bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Life in Youth With Chronic Pain
Authors: Lee Soeun , McMurtry C. Meghan , Summers Caroline , Edwards Kim , Elik Nezihe , Lumley Margaret N. 
Published: February 2020

Objectives:
Pediatric chronic pain has often been examined from a risk perspective, and relatively less is known about the individual and family-level resilience factors that help youth with chronic pain maintain their quality of life (QOL). This cross-sectional study: (1) examined the relations among purported youth and parent resilience (youth pain acceptance and pain self-efficacy, parent psychological flexibility) and risk (youth pain intensity and parent protectiveness) factors with youth QOL, and (2) tested exploratory statistical mechanisms that may explain relations between parent and youth variables.

Methods:
Participants included 122 youth (10 to 17 y; M=14.26, SD=2.19) seen in an interdisciplinary pediatric chronic pain program and a parent. Youth completed measures of their average pain, QOL, pain acceptance, and pain self-efficacy. Parents completed measures of their pain-related psychological flexibility and behavioral responses to pain (ie, protectiveness, distraction, monitoring, minimizing).

Results:
Youth pain acceptance, pain self-efficacy, and parent psychological flexibility were highly positively correlated with each other, and with overall youth QOL. Evidence for a buffering effect of pain acceptance and pain self-efficacy on the association between pain intensity and QOL was not found. Protectiveness was found to be a significant mediator of the relation between parental psychological flexibility and youth QOL.

Discussion:
The results are discussed in the context of the resilience-risk framework and current understandings of the role of parental factors for pediatric chronic pain.
Effect of Extended Prophylactic Antibiotic Duration in the Treatment of Open Fracture Wounds Differs by Level of Contamination
Authors: Stennett Christina A. , O'Hara Nathan N. , Sprague Sheila , Petrisor Brad , Jeray Kyle J. , Leekha Surbhi , Yimgang Doris P. , Joshi Manjari , O'Toole Robert V. , Bhandari Mohit , Slobogean Gerard P. ,   the FLOW Investigators
Published: February 2020

Objective:
To determine the association between prophylactic antibiotic duration after the definitive wound closure of an open fracture and deep surgical site infection (SSI).

Design:
Retrospective cohort study.

Setting:
41 clinical sites in the United States, Canada, Australia, Norway, and India.

Participants:
Patients (N = 2400) with open fractures of the extremities who participated in the Fluid Lavage of Open Wounds (FLOW) trial.

Intervention:
Extended antibiotic prophylaxis, defined as more than 72 hours of continuous antibiotic use after definitive wound closure.

Main Outcome Measurement:
Deep SSI diagnosed within 1 year of enrollment.

Results:
Forty-two percent of participants received extended antibiotic prophylaxis. Deep SSI prevalence was 5%, 8%, and 23% for wounds with mild, moderate, and severe contamination, respectively. In open fractures with mild contamination, extended antibiotic use showed a trend toward increased odds [adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI), 0.92–2.11] of deep SSI compared with shorter use. No association was found among patients with moderate contamination (aOR = 1.09; 95% CI, 0.53–2.27). By contrast, extended antibiotic prophylaxis was strongly protective (aOR = 0.20; 95% CI, 0.07–0.60) against deep SSI in patients with severe contamination. Propensity score sensitivity analysis results were consistent with these findings.

Conclusions:
The evidence suggests differential effects of extended postclosure antibiotic duration on SSI odds contingent on the degree of contamination in open fracture wounds. Although extended antibiotic duration resulted in lower odds of SSI among patients with severely contaminated wounds, we observed a trend toward higher odds of SSI in mildly contaminated wounds.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Making the Most of Systematic Reviews and Meta-analyses in Spine Surgery
Authors: Lu Victor M. , Graffeo Christopher S. , Mikula Anthony L. , Perry Avital , Carlstrom Lucas P. , Elder Benjamin D. , Freedman Brett A. , Krauss William E. 
Published: February 2020

Study Design.
Review.

Objective.
To provide practicing spine surgeons a primer with key insights for reading, interpreting, and clinically integrating systematic reviews and meta-analyses.

Summary of Background Data.
Evidence-based medicine (EBM) refers to a family of standardized techniques for critical appraisal of clinical research. Within the contemporary spine literature, EBM is most commonly encountered in the form of systematic reviews and meta-analyses. Although these analytic techniques are potentially useful when appropriately applied to well-formulated questions with adequate primary data in the literature, the rapid and somewhat indiscriminate increase in volume of systematic reviews and meta-analyses published may be associated with an overall dilution in their quality, as well as misperceptions regarding the applicability of particular EBM studies to spine surgery in general.

Methods.
The collective experience of spine specialists with vested interests in advancing EBM and its utility was summarized into a primer.

Results.
We emphasize components that are pertinent methodologically (search strategy, study number, meta-analysis, bias, and certainty), and pertinent clinically (outcomes) to interpreting, and clinically integrating systematic reviews and meta-analyses into spine surgery practice.

Conclusions.
Armed with these insights into these five perspectives, we anticipate that practicing spine surgeons will be better equipped to interpret systematic reviews and meta-analyses in a fashion that will meaningfully impact their patient care.

Level of Evidence: 2
The Effect of Surgical Decompression and Fusion on Functional Balance in Patients With Degenerative Lumbar Spondylolisthesis
Authors: Haddas Ram , Lieberman Isador , Block Andrew , Derman Peter 
Published: February 2020

Study Design.
Prospective cohort study.

Objective.
To quantify the effect of lumbar decompression and fusion surgery on balance and stability in patients with degenerative lumbar spondylolisthesis (DLS) and compare them to controls.

Summary of Background Data.
DLS is a condition in which one vertebra subluxates relative to an adjacent vertebra in the absence of a disruption in the neural arch. While the existing literature demonstrates that decompression and fusion can successfully alleviate pain and reduce disability in patients with DLS, no studies to date have used quantitative dynamic testing to determine the effect of surgery on cone of economy (CoE) measures in this patient population.

Methods.
Forty-five DLS patients performed a series of functional balance tests a week before and 3 months after surgery and were compared to 28 controls. The outcome measures included range of sway (RoS) and total sway for the center of mass (CoM) and head in the sagittal, coronal, and axial planes, along with leg and back Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear/Avoidance Behavior Questionnaire (FABQ), Tampa Scale of Kinesophobia (TSK), and Demoralization scale.

Results.
RoS for the CoM (P < 0.005) and head (P < 0.017) decreased in all planes postoperatively. Reductions in CoM (P = 0.001) and head total sway (P = 0.001) were also observed after surgery. Furthermore, patients with DLS reported strong improvements in VAS low back (P = 0.001), VAS leg (P = 0.001), ODI (P = 0.001), FABQ Physical (P = 0.003), TSK (P = 0.001), and demoralization (P = 0.044) with surgical intervention. Although total sway was reduced after surgery, it did not return to the level of normal controls as demonstrated with more total sway of their CoM (P = 0.002) and head (P = 0.001) as well as more sagittal head RoS (P = 0.048).

Conclusion.
This study confirms that surgical intervention for degenerative spondylolisthesis is effective at reducing disability, back and leg pain, demoralization, kinesiophobia, and fear-avoidance beliefs related to physical activity in patients with DLS. Furthermore, such patients exhibit a significantly more stable stance after surgery. However, balance parameters did not completely normalize by 3 months postoperatively.

Level of Evidence: 3
Preoperative Risk Stratification
Authors: Casper David S. , Rihn Jeffrey A. 
Published: February 2020

Study Design.
Spine update.

Objective.
The purpose of this study is to provide a review of preoperative clearance and optimization, before elective spine surgery.

Summary of Background Data.
Patient optimization preceding elective surgery is critical to ensure the best possible outcome.

Methods.
Historical and current literature pertaining to patient clearance and optimization, before elective surgery, was reviewed. These data were then synthesized and assessed to provide a balanced view on current trends in regards to preoperative management and optimization.

Results.
The American Academy of Cardiology defines spine surgery as “intermediate” risk, and thus patients are permitted to forgo formal cardiac evaluation if they have no active cardiac condition and demonstrate adequate functional capacity; however, those with active or chronic medical conditions require further investigation before elective operations.

Conclusion.
Overall, preoperative screening and optimization of comorbidities are vital to ensure positive outcomes in elective spine surgery, and the aforementioned criteria must be considered on an individual basis. Further research into specific preoperative optimization guidelines would help to ensure successful outcomes for those undergoing spine surgery.

Level of Evidence: N/A
Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients*
Authors: Sahetya Sarina K. , Wu T. David , Morgan Brooks , Herrera Phabiola , Roldan Rollin , Paz Enrique , Jaymez Amador A. , Chirinos Eduardo , Portugal Jose , Quispe Rocio , Brower Roy G. , Checkley William ,   INTENSIVOS Cohort Study
Published: February 2020

Objectives:
To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure.

Design:
Prospective observational cohort.

Setting:
Five ICUs in Lima, Peru.

Subjects:
Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure.

Interventions:
None.

Measurements and Main Results:
Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean Pao
2/Fio
2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10–16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10–14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10–1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline Pao
2/Fio
2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure.

Conclusions:
In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.
YEARS Algorithm Versus Wells’ Score: Predictive Accuracies in Pulmonary Embolism Based on the Gold Standard CT Pulmonary Angiography*
Authors: Abdelaal Ahmed Mahmoud M. Alkhatip Ahmed , Donnelly Maria , Snyman Lindi , Conroy Patrick , Hamza Mohamed Khaled , Murphy Ian , Purcell Andrew , McGuire David 
Published: February 2020

Objectives:
This study retrospectively applied Wells’ score and YEARS algorithm to the same sample of patients to evaluate the predictive performance of each when compared with the gold standard CT pulmonary angiography.

Design:
Retrospective analytical study.

Setting:
A tertiary University Hospital in Ireland.

Patients:
Data from 794 patients who underwent CT pulmonary angiography to rule out pulmonary embolism.

Interventions:
Patients were analyzed using retrospective application of both Wells’ score and YEARS algorithm. Sensitivity, specificity, and diagnostic odds ratio were calculated and compared.

Measurements and Main Results:
Of 794 scans, 78 (9.8%) were positive for pulmonary embolism. The YEARS algorithm was more sensitive than the Wells’ score (97.44% vs 74.36%) but was less specific (13.97% vs 33.94%). Furthermore, the diagnostic odds ratio of YEARS was higher than Wells’ score (6.27 vs 1.48). YEARS provides better negative predictive value (98% vs 92.4%), and both scores have poor positive predictive value (10.9%).

Conclusions:
Both scores successfully exclude pulmonary embolism, although YEARS has a better negative predictive value. Both exhibit poor positive predictive value.
The Ethics of Compulsory Treatment of Addictions Under Canadian Legislation: Restricting Freedom to Promote Long-Term Autonomy?
Authors: Chase Jocelyn 
Published: February 2020

ABSTRACT
The opioid epidemic has brought a growing focus on the treatment of addictions. Some have proposed that patients with severe addiction be subject to mandated compulsory treatment under Canadian Mental Health Legislation, paralleling the growing use of civil commitment for addiction treatment in the United States. This article presents a bioethical analysis of the legal, medical, and societal implications of compulsory treatment for addiction under civil commitment. Concerns around patient autonomy, harm, efficacy, and social justice make compulsory treatment of addiction an inadequate routine option for a complex biopsychosocial illness. Instead, continued efforts to foster voluntary, evidence based and socially compassionate care for Canadians with addictions must be emphasized through policy and research.

Résumé
L’épidémie d’opioïdes met de plus en plus l’accent sur le traitement des dépendances. Certains ont proposé que les patients souffrant de toxicomanie grave soient soumis à un traitement obligatoire en vertu de la législation canadienne sur la santé mentale, parallèlement à l’utilisation croissante de l’engagement civil pour le traitement de la toxicomanie aux États-Unis. Cet article présente une analyse bioéthique des implications juridiques, médicales et sociétales du traitement obligatoire de la dépendance sous l’engagement civil. Les préoccupations concernant l’autonomie, le préjudice, l’efficacité et la justice sociale des patients font du traitement obligatoire de la toxicomanie une option de routine inadéquate pour une maladie biopsychosociale complexe. Au lieu de cela, il faut mettre l’accent sur les politiques et la recherche afin de favoriser les soins volontaires, fondés sur des preuves et socialement compatissants pour les Canadiens souffrant de toxicomanie.
Tracing the Origin of Food-borne Disease Outbreaks
Authors: Jacobs Rianne , Teunis Peter , van de Kassteele Jan 
Published: February 2020

Background:
Food-borne disease outbreaks constitute a large health burden on society. One of the challenges when investigating such outbreaks is to trace the origin of the outbreak. In this study, we consider a network model to determine the spatial origin of the contaminated food product that caused the outbreak.

Methods:
The network model we use replaces the classic geographic distance of a network by an effective distance so that two nodes connected by a long-range link may be more strongly connected than their geographic distance would suggest. Furthermore, the effective distance transforms complex spatial patterns into regular topological patterns, creating a means for easier identification of the origin of the spreading phenomenon. Because detailed information on food distribution is generally not available, the model uses the gravity model from economics: the flow of goods from one node to another increases with population size and decreases with the geographical distance between them.

Results:
This effective distance network approach has been shown to perform well in a large Escherichia coli O104:H4 outbreak in Germany in 2011. In this article, we apply the same method to various food-borne disease outbreaks in the Netherlands. We found the effective distance network approach to fail in certain scenarios.

Conclusions:
Great care should be taken as to whether the underlying network model correctly captures the spreading mechanism of the outbreak in terms of spatial scale and single or multiple source outbreak.
Community-wide Mortality Rates in Beijing, China, During the July 2012 Flood Compared with Unexposed Periods
Authors: Yan Meilin , Wilson Ander , Peel Jennifer L. , Magzamen Sheryl , Sun Qinghua , Li Tiantian , Anderson G. Brooke 
Published: February 2020

Background:On 21–22 July 2012, Beijing, China, suffered its heaviest rainfall in 60 years. Two studies have estimated the fatality toll of this disaster using a traditional surveillance approach. However, traditional surveillance can miss disaster-related deaths, including a substantial number of deaths from natural causes triggered by disaster exposure. Here, we investigated community-wide mortality risk during this flood compared with rates in unexposed reference periods.Methods:We compared community-wide mortality rates on the peak flood day and the four following days to seasonally matched nonflood days in previous years (2008–2011), controlling for potential confounders, to estimate the relative risks (RRs) of daily mortality among Beijing residents associated with this flood.Results:On 21 July 2012, the flood-associated RRs were 1.34 (95% confidence interval = 1.11, 1.61) for all-cause, 1.37 (1.01, 1.85) for circulatory, and 4.40 (2.98, 6.51) for accidental mortality, compared with unexposed periods. We observed no evidence of increased risk of respiratory mortality. For the flood period of 21–22 July 2012, we estimated a total of 79 excess deaths among Beijing residents; by contrast, only 34 deaths were reported among Beijing residents in a study using a traditional surveillance approach.Conclusions:To our knowledge, this is the first study analyzing community-wide changes in mortality rates during the 2012 flood in Beijing and one of the first to do so for any major flood worldwide. This study offers critical evidence on flood-related health impacts, as urban flooding is expected to become more frequent and severe in China.
Closing the Breast Cancer Loop: Barriers and Perceptions of Breast Reconstruction among Rural Women
Authors: Mullens Cody L. , Hernandez J. Andres , Conn Mary Ellen , Kennedy-Rea Stephenie , Ueno Cristiane M. 
Published: February 2020

Background:
Despite policies such as the Women's Health and Cancer Rights Act (WHCRA) and Breast Cancer Patient Education Act, rates for breast reconstruction vary and are especially low for some subpopulations of patients, especially rural women. In order to better understand patient perceptions, qualitative analysis using focus groups is an underutilized tool for obtaining patient perspectives regarding health-related issues and access to care. Our aim was to better understand patient perceptions using qualitative analysis.

Methods:
Three focus groups were held in rural counties within West Virginia in order to better understand patient perceptions, knowledge, and beliefs regarding breast health, breast cancer, access to breast reconstruction, and how to disseminate and educate this patient population regarding their right to accessing breast reconstruction.

Results:
Major themes analyses revealed perceived barriers to care related to lacking care coordination, lack of insurance coverage and other resources, as well as issues related to transportation. Participants consistently discussed avoiding breast screening care due fear and denial in addition to pain. Few patients were aware of their right to accessing breast reconstruction per the WHCRA, and many were concerned about follow-up burden, complications, and general fear related to breast reconstruction. Themes related to dissemination of information to promote the option of breast reconstruction included social media, patient counseling by their referring physician, and other means of intervention in clinics and other points in the care coordination chain.

Conclusions:
Rural women have important, unique viewpoints regarding access to and perceived barriers from obtaining breast reconstruction. Plastic surgeons must work diligently to educate, disseminate, and improve care coordination among this population in order to improve access to breast reconstruction among rural breast cancer patients.
Clinical Description and Outcomes of Australian Children With Invasive Group A Streptococcal Disease
Authors: Thielemans Elise , Oliver Jane , McMinn Alissa , Baker Ciara , Britton Philip N. , Clark Julia , Marshall Helen , Blyth Christopher C. , Francis Joshua , Buttery Jim , Smeesters Pierre R. , Crawford Nigel , Steer Andrew C. 
Published: February 2020

Background:
Invasive group A streptococcal disease is a severe infection with a high case fatality rate, estimated to cause more than 150,000 deaths per year worldwide. The clinical presentation of this infection is variable, and early diagnosis can be challenging. There are few data on its short- and longer-term outcomes, especially in children. The aim of this study was to assess the clinical presentation, management and short- and longer-term outcomes of invasive group A streptococcal disease in children in Australia.

Methods:
We undertook a prospective surveillance study of children with laboratory-confirmed invasive group A streptococcus disease admitted to 7 sentinel tertiary and quaternary pediatric hospitals in Australia between July 2016 and June 2018. We collected demographic and clinical data and contacted patients 6 months after discharge to assess longer-term outcomes.

Results:
We enrolled 181 children, 7 days to 16 years of age. The principal site of invasive infection was blood (126 children, 69.6%), and the most frequent clinical presentation was pneumonia in 46 children (25.4%). Twenty-six children developed streptococcal toxic shock syndrome (14.4%), and 74 had severe disease (40.9%), including 71 admitted to the intensive care unit. Five children died (2.8%). At discharge and 6 months, 29.3% and 15.2% of the children had persisting health problems, respectively.

Conclusions:
Invasive group A streptococcal infection in Australian children is frequently severe and has a high long-term morbidity burden, highlighting the need for strengthened clinical care pathways, epidemiologic surveillance and prevention strategies.