bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Causes of Tibial Component Loosening Based on Level of Obesity in a Large Consecutive Cohort of Cemented Primary TKAs without Stem Extensions
Authors: Longawa Lilly , Buller Leonard , Ziemba-Davis Mary , Meneghini R. Michael 
Published: December 2020

Background and Hypothesis: Aseptic loosening is one of the most common failure mechanisms of total knee arthroplasty (TKA) requiring revision. The influence of obesity on tibial component aseptic loosening remains unknown. Some surgeons advocate the addition of a tibial stem extension to reduce the risk of loosening. The purpose of this study was to quantify the incidence and causes of revision for tibial component loosening in a large consecutive cohort of cemented primary TKAs without stem extensions based upon level of obesity.

Experimental Design or Project Methods: 534 consecutive cemented primary TKAs performed between 2016 and 2018 by one surgeon were retrospectively reviewed. Procedures were performed using consistent surgical, perioperative medical, and pain-control protocols. All tibial implants were tapered thin keeled designs without stem extensions and implanted with low viscosity cement. Medical records were examined and all-cause revisions of the index surgery were documented.

Results: After exclusions for confounds, 525 TKAs were analyzed. Mean age and BMI were 67.8 years and 33.9kg/m2 respectively and 72% were female. Mean follow-up was 19.1 (SD 10.5) months and 48% had minimum two-year follow-up. 41.3% of patients had a BMI greater than 35kg/m2 and 21.9% above 40kg/m2. There were 11 revisions in 10 patients, 1.9% out of all TKAs performed. Five TKAs required both-component revision and three involved the femoral component only. No tibial component revisions were performed for aseptic loosening.

Conclusion and Potential Impact: None of the standard tibial implants with a keeled design without stem extensions failed in a patient population with greater than 40% obesity. Despite some suggesting tibial stem extensions should be used in obese TKA patients, these findings suggest that tibial component failure in obese patients may be design specific and routinely utilizing stem extensions may not be warranted and could result in deleterious bone loss at revision if required for reasons other than aseptic loosening.
Impact of Gabapentin and Pregabalin on Neurological Outcome After Central Nervous System Injury
Authors: Morton Caleb , Cheng Fen-Lei 
Published: December 2020

Background and Purpose:
Injury to the central nervous system (CNS) is often detrimental to the health, functionality, and quality of life in both the short- and long-term. Injuries that fall under this umbrella include traumatic brain injury (TBI), traumatic spinal cord injury (TSCI), and stroke. These types of injuries vary in what initiates them, but their proposed mechanisms leading to cell dysfunction and death are strikingly similar. There has been pre-clinical and limited retrospective data supporting the idea that gabapentin and pregabalin both have neuroprotective qualities and may alleviate some of the sub-acute damage initiated by these different injuries. The purpose of this study is to determine whether patients taking either gabapentin or pregabalin at the time of their injury tend to have better outcomes than patients with similar injuries who were not taking either one of the two medications.
Methods:
This is a retrospective chart review analysis of 600 patients admitted to Parkview Hospitals from 2016-2019 for TBI, TSCI, or stroke. The outcomes of patients taking either gabapentin or pregabalin with one of the prior diagnoses will be compared to patients with the same diagnosis who were not taking either of the medications mentioned. Statistical analysis will be performed to evaluate if any significant difference exists between the outcomes at discharge of patients taking either medication versus patients who were not.
Results:
Results will be listed as comparisons between patients grouped by injury, and sub-grouped by medication usage. P-values will be included to show significance of comparisons.
Conclusion and Potential Impact:
The main impact of this study is to provide evidence and support leading to a potential method to improve outcomes in patients with CNS injuries. Secondary impacts are providing basis for development of a CNS injury registry and support for developing a unified CNS injury assessment scale to allow comparison of the treatments of different CNS injuries.
Validation of the COVAS (Comorbidities, Obesity, Vitals, Age, Sex) Score as a Practical Tool for Assessing Need for Intensive Care Services in Suspected SARS-CoV2 Patients
Authors: Kline Jeffrey , Sharp Adam , Munson Caleb 
Published: December 2020

Background and Hypothesis
Various scoring instruments have been proposed to risk-stratify patients with suspected COVID-19. Here we test prognostic system derived and tested in the Kaiser Permanente health system (the COVAS score).
Experimental Design and Methods
This was a primary analysis of the multicenter RECOVER registry, which includes patients tested for SARs-CoV-2 from 40 emergency departments around the US. We extracted components of COVAS score with two modifications, and computed a modified COVAS score, and used that as the “test” to compute the area under the receiver operating characteristic curve (AUROC) to predict any initial intensive care unit (ICU) admission or transfer to ICU.
Results
For SARS-CoV-2 positive patients, for the prediction of ICU admission, the COVAS AUROC=0.74 (95% CI = 0.72 to 0.77), with overall mean = 7.4 (SD=4.7), and the mean for ICU admission was higher (10.1, SD=4.6) versus no ICU admission (6.8, SD=4.5), p<0.001 paired t-test. For SARS-CoV-2 negative patients, the COVAS score showed an AUROC= 0.70 (0.68-0.72) and the mean was 7.3, SD=4.2.
Potential Impact
The modified COVAS scoring system had modest overall discriminative value at predicting ICU admission, but was more accurate in SARS-CoV-2 positive patients, compared with SARs-CoV-2 negative suggesting the instrument is calibrated to predict ICU requirements in patients with suspected COVID-19, as opposed to functioning as a generic risk-stratification tool.
Using COVID-19 Narratives to Think Deeply About Physicians’ Conflicting Roles and Responsibilities
Authors: Olivera Jesus , Gunderman Richard 
Published: December 2020

Background: In recent decades, many physicians have abandoned the private practice model of medicine, electing instead to work as hospital employees. For the most part, hospitals and physician employees enjoy a synergistic relationship. In other cases, conflicts can arise between the two parties. This paper explores a subset of such conflicts, those which transpired within the context of the COVID-19 pandemic.

Methods: We utilized the study of Narrative, a Medical Humanities discipline, as an analytical tool. First, we compiled narratives detailing disagreements between various clinicians and their respective employers’ COVID-19 response. Second, we employed literary analysis question prompts to explore the ethical implications of, and potential solutions to, such conflicts.

Results: Physicians, like all individuals, have multiple roles within society. In today’s healthcare landscape, many physicians concurrently assume the roles of caregiver and employee. The moral priorities, values, and obligations inherent to these two roles can sometimes be misaligned, creating ethical dilemmas for physicians and their employers.

Conclusion: Physicians must recognize that their primary professional responsibility is to patients. When the welfare or safety of patients appears to be at risk, physicians have a duty to advocate on their behalf. However, physicians and hospital administration alike must seek out synergies and minimize potential conflict. Good hospitals should have forums, communication lines, and organizational cultures that allow clinicians to openly voice concerns and feedback. Good physicians should voice dissenting opinions in a diplomatic, stepwise, and cooperative manner. If patient welfare remains at risk, other recourses are available, but teamwork and collaboration should be the initial focus.

Impact and Implications:
This discussion can help physicians think deeply about their different roles and responsibilities in society and how to ethically balance those roles. It can also inform various topics within healthcare ethics, including care transformation, resource allocation, organizational ethics, and patient advocacy.
Impact of the COVID-19 Pandemic on Cystic Fibrosis Pulmonary Exacerbations
Authors: Patel Shreya , Thompson Misty , Slaven James , Ren Clement 
Published: December 2020

​Background and Hypothesis
CF pulmonary ￼exacerbations (PEx) are episodes of decline in respiratory function that can be triggered by a variety of mechanisms, including respiratory viral infections. The COVID-19 pandemic resulted in school closures and home isolation policies and a potential reduction in exposure to other respiratory viruses. The goal of this project is to study the impact of the COVID-19 pandemic on CF PEx at the Riley Hospital for Children. We hypothesize that the incidence of PEx will be lower during the period of the COVID-19 lockdown from March 1 to May 15 in 2020 compared to the same time interval in 2019. ￼
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Methods￼
We performed a retrospective chart review of children with CF ages 2-12 (N=80) seen at Riley in 2019 and 2020 and collected data within the following timeframes: January 1 to March 15 2019 and 2020, and March 16 to May 15 2019 and 2020. We collected data on baseline clinical features and details of each PEx event. Data were analyzed with parametric and non-parametric descriptive statistic tests as appropriate; significance was set at P≤0.05. ￼
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Results
The percent of PEx events in the study cohort was significantly lower in 2020 compared to 2019 for January 1 to March 15 (56% vs 42%, P=0.0116) and March 16 to May 15 (35% vs 14%, P<0.0001). The percent of in-person PEx events was significantly lower during March 16 to May 15 in 2020 compared to 2019 (15% vs 1%, P=0.0066)
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Conclusions and Potential Impact ￼
COVID-19 restrictions were associated with a decrease PEx events. We speculate that this reflects a reduced exposure to respiratory viral infections in general. The decrease in in-person PEx events may reflect a shift towards telehealth during the COVID-19 restrictions. These results provide a foundation for further research into triggers and prevention of CF PEx.
A Comparison of Metabolic Disruptions in Alzheimer Disease and Parkinson Disease
Authors: Plyer Cade , Chang Fen-Lei 
Published: December 2020

Background and Hypothesis:
There has been a shift in focus toward metabolic factors in the study of neurodegenerative disorders as their importance has been highlighted by recent discoveries involving disruption of shared mechanisms. Alzheimer disease (AD) and Parkinson disease (PD) share similar metabolic risk factors. We hypothesize that type 2 diabetes mellitus (T2DM) will be most associated with AD, while gastrointestinal (GI) problems will be most associated with PD; however, both AD and PD will have greater associations with GI problems and T2DM relative to control.
Project Methods:
This retrospective chart review included three groups: AD, PD, and control. All data were obtained from neurology clinics in Parkview Health's electronic medical record (EMR). ICD-10 codes identified 65+ year old patients who had visited a clinic within the last year and had a diagnosis of either AD, PD, or non-neurodegenerative symptoms (control): neuropathy, headaches, or seizures. ANOVA and chi-square tests were performed for group analyses, and multiple regression analyses were performed between AD and PD disease severity and various metabolic predictors (e.g., HbA1c, total cholesterol).
Results:
This study currently consists of a protocol. Data collection and analysis will take place between May 2021 and August 2022.
Potential Impact:
This study aims to fully characterize certain metabolic disruptions with AD and PD by analyzing a ten-year span of clinical data in the same patient population; this may reveal risk factors that are amenable to clinical interventions. This may also facilitate the understanding of Lewy body dementia, a disorder that contains elements of both AD and PD. The main metabolic elements explored in this study are those concerning GI problems (e.g., constipation) and T2DM (e.g., elevated HbA1c). These associations will form the basis of a follow-up study that investigates the potential mechanisms linking these disruptions with pathogenesis of either AD or PD.
Multilevel Factors Underlying Adolescent Retention and Disengagement in HIV Care
Authors: Risk Nathan , Toromo Judith , Misquith Chelsea , Enane Leslie 
Published: December 2020

Background/Objective: Adolescents (ages 10-19) living with HIV are at risk for disengagement from HIV care, resulting in poor health and potential for viral transmission. It is important to uncover the central barriers that result in adolescents becoming disengaged from care in order to develop interventions or models to support adolescent retention. We sought to investigate the multilevel barriers and facilitators to adolescent retention in HIV care.

Methods: A systematic search was performed to identify relevant studies from 1994 onwards, both qualitative and quantitative, in any language, and in all geographic regions. Title and abstract screening identified relevant articles. A full text review determined final inclusion. Key variables were extracted, focused on the range of multilevel barriers and facilitators to retention, and any differences according to population or setting. Preliminary findings are summarized.

Results: Quantitative factors associated with disengagement include: older adolescence, racial or ethnic minority status, family-level poverty, and receiving care at a rural clinic. Qualitative barriers to retention include: distance to the clinic and associated travel costs, psychosocial challenges and lack of support for them, anticipated stigma with inadvertent disclosure of HIV status, nondisclosure of HIV status to both the adolescent and family members, negative experiences with care providers, challenges requesting absence from school, and negative school environments. Facilitators to retention include: having strong social support, having a family member with HIV, having positive relationships with providers and clinic staff, attending an adolescent-dedicated clinic or a clinic with adolescent-dedicated hours, having access to intensive counseling, and having access to peer groups/peer mentors.

Conclusion and Policy Implications: Improving adolescent retention requires addressing the multilevel factors that lead to disengagement. Interventions with potential to mitigate against the range of challenges adolescents face are needed to support adolescents to overcome these challenges and continue in life-long HIV care.
How Pediatric Hematologic and Oncologic Patients Experienced Virtual Learning During COVID-19: Importance of Amplifying the Family Voice for Informing Future Recommendations
Authors: Rose Margaret , LaMotte Julia , Todd Hannah , Fraser Greer , Fraser Louise , Renbarger Jamie , Romack Donna , Sajdyk Tammy 
Published: December 2020

Background: With medical advancements in the detection and treatment of pediatric oncologic and hematologic disorders, survival and life expectancy rates continue to improve. However, the treatments themselves have been linked to long-term cognitive issues (e.g., attention, working memory, and executive functioning). These difficulties have particular salience to academic achievement and often necessitate educational accommodations to support learning. However, these plans are designed for the traditional school environment and may be insufficient for virtual learning. The purpose of this study is to investigate the perceived impact of COVID-19 in the context of virtual learning for children with hematologic or oncologic disorders to inform the development of appropriate recommendations for patients and schools this fall.
Methods: Qualitative interviews assessing academic accommodations and COVID-19 adjustments to virtual learning were conducted separately with participants and their guardians by phone. Medical histories were obtained via electronic health record.
Results: Thirty children (Mage=12.8 years, SD=1.4 years) with status post cancer treatment (n=17), sickle cell disease (n=11), or neurofibromatosis type 1 (n=2), with an IEP (n=15) or 504-plan (n=15) in place prior to COVID-19. During virtual learning, children reported a lack of interaction with teachers or other resource help. Guardians felt pressured to assist with schoolwork without sufficient support or qualifications. Anecdotally, families still expressed gratitude to their schools and teachers, revealing overall low expectations for virtual learning.
Potential Impact: This pediatric population faces unique education challenges, specific to neurocognitive impairment secondary to their chronic health conditions. Unsurprisingly, families perceived that their educational needs were not met during virtual learning related to COVID-19. To prevent the cascading effect of insufficiently addressed academic needs, the inclusion of family’s perceived experiences is critical for informing individual recommendations and the Indiana Department of Education broadly during the transition back to school this fall, both in the physical and virtual classrooms.
The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features
Authors: Rukes Marelle , Jones Alexander , Novinger Leah , Davis Kyle , Campiti Vincent , Yedlicka Grace , Bonetto Andrea 
Published: December 2020

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients.

Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05.

Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension.

Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes.
Identification of Atypical Diabetes Using Algorithms to Search the Electronic Medical Record
Authors: Salichs-Perez Veronica , Robert Hood Daniel , Saeed Zeb , Evans-Molina Carmella 
Published: December 2020

Background and Hypothesis:
Atypical diabetes (DM) comprises phenotypically and potentially genotypically distinct forms of DM not fitting current sub-categories of classification. Understanding these rare and uncharacterized types of DM can potentially inform the application of personalized therapeutic approaches and is the emphasis of a recent NIH-funded Consortium focused on Rare and Atypical Diabetes (RADIANT). We aimed to employ informatic-based algorithms to identify potentially atypical DM cases from electronic medical records (EMR) to identify candidates for inclusion in RADIANT.

Project Methods:
Diabetic patients were identified based on two DM diagnostic codes, treatment with anti-diabetic medication, and two diagnostic labs elevated. We filtered for patients with BMI <25 at diagnosis and normal lipid profile. Charts were reviewed manually. Demographic and clinical data were extracted from EMR and entered into a REDCap database. SPSS was used for statistical analysis.

Results:
A total of 21,820 individuals met criteria for DM; 208 were identified as potentially atypical. Chart review was completed for 126 cases. Fifteen were deceased and removed from the final cohort. Of those remaining, 12 (11%) exhibited features consistent with atypical diabetes. The remainder were classified as typical T2D. No significant differences regarding ethnicity or diabetes complication status were identified between typical and atypical cases. Demographics of atypical cases were, 66% female, and 33% male. The average age of diagnosis was 46.8 ± 19.3 yrs. Average BMI was 23.7 ± 4.1. Atypical diabetes individuals were more likely to present with ketoacidosis (p=0.01) exhibiting a trend towards increased insulin use (50% vs. 14%; p=0.09).

Conclusion:
Our study suggests that using EMR may be effective in flagging phenotypically distinct forms of DM in real world settings, associated with a high false positive rate. Data suggests this form of atypical diabetes represents a small percentage of overall DM cases (0.05%). Future studies will focus on application of algorithms to identify other atypical diabetes subsets.