bluuebunny/crossref_metadata_2025_split huggingface dataset:
Valuing the SF-6Dv2 Classification System in the United Kingdom Using a Discrete-choice Experiment With Duration
Authors: Mulhern Brendan J. , Bansback Nick , Norman Richard , Brazier John 
Published: March 2020

Objective:
An updated version of the SF-6D Classification System (SF-6Dv2) has been developed, and utility value sets are required. The aim of this study was to test the development of a United Kingdom SF-6Dv2 value set, and address limitations of the existing SF-6D value set (which results in a narrow range of utilities). This was done using 2 discrete-choice experiment (DCE) tasks. Interactions and preference heterogeneity were also investigated.

Research Design and Subjects:
An online sample of respondents (n=3014) completed 10 DCE with duration choice sets from an efficient design of 300 (Design 1) and 2 DCE with duration choice sets including immediate death from a set of 60 (Design 2). Conditional logit regression was used to estimate value set models with and without interactions. We investigated preference heterogeneity using latent class models.

Results:
Models including ordered coefficients within each dimension were developed, with the favored model including an additional interaction term when one dimension was at the most severe level. Value sets differed across Designs 1 and 2. Design 1 models had a wider utility range and a higher proportion of negative values. The most important dimensions were pain, mental health, and physical functioning. Preference heterogeneity was apparent, with a 2-class model describing the data.

Conclusions:
We developed and applied a protocol to value the SF-6Dv2 using DCE. The results provide a provisional value set for use in resource allocation. The protocol can be applied internationally. Further work should investigate how to account for preference heterogeneity in value set production.
Determinants of Therapeutic Alliance With People With Psychotic Disorders
Authors: da Costa Héloïse , Martin Brice , Franck Nicolas 
Published: March 2020

Abstract
Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis.
Aggression and Violence Toward Healthcare Workers in a Psychiatric Service in Italy
Authors: Bizzarri Jacopo V. , Piacentino Daria , Kotzalidis Georgios D. , Moser Sabine , Cappelletti Simone , Weissenberger Gerd , Pompili Maurizio , Conca Andreas 
Published: March 2020

Abstract
Workplace violence and aggression are receiving increasing attention, especially when perpetrated in at-risk services such as psychiatric and emergency departments. Many healthcare providers have been victims of verbal aggressions (VAs) and physical aggressions (PAs), as well as injuries (INs), at the hands of patients. We conducted a 1-year retrospective questionnaire-based survey to assess workplace violence and aggression experienced by staff working at the Psychiatric Service of the Health District of Bolzano-Bozen (Italy). We performed parametric statistics. Logistic regression estimated the size of the association between PA occurrence and staff characteristics. Our psychiatric service's employees were frequent victims (91.5%) of 1 or more aggression/injury in the previous year. VAs and INs showed comparable frequencies among the three sites of our service, that is, the inpatient (INP), the outpatient (OUTP), and the rehabilitation (REHAB) units, differently from PAs, which were more common at INP (p < 0.001). The logistic regression model showed that female sex, working at INP, and a shorter psychiatry work experience predicted PAs occurrence. Most of the staff felt they could benefit from aggression management. Findings show that VAs, PAs, and INs are common among our psychiatric service's employees and point to the need to provide staff training on de-escalation.
Improving Accuracy and Timeliness of Nursing Documentation of Pediatric Early Warning Scores
Authors: Dean Nathan P. , Cheng Jenhao J. , Crumbley Ian , DuVal Jennifer , Maldonado Eliana , Ghebremariam Emanuel 
Published: March 2020

Introduction:Accurate and timely documentation of pediatric early warning scores (PEWS) by the bedside nurse into the electronic health record (EHR) is important to promote early identification of patients in stages of deterioration. Through the implementation of a PEWS calculator embedded in the EHR, we hope to improve the accuracy of the recorded score and reduce the time between vital sign collection and final documentation in the EHR.Methods:Identification of the highest PEWS value in the 24 hours before all unplanned transfers or rapid response activations without a transfer occurred between the period November 1, 2013, through December 31, 2016. The accuracy of the calculated cardiac or respiratory subscore based on heart rate or the respiratory rate at the time of PEWS calculation was determined. We tracked the calculation of the time to chart via the difference between nursing documentation of PEWS compared to vital sign collection. Before September 3, 2015, PEWS was calculated mentally by the bedside nurse; afterward, the nurse entered the unique PEWS features into the EHR, and the EHR automatically calculated PEWS.Results:This study evaluated 2,409 PEWS scores, 1,411 before and 998 after initiation of the PEWS calculator. Accuracy before the EHR calculator was 71%, and the median time to document was 55 minutes. Following the implementation of the calculator, no scores were incorrectly calculated too low, and the median time to document was 20 minutes.Conclusions:Transition to an EHR-based PEWS calculator eliminated inaccurately low PEWS values and reduced time to document.
Suppressive Effect of Leukotriene Antagonists on Capsular Contracture in Patients Who Underwent Breast Surgery with Prosthesis: A Meta-Analysis
Authors: Wang Yuanliang , Tian Jing , Liu Jianshu 
Published: March 2020

Background:
Capsular contracture is a troublesome and distressing complication in mammaplasty or breast reconstruction involving a prosthesis. Previous studies have indicated that leukotriene antagonists effectively reverse capsular contracture. However, this treatment method lacks comprehensive support from evidence-based medicine and remains considerably controversial. In this study, a meta-analysis was conducted to evaluate the therapeutic and preventive effects of leukotriene antagonists on capsular contracture in patients after breast prosthesis implantation.

Methods:
A comprehensive literature search was performed in English and Chinese databases. All clinical studies assessing the therapeutic and prophylactic effects of leukotriene antagonists on capsule contracture after breast prosthesis implantation were selected. Risk differences and 95 percent confidence intervals were applied as the final pooled statistics.

Results:
A total of five eligible studies were included, involving 1710 breast prosthesis implantations. The final results indicated that leukotriene antagonists markedly inhibited capsular contracture formation, with statistical significance at 32.02 (p < 0.001) (pooled risk difference, 0.84; 95 percent CI, 0.79 to 0.89). In subgroup analysis, subgroups based on different leukotriene antagonists included the montelukast and zafirlukast groups, with significant pooled statistical levels of 19.34 (p < 0.001) and 79.48 (p < 0.001), respectively (montelukast: pooled risk difference, 0.83; 95 percent CI, 0.75 to 0.92; zafirlukast: pooled risk difference, 0.85; 95 percent CI, 0.83 to 0.87), indicating that both montelukast and zafirlukast were effective in inhibiting encapsulation.

Conclusions:
This meta-analysis demonstrated that leukotriene antagonists (montelukast and zafirlukast) have significant effects in treating and preventing capsular contracture. These medications should be administered in a reasonable and safe way. Further studies of clinical efficacy, duration, safety, and exact mechanism of leukotriene antagonists for periprosthetic capsular contracture are warranted.
Pediatric Frontal Bone and Sinus Fractures: Cause, Characteristics, and a Treatment Algorithm
Authors: Lopez Joseph , Pineault Kevin , Pradeep Tejus , Khavanin Nima , Kachniarz Bart , Faateh Muhammad , Grant Michael P. , Redett Richard J. , Manson Paul N. , Dorafshar Amir H. 
Published: March 2020

Background:
The purpose of this study was to assess the incidence, cause, characteristics, presentation, and management of pediatric frontal bone fractures.

Methods:
A retrospective cohort review was performed on all patients younger than 15 years with frontal fractures that presented to a single institution from 1998 to 2010. Charts and computed tomographic images were reviewed, and frontal bone fractures were classified into three types based on anatomical fracture characteristics. Fracture cause, patient demographics, management, concomitant injuries, and complications were recorded. Primary outcomes were defined by fracture type and predictors of operative management and length of stay.

Results:
A total of 174 patients with frontal bone fractures met the authors’ inclusion criteria. The mean age of the patient sample was 7.19 ± 4.27 years. Among these patients, 52, 47, and 75 patients were classified as having type I, II, and III fractures, respectively. A total of 14, 9, and 24 patients with type I, II, and III fractures underwent operative management, respectively. All children with evidence of nasofrontal outflow tract involvement and obstruction underwent cranialization (n = 11).

Conclusions:
The authors recommend that type I fractures be managed according to the usual neurosurgical guidelines. Type II fractures can be managed operatively according to the usual pediatric orbital roof and frontal sinus fracture indications (e.g., significantly displaced posterior table fractures with associated neurologic indications). Lastly, type III fractures can be managed operatively as for type I and II indications and for evidence of nasofrontal outflow tract involvement. The authors recommend cranialization in children with nasofrontal outflow tract involvement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
The Impacts of Orthognathic Surgery on the Facial Appearance and Age Perception of Patients Presenting Skeletal Class III Deformity: An Outcome Study Using the FACE-Q Report and Surgical Professional–Based Panel Assessment
Authors: Denadai Rafael , Chou Pang-Yun , Su Yu-Ying , Lin Hsiu-Hsia , Ho Cheng-Ting , Lo Lun-Jou 
Published: March 2020

Background:
A recent artificial intelligence–based investigation has shown the impacts of orthognathic surgery on the patient’s facial appearance and apparent age. However, appearance and age perception as reported by patients and surgical professionals have not been addressed in the same cohort to date.

Methods:
FACE-Q facial appraisal (appearance and age) and quality-of-life scale scores obtained before and after orthognathic surgery, in addition to three-dimensional photographs of 70 patients with skeletal class III deformity, were collected for a comparative cross-sectional study. Seven blinded plastic surgeons rated all photographs for apparent facial aesthetic and age scales. The FACE-Q data from 57 matched normal individuals were adopted for the comparative analyses. The correlation between the FACE-Q and the professional-based scales was tested.

Results:
Pre–orthognathic surgery versus post–orthognathic surgery comparisons showed significant differences (p < 0.001) for all FACE-Q scales and panel assessments, with higher (FACE-Q scales and professional-based aesthetic parameters) and lower (FACE-Q patient-perceived age scale and professional-based age parameter) values for post–orthognathic surgery measurements. Patients had significantly (p < 0.001) higher (patient-perceived age scale) and lower (facial appraisal and quality-of-life scales) FACE-Q values than normal individuals for pre–orthognathic surgery but not for post–orthognathic surgery measurements. The FACE-Q facial appearance overall scale had significant correlations (p < 0.001) with the panel assessment for the parameters “beautiful” and “attractive” but not for the “pleasant” parameter. No significant correlations were observed for facial age scales.

Conclusion:
This study contributes to the orthognathic surgery literature by revealing that orthognathic surgery positively impacts the perception of apparent facial age and improves facial appearance and quality of life.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Estimation of Contralateral Perfusion in the DIEP Flap by Scoring the Midline-Crossing Vessels in Computed Tomographic Angiography
Authors: Han Hyun Ho , Kang Min Kyu , Choe Jooae , Jaikel Karina , Kim Eun Key , Cha Han Gyu , Choi Eun Jeong , Eom Jin Sup 
Published: March 2020

Background:
In deep inferior epigastric perforator flap surgery, the amount of perfusion achievable in the contralateral side over a midline is unclear. Predicting contralateral perfusion preoperatively using computed tomographic angiography will allow efficient breast reconstruction with decreased complications. The authors used computed tomographic angiography to determine whether contralateral perfusion is related to blood vessel status across the midline.

Methods:
Preoperative computed tomographic angiography scans and intraoperative perfusion in patients who underwent breast reconstruction with a deep inferior epigastric perforator flap between January of 2018 and July of 2018 were checked prospectively. A vessel scoring system was prepared according to vessel density across the flap midline on the scan (grade 0, no visible vessels; grade 1, visible vessels with disconnection or could not be judged as grade 0 or 2; grade 2, definite vessels). Intraoperative flap perfusion was confirmed with indocyanine green angiography. Postoperative fat necrosis was analyzed using ultrasonography.

Results:
Ninety-four patients were analyzed. Mean maximal contralateral perfusion length was as follows: grade 0, 7.50 ± 1.89 cm; grade 1, 7.93 ± 2.01 cm; and grade 2, 10.14 ± 2.29 cm. Grade 2 had a statistically significantly greater contralateral perfusion length than grade 0 (p < 0.001) and grade 1 (p < 0.001). Fat necrosis occurred in 27.3 percent (grade 0), 19.1 percent (grade 1), and 8 percent (grade 2), which was statistically significant (p = 0.035).

Conclusions:
A definite vessel connection across the midline (as in grade 2) in preoperative computed tomographic angiography indicates that contralateral perfusion will be sufficiently achieved. This vessel scoring system would be helpful in predicting flap perfusion and planning the surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Cleidocranial Dysplasia: Management of the Multiple Craniofacial and Skeletal Anomalies
Authors: Jirapinyo Chutima , Deraje Vybhav , Huang Gwendolyn , Gue Sam , Anderson Peter J. , Moore Mark H. 
Published: March 2020

Abstract
Cleidocranial dysplasia (CCD) is a rare autosomal dominant disorder caused by mutations in the Runx2 gene. The CCD is characterized by frontal bossing, a patent anterior fontanelle, presence of Wormian bones, midface hypoplasia, multiple dental abnormalities, clavicular hypoplasia or aplasia, skeletal abnormalities, and short stature. The aims of this study are to report the phenotypic manifestations of all patients who presented with CCD and to review the multidisciplinary management of these patients. The longitudinal data of patients with a diagnosis of CCD treated at The Australian Craniofacial Unit from 1980 to 2019 were reviewed. Fourteen patients were identified for inclusion in this study. The age at referral to the unit ranged from 1 week old to 49 years old (mean 11.2 years old). All patients had clinical features of frontal bossing, a patent anterior fontanelle, multiple Wormian bones, midface hypoplasia, abnormal dentition, clavicular hypoplasia/aplasia, and normal intellect. Eleven patients had obstructive sleep apnea. Eight patients had positive family history. Speech issues were found in 6 patients and abnormal hearing was found in 4 patients. Seven patients who underwent skeletal survey were found to have skeletal abnormalities. All patients were evaluated and managed by the multidisciplinary team, which consisted of craniofacial surgeons, pediatric dentists, orthodontists, ENT surgeons, pediatricians, clinical geneticists, radiologists, orthopedic surgeons, and social workers. All patients were treated by dentists/orthodontists requiring multiple surgical interventions and orthodontic treatment. Seven patients who had recurrent ear infection underwent ventilation tube insertion. Seven of 11 patients who had obstructive sleep apnea underwent adenotonsillectomy. Four patients underwent orthognathic surgery to correct midface hypoplasia and malocclusion. Two patients had cranioplasty for correction of metopic depressions. The characteristic findings of patients with CCD involving multiple regions of the body should draw clinicians’ attention to the need for multidisciplinary management of these patients.
Comparative Three-Dimensional Finite Element Analysis on Miniplate and Lag Screw Fixation to Symphysis Fractures
Authors: Ertem Sinan Yasin 
Published: March 2020

Abstract
The purpose of this study was to compare the amount of stress on the fracture site via three-dimensional finite element analysis between lag screw and miniplate systems. Solid mathematical models were created from the CT of a patient and a fracture observed in the symphysis area. On the fracture site mini plates and lag screws applied to the bone to fixate segments. The physiologic mastication chewing forces were applied for simulation. These 2 fixation methods: were evaluated by their amount of stress values. The maximum Von Misses stress lag screw model was 2727 MPa on the apex of the lag screw and 934 MPa on the fracture site of the screw. At the miniplate model, the maximum Von Misses stress was 571 MPa on the head of the miniplate screw, and it was 202 MPa on the fracture site. Thus, lag screw model causes at least 4 times higher stress values than mini plate model. The stress level of lag screw model is higher than miniplate model. However, when the chewing forces are taken into account, the amount of stress in the lag screw system is also acceptable in clinical applications.
Delayed Traumatic Pseudoaneurysm of the Dorsal Nasal Artery
Authors: Kim Tae Hoon , Lim Eung Jung , Kim SungHee , Park Jun Ho 
Published: March 2020

Abstract
A pseudoaneurysm is an uncommon pathology arising from any artery in the human body. It typically presents as a pulsatile swelling in contact with a blood vessel. Of pseudoaneurysms of the head and neck region, the most common site is the superficial temporal artery while that of the dorsal nasal artery is extremely rare. A pseudoaneurysm can be routinely diagnosed by its clinical features and confirmed by radiologic evaluation. The authors report a case of pseudoaneurysm of the dorsal nasal artery, which was misdiagnosed as a hematoma owing to its non-pulsatile nature during initial presentation.
Investigation of the Relationship Between Mandibular Morphology and Upper Airway Dimensions
Authors: Golchini Ehsan , Rasoolijazi Homa , Momeni Farzaneh , Shafaat Pedram , Ahadi Reza , Jafarabadi Mohammad Asghari , Rahimian Saba 
Published: March 2020

Introduction:
In this study, the authors aimed to perform a novel and extensive analysis, based on the most applicable correlations between the mandibular and upper airway parameters, using cone beam computed tomography across all malocclusion classes. The authors also focused on gender-dependent differences in an Iranian population.

Materials and Methods:
Images were acquired from adult patients using cone beam computed tomography. The patients were classified into three groups of malocclusion classes (class I: 13 males and 27 females, class II: 13 males and 27 females, and class III: 25 males and 15 females). For each patient, 10 parameters for the mandible and 23 parameters for the pharynx, pyriform aperture, and nasal cavity were evaluated in the images.

Results:
Pearson's correlation coefficient showed significant correlations between the mandibular morphology and upper airway dimensions in each malocclusion class. In females, the menton angle had a significant correlation with pharyngeal dimensions in all malocclusion classes. In males, the bigonial width, bicondylar width, and symphyseal height of the mandible were correlated with pharyngeal dimensions in all classes. The greatest correlation between the mandible and upper airways was observed in class III malocclusions, and the lowest correlation was observed in class I malocclusions. In addition, the mandibular parameters had relationships with the nasal cavity and pyriform aperture.

Conclusion:
It is important to consider the knowledge of the relationship between some characteristics of the mandible and airways in various clinical approaches.
Alternative Methods to Local Flap Applications in Large Tissue Losses Caused by Gunshot Injuries in the Syrian War
Authors: Uçak Murat 
Published: March 2020

Purpose/Object/Background:
In gunshot injury (GSI), the distance, ballistic properties, and the site of injury of lead or scattering gain importance. The authors investigated alternative methods to local flap applications in large tissue losses on facial regions caused by GSI in the Syrian War at the light of our approaches and outcomes.

Materials and Methods:
The study was designed as a cross-sectional retrospective clinical cohort analyze. The authors analyzed data describing the distribution and comparisons of 187 Syrian patients who injured in the war due to GSI and transferred to our medical center from Jan 2011 and June 2018. The study included data of the patients with demographics, mechanisms of a war injury, clinical data, treatment, and outcomes.

Results:
131(70%) of all the patients were soldiers, while the rest 56 was civilians. 58% (n = 108) of the GSI was female while remaining was males (42%; n = 79). The rate for children was 32% in all the patients as the most common soft tissues of the face were around the maxilla-zygoma (38.4%), orbita-nose region (29.3%), mandibula-teeth (18.5%). The authors performed a fascio cutaneous transposition flap that was planned from the cervical region (58%), interpolation flap that was planned from the frontotemporal region (28%), and forehead rotation flap (14%). The authors did not lose any patients due to plastic reconstruction.

Conclusion:
The fasciocutaneous transposition flap, interpolation flap, and forehead rotation flap that The authors apply to these patients are extremely rare flaps today. These flap applications have achieved tremendous outcomes, even without any sign of necrosis in war surgery.