bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Neck Pain with Opioids in the Primary Care Setting: Trends and Geographic Variation
Authors: Jami Meghana , Marrache Majd , Puvanesarajah Varun , Raad Micheal , Prasad Niyathi , Jain Amit 
Published: September 2020

Abstract

Objective
Neck pain is a leading cause of years lived with disability and is often managed with opioid medications in primary care settings, though this is contraindicated by national guidelines. The aim of this study was to determine the prevalence of opioid prescription for neck pain at a primary care visit and to analyze the geographic variation and trends in opioid prescriptions between 2011 and 2017.

Methods
Using a prescription drug claims database, we identified 591,961 adult patients who presented for neck pain in primary care settings between 2011 and 2017. Patients who had outpatient specialty visits within 1 year before presentation, a concomitant diagnosis of a non-musculoskeletal cause of neck pain, or preexisting chronic opioid use were excluded.

Results
The mean age of the patients was 45 ± 12 years, and 64% were female. Fifteen percent of patients were prescribed opioids within 30 days of their encounter. Eleven percent of patients were prescribed moderate- to high-dose opioids (&gt;20 morphine milligram equivalents). From 2011–2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions given to first time presenters to an outpatient clinic for neck pain was highest in Mississippi (20%) and lowest in New Mexico (6%) (P &lt; 0.001). In 2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions was highest in the Midwest (10.4%) and lowest in the Northeast (4.9%). The proportion of patients with filled opioid prescriptions declined between 2011 (19%) and 2017 (13%) (P &lt; 0.001), and the proportion of patients with moderate- to high-dose prescriptions declined from 2011 (13%) to 2017 (8%) (P &lt; 0.001). first-time presenters of neck pain to an outpatient clinic

Conclusions
Opioid medication use for neck pain in the primary care setting is significant. Although opioid prescriptions are declining, there remains a need for further standardization in prescription practices.
Frequency of Physical Therapist Intervention Is Associated With Mobility Status and Disposition at Hospital Discharge for Patients With COVID-19
Authors: Johnson Joshua K , Lapin Brittany , Green Karen , Stilphen Mary 
Published: September 2020

AbstractObjectiveFor patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients’ mobility status at discharge and probability of discharging home.MethodsThis retrospective study included patients with COVID-19 admitted to any of 11 hospitals in 1 health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility scales. Discharge to home versus to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models.ResultsFor the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI, 1.54–5.71) and Johns Hopkins Highest Level of Mobility scores (b = 1.15; 95% CI, 0.37–1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI, 1.25–2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed.ConclusionPatients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics.ImpactPhysical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread.Lay SummaryPatients with COVID-19 can benefit from more frequent and longer physical therapy visits in the hospital.
Balance and Physical Functioning in Patients After Head and Neck Cancer Post–Neck Dissection Surgery: A Case Series
Authors: Tan Chun Ju , Timon Conrad , Stassen Leo F. A. , Clark Ross A. , Meldrum Dara , Baily-Scanlan Maria , Broderick Julie 
Published: September 2020

Background and Purpose:
Rehabilitation research in people with head and neck cancer undergoing neck dissection (ND) surgery has been largely confined to evaluation of shoulder dysfunction. Balance and broader physical functioning variables were evaluated in this patient group.

Case Description:
This case series presents 4 patients scheduled for ND surgery who completed a comprehensive battery of balance and physical functioning assessments preoperatively and 6 weeks postoperatively.

Outcomes:
Post-ND surgery, the majority (n = 3) of patients reported increased upper-quadrant pain, with proprioception and neck range-of-motion measurements showing a decreasing trend. One patient had no neck pain or changes in proprioception. The changes for standing balance and endurance varied across the patients, with no observable trend.

Discussion:
Quality of life, physical activity, and a number of physical functioning measures, including proprioception and physical activity, were lower after ND surgery. This case series identifies the adverse effects of ND surgery performed prior to the start of adjuvant therapy, with many deficits noted potentially amenable to therapeutic intervention. The clinical implication of this study is that physical therapists should assess physical functioning variables after ND surgery and intervene early if deficits are noted.
Management of Incidental High-grade Dedifferentiated Chondrosarcoma by Triple Vertebrectomy and Anterior Reconstruction Using a Posterior-only Approach
Authors: Kalidindi Kalyan K.V. , Sath Sulaiman , Mallepally Abhinandan R. , Sharma Jeevan , Surapaneni Venkata N. , Chhabra Harvinder S. 
Published: September 2020

Introduction:
Chondrosarcomas of the spine most commonly present with pain and neurological involvement and surgical resection is the standard of care. However, the involvement of 3 contiguous vertebral bodies is rare and surgical en bloc resection may not be possible in all cases, particularly when there is an extra compartmental spread.

Materials and Methods:
We report a case of incidentally detected biopsy-proven chondrosarcoma who was treated by a triple vertebrectomy through a posterior-only approach.

Results:
Three nerve roots had to be sacrificed on one side and 1 nerve root on the other side. The radicular arteries were freed from the vertebral body and tumor mass. Since the pedicles and lamina were involved and there was an extra compartmental spread to the nearby vital structures, an en bloc resection could not be accomplished. Anterior reconstruction was performed through the posterior approach using a MESH cage. Posterior stabilization using pedicle screws and rods was done 3 levels above and below the vertebrectomy levels. Biopsy suggested a very rare aggressive variant of spinal chondrosarcoma labeled as a dedifferentiated chondrosarcoma. Postoperative Image-guided radiotherapy was given and the patient was doing well at 1-year follow-up.

Discussion:
Primary chondrosarcoma involving 3 or more vertebra has been rarely reported in the literature and no specific guidelines exist on the management of such tumors. The aim of this case report was to emphasize the feasibility of doing a triple vertebrectomy and anterior reconstruction using a posterior-only approach. Posterior-only approach allows for complete tumor removal and circumferential stabilization in a single setting.
Pathophysiologic Signatures of Bloodstream Infection in Critically Ill Adults
Authors: Zimmet Alex N. , Clark Matthew T. , Gadrey Shrirang M. , Bell Taison D. , Zimmet Amanda M. , Moorman J. Randall , Moore Christopher C. 
Published: September 2020

Objectives:
Bloodstream infection is associated with high mortality rates in critically ill patients but is difficult to identify clinically. This results in frequent blood culture testing, exposing patients to additional costs as well as the potential harms of unnecessary antibiotics. The purpose of this study was to assess whether the analysis of bedside physiologic monitoring data could accurately describe a pathophysiologic signature of bloodstream infection in patients admitted to the ICU.

Design:
Development of a statistical model using physiologic data from a retrospective observational cohort.

Setting:
University of Virginia Medical Center (Charlottesville, VA), a tertiary-care academic medical center.

Patients:
Critically ill patients consecutively admitted to either the medical or surgical/trauma ICUs with available physiologic monitoring data between February 2011 and June 2015.

Interventions:
None.

Measurements and Main Results:
We analyzed 9,954 ICU admissions with 144 patient-years of vital sign and electrocardiography waveform data, totaling 1.3 million hourly measurements. There were 15,577 blood culture instances, with 1,184 instances of bloodstream infection (8%). The multivariate pathophysiologic signature of bloodstream infection was characterized by abnormalities in 15 different physiologic features. The cross-validated area under the receiver operating characteristic curve was 0.78 (95% CI, 0.69–0.85). We also identified distinct signatures of Gram-negative and fungal bloodstream infections, but not Gram-positive bloodstream infection.

Conclusions:
Signatures of bloodstream infection can be identified in the routine physiologic monitoring data of critically ill adults. This may assist in identifying infected patients, maximizing diagnostic stewardship, and measuring the effect of new therapeutic modalities for sepsis.
Population-based Assessment of Intermittent Androgen Deprivation Therapy Utilization for Relapsed, Nonmetastatic, Hormone-sensitive Adenocarcinoma of the Prostate
Authors: Janzen Bryan W. , Ong Aldrich , Penner Makoy , Koul Rashmi , Dubey Arbind , Ahmed Shahida , Bashir Bashir , Chowdhury Amitava , Dawe David E. , Nayak Jasmir , Kim Julian O. 
Published: September 2020

Objectives:
Androgen deprivation therapy (ADT) is the standard of care for men with nonmetastatic hormone-sensitive prostate cancer (nmHSPC) after treatment failure. Although intermittent ADT (iADT) is noninferior to continuous ADT for prostate cancer outcomes, with superior quality of life and cost-to-benefit ratio, little is known regarding its real-world utilization. The authors aimed to determine the utilization of iADT in a Canadian Provincial Cancer Program for relapsed nmHSPC and identified risk factors associated with the nonreceipt of iADT.

Materials and Methods:
This retrospective population-based cohort study used linked administrative databases to identify all patients with relapsed nmHSPC from 2012 to 2016 and quantified ADT prescription history. Patients were defined as iADT eligible if prostate-specific antigen (PSA) was <4 ng/mL and trending downwards on ≥2 sequential PSAs after ≥6 months of ADT. Univariable and multivariable logistic regression analyses were performed to determine factors associated with nonreceipt of iADT.

Results:
A total of 601 men with relapsed, nmHSPC were included with a median age at relapse of 73 (range, 46 to 96), pre-ADT PSA of 12.2 ng/mL, and a median pre-ADT PSA doubling time of 7.8 months. 80.9% of the cohort were eligible to receive iADT and 74.4% were treated with iADT. On multivariable analysis, patients originally treated with surgery (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.08-0.46) or having a Gleason Score ≥8 (OR, 0.30; 95% CI, 0.12-0.78) had decreased odds of receipt of iADT. Patients with longer PSA doubling times were more likely to receive iADT (OR, 2.71; 95% CI, 1.17-6.31).

Conclusions:
The utilization of iADT was relatively common for men in Manitoba during the study period, however, the uptake of iADT can be improved among identified subgroups.
Effect of Age on Cancer-specific Mortality in Patients With Urothelial Carcinoma of the Urinary Bladder
Authors: Luzzago Stefano , Knipper Sophie , Palumbo Carlotta , Rosiello Giuseppe , Pecoraro Angela , Deuker Marina , Mistretta Francesco A. , Tian Zhe , Musi Gennaro , Montanari Emanuele , Shariat Shahrokh F. , Saad Fred , Briganti Alberto , de Cobelli Ottavio , Karakiewicz Pierre I. 
Published: September 2020

Objective:
The objective of the study is to test the effect of age on cancer-specific mortality (CSM) in patients with urothelial carcinoma of the urinary bladder (UCUB), across all disease stages.

Materials and Methods:
Within the Surveillance, Epidemiology, and End Results (SEER) registry (2004-2016), we identified 207,714 patients. Age was categorized as: below 60 versus 60 to 69 versus 70 to 79 versus 80 years and above. Multivariable competing-risks regression (CRR) models were used according to disease stage (low-risk nonmuscle invasive: TaN0M0 low grade, high-risk nonmuscle invasive: Ta high grade or Tis-1N0M0, muscle invasive: T2-3N0M0, regional: T4N0M0/TanyN1-3M0, and metastatic: TanyNanyM1).

Results:
Overall, 33,970 (16.4%) versus 52,173 (25.1%) versus 64,537 (31.1%) versus 57,034 (27.4%) patients were below 60 versus 60 to 69 versus 70 to 79 versus 80 years and above, respectively. In multivariable CRR models that focused on low-risk nonmuscle invasive UCUB, advanced age was associated with higher CSM rates (hazard ratio [HR]: 7.04 in patients aged 80 y and above, relative to below 60 y; P<0.001). Moreover, advanced age was also associated with higher CSM rates in high-risk nonmuscle invasive UCUB (HR: 2.77 in patients aged 80 y and above, relative to below 60 y; P<0.001) and in muscle invasive UCUB patients (HR: 1.38 in patients aged 80 y and above, relative to below 60 y; P<0.001). Conversely, lower CSM rates with advanced age were observed in multivariable CRR that focused on regional (HR: 0.91 for patients aged 80 y and above, relative to below 60 y; P=0.02) or metastatic UCUB (HR: 0.75 for patients aged 80 y and above, relative to below 60 y; P<0.001).

Conclusions:
The direction and the magnitude of the association between advanced age and CSM in UCUB patients changes according to tumor stage. In low-risk nonmuscle invasive, high-risk nonmuscle invasive, and muscle invasive UCUB, more advanced age is associated with higher CSM rates. Conversely, in regional and metastatic UCUB patients, more advanced age is associated with lower CSM rates.
Mucinous Syringometaplasia: Surrounding Acanthosis With Hyperkeratosis Tends to Conceal the Change
Authors: Shimizu Yuri , Hayashi Misa , Ohata Chika 
Published: September 2020

Abstract:
A 57-year-old man had a 2-year history of a painful nodule on the right sole. Physical examination revealed an 8 × 8 mm hyperkeratotic plaque with a central fissure. Excisional biopsy disclosed epithelial invagination surrounded by the acanthotic epidermis with parakeratotic hyperkeratosis and focal hypergranulosis. The invaginated epithelium lacked a cornified layer and was composed of a mixture of small basaloid squamous cells and goblet cells showing tubular structures. The patient was diagnosed with mucinous syringometaplasia. Our literature review established that surrounding acanthosis with hyperkeratosis typically tends to conceal mucinous syringometaplastic changes. Because mucinous syringometaplasia often presents as an asymptomatic papule/nodule with no distinct ulcer, fissure, or depressed area, cases may be overlooked.
The Relationship Between Parental Accommodation and Sleep-Related Problems in Children with Anxiety
Authors: Chevalier Lydia L. , O'Connor Erin E. , Holly Lindsay E. , Langer David A. , Pincus Donna B. 
Published: September 2020

ABSTRACT:

Objective:
Sleep-related problems, defined as sleep patterns atypical for the child's developmental stage, are common in children with elevated anxiety symptoms and linked to significant mental and physical health consequences. Despite the consequences of sleep-related problems, it remains unclear how these problems are initiated and maintained in children with elevated anxiety symptoms. The current study examines the relationship between sleep-related problems and parental accommodation (e.g., co-sleeping) to determine whether higher levels of accommodation are associated with more frequent sleep-related problems in a sample of children with elevated anxiety symptoms.

Methods:
Participants were 122 children aged 8 to 17 years old (M = 11.97, SD = 2.68; 57% female) and their parents who presented to a university-based anxiety specialty clinic for assessment and treatment. Children completed the Multidimensional Anxiety Scale for Children, and their parents completed the Children's Sleep Habits Questionnaire and Family Accommodation Checklist and Interference Scale. Multiple regression analyses were performed to examine variance in sleep-related problems explained by parental accommodation.

Results:
Parental accommodation accounted for a significant amount of variance in sleep-related problems over and above child anxiety and age for both mother report (19%) and father report (15%). When individual accommodation items were examined, parental sleep accommodations (e.g., slept in my child's bed) and nonsleep accommodations (e.g., came home early) were significant predictors for mother-reported sleep-related problems, but only sleep accommodations (e.g., let my child sleep with the lights on) were significant for father-reported sleep-related problems.

Conclusion:
Parents of children with elevated anxiety symptoms and sleep-related problems engage in accommodation related to their child's sleep (e.g., co-sleeping). Future research elucidating the potential bidirectional and causal links between parental accommodation and sleep-related problems is a necessary step in adapting sleep treatments for this population.
Anticontractile Effect of Perivascular Adipose Tissue But Not of Endothelium Is Enhanced by Hydrogen Sulfide Stimulation in Hypertensive Pregnant Rat Aortae
Authors: Souza-Paula Edileia , Polonio Leticia C. C. , Zochio Gabriela P. , da Silva Katiussia Pinho , Kushima Helio , Dias-Junior Carlos A. 
Published: September 2020

Abstract:
Perivascular adipose tissue (PVAT) modulates the vascular tone. Hydrogen sulfide (H2S) is synthetized by cystathionine gamma-lyase (CSE) in brown PVAT. Modulation of vascular contractility by H2S is, in part, adenosine triphosphate (ATP)-sensitive potassium channels dependent. However, the role of PVAT-derived H2S in hypertensive pregnancy (HTN-Preg) is unclear. Therefore, we aimed to examine the involvement of H2S in the anticontractile effect of PVAT in aortae from normotensive and hypertensive pregnant rats. To this end, phenylephrine-induced contractions in the presence and absence of PVAT and endothelium in aortae from normotensive pregnant (Norm-Preg) and HTN-Preg rats were investigated. Maternal blood pressure, fetal-placental parameters, angiogenesis-related biomarkers, and H2S levels were also assessed. We found that circulating H2S is elevated in hypertensive pregnancy associated with angiogenic imbalance, fetal and placental growth restrictions, which revealed that there is H2S pathway activation. Moreover, under stimulated H2S formation PVAT, but not endothelium, reduced phenylephrine-induced contractions in aortae from HTN-Preg rats. Also, H2S synthesis inhibitor abolished anticontractile effects of PVAT and endothelium. Furthermore, anticontractile effect of PVAT, but not of endothelium, was eliminated by ATP-sensitive potassium channels blocker. In accordance, increases in H2S levels in PVAT and placenta, but not in aortae without PVAT, were also observed. In conclusion, anticontractile effect of PVAT is lost, at least in part, in HTN-Preg aortae and PVAT effect is ATP-sensitive potassium channels dependent in normotensive and hypertensive pregnant rat aortae. PVAT but not endothelium is responsive to the H2S stimulation in hypertensive pregnant rat aortae, implying a key role for PVAT-derived H2S under endothelial dysfunction.
Quick Response Codes: An Innovative Approach to Just-in-Time Education
Authors: Hirsch Sonya M. , Bueno Elyse , Tenure Krystal C. 
Published: September 2020

ABSTRACT

BACKGROUND: Many nurses are digital natives who have grown up with advanced technology. Bedside competence is essential, and written policies and procedures guide our practice. Newer learning styles, time constraints, and available personnel may be barriers to historical approaches to information dissemination. METHODS: Quick Response code technology was incorporated to provide just-in-time resources that can be readily accessed at the point of care. RESULTS: Nurses have incorporated Quick Response codes in novel ways to provide quick resources in a dynamic environment. Examples include orientation documents, educational rollouts, infrequently used and high-risk equipment, and leadership updates. IMPLICATIONS: Bedside nurses in our institution have embraced this technology. Benefits include engagement, increased knowledge, and a sense of value among our nursing team.
Deep Venous Thrombosis With Symptomatic Bilateral Pulmonary Embolism After Using an Infrapatellar Strap for Patellofemoral Pain in an Athletic Cardiothoracic Surgeon
Authors: Segers Patrique , Hendriks Babs M. F. , Heuts Samuel 
Published: September 2020

Abstract:
Knee braces and patellar straps are frequently prescribed devices for treatment of patellofemoral pain syndrome. In this report, we describe the occurrence of localized deep venous thrombosis (DVT) after use of an infrapatellar strap. Until now, external mechanical compression has not been recognized as a cause of DVT. In young and athletic patients presenting with DVT, after exclusion of the most prominent risk factors, untraditional causes should be considered to mistakenly label a DVT as unprovoked.
Successful Nonsurgical Management of a Posteriorly Displaced Medial Clavicular Physeal Fracture in an Adolescent Athlete: A Case Report
Authors: Wagner Ryan J. , Symanski John S. , Raasch William G. , Young Craig C. 
Published: September 2020

Abstract:
Traumatic and sport-related sternoclavicular (SCJ) injuries in adolescent athletes are more commonly physeal fractures rather than true SCJ dislocations. Although rare, posterior displacement of the medial clavicular metaphysis after a physeal fracture necessitates prompt evaluation and treatment. Despite the inherent healing ability of physeal separations, delayed or failed diagnosis has the capacity to cause serious complications or fatality secondary to injury of retrosternal structures. Even with the potential severity, a lack of consensus exists in the literature regarding the most appropriate treatment modality. We report an adolescent football player with a medial clavicular physeal fracture with posterior metaphyseal displacement abutting the left brachiocephalic vein. After nonsurgical management and progression to play, the patient returned to play football. This case not only highlights the diagnostic principles of medial clavicular physeal fractures with posterior metaphyseal displacement but also discusses how these challenging injuries can be managed successfully with conservative treatment.