bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to driving after fracture an overview of current recommendations
Authors: Danilkowicz Richard , Tainter David , Gage Mark 
Published: May 2020

One of the many important considerations after fracture is determining the time for safe return to driving. Although a seemingly mundane question, patients rely on their ability to drive in order to work, take care of their families, and perform day-to-day tasks, making it an important landmark on their road to recovery. Patients who are currently taking narcotic medications, are wearing restrictive medical devices, or have inadequate fracture healing all pose a potential risk to themselves and others if they operate a motor vehicle. Despite objective data on when a patient physically might be able to perform the tasks required to drive safely, practitioners often provide nonstandardized recommendations largely due to a lack of formal recommendations from any governing body. It is important to adhere to evidence-based practices for the safety of the patient and provider. This review aims to aggregate the literature on return to driving after fracture to provide a succinct overview of the data and recommendations.

Level of Evidence:
Level IV.
Measuring Lateral Screw Protuberance Is a Clinically Accurate Method for Quantifying Femoral Neck Shortening
Authors: Sepehri Aresh , Martinson James , Marchand Lucas S. , Riedel Matthew D. , McAlister Ian P. , O'Hara Nathan N. , Stockton David J. , Slobogean Gerard P. 
Published: May 2020

Objectives:
The purpose of this study is to compare the reliability and accuracy of the screw protuberance method (SPM) and overlay method (OM) for measuring femoral neck shortening on anterior–posterior (AP) radiographs. The secondary aim is to investigate the changes in reliability and accuracy with varying femoral rotation.

Methods:
Radio-opaque femur sawbone models were fitted with either 3 cancellous screws or a sliding hip screw implant. Anterior–posterior radiographs were obtained using C-arm fluoroscopy with femoral neck shortening up to 15 mm and with the femoral shaft in 30 degrees of internal rotation to 30 degrees of external rotation (ER). Four observers measured femoral neck shortening at 2 time points. Intraobserver and interobserver reliability were calculated using the intraclass coefficient. Accuracy was analyzed through a Bland–Altman agreement statistic stratified by femoral rotation.

Results:
Both measurement techniques displayed excellent reliability, regardless of femoral rotation or implant. There was a significant difference in femoral neck shortening measurements with rotation for both the OM (P < 0.001) and SPM (P < 0.001). Both methods are accurate within 1 mm of the actual magnitude of shortening from 30-degree internal rotation to 15-degree ER. At 30-degree ER, shortening was underestimated by −2.10 mm using the OM (95% confidence interval, −2.43 to −1.76; P < 0.01) and by −1.64 mm using the SPM (95% confidence interval, −1.83 to −1.45; P < 0.01).

Conclusion:
This study demonstrates that both the OM and SPM are accurate and reliable assessments for femoral neck shortening; however, both methods are sensitive to extreme ER. Given the simplicity of the SPM technique, it may have increased utility for pragmatic research studies.
Inflammatory and Coagulative Considerations for the Management of Orthopaedic Trauma Patients With COVID-19: A Review of the Current Evidence and Our Surgical Experience
Authors: Puzzitiello Richard N. , Pagani Nicholas R. , Moverman Michael A. , Moon Andrew S. , Menendez Mariano E. , Ryan Scott P. 
Published: May 2020

Summary:
Mounting evidence suggests that the pathogenesis of coronavirus disease 2019 (COVID-19) involves a hyperinflammatory response predisposing patients to thromboembolic disease and acute respiratory distress. In the setting of severe blunt trauma, damaged tissues induce a local and systemic inflammatory response through similar pathways to COVID-19. As such, patients with COVID-19 sustaining orthopaedic trauma injuries may have an amplified response to the traumatic insult because of their baseline hyperinflammatory and hypercoagulable states. These patients may have compromised physiological reserve to withstand the insult of surgical intervention before reaching clinical instability. In this article, we review the current evidence regarding pathogenesis of COVID-19 and its implications on the management of orthopaedic trauma patients by discussing a case and the most recent literature.

Level of Evidence:
Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Diabetes Does Not Increase Complications, Length of Stay, or Hospital Costs After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Narain Ankur S. , Haws Brittany E. , Jenkins Nathaniel W. , Parrish James M. , Block Andrew M. , Lamoutte Eric H. , Karmarkar Sailee S. , Singh Kern 
Published: May 2020

Study Design:
Retrospective cohort.

Objective:
To determine if the presence of diabetes mellitus as comorbidity is associated with complications, inpatient length of stay, or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
Very few studies have investigated the effect of diabetes on complications, length of stay, or costs in minimally invasive lumbar surgeries.

Methods:
Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. Diabetic and nondiabetic patients were propensity matched in a 1:1 manner for age, sex, and comorbidity burden. An association between diabetic status and preoperative demographic or perioperative variables, including inpatient length of stay, was tested for using Student t test or χ2 analysis. Multivariate linear regression was used to test for an association between diabetic status and direct hospital costs.

Results:
After 1:1 propensity matching, 100 patients were included in this analysis. There were no significant differences in age, sex, body mass index, smoking status, or Charlson Comorbidity Index between propensity-matched patients with and without diabetes. In regards to the length of stay, no significant differences existed between diabetic and nondiabetic groups (68.7 vs. 58.3 h, P=0.218). No other significant differences existed in other perioperative variables including operative time, intraoperative blood loss, or complication rate (P≥0.05 for each). Multivariate analysis indicated that diabetic status was not associated with differences in total direct hospital costs (US$20,428 vs. US$20,429, P=0.792) or cost subcategories after MIS TLIF (P≥0.05 for each).

Conclusions:
In this investigation, diabetes was not associated with postoperative complication rates, inpatient length of stay, or direct hospital costs after primary, single-level MIS TLIF. The reduced extent of operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications in diabetic patients, possibly preventing extensions in hospital stay length and associated hospital costs.
Association of Insurance Status With Treatment and Outcomes in Pediatric Patients With Severe Traumatic Brain Injury
Authors: Porter Austin , Brown Clare C. , Tilford J. Mick , Thomas Kevin , Maxson R. Todd , Sexton Kevin , Karim Saleema , Zohoori Namvar , Rodriguez Analiz 
Published: May 2020

Objective:
To determine whether a health insurance disparity exists among pediatric patients with severe traumatic brain injury using the National Trauma Data Bank.

Design:
Retrospective cohort study.

Setting:
National Trauma Data Bank, a dataset containing more than 800 trauma centers in the United States.

Patients:
Pediatric patients (< 18 yr old) with a severe isolated traumatic brain injury were identified in the National Trauma Database (years 2007–2016). Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+ and excluded those with another regional Abbreviated Injury Scale of 3+.

Interventions:
None.

Measurement and Main Results:
Procedure codes were used to identify four primary treatment approaches combined into two classifications: craniotomy/craniectomy and external ventricular draining/intracranial pressure monitoring. Diagnostic criteria and procedure codes were used to identify condition at admission, including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Score. Children were propensity score matched using condition at admission and other characteristics to estimate multivariable logistic regression models to assess the associations among insurance status, treatment, and outcomes. Among the 12,449 identified patients, 91.0% (n = 11,326) had insurance and 9.0% (n = 1,123) were uninsured. Uninsured patients had worse condition at admission with higher rates of hypotension and higher Injury Severity Score, when compared with publicly and privately insured patients. After propensity score matching, having insurance was associated with a 32% (p = 0.001) and 54% (p < 0.001) increase in the odds of cranial procedures and monitor placement, respectively. Insurance coverage was associated with 25% lower odds of inpatient mortality (p < 0.001).

Conclusions:
Compared with insured pediatric patients with a traumatic brain injury, uninsured patients were in worse condition at admission and received fewer interventional procedures with a greater odds of inpatient mortality. Equalizing outcomes for uninsured children following traumatic brain injury requires a greater understanding of the factors that lead to worse condition at admission and policies to address treatment disparities if causality can be identified.
Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review
Authors: Coates Dominiek , Clerke Teena 
Published: May 2020

Introduction:
To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes.

Method:
A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap.

Results:
The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients.

Discussion:
Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
Stumped by the Hump: The Curious Rise and Fall of Norwegian Birthweights, 1991–2007
Authors: Carlsen Ellen Øen , Magnus Maria C. , Omsland Tone K. , Magnus Per M. , Håberg Siri E. , Wilcox Allen J. 
Published: May 2020

Background:There was a distinct rise in mean birthweights in Norway starting in 1991 that plateaued in 1996–2002 and then declined to previous levels. We investigated whether these changes corresponded to trends in neonatal mortality or other birthweight-associated pregnancy outcomes. We also explored known predictors of birthweight and examined whether these could explain the birthweight trends.Methods:We calculated mean birthweight for all live births in Norway in each year from 1982 to 2016, together with annual neonatal mortality and proportion of infants born preterm, or with low Apgar score. We stratified mean birthweight over time by factors including parity, gestational age, and Scandinavian versus non-Scandinavian origin of mother, to test robustness of the pattern. In addition, we used multivariable linear regression to obtain adjusted estimates for mean birthweight per year.Results:A 50-g rise and fall of mean birthweights during a 25-year period was not accompanied by corresponding changes in neonatal mortality, preterm births, or Apgar scores. The distinct hump pattern was restricted to term births and was not apparent among infants of mothers born outside Scandinavia. We saw a similar pattern for Sweden but not Finland. Known predictors of birthweight (such as parity, mode of onset of delivery, and marital status) did not explain the hump.Conclusions:A distinct temporal hump in mean birthweight among Norwegian term births had no obvious explanations. Furthermore, these fluctuations in birthweight were not associated indirectly with adverse outcomes in measures of infant health.
Harvest of Rib Graft for Rhinoplasty in Breast Implant Patients
Authors: Ors Safvet 
Published: May 2020

Summary:
Combined cosmetic surgeries are advantageous to patients, requiring only 1 anesthesia administration and the loss of fewer working days. There is no previous study reporting on a submuscular implant placement with the simultaneous reconstruction of a nose deformity using a rib graft. Reconstructions of nose deformities through a rib graft, augmentation mammoplasty, and augmentation mastopexy were performed on 4 female patients (who were 19, 23, 24, and 27 years old) between 2006 and 2016. The patients were taken for operations under general anesthesia. First, the rib graft was taken and the breast implant was placed to prevent contamination. An inframammary incision was made, the skin and the subcutaneous layers were passed, and the pectoral muscle fascia was accessed for the rib graft in all 3 patients. After the perichondrium was dissected, an osteochondral graft was harvested at full thickness. The remaining sharp edges were rasped to avoid damaging the silicone. The perichondrium and the periosteum were sutured edge-to-edge, and the donor area was closed. The harvested grafts were used to produce a spreader graft, a nasal valve graft, an onlay graft, and an L-strut graft. In the early period, no seroma, hematoma, or infections were experienced. There were no ruptures, leakages, capsules, or deformities during the 2- to 10-year follow-up. Primary and secondary rhinoplasties requiring a rib graft can be safely performed simultaneously with a breast implant, provided that the rib stumps are closed with a thick protective layer.
Biokinetic Method on Simultaneous Intake of Radionuclides from Multiple Intake Scenarios for Application in Internal Exposures
Authors: Zhang Bin , Sheng Wei , Zhang Yang , Feng Tian-Cheng , Yin Guo-Hui , Lei Jie-Ying , Xu Ming , He Xin-Zhao , Ma Huai-Cheng 
Published: May 2020

Abstract
Biokinetics underlies the basis for assessment of internal exposures. This paper develops a biokinetic method on simultaneous intake of radionuclides from multiple intake scenarios in internal exposures. With numerical techniques that transform the whole biokinetics between the coupled and decoupled representations of the same problem, this method applies to coupled biokinetics with complex structures and has no restrictions of practical importance on the number of intake scenarios, the number of intake parent radionuclides and decay products, and the complexity of decay relationships between parent and progeny nuclides. For illustration, this method is applied to an assumed case of mixed inhalation and ingestion of weapon-grade plutonium material for reference workers that is focused on 241Pu and 241Am. Due to coupled biokinetics between the direct intake and ingrowth parts in different intake pathways, the multiple intake results (the contents of lungs, daily excretions, and cumulative contents) display richer behaviors as compared to single intake cases. This method benefits both the prospective and retrospective assessment of internal exposures for complex intake cases in actual applications.
Tranexamic Acid
Authors: Yorozuya Lauren I. , Luke Janiene D. 
Published: May 2020

ABSTRACT
A drug is defined in physiology as being a substance that exerts an effect on the body once it has been ingested or otherwise introduced. Drugs are administered in many forms, which include (but are not limited to) a variety of oral and topical preparations. The purpose of this column was to take a closer look at drugs that are used in the field of dermatology. More specifically, this column hopes to bring an understanding to the reader regarding mechanism of action, administration, dosage, adverse effects, contraindications, and viable alternatives to each particular drug being discussed. In this article, tranexamic acid and its use as a dermatologic treatment for melasma, as well as other treatment modalities, will be discussed.
Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation
Authors: Stanley Sophie A. , Rutty Guy N. , Rutty Jane E. 
Published: May 2020

ABSTRACT
The traditional invasive autopsy has been considered the “gold standard” for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners’ offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.
A contemporary review of radiation pneumonitis
Authors: Ullah Tofura , Patel Harsh , Pena Grace M. , Shah Rakesh , Fein Alan M. 
Published: May 2020

Purpose of review
The current article reviews recent literature and summarizes the current understanding, diagnosis, risk, predictors, and management of radiation pneumonitis.

Recent findings
We discuss the different parameters that contribute to radiation toxicity, the potential biomarkers that predict the risk, and mitigators of radiation pneumonitis.

Summary
Radiotherapy aims to provide care and a better quality of life in cancer patients however with complications. Radiation pneumonitis is important to recognize to appropriately plan and care for this population.
Head-up tilt test induces T-wave alternans in long QT syndrome with KCNQ1 gene mutation
Authors: Gu Beiyin , Liu Tingliang , Yang Lei , Zhang Haiyan , Xin Yili , Wang Jian 
Published: May 2020

Abstract

Introduction:
Long QT syndrome (LQTS) is a congenital disorder characterized by a prolongation of the QT interval on electrocardiograms (ECGs) and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death. T-wave alternans (TWA) refers to the periodic beat-to-beat alternation of T-wave shape, polarity and amplitude on surface ECG during regular heart rhythm. In this report, a case of long QT syndrome with KCNQ1 gene mutation induced TWA in the head-up tilt test (HUTT), which has not been reported yet.

Patient concerns:
A 6-year-old boy presented with loss of consciousness twice, 5 months in duration. The boy's ECG showed prolonged QT interval (QTc = 600 ms, QTc = QT/RR1/2). During HUTT test, QT interval was significantly prolonged (QTc = 716 ms) based on macroscopic TWA.

Diagnosis:
The patient was diagnosed with 1. Long QT syndrome type 1(LQT1); 2. Vasovagal syncope (VVS)

Interventions:
Metoprolol 12.5 mg was given orally twice a day. The child was told avoid standing for a long time and strenuous exercises.

Outcomes:
There was no syncope or arrhythmia occurred during hospitalization and follow-up for 1 year.

Conclusions:
VVS may exist in patients with long QT syndrome. Increased sympathetic tone during the early stage of HUTT may induce macroscopic TWA in long QT syndrome with KCNQ1 gene mutation.
Prognostic value of high-sensitivity troponin I after cardiac surgery according to preoperative renal function
Authors: Nam Karam , Shin Kyung Won , Kim Tae Kyong , Kim Kyung Hwan , Kim Ki-Bong , Jeon Yunseok , Cho Youn Joung 
Published: May 2020

Abstract
Cardiac troponin levels can be elevated without myocardial injury in patients with renal impairment. However, the prognostic value of elevated troponin levels after cardiac surgery has not been well evaluated in patients with renal impairment. We evaluated the relationship between postoperative troponin levels and mortality following cardiac surgery according to preoperative renal function.
Among 3661 patients underwent cardiac surgery between March 2005 and December 2015, 1909 patients were analyzed after excluding those with insufficient laboratory data, preoperative myocardial infarction, underwent Cox-Maze or redo surgery, or with a follow-up period <30 days. The primary outcome was risk of 30-day mortality according to elevated postoperative high-sensitivity cardiac troponin I (hs-cTnI) levels in varying degrees of renal function. Secondary outcomes included long-term cardiac-cause and all-cause mortality during the median follow-up of 52 months.
After adjustment for risk factors, elevated peak postoperative hs-cTnI was associated with 30-day mortality [adjusted odds ratio 1.028, 95% confidence interval (CI) 1.013–1.043, P < .001], long-term cardiac-cause [adjusted hazard ratio (HR) 1.013, 95% CI 1.009–1.017, P < .001] and all-cause mortality (adjusted HR 1.013, 95% CI 1.009–1.016, P < .001), in patients with preoperative normal renal function [estimated glomerular filtration rate (eGFR) ≥60 ml/minute/1.73 m2]. However, in patients with renal impairment (eGFR < 60 ml/minute/1.73 m2), hs-cTnI levels were not associated with mortality following cardiac surgery.
Elevated hs-cTnI levels following cardiac surgery did not predict short- and long-term mortality in patients with preoperative renal impairment.