and 6:00 am were excluded due to their likely emergent nature. Cases starting before and after 2:00 pm were compared on the basis of length of stay and cost as the primary outcomes using multivariable logistic regression.

Result.
The patients undergoing ACDF and PCDF were both similar on the basis of comorbidity burden, preoperative diagnosis, and number of segments fused. The patients undergoing ACDF starting after 2 pm had longer LOS values (adjusted difference of 0.65 days; 95% confidence interval [CI]: 0.28–1.03; P = 0.0006) and higher costs of hospitalization (adjusted difference of $1177; 95% CI: $549–$1806; P = 0.0002). Patients undergoing PCDF starting after 2 pm also had longer LOS values (adjusted difference of 1.19 days; 95% CI: 0.46–1.91; P = 0.001) and higher costs of hospitalization (adjusted difference of $2305; 95% CI: $826–$3785; P = 0.002).

Conclusion.
Later surgical start time is associated with longer LOS and higher cost. These findings should be further confirmed in the spine surgical literature to investigate surgical start time as a potential cost-saving measure.

Level of Evidence: 3
Therapeutic Hypothermia in Critically Ill Patients: A Systematic Review and Meta-Analysis of High Quality Randomized Trials*
Authors: Kim Jun Hyun , Nagy Ádám , Putzu Alessandro , Belletti Alessandro , Biondi-Zoccai Giuseppe , Likhvantsev Valery V. , Yavorovskiy Andrey G. , Landoni Giovanni 
Published: April 2020

Objectives:
To investigate the effect of the application of therapeutic hypothermia (32–35°C) on survival and major clinical endpoints in critically ill patients.

Data Sources:
We searched online database and clinical trial registries dated up to April 30, 2019, and references of relevant studies.

Study Selection:
Low risk of bias randomized trials which compared hypothermia applied for at least 24 hours and conventional therapy in critically ill patients were included. We excluded trials investigating therapeutic hypothermia in indications already supported by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns) or intraoperative hypothermia.

Data Extraction:
Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed, and data were abstracted using a structured template.

Data Synthesis:
Our search retained 14 low risk of bias randomized trials (2,670 patients) performed in three different settings: traumatic brain injury, serious infections, and stroke. Therapeutic hypothermia was associated with an increase in mortality at longest follow-up available (432/1,375 [31%] vs 330/1,295 [25%]; risk ratio, 1.24; 95% CI, 1.10–1.39; p = 0.0004; I
2 = 0%). Pooled results showed no difference of good neurologic outcome among survivors between the two treatment arms (493/1,142 [43%] vs 486/1,067 [46%]; risk ratio, 1.04; 95% CI, 0.97–1.12; p = 0.27; I
2 = 1%). Arrhythmias were significantly increased among patients undergoing therapeutic hypothermia. We found no difference between groups in pneumonia, serious infections, any infection, hemorrhage, renal failure, deep vein thrombosis, and uncontrollable intracranial hypertension.

Conclusions:
High-quality randomized evidence indicates that therapeutic hypothermia is associated with higher mortality and no difference in good neurologic outcome compared with normothermia in critically ill patients. Although there still might be a possibility that therapeutic hypothermia is beneficial in a specific setting, routine application of therapeutic hypothermia would better be avoided outside the settings indicated by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns).
Can preventive hyperbaric oxygen therapy optimise surgical outcome?
Authors: Boet Sylvain , Martin Leonardo , Cheng-Boivin Olivia , Etherington Cole , Louge Pierre , Pignel Rodrigue , Pellégrini Michel , Magnan Marie-Anne , Bennett Michael 
Published: April 2020

BACKGROUND
A primary underlying cause of postoperative complications is related to the surgical stress response, which may be mitigated by hyperbaric oxygen therapy (HBOT), the intermittent administration of oxygen at a pressure higher than the atmospheric pressure at sea level. Promising clinical studies have emerged suggesting HBOT's efficacy for reducing some postoperative complications. Notwithstanding, the effectiveness (if any) of HBOT across a range of procedures and postoperative outcomes has yet to be clearly quantified.

OBJECTIVE
This systematic review aimed to summarise the existing literature on peri-operative HBOT to investigate its potential to optimise surgical patient outcome.

DESIGN
A systematic review of randomised controlled trials (RCTs) with narrative summary of results.

DATA SOURCES
MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched without language restrictions through to 19 June 2018.

ELIGIBILITY CRITERIA
Studies were included if they involved patients of any age undergoing any surgical procedure and provided with at least one HBOT session in the peri-operative period. Two independent reviewers screened the initial identified trials and determined those to be included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs.

RESULTS
The search retrieved 775 references, of which 13 RCTs were included (627 patients). Ten RCTs (546 patients) reported treatment was effective for improving at least one of the patient outcomes assessed, while two studies (55 patients) did not find any benefit and one study (26 patients) found a negative effect. A wide range of patient outcomes were reported, and several other methodological limitations were observed among the included studies, such as limited use of sham comparator and lack of blinding.

CONCLUSION
Peri-operative preventive HBOT may be a promising intervention to improve surgical patient outcome. However, future work should consider addressing the methodological weaknesses identified in this review.

TRIAL REGISTRATION
The protocol (CRD42018102737) was registered with the International ProspectiveRegister of Systematic Reviews (PROSPERO).
Less Invasive Management of Tissue Deficits for Deep Sternal Wound Infections
Authors: Watanabe Hidetaka , Uemura Tetsuji , Yanai Tetsu , Kurokawa Masato , Harada Yoshimi , Ishihara Yasuhiro , Chuman Takahiro , Kawano Hiroshige 
Published: April 2020

Background:
The frequency of sternomyelitis after cardiovascular surgery has been reported to be 0.4% -5%.

Methods:
The treatment method used for 47 patients (29 male and 18 female) who developed sternomyelitis after sternotomy with tissue defects in the chest was examined retrospectively.

Results:
Of the original conditions, the most frequent was coronary artery disease undergoing bypass grafting (22 cases, 46.8%), followed by acute aortic dissection (10 cases, 21.3%). The number of times debridement was performed was: once, 35 cases; twice, 11 cases; 7 times, 1 case; and unknown, 2 cases. The most frequent time of occurrence of sternomyelitis was within 2 weeks after surgery (12 patients, 25.5%). A residual internal thoracic artery remained on both sides in 28 cases (59.6%), and only on the right side in 17 cases (36.2%); there was no remaining one in 2 cases (4.2%). The reconstruction method was a pectoralis major musculocutaneous flap in 31 cases (66.0%), internal mammary artery perforator flap in 7 cases (14.9%), rectus abdominis musculocutaneous flap in 4 cases (8.5%), omentum transplant in 3 cases (6.4%), superior epigastric artery perforator flap in 2 cases (4.3%), external abdominal oblique muscle flap in 1 case (2.1%), and latissimus dorsi musculocutaneous flap in 1 case (2.1%). The internal mammary artery perforator flap and the superior epigastric artery perforator flap have been effective treatment.

Conclusions:
In 47 patients, our method of treatment for tissue defects of the chest wall after sternal osteomyelitis was examined, and an algorithm using less invasive management was proposed.
Considerations for STI Clinics During the COVID-19 Pandemic
Authors: Napoleon Siena C. , Maynard Michaela A. , Almonte Alexi , Cormier Kevin , Bertrand Thomas , Ard Kevin L. , Chan Philip A. 
Published: April 2020

Abstract
Coronavirus disease (COVID-19) is responsible for a global pandemic. It is important to balance the need for access to healthcare services, including testing and treatment for sexually transmitted infections. Sexually transmitted infection programs must consider how to use limited resources and implement novel approaches to provide continued access to care.
Traumatic Pneumoperitoneum After Vaginal Intercourse
Authors: Thomas John W. , Buckley Clifford James 
Published: April 2020

Objectives
Pneumoperitoneum with peritonitis, although uncommon, is a serious injury encountered in the pediatric emergency department. Although the patients may often appear ill or toxic, they can have normal vital signs at initial presentation. Patients with such injury can present with a variety of complaints because of the nature of referred pain. As a result, some patients may be more or less straightforward, thus illustrating the importance of obtaining a detailed history and performing a thorough physical examination.

Methods
We discuss an uncommon case report of pneumoperitoneum with peritonitis in an adolescent patient presenting with vaginal bleeding and abdominal pain hours after vigorous coitus.

Results
Examination under anesthesia, flexible sigmoidoscopy, and exploratory laparoscopy revealed a vaginal laceration and a 2- to 3-cm perforated area at the left edge of the vaginal laceration that involved the rectovaginal septum entering the peritoneal cavity.

Conclusions
Pneumoperitoneum resulting from vaginal intercourse in an otherwise healthy adolescent female is a rare cause of peritonitis. Although it has been described in the adult literature, this case illustrates the importance of considering sexual history as a contributory factor in pediatric patients presenting with an acute abdomen.
A Quality Improvement Project to Reduce Combination Acetaminophen-opioid Prescriptions to Pediatric Orthopedic Patients
Authors: Caruso Thomas J. , Trivedi Sunny , Chadwick Whitney , Gaskari Shabnam , Wang Ellen , Marquez Juan , Lagasse Sara , Bailey Madison , Shea Kevin 
Published: April 2020

Background:
Acetaminophen-opioid analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, these combined opioid analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. The primary aim of this quality improvement project was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative acetaminophen-opioid analgesics to independent acetaminophen and opioids.

Methods:
The study took place in a level 1 trauma center at a children’s hospital. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, we removed acetaminophen-oxycodone products from hospital formulary, implemented a revised inpatient and outpatient electronic order set, and conducted multiple education efforts. Outcomes included inpatient and outpatient percent combined acetaminophen-opioid orders by surgical providers over 27 months.

Results:
Before the intervention, inpatient acetaminophen-opioid products accounted for an average of 46% of all opioid prescriptions for orthopedic patients. After the intervention and multiple educational efforts, we reported a reduction in the acetaminophen-opioid products to 2.9%. For outpatient prescriptions, combined analgesics accounted for 88% before the intervention, and we reported a reduction to 15% after the intervention.

Conclusions:
By removing acetaminophen-oxycodone products from hospital formulary, educating the medical staff, and employing revised electronic order sets, the prescribing practice of pediatric orthopedic surgeons changed from the routine use of acetaminophen-opioid analgesics to independent medications.
A deeper look at COVID-19 CFR: health care impact and roots of discrepancy
Authors: Dehkordi Amirhoshang Hoseinpour , Nemati Reza , Tavousi Pouya 
Published: April 2020

AbstractIntensive care capacity and proper testing play a paramount role in the COVID-19 Case Fatality Rate (CFR). Nevertheless, the real impact of such important measures has not been appreciated due to the lack of proper metrics. In this work, we have proposed a method for estimating a lower bound for the number of positive cases by using the reported data on the oldest age group and the regions’ population distributions. The proposed estimation method improved the expected similarity between the age-distribution of positive cases and regions’ population. Further, we have provided a quantitative measure for the impact of intensive care on the critical cases by comparing the CFR among those who did and did not receive intensive care. Our findings showed that the chance of living among non-ICU receivers is less than half of ICU receivers (∼24% vs ∼60%).
Estimation of the actual incidence of coronavirus disease (COVID-19) in emergent hotspots: The example of Hokkaido, Japan during February–March 2020
Authors: Akhmetzhanov Andrei R. , Mizumoto Kenji , Jung Sung-mok , Linton Natalie M. , Omori Ryosuke , Nishiura Hiroshi 
Published: April 2020

AbstractFollowing the first report of coronavirus disease 2019 (COVID-19) in Sapporo City, Hokkaido Prefecture, Japan on 14 February 2020, a surge of cases was observed in Hokkaido during February and March. As of 6 March, 90 cases were diagnosed in Hokkaido. Unfortunately, many infected persons may not have been recognized as cases due to having mild or no symptoms. We therefore estimated the actual number of COVID-19 cases in (i) Hokkaido Prefecture and (ii) Sapporo City using data on cases diagnosed outside these areas. The estimated cumulative incidence in Hokkaido as of 27 February was 2297 cases (95% confidence interval [CI]: 382, 7091) based on data on travelers outbound from Hokkaido. The cumulative incidence in Sapporo City as of 28 February was estimated at 2233 cases (95% CI: 0, 4893) based on the count of confirmed cases within Hokkaido. Both approaches resulted in similar estimates, indicating higher incidence of infections in Hokkaido than were detected by the surveillance system. This quantification of the gap between detected and estimated cases can help inform public health response as it provides insight into the possible scope of undetected transmission.
Genetic structure of SARS-CoV-2 in Western Germany reflects clonal superspreading and multiple independent introduction events
Authors: Walker Andreas , Houwaart Torsten , Wienemann Tobias , Vasconcelos Malte Kohns , Strelow Daniel , Senff Tina , Hülse Lisanna , Adams Ortwin , Andree Marcel , Hauka Sandra , Feldt Torsten , Jensen Björn-Erik , Keitel Verena , Kindgen-Milles Detlef , Timm Jörg , Pfeffer Klaus , Dilthey Alexander T 
Published: April 2020

AbstractWe whole-genome sequenced 55 SARS-CoV-2 isolates from Western Germany and investigated the genetic structure of SARS-CoV-2 outbreaks in the Heinsberg district and Düsseldorf. While the genetic structure of the Heinsberg outbreak indicates a clonal origin, reflective of superspreading dynamics during the carnival season, distinct viral strains are circulating in Düsseldorf, reflecting the city’s international links. Limited detection of Heinsberg strains in the Düsseldorf area despite geographical proximity may reflect efficient containment and contact tracing efforts.
Informative Ranking of Stand Out Collections of Symptoms: A New Data-Driven Approach to Identify the Strong Warning Signs of COVID 19
Authors: AlMomani Abd AlRahman , Bollt Erik 
Published: April 2020

AbstractWe develop here a data-driven approach for disease recognition based on given symptoms, to be efficient tool for anomaly detection. In a clinical setting and when presented with a patient with a combination of traits, a doctor may wonder if a certain combination of symptoms may be especially predictive, such as the question, “Are fevers more informative in women than men?” The answer to this question is, yes. We develop here a methodology to enumerate such questions, to learn what are the stronger warning signs when attempting to diagnose a disease, called Conditional Predictive Informativity, (CPI), whose ranking we call CPIR. This simple to use process allows us to identify particularly informative combinations of symptoms and traits that may help medical field analysis in general, and possibly to become a new data-driven advised approach for individual medical diagnosis, as well as for broader public policy discussion. In particular we have been motivated to develop this tool in the current environment of the pressing world crisis due to the COVID 19 pandemic. We apply the methods here to data collected from national, provincial, and municipal health reports, as well as additional information from online, and then curated to an online publically available Github repository.
Public perceptions of COVID-19 in Australia: perceived risk, knowledge, health-protective behaviours, and vaccine intentions
Authors: Faasse Kate , Newby Jill 
Published: April 2020

AbstractWidespread and sustained engagement with health-protective behaviours (i.e., hygiene and distancing) is critical to successfully managing the COVID-19 pandemic. Evidence from previous emerging infectious disease outbreaks points to the role of perceived risk, worry, media coverage, and knowledge in shaping engagement with health-protective behaviours as well as vaccination intentions. The current study examined these factors in 2,174 Australian residents. An online survey was completed between 2-9 March 2020, at an early stage of the COVID-19 outbreak in Australia. Results revealed that two thirds of respondents were at least moderately worried about a widespread COVID-19 outbreak in Australia (which subsequently occurred). Worry about the outbreak and closely following media coverage were consistent predictors of health-protective behaviours (both over the previous month, and intended behaviours in the case of a widespread outbreak) as well as vaccination intentions. Health-behaviour engagement over the previous month was lower in some demographic groups, including males and younger individuals (18-29 age group). These was a substantial mismatch between respondents’ expected symptoms of infection and emerging evidence that a meaningful proportion of people who contract the novel coronavirus will experience asymptomatic infection (i.e., they will not experience symptoms associated with COVID-19). Only 0.3% of those in the current study believed that they personally would not experience any symptoms if they were infected. Uncertainty and misconceptions about COVID-19 were common, including one third of respondents who reported being unsure whether people are likely have natural or existing immunity. There was also uncertainty around whether specific home remedies (e.g., vitamins, saline rinses) would offer protection, whether the virus could spread via the airborne route, and whether the virus was human made and deliberately released. Such misconceptions are likely to cause concern for members of the public. These results point to areas of uncertainty that could be usefully targeted by public education campaigns, as well as psychological and demographic factors associated with engagement with health-protective behaviours. These findings offer potential pathways for interventions to encourage health-protective behaviours to reduce the spread of COVID-19.
Systematic review of international guidelines for tracheostomy in COVID-19 patients
Authors: Chiesa-Estomba Carlos M. , Lechien Jérome R. , Calvo-Henríquez Christian , Fakhry Nicolas , Karkos Petros D. , Peer Shazia , Sistiaga-Suarez Jon A. , Gónzalez-García José A. , Cammaroto Giovanni , Mayo-Yánez Miguel , Parente-Arias Pablo , Saussez Sven , Ayad Tareck 
Published: April 2020

AbstractAt this moment, the world leaves under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.
Decomposing complex links between the childhood environment and brain structure in school-aged youth
Authors: Hong Seok-Jun , Sisk Lucinda , Caballero Camila , Mekhanik Anthony , Roy Amy K. , Milham Michael P. , Gee Dylan G. 
Published: April 2020

ABSTRACTChildhood experiences play a profound role in conferring risk and resilience for brain and behavioral development. However, how different facets of the environment shape neurodevelopment remains largely unknown. Here we sought to decompose heterogeneous relationships between environmental factors and brain structure in 989 school-aged children from the Adolescent Brain Cognitive Development Study. We applied a cross-modal integration and clustering approach called ‘Similarity Network Fusion’, which combined two brain morphometrics (i.e., cortical thickness and myelin-surrogate markers), and key environmental factors (i.e., trauma exposure, neighborhood safety, school environment, and family environment) to identify homogeneous subtypes. Depending on the subtyping resolution, results identified two or five subgroups, each characterized by distinct brain structure-environment profiles. Notably, more supportive caregiving and school environments were associated with increased myelination, whereas less supportive caregiving, higher family conflict and psychopathology, and higher perceived neighborhood safety were observed with increased cortical thickness. These subtypes were highly reproducible and predicted externalizing symptoms and overall mental health problems. Our findings support the theory that distinct environmental exposures differentially influence neurodevelopment. Delineating more precise associations between risk factors, protective factors, and brain development may inform approaches to enhance risk identification and optimize interventions targeting specific experiences.