bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Respiratory Depression After Epidural Administration of Morphine for Cesarean Delivery: Findings Using a Continuous Respiratory Rate Monitoring System
Authors: Terada S. , Irikoma S. , Yamashita A. , Murakoshi T. 
Published: February 2020

(Int J Obst Anesth. 2019;38:32–36)
Epidural morphine is widely used for postcesarean analgesia. However, because of the risk of respiratory depression after neuraxial administration of morphine, the American Society of Anesthesiologists (ASA) recommends frequent respiratory rate monitoring in the 24 hours after administration. This has typically been assessed through intermittent manual counting of the respiratory rate—a practice that is prone to observer error and does not allow continuous monitoring. Using this technique has resulted in documented rates of respiratory depression after epidural or intrathecal morphine administration of 0% to 0.9%.This study aimed to estimate the incidence of respiratory depression using the Nellcor respiratory rate monitoring system, which allows continuous monitoring, in patients who received 3 mg of epidural morphine for postcesarean analgesia.
Emerging practices in onboarding programs for PAs and NPs
Authors: Morgan Perri , Sanchez Mara , Anglin Lorraine , Rana Rachel , Butterfield Rita , Everett Christine M. 
Published: February 2020

ABSTRACT

Objective:
To describe administrative factors that should be considered when designing an onboarding program for physician assistants (PAs) and NPs.

Methods:
Interview study of 13 administrators of onboarding programs. Interviews were transcribed and analyzed for themes by a team of researchers, with feedback from interviewees.

Results:
Five administrative themes are summarized: goals of onboarding, critical organization factors, organizational fit, designing the program, and costs of onboarding.

Conclusions:
Careful planning and administration are essential to the success of onboarding programs. Although onboarding programs must be designed with unique institutional needs in mind, the considerations identified by our project might serve as a useful guide to PA and NP employers in the process of creating an onboarding program.
Cost–Utility Analysis of rhBMP-2 Use in Adult Spinal Deformity Surgery
Authors: Jain Amit , Yeramaneni Samrat , Kebaish Khaled M. , Raad Micheal , Gum Jeffrey L. , Klineberg Eric O. , Hassanzadeh Hamid , Kelly Michael P. , Passias Peter G. , Ames Christopher P. , Smith Justin S. , Shaffrey Christopher I. , Bess Shay , Lafage Virginie , Glassman Steve , Carreon Leah Y. , Hostin Richard A. 
Published: February 2020

Study Design.
Economic modeling of data from a multicenter, prospective registry.

Objective.
The aim of this study was to analyze the cost utility of recombinant human bone morphogenetic protein-2 (BMP) in adult spinal deformity (ASD) surgery.

Summary of Background Data.
ASD surgery is expensive and presents risk of major complications. BMP is frequently used off-label to reduce the risk of pseudarthrosis.

Methods.
Of 522 ASD patients with fusion of five or more spinal levels, 367 (70%) had at least 2-year follow-up. Total direct cost was calculated by adding direct costs of the index surgery and any subsequent reoperations or readmissions. Cumulative quality-adjusted life years (QALYs) gained were calculated from the change in preoperative to final follow-up SF-6D health utility score. A decision-analysis model comparing BMP versus no-BMP was developed with pseudarthrosis as the primary outcome. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates (Alpha = 0.05).

Results.
BMP was used in the index surgery for 267 patients (73%). The mean (±standard deviation) direct cost of BMP for the index surgery was $14,000 ± $6400. Forty patients (11%) underwent revision surgery for symptomatic pseudarthrosis (BMP group, 8.6%; no-BMP group, 17%; P = 0.022). The mean 2-year direct cost was significantly higher for patients with pseudarthrosis ($138,000 ± $17,000) than for patients without pseudarthrosis ($61,000 ± $25,000) (P < 0.001). Simulation analysis revealed that BMP was associated with positive incremental utility in 67% of patients and considered favorable at a willingness-to-pay threshold of $150,000/QALY in >52% of patients.

Conclusion.
BMP use was associated with reduction in revisions for symptomatic pseudarthrosis in ASD surgery. Cost–utility analysis suggests that BMP use may be favored in ASD surgery; however, this determination requires further research.

Level of Evidence: 2
An Exploratory Analysis of Spine Patients’ Preoperative Concerns and Decision-making Process
Authors: Matthies Norah , Keshen Sam , Lewis Stephen , Webster Fiona , Perruccio Anthony V. , Rampersaud Yoga Raja 
Published: February 2020

Study Design.
Cross-sectional, pre-post patient survey.

Objective.
The aim of this study was to determine what factors affect a patient's decision to undergo elective surgery following a surgical consultation.

Summary of Background Data.
The surgical consultation is an important step in selecting and preparing patients for elective surgery. Despite the proven effectiveness and low risk of complications, many spine procedure candidates may still choose to forgo surgery after an appropriate discussion and clear surgical indications.

Methods.
Survey and open-response questions regarding pre- and post-consultation surgical concerns and overall willingness to undergo surgery were collected and analyzed from 124 patients deemed surgical candidates. Demographics, surgical willingness, and patient concerns were analyzed. Open-ended response data were tallied for surgical concerns and responses were analyzed line-by-line to assess for main themes. Sub-analysis was included on patients who reconsidered their willingness post-consultation.

Results.
Qualitative thematic analysis of patient's concerns regarding surgery uncovered six major themes: Interference on quality of life (QOL), fear, physical concerns, success, risk, and concerns regarding the surgeon (CS). Success and risk were most commonly mentioned pre-consultation (27%, 26%); risk and QOL were most commonly mentioned post-consultation (22%, 21%). Of 124 patients, 103 were willing to have surgery before consultation and remained willing post-consultation; six patients became unwilling. Twenty-one patients were unwilling to consider surgery before consultation; only five remained unwilling. No differences were found between degenerative and deformity patients regarding initial willingness or changes thereafter.

Conclusion.
The decision to undergo surgery is a multifactorial and complex process with a variety of patient concerns. We grouped these concerns into six categories to aid in future discussion with patients. 87% of patients have made up their mind before attending their surgical consultation. Appropriate understanding of patient-specific willingness and concerns should help facilitate necessary discussion and aid in a more efficient and useful shared decision-making process.

Level of Evidence: 4
Long-term Results After Surgical or Nonsurgical Treatment in Patients With Degenerative Lumbar Spinal Stenosis
Authors: Burgstaller Jakob M. , Steurer Johann , Gravestock Isaac , Brunner Florian , Fekete Tamás F. , Pichierri Giuseppe , Ulrich Nils H. , Winklhofer Sebastian , Porchet François , Farshad Mazda 
Published: February 2020

Study Design.
Prospective, multicenter cohort study.

Objective.
The aim of our study was to assess the course of patients over a period of 3 years undergoing surgical or nonsurgical treatments for degenerative lumbar spinal stenoses (DLSS) based on data from the Lumbar Stenosis Outcome Study (LSOS), prospectively performed in eight hospitals.

Summary of Background Data.
The optimal treatment strategy for patients with DLSS is still debated.

Methods.
The outcomes of patients with verified DLSS were quantified by Spinal Stenosis Measure (SSM) symptoms- and SSM function-scores, and EQ-5D-3L (quality of life) summary index (SI) over time (up to 36-month follow-up), and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and EQ-5D-3L SI from baseline to 36-month follow-up.

Results.
For this study, 601 patients met the inclusion criteria; 430 underwent surgery, 18 of them only after more than a year after enrolment, 171 received nonsurgical treatment only. At baseline, patients in the surgical and nonsurgical groups had similar values for the SSM symptoms and SSM function scores, but patients in the surgical group suffered significantly more from buttocks pain and reported more worsening symptoms over the last 3 months before enrollment in the study. Surgically treated patients (except changers) performed significantly better in all clinical outcome measures (P < 0.001) with a plateau at 12-month follow-up staying constant until the follow-up ended. Further, two-thirds of patients in the surgical group had a relevant improvement in function, symptoms, and quality of life, compared with only about half of those in terms of symptoms and even less in terms of function and quality of life with nonsurgical treatment.

Conclusions.
Surgical treatment of DLSS results in more favorable clinical outcomes with a sustained effect over time, compared to nonsurgical treatment.

Level of Evidence: 3
Cervical Spine Endplate Abnormalities and Association With Pain, Disability, and Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion
Authors: Harada Garrett K. , Alter Kevin , Nguyen Austin Q. , Tao Youping , Louie Philip K. , Basques Bryce A. , Galbusera Fabio , Niemeyer Frank , Wilke Hans-Joachim , An Howard S. , Samartzis Dino 
Published: February 2020

Study Design.
A retrospective study with prospectively-collected data.

Objective.
To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptoms and clinical outcomes after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Structural endplate abnormalities are important, yet understudied, phenomena in the cervical spine. ACDF is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop.

Methods.
Assessed the imaging, symptoms and clinical outcomes of 861 patients who underwent ACDF at a single center. MRI and plain radiographs of the cervical spine were evaluated. Endplate abnormalities on MRI were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes.

Results.
Of 861 patients (mean follow-up: 17.4 months), 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (P = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fused segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD (irrespective of size/location; P = 0.004) and reoperations, when a large abnormality was present at the proximal adjacent level (P = 0.025).

Conclusion.
This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery.

Level of Evidence: 3
Comparison of Anterior Controllable Antedisplacement and Fusion With Posterior Laminoplasty in the Treatment of Multilevel Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Chen Yu , Sun Jingchuan , Yuan Xiaoqiu , Guo Yongfei , Yang Haisong , Chen Deyu , Shi Jiangang 
Published: February 2020

Study Design.
A prospective, randomized, controlled study.

Objective.
To compare anterior controllable antidisplacement and fusion (ACAF) with laminoplasty in the treatment of multilevel ossification of the posterior longitudinal ligament (OPLL), and evaluate the efficacy and safety of this procedure.

Summary of Background Data.
The optimal approach for the treatment of OPLL still remains controversial. Both anterior and posterior approaches have their advantages and disadvantages.

Methods.
Between September 2016 and April 2018, a total of 80 patients with multilevel OPLL were randomized in a 1:1 ratio to ACAF group and laminoplasty group. All patients were followed up at least 1 year. Clinical and radiological results were compared between ACAF group and laminoplasty group.

Results.
ACAF took a longer operation time. C5 palsy and axial pain occurred more commonly in laminoplasty group, whereas dysphagia and hoarseness appeared easily in ACAF group. At 1-year follow-up, the final Japanese Orthopedic Association (JOA) score and recovery rate were significant higher in ACAF group than those in laminoplasty group, when occupying rate (OR) was not less than 60%, or K-line was negative. ACAF was also good at preservation of cervical lordosis and sagittal balance, but range of movement of cervical spine in both groups decreased significantly.

Conclusion.
Generally speaking, ACAF is a safe and effective alternative for multilevel OPLL. Compared with laminoplasty, ACAF is more effective in the cases when OR is not less than 60%, or K-line is negative.

Level of Evidence: 2
Therapeutic Drug Monitoring Coupled With Bayesian Forecasting Could Prevent Vancomycin-Associated Nephrotoxicity in Renal Insufficiency Patients: A Prospective Study and Pharmacoeconomic Analysis
Authors: Zhang Ying , Wang Taotao , Zhang Di , You Haisheng , Dong Yuzhu , Liu Yang , Du Qian , Sun Dan , Zhang Tao , Dong Yalin 
Published: February 2020

Background:
Vancomycin is a critical antibiotic used in important infections, and therapeutic drug monitoring (TDM) is recommended. Bayesian forecasting is demonstrated to provide an approach that can improve trough concentration monitoring for dose adjustment. The objective of this study was to determine whether TDM coupled with a Bayesian approach could increase trough concentration target attainment and prevent vancomycin-associated nephrotoxicity in patients with renal insufficiency.

Methods:
A prospective study was performed using propensity score matching to provide covariate balance in renal insufficiency patients with gram-positive bacterial infections treated with vancomycin. Patients were divided into non-TDM (84 cases) and TDM (84 cases) groups, and their clinical outcomes were compared. The primary endpoints were probability of trough concentration target attainment and incidence of vancomycin-associated nephrotoxicity. A decision-tree model was developed to assess the cost effectiveness of TDM to prevent vancomycin-associated nephrotoxicity.

Results:
Of the 168 eligible patients, 69 from each group (non-TDM and TDM) were matched based on propensity scores. In the matched cohort, trough concentration target attainment was higher with TDM (P = 0.003). Furthermore, reaching toxic trough concentrations was avoided (P = 0.027) in the TDM group. Multivariate logistic regression analysis confirmed that TDM practice independently reduced the incidence of vancomycin-associated nephrotoxicity in renal insufficiency patients (P = 0.021). According to this reduced nephrotoxicity, the incremental cost-effectiveness ratios of ¥22,638 per nephrotoxic episode prevented was found for vancomycin TDM.

Conclusions:
TDM coupled with Bayesian forecasting led to an increase in trough concentration target attainment and a decrease in the incidence of vancomycin-associated nephrotoxicity in renal insufficiency patients. In this high-risk population, TDM was demonstrated to be a cost-effective procedure.
Changes in Corneal Dendritic Cell and Sub-basal Nerve in Long-Term Contact Lens Wearers With Dry Eye
Authors: Liu Qiaoli , Xu Zhiqiang , Xu Yangyang , Zhang Junsong , Li Yong , Xia Jiahui , Wang Yuzhou , He Xiaoxing , Qu Jia , Hu Liang 
Published: February 2020

Objectives:
To evaluate the changes of corneal sub-basal nerve (SBN) and dendritic cell (DC) in contact lens (CL) wearers with mild dry eye and their potential relationship.

Methods:
Twenty mild dry eye volunteers who had never worn CLs were recruited for long-term CL wearing. Each subject underwent ocular surface evaluations at baseline and at 1, 4, 12, and 24 weeks, including Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TBUT), and Schirmer I test. In vivo confocal microscopy was used to examine the density, area, number of dendrites, total dendritic length of DC, and SBN densities in central and peripheral corneas. Only right eyes were included.

Results:
The DCs were activated and peaked at week 4 after wearing CLs. The peripheral DC density increased beginning the first week, whereas the central ones increased by week 4. After 4 weeks, both began to decrease, but still higher than baseline at week 24. The central and peripheral SBN densities decreased. However, the peripheral SBN tended to increase beginning at week 12. In early period, SBN was negatively correlated with DC parameters. After 4 weeks, the correlation changed to be positive. The OSDI increased, whereas the Schirmer I test and TBUT showed no significant change.

Conclusions:
After wearing CLs, corneal DC were activated and increased, indicating ocular surface inflammation and decreased after week 4. In the early period, increases in DC may lead to decreases in SBN. Upon decrease of DC, the SBN may regenerate.
Comparison Between the eyeWatch Device and the Ahmed Valve in Refractory Glaucoma
Authors: Roy Sylvain , Villamarin Adan , Stergiopulos Constantinos , Bigler Stéphane , Stergiopulos Nikolaos , Wachtl Josephine , Mermoud André , Kniestedt Christoph 
Published: February 2020

Purpose:
To assess the efficacy and safety of a glaucoma procedure to control intraocular pressure (IOP) using the adjustable eyeWatch glaucoma drainage device compared with Ahmed glaucoma valve (AGV) in refractory glaucoma.

Patients and Methods:
Monocentric, retrospective, comparative clinical trial. Patients suffering from refractory glaucoma after failed surgeries and requiring a further glaucoma procedure including an aqueous shunt were enrolled in this study. The first group AGV included patients with an AGV. The second group eW-B included patients receiving an eyeWatch used in connection with a Baerveldt glaucoma implant. The primary outcome was the success rate, defined as an IOP≤16 mm Hg and reduction of >20% from baseline, and IOP≥5 mm Hg. Secondary outcomes were mean IOP, number of antiglaucoma medications, visual acuity, number and type of complications.

Results:
Twenty-one patients were included. The mean follow-up time was 13.2±3.4 months. Mean IOP decreased from 24.8±9.0 mm Hg before surgery to 13.8±3.6 mm Hg at 12 months for group AGV, and 27.3±7.0 to 12.8±2.4 mm Hg for group eW-B, respectively (P<0.05). Mean number of glaucoma medications decreased from 3.0±0.7 before surgery to 0.3±0.7 at last control for group AGV, and 2.9±0.8 before surgery to 0.2±0.4 for group eW-B, respectively (P<0.05). The complete and overall success rates were 50% and 58% for group AGV, and 67% and 89% for group eW-B, respectively.

Conclusions:
The postoperative adjustability of the eyeWatch is believed to help with getting fewer complications and better IOP management whereas AGV cannot be adjusted postoperatively.
Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running
Authors: Lipman Grant S. , Burns Patrick , Phillips Caleb , Jensen Jacob , Little Colin , Jurkiewicz Carrie , Jarrett Bryan , Walker Anne , Mansfield Nicky , Krabak Brian J. 
Published: February 2020

Objective:
Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners.

Design:
Prospective observational study.

Setting:
The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts.

Participants:
All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire.

Intervention:
Weight change and finish line serum sodium levels were gathered.

Main outcome measures:
Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L−1) and hypernatremia (>145 mmol·L−1) by sodium ingestion and climate.

Results:
Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), −4.7 kg (± 9.8)] than EAH [4 (14%), −1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races.

Conclusions:
This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.