bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variability in opioid prescribing following fracture fixation: A retrospective cohort analysis
Authors: Fithian Andrew , Nathan Karthik , Campbell Sean T. , Finlay Andrea , Bishop Julius , Gardner Michael J. 
Published: January 2020

Background:
We quantified variability in opioid prescriptions for orthopaedic trauma patients at an academic level 1 trauma center and examined patient, prescriber, and injury factors associated with prescription practices.

Methods:
Patients with malleolar, diaphyseal tibia, plateau, proximal femur, and forearm fractures at a level 1 trauma center were identified retrospectively. The number of opioid pills prescribed at discharge, demographics, and prescriber (MD vs. APP) data were collected. Statistical analysis was done to compare opioid prescription with injury location, patient, and prescriber data. Multivariate linear regression analysis was performed to examine factors associated with opioid prescribing.

Results:
One hundred and one patients were included in the study. Discharge prescriptions had a mean of 60 oxycodone 5 mg pill equivalents (OEQ) for all patients, with a standard deviation of 33 pill equivalents and a coefficient of variation of 56%. Older patients received fewer opioids compared to younger patients (P=0.008). Patients treated for tibial plateau fractures received more opioids compared to other fractures types (76 vs. 60 pill equivalents, P=0.03). In the multivariate analysis, older age was associated with lower prescribing, whereas a tibial plateau fracture was associated with higher prescribing. Physicians were more likely to prescribe low numbers of narcotics (<10th percentile) compared to advance practice practitioners (APPs) (P=0.04).

Conclusions:
There was high variability in opioid prescribing practices after fracture fixation. Patients with plateau fractures received more opioids, while older patients received fewer. Physicians were less likely to overprescribe than APPs. This highlights opportunities for a postoperative pain protocol to minimize overprescription of opioids.

Level of Evidence:
Level IV.
A prospective assessment of adequacy of orthopaedic emergency medicine consultations: The experience at an academic level I trauma center
Authors: Kusnezov Nicholas , VanTienderen Richard J. , Prabhakar Gautham , Dunn John C. , Rensing Nicholas , Eisenstein Emmanuel D. , Abdelgawad Amr A. 
Published: January 2020

Background:
This study sought to determine the diagnostic accuracy, consultation appropriateness, and effectiveness of management of orthopaedic conditions in an emergency setting.

Methods:
A prospective, blinded analysis of all orthopaedic consults by emergency medicine providers at our institutional level I trauma center was conducted between May 1, 2016 and Jun 30, 2016. Providers were blinded to eliminate Hawthorne effect bias. Direct orthopaedic transfers and general surgery trauma consults were excluded. The accuracy of the initial diagnosis, effectiveness of management by the emergency medicine physician, and ultimately, consult appropriateness were evaluated.

Results:
The emergency department received 239 consecutive consults over the 2-month period. Of these 38.5% (92/239) were inaccurate due to nonspecific consults (14.6%; 35/239), incomplete information with missed injuries (12.6%; 30/239), grossly incorrect diagnosis (11.3%; 27/239), or use of incorrect terminology (5.9%; 14/239). Inaccurate diagnoses led to a significant change in orthopaedic management in 73.9% (68/239) of patients. Of the open injuries, 30.8% (4/13) were incorrectly called “closed.” Antibiotics were not initiated prior to orthopaedic consultation for open fractures in 61.5% (8/13) of patients. Initial work-up was incomplete in 25.5% (61/239), affecting management in 44.3% (27/61) of cases; 56.9% (136/239) of consults required acute orthopaedic intervention in the emergency department setting.

Conclusions:
In this study a significant number of patients presenting to a level one trauma center referred for orthopaedic consultation by emergency medicine providers were initially misdiagnosed and suboptimally managed. This may have a significant impact on patient morbidity and mortality. Orthopaedic consultants must be vigilant and apply due diligence to ensure that emergency patients receive proper and thorough evaluation and treatment.

Level of Evidence:
Level IV.
Reduction in Traumatic Spine Injuries in the Thoracic and Lumbar Spine With Percutaneous Versus Open Dorsal Stabilization
Authors: Rillig Jan , Keil Holger , Jung Matthias , Grützner Paul A. , Matschke Stefan , Kreinest Michael 
Published: January 2020

Study Design:
Retrospective cohort study.

Objectives:
Doubts still remain whether a sufficient reduction of vertebral body fractures can be achieved if a percutaneous surgical approach is adopted. The aim of this retrospective cohort study was to analyze the reduction and perioperative complications using a percutaneous versus open surgical approach for dorsal stabilization.

Methods:
Patients suffering from a traumatic injury of the thoracic or lumbar spine who were treated with dorsal stabilization at our level 1 trauma center were included. From January 2007 through June 2009, only the open approach was used; from June 2009 through March 2014, only the percutaneous approach with a special reduction technique was used. Retrospectively, total reduction, perioperative and intraoperative data, and postoperative complications were analyzed.

Results:
Using the percutaneous (n=185) versus open surgical approach (n=91), the mean reduction over all spinal injuries was 7.7±6.6 versus 8.3±5.5 degrees, respectively. The mean operation time was 75.5±50.2 versus 71.5±41.9 minutes, respectively. There was no significant difference between the 2 treatment groups in terms of the total reduction (P=0.753) or operation time (P=0.814).
After the percutaneous and open surgical approach, 7 (3.8%) and 22 (24.2%) complications were documented. Complications requiring interventions were more frequent in the open treatment group.

Conclusions:
Percutaneous dorsal stabilization seems to be a good alternative to the traditional open surgical approach. The fracture’s reduction is similar, whereas severe complications are reduced and the operation time is not prolonged.

Level of Evidence:
Level III—retrospective cohort study.
Comparative Analysis of 2 Different Types of Titanium Mesh Cage for Single-level Anterior Cervical Corpectomy and Fusion in Terms of Postoperative Subsidence and Sagittal Alignment
Authors: Hur Jung-Woo , Ryu Kyeong-Sik , Ahn Stephen , Kim Jin-Sung , Chung Ho-Jung , Song Myung-Soo 
Published: January 2020

Study Design:
This was a retrospective observatory analysis study.

Objective:
The objective of this study was to compare the differences in clinical and radiologic outcomes among patients who underwent anterior cervical corpectomy and fusion (ACCF) using titanium mesh cage (TMC) with end-caps and patients who underwent ACCF using TMC without end-cap.

Summary of Background Data:
TMC has been widely used as an effective treatment option for ACCF. However, the subsidence of TMC has been observed frequently in the early postoperative period in some cases, resulting in related clinical complications.

Materials and Methods:
Patients who underwent single-level ACCF using TMC from September 2008 to June 2014 at our institute were retrospectively reviewed. Patients treated with TMC with end-cap were classified as an end-cap group, while patients treated with TMC without end-cap classified as a control group. The round press-fit–type end-caps with 2.5-degree angulation were used at both ends of the cage for the end-cap group. Patients were followed postoperatively for a minimum of 36 months with radiologic evaluation.

Results:
The subsidence was lower in the end-cap group (4.3±3.6 vs. 4.8±3.0, P<0.01), with lower rates of severe subsidence (≥3 mm) than the control group (34.2% vs. 52.1%, P<0.01). Visual analogue scale (VAS) scores for neck pain and Neck Disability Index (NDI) was reported significantly less in the study group, which showed a positive correlation with lesser severe subsidence. Also, the characteristics of subsidence differed between the 2 groups. In the end-cap group, slippage type subsidence occurred, resulting in better sagittal alignment than that in the control group.

Conclusions:
For patients undergoing single-level ACCF, using TMC with end-cap provided better clinical results and similar fusion rate, compared with using TMC without end-cap. The end-cap decreased the severity of postoperative subsidence and related neck pain. Also, sagittal alignment was well preserved, suggesting it may contribute to cervical lordosis.
Pressurized Intraperitoneal Aerosol Chemotherapy, a Palliative Treatment Approach for Patients With Peritoneal Carcinomatosis: Description of Method and Systematic Review of Literature
Authors: Winkler Carl S. , Sandhu Jaspreet , Pettke Erica , Merchea Amit , Fong Yuman , Kumara H.M.C. Shantha , Whelan Richard L. 
Published: January 2020

BACKGROUND:
Peritoneal metastases arise in patients with a variety of primary cancers, and are associated with a poor prognosis. Systemic chemotherapy is the mainstay of treatment; however, the morbidity is considerable and the survival benefit is modest. Cytoreductive surgery and heated intraperitoneal chemotherapy is a potentially curative treatment available to a minority of patients; however, most develop recurrent disease. A novel palliative treatment for peritoneal metastases, pressurized intraperitoneal aerosol chemotherapy, has recently been introduced. Pressurized intraperitoneal aerosol chemotherapy utilizes an aerosol of chemotherapy in carbon dioxide gas. It is instilled into the abdomen under pressure via laparoscopic ports. No cytoreduction is performed. Pressurized intraperitoneal aerosol chemotherapy can be repeated at 6-week intervals. Oxaliplatin or cis-platinum and doxorubicin have been used to date.

OBJECTIVE:
This study aims to systematically review and evaluate the method, and the preclinical and early clinical results of pressurized intraperitoneal aerosol chemotherapy.

DATA SOURCES:
Medline and the Cochrane Library were the data sources for the study.

STUDY SELECTION:
Peer-reviewed series of greater than 10 patients, with sufficient patient data, through April 2019, were selected.

INTERVENTION:
Patients with peritoneal metastases underwent pressurized intraperitoneal aerosol chemotherapy.

MAIN OUTCOME MEASURES:
Patient dropout, histologic tumor response, adverse events, and 30-day mortality were the primary outcomes measured.

RESULTS:
A total of 921 patients with peritoneal metastases were brought to the operating room for pressurized intraperitoneal aerosol chemotherapy. The number of pressurized intraperitoneal aerosol chemotherapy treatments administered was as follows: 1 treatment, 862 (94%); 2 treatments, 645 (70%); and 3 treatments, 390 patients (42%). Initial laparoscopic access was not possible in 59 patients (6.4%). Common Terminology Criteria for Adverse Events grade 3 or higher were noted in 13.7% of the patients who, collectively, underwent a total of 2116 treatments. The 30-day mortality was 2.4% (22/921).

LIMITATIONS:
This study was limited by the heterogeneity of reported data and primary tumor types and by the lack of long-term survival data.

CONCLUSIONS:
Early clinical results are encouraging, but tumor-specific, prospective, randomized trials are needed to compare pressurized intraperitoneal aerosol chemotherapy to systemic chemotherapy. This method has yet to be introduced to the United States. It is another therapeutic option for patients with peritoneal metastases and will broaden the patient base for future clinical trials.
Population Pharmacokinetics of Vancomycin Under Continuous Renal Replacement Therapy Using a Polymethylmethacrylate Hemofilter
Authors: Yamazaki Shingo , Tatebe Mizuki , Fujiyoshi Masachika , Hattori Noriyuki , Suzuki Tatsuya , Takatsuka Hirokazu , Uchida Masashi , Suzuki Takaaki , Ishii Itsuko 
Published: January 2020

Background:
Although continuous hemodiafiltration (CHDF) is often performed in critically ill patients during sepsis treatment, the pharmacokinetics of vancomycin (VCM) during CHDF with a polymethylmethacrylate hemofilter (PMMA-CHDF) have not been revealed. In this study, the authors aimed to describe the population pharmacokinetics of VCM in critically ill patients undergoing PMMA-CHDF and clarify its hemofilter clearance (CLhemofilter).

Methods:
This single-center, retrospective study enrolled patients who underwent intravenous VCM therapy during PMMA-CHDF at the intensive care unit of Chiba University Hospital between 2008 and 2016. A population analysis was performed, and CLhemofilter was assessed.

Results:
Twenty-five patients were enrolled. Median body weight (BW) and Sequential Organ Failure Assessment (SOFA) score were 63 kg and 15, respectively. Mean conditions for CHDF were 107.5 ± 18.3 mL/min for blood flow rate and 26.3 ± 6.3 mL/kg/h for effluent flow rate. The mean parameter estimates were distribution volume of the central compartment (V1), 59.1 L; clearance of the central compartment (CL1), 1.35 L/h; distribution volume of the peripheral compartment (V2), 56.1 L; and clearance of the peripheral compartment (CL2), 3.65 L/h. BW and SOFA score were significantly associated with V1 (P < 0.05) and CL1 (P < 0.05), respectively, and were thus selected as covariates in the final model. The estimated dosage of VCM to achieve a target area under the concentration–time curve/minimum inhibitory concentration ≥400 was 27.1 mg/kg for loading and 9.7 mg/kg every 24 hours for maintenance; these dosages were affected by BW and SOFA score. Mean CLhemofilter obtained from 8 patients was 1.35 L/h, which was similar to CL1.

Conclusions:
The authors clarified the pharmacokinetics and CLhemofilter of VCM in PMMA-CHDF patients. The PK of VCM in patients undergoing CHDF appeared to vary not only with the CHDF setting and BW but also with SOFA score.
Hot flashes are associated with altered brain function during a memory task
Authors: Maki Pauline M. , Wu Minjie , Rubin Leah H. , Fornelli Deanne , Drogos Lauren L. , Geller Stacie , Shulman Lee P. , Banuvar Suzanne , Little Deborah M. , Conant Rhoda J. 
Published: January 2020

Abstract

Objective:
Vasomotor symptoms (VMS) are associated with decreased memory performance and alterations in brain function. We conducted a preliminary examination of VMS and patterns of brain activity during a verbal memory task to provide insights into the VMS-related brain mechanisms that can contribute to memory problems in midlife women.

Methods:
Fourteen postmenopausal women (mean age 53.5, 64% African-American) with moderate-to-severe VMS (>35/wk) and not taking hormone therapy completed functional magnetic resonance imaging (fMRI) assessments during word encoding and recognition, 24-hour physiologic VMS monitoring, symptom questionnaires, and two verbal memory tests.

Results:
In regression analyses, a higher number of physiologic VMS, but not reported VMS, was associated with worse verbal memory on immediate and delayed logical memory (r = 0.53 and r = 0.72, P < 0.05). On fMRI assessments, a higher number of physiologic VMS, but not subjective VMS, was associated with greater activation in the left orbitofrontal cortex, left medial and superior frontal gyrus, right superior frontal gyrus, and right parahippocampal gyrus during the encoding task (P < 0.005). During the recognition task, physiologic VMS were associated with greater activation in the left medial and superior frontal gyrus, left parahippocampal gyrus and hippocampus, right medial and superior frontal gyrus, right parahippocampal gyrus and hippocampus (P < 0.005), and with decreased activation in the ventral medial prefrontal cortex (P < 0.005). Those associations were independent of symptoms and hormone levels.

Conclusions:
Preliminary data suggest that VMS may contribute to memory performance through effects on the hippocampus and prefrontal cortex. Larger studies are warranted to determine the robustness of these initial observations.

Video Summary:
http://links.lww.com/MENO/A508.
Safety of vaginal estrogens: a systematic review
Authors: Crandall Carolyn J. , Diamant Allison , Santoro Nanette 
Published: January 2020

Abstract

Objective:
This systematic review included clinical trials of Food and Drug Administration-approved vaginal estrogens. The primary objective of this systematic review was to examine the comparative safety of the Food and Drug Administration-approved vaginal estrogen preparations among postmenopausal women.

Methods:
We performed a PubMed search of the primary literature from January 1, 1966 to July 16, 2019 for English-language clinical trials. Manual review of retrieved citations identified additional citations.

Results:
Of 882 retrieved citations, 75 clinical trials met inclusion criteria. Maximum trial duration was 52 weeks. None of the trials predesignated breast or endometrial cancer, cardiovascular events, or venous thromboembolism as primary outcomes. Studies were not designed to rule out an increase in endometrial carcinoma risk with long-term use of vaginal estrogen. There were few head-to-head comparisons. Fifty trials examined serum sex steroid and gonadotrophin levels; assay methodologies varied. Serum estradiol levels were 11 pg/mL at baseline or during placebo use and increased to a mean of 30 pg/mL after treatment. Estradiol levels were usually highest during the first 12 weeks of treatment, and were higher for estrogen creams than for inserts or rings. The 22 trials of endometrial thickness and the 15 trials of endometrial biopsy did not clearly demonstrate endometrial proliferation after vaginal estrogen treatment, but data were limited, and studies did not always perform systematic endometrial biopsy.

Conclusions:
Newer low-dose estradiol rings, tablets, and inserts appear to induce the least increases in serum hormones, possibly indicating greater safety. Limited evidence in trials lasting up to 52 weeks suggest endometrial safety of vaginal estrogen use. Long-term trials are needed.

Video Summary:
http://links.lww.com/MENO/A513.
Endometrial safety and bleeding profile of a 17β-estradiol/progesterone oral softgel capsule (TX-001HR)∗
Authors: Mirkin Sebastian , Goldstein Steven R. , Archer David F. , Pickar James H. , Graham Shelli , Bernick Brian 
Published: January 2020

Abstract

Objective:
The aim of the study was to evaluate the effect of a single-capsule 17β-estradiol/progesterone (E2/P4), TX-001HR, on endometrial safety, to report on amenorrhea and bleeding patterns of users, and to identify predictors of amenorrhea.

Methods:
The REPLENISH trial (NCT01942668) evaluated use of TX-001HR in menopausal women (40-65 y) with vasomotor symptoms (VMS) and a uterus. Women were randomized to daily E2/P4 (mg/mg: 1/100, 0.5/100, 0.5/50, or 0.25/50), or placebo for 12 months. Incidence rate of endometrial hyperplasia was calculated from endometrial biopsies conducted at screening and study completion. Women reported bleeding and spotting in daily diaries. The number of bleeding and/or spotting days and the proportion of women with no bleeding or amenorrhea were compared between treatment and placebo using the Fisher exact test. Predictors of cumulative amenorrhea were assessed by univariate analyses.

Results:
Women (n = 1,835) who took at least one study dose comprised the safety population; 1,255 had baseline and 12-month biopsies and comprised the endometrial safety population. Incidence of endometrial hyperplasia was ≤0.36% with any dose of TX-001HR after 1 year of use (one-sided upper 95% confidence interval ≤4%). Cumulative amenorrhea (no bleeding/spotting) rates increased over time and were relatively high from cycle 1 to 13 with TX-001HR (56%-73%; placebo 79%; P < 0.05 except with 0.25/50 dose). Few vaginal bleeding adverse events (1.0%-4.6% TX-001HR vs 0.7% placebo) were reported and discontinuations due to bleeding were low (0.4%-1.4% vs 0%). Cumulative amenorrhea was significantly more frequent in older women, those further from their last menstrual period, and those with lower baseline E2 concentrations (all; P < 0.01).

Conclusions:
All doses of TX-001HR provided endometrial protection and were associated with an improved bleeding profile over time; older age, further last menstrual period, or lower baseline E2 may predict amenorrhea with TX-001HR.
Short rest between shifts and risk of hypertension in hospital workers
Authors: Cho Yun-Sik , Lee Seungho , Yoon Jin-Ha , Lee Jieun , Park Jae Bum , Lee Kyung-Jong , Jeong Inchul 
Published: January 2020

Objectives:
Shift work is related to hypertension and other cardiovascular diseases, and short shift intervals of less than 11 h (quick returns) are reported to be related to health problems, including sleep disturbance and fatigue. However, its cardiovascular effect has rarely been examined. The purpose of this study was to investigate the relationship between quick returns, consecutive night shifts, and risk of hypertension in hospital workers.

Methods:
Data collected from a medical examination of 1372 nonhypertensive shift workers in a hospital were retrospectively followed up. Demographic factors (sex and age), lifestyle habits (smoking, alcohol use, exercise, and obesity), and work-related factors (working hours, shift work experience, consecutive night shifts, and quick returns status) were included in the analyses. Multivariate Cox proportional-hazard models were conducted to estimate hazard ratio and 95% confidence interval (CI).

Results:
The findings showed that quick returns was related to an increased risk of hypertension (hazard ratio, 95% CI: 1.88, 1.00–3.54), whereas consecutive night shifts were not. However, the risk of hypertension was significantly higher in workers with quick returns and 2–3 days of consecutive night shifts (3.33, 1.18–9.39) and those with quick returns and at least 4 days of consecutive night shifts (3.79, 1.22–11.76), compared with the reference group.

Conclusion:
The findings of this study indicate that short shift intervals and consecutive night shifts are related to an increased risk of hypertension in shift-working hospital workers.