bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Patterns of Prescription Opioid Supply and Risk of Mortality Among Insured Adults in the United States
Authors: Aroke Hilary A. , Buchanan Ashley L. , Bratberg Jeffrey , Hogan Joseph W. , Rich Josiah D. , Wen Xuerong , Kogut Stephen J. 
Published: August 2020

Objective:
To examine the association between initial patterns of prescription opioid supply (POS) and risk of all-cause mortality among an insured opioid-naïve patient population in the United States (US).

Methods:
This retrospective observational cohort study used de-identified, administrative health care claims data from a large national insurer (Optum Clinformatics Data Mart) from 2010 to 2015. Participants included insured, cancer-free adults prescribed opioid analgesics. Prescription opioids received during the first 6 months of therapy were used to categorize initial patterns of POS as daily or nondaily. Cox regression was used to estimate the association of initial patterns of POS with all-cause mortality within one year of follow-up, adjusting for baseline covariates to control for confounding.

Results:
A total of 4,054,417 patients were included, of which 2.75% had incident daily POS; 54.8% were female; median age was 50 years; mean Charlson comorbidity index (CCI) was 0.21 (standard deviation = 0.77); and mean daily morphine milligram equivalent was 34.61 (95% confidence intervals: 34.59, 34.63). There were 2068 more deaths per 100,000 person-years among patients who were prescribed opioids daily than nondaily. After adjusting for baseline covariates, the hazard of all-cause mortality among patients with incident daily POS was nearly twice that among those prescribed nondaily (hazard ratio [HR] = 1.94; 95% confidence intervals: 1.84, 2.04).

Conclusions:
Among insured adult patients with noncancer pain, incident chronic POS was associated with a significantly increased risk of all-cause mortality over at most 1 year of follow-up. Because these results may be susceptible to bias, more research is needed to establish causality.
Hospital Initiated Injectable Opioid Agonist Therapy for the Treatment of Severe Opioid Use Disorder: A Case Series
Authors: Brar Rupinder , Fairbairn Nadia , Colizza Kate , Ryan Andrea , Nolan Seonaid 
Published: August 2020

Background:
Across North America, there is an unprecedented opioid overdose epidemic. Approximately 15% of individuals with severe opioid use disorder (OUD) do not benefit from opioid agonist therapy (OAT) such as buprenorphine/naloxone or methadone and are considered treatment refractory. Of those who inject, injectable OAT (iOAT), with hydromorphone or diacetylmorphine, offered in community settings has demonstrated improved retention to treatment and decreased nonprescription opioid use. This case series seeks to describe iOAT initiation and titration in a hospital setting for treatment refractory individuals with OUD and examine impacts of iOAT on leaving hospital against medical advice (AMA).

Methods:
A retrospective chart review of 4 patients initiated on iOAT during hospitalization at St. Paul's Hospital in Vancouver, BC was completed between July 2017 to May 2018. Outcomes of interest included: (1) dose titration schedules of hydromorphone; and (2) reports of leaving hospital AMA; and (3) continuation of iOAT in community postdischarge.

Results:
Of the 4 participants, 2 were female and the mean age was 42 years. Despite a history of AMA, all participants stayed until the recommended the discharge after iOAT initiation. The average total doses of intravenous hydromorphone used during titration were: day 1: 100 mg and days 2 to 3: 200 mg. All continued iOAT in the community and one participant was readmitted within 30 days postdischarge.

Interpretation:
This case series describes a novel approach to the management of treatment refractory individuals with severe OUD during hospitalization. Prescribing iOAT in acute care settings is feasible and may reduce rates of leaving hospital AMA.
Why do Patients Engage in Pain Behaviors? A Qualitative Study Examining the Perspective of Patients and Partners
Authors: Akbari Fatemeh , Dehghani Mohsen , Mohammadi Somayyeh , Goubert Liesbet , Sanderman Robbert , Hagedoorn Mariёt 
Published: August 2020

Objectives:
Patients’ pain behavior plays an important role in the interaction between patients and their partners, as acknowledged in operant models of pain. However, despite the considerable research attention to pain behaviors, the underlying motives of such behaviors are still unclear. The current study explores the motives to engage in pain behaviors and the possible discrepancies between individuals experiencing pain and partners’ perceptions of those motives.

Methods:
A qualitative study was performed, comprising semistructured interviews with 27 patients with chronic low back pain and their partners. They were recruited through purposive sampling at 2 pain clinics located in Tehran, Iran.

Results:
Patients and partners mentioned a variety of motives for pain behaviors, including protecting oneself against more pain, regulating negative emotions, informing others about the pain severity, seeking validation or intimacy, gaining advantages from pain, and expressing anger. Patients and partners revealed the most similarities in motives such as protecting oneself against more pain and informing others about the pain severity. However, partners rarely acknowledged patients’ motives for seeking validation and they were more likely to mention negative motives (eg, expressing anger).

Discussion:
In conclusion, partners are more likely to attribute negative motives to the patient’s pain behaviors, which may lead to their hostility toward patients. The findings of this study provide new insights into motives of pain behaviors from the perspective of patients and partners, which can inform couple-based interventions in terms of effective pain communication.
Is It Worth It? A Comparison of an Intensive Interdisciplinary Pain Treatment and a Multimodal Treatment for Youths With Pain-related Disability
Authors: Hurtubise Karen , Blais Samuel , Noel Melanie , Brousselle Astrid , Dallaire Frederic , Rasic Nivez , Camden Chantal 
Published: August 2020

Objective:
The objective of this study was to evaluate the effectiveness of an intensive interdisciplinary pain treatment (IIPT) day-hospital program as compared with an outpatient multimodal treatment (MMT) for youth with chronic pain.

Materials and Methods:
A nonrandomized pretest posttest with control group design was used. A battery of patient-oriented measures assessing pain interference, quality of life, and depressive symptoms were completed at treatment commencement and at 3, 6, and 12 months after treatment by 44 youths enrolled in the IIPT and 138 youths engaged in the MMT, with various chronic pain conditions. Data were analyzed using longitudinal mixed-effects models.

Results:
The main outcomes were the score difference from baseline of patient-oriented measures across 3 timepoints within 12 months of intervention initiation for both treatment groups. IIPT participants demonstrated greater improvement in pain interference, as compared with MMT at 3 and 12 months. Initially, health-related quality of life scores improved similarly in both groups, but greater improvement was seen in the MMT group at 12 months. Depressive symptom scores did not improve with either intervention. Only pain interference scores reached statistically and clinically significant difference levels.

Discussion:
This study supports the benefits of specialized rehabilitation interventions, including both MMT and IIPT programs, for youths with chronic pain. The findings also suggest that IIPT might have a greater long-term effect for helping youths, in particular those with high pain interference scores.
Multidisciplinary-based Rehabilitation (MBR) Compared With Active Physical Interventions for Pain and Disability in Adults With Chronic Pain
Authors: Casey Máire-Bríd , Smart Keith M. , Segurado Ricardo , Doody Catherine 
Published: August 2020

Objective:
This systematic review and meta-analysis examined the effectiveness of multidisciplinary-based rehabilitation (MBR) in comparison with active physical interventions for adults with chronic pain.

Materials and Methods:
The review was conducted in line with the recommendations provided in the Cochrane Handbook for Systematic Reviews and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 8 electronic databases were searched from inception to November 2018. Only randomized controlled trials were eligible for inclusion. In total, 31 trials were identified, and most studies involved patients with chronic low back pain (25 trials). The main outcomes considered were pain intensity and disability at short-term follow-up (≤3 mo after treatment), medium-term follow-up (>3 and <12 mo), and long-term follow-up (≥12 mo). The quality of the evidence was assessed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach

Results:
A total of 27 studies were included in the meta-analysis. Statistically significant differences in favor of MBR were found for pain intensity and disability at short-term follow-up (standardized mean difference=0.53 and 0.50) and long-term follow-up (standardized mean difference=0.56 and 0.77), but the quality of the evidence was low. There was no significant difference between MBR and active physical interventions in the medium-term follow-up.

Conclusions:
Overall, the results suggest that MBR may lead to greater improvements in pain intensity and disability compared with active physical interventions, and the effects appear to be sustained in the long term. However, these findings should be interpreted with caution in light of the low quality of the evidence, with all but one trial judged to be at high risk of bias. Further research is required to assess the effectiveness of MBR for people with chronic pain conditions other than low back pain.
The Effect of Auditory Residual Inhibition on Tinnitus and the Electroencephalogram
Authors: King Rohan O. C. , Singh Shekhawat Giriraj , King Chris , Chan Emily , Kobayashi Kei , Searchfield Grant D. 
Published: August 2020

Objectives:
Tinnitus is the perception of sound in the absence of an external physical sound source, for some people it can severely reduce the quality of life. Acoustic residual inhibition (ARI) is a suppression of tinnitus following the cessation of a sound. The present study investigated the effect of ARI on brain activity measured using EEG.

Design:
Thirty adult participants (mean age of 58 years) experiencing chronic tinnitus (minimum 2 years) participated. Participants were presented broad band noise at 10 dB above minimum masking level (1 min followed by 4 min of silence, 4 times) counterbalanced with a control treatment of broad band noise at threshold (1 min followed by 4 min of silence, 4 times) while 64-channel EEG was simultaneously recorded. Tinnitus loudness was measured using a 9-point tinnitus loudness rating scale.

Results:
The ARI stimulation resulted in a self-reported reduction in tinnitus loudness in 17 of the 30 participants. Tinnitus rating reduced following stimulation but gradually returned to near baseline during 4 min of silence post sound exposure; successive sound exposures resulted in lower loudness ratings. No significant reductions in loudness rating were found with the control stimulation. The EEG showed increases in power spectral density, particularly in the alpha and gamma bands, during ARI compared to the control periods.

Conclusions:
These results contribute to the understanding of ARI and tinnitus. We recommend that there be a closer examination of the relationship between onset and offset of sound in both tinnitus and nontinnitus control participants to ascertain if EEG changes seen with ARI relate to tinnitus suppression or general postsound activity.
Acclimatization to Hearing Aids by Older Adults
Authors: Wright Dominique , Gagné Jean-Pierre 
Published: August 2020

Objectives:
Audiologists and hearing aid users (HAUs) generally agree that an adaptation period is needed following the first hearing aid (HA) experience. The main purpose of this study is to investigate the acclimatization of older adult listeners with hearing loss to HAs using listening effort and behavioral measures.

Design:
Participants (N=47) were older adults with mild to moderately severe sensorineural hearing loss. Thirty-two participants were new HAUs and 15 participants were experienced HAUs. New HAUs were randomly assigned to one of two groups: noise reduction algorithms and directional microphones activated or noise reduction algorithms and directional microphones deactivated. Speech recognition in noise and listening effort were assessed on 8 different occasions during a 10-month period. A dual-task paradigm was used to measure the listening effort deployed to recognize speech in noise. The primary task consisted of the Hearing in Noise Test which also served as the behavioral speech in noise measure. The secondary task was a tactile pattern-recognition task in which participants had to identify a sequence of three tactile stimuli that varied in duration. The two listening effort outcomes were the proportional dual-task cost and the response time on the secondary task. Cognitive abilities, including working memory and speed of processing, were evaluated using the Reading Span Test and the Digit Symbol Substitution Test, respectively.

Results:
Results show a significant time*group interaction. Both groups of new HAUs showed improvement over time in speech in noise performances (change of ~2 dB signal to noise ratio) and the experienced HAUs did not improve over time. The acclimatization effect was observed over a period of 4 weeks. There was no significant change over time on both measures of listening effort. There was no association between amplitude of acclimatization and the cognitive abilities measured.

Conclusion:
An acclimatization effect following HA experience was observed. Specifically, the new HAUs displayed a clinically significant change of 2 dB in signal to noise ratio on the Hearing in Noise Test 4 weeks following their initial fitting. The acclimatization effect is not correlated to cognitive abilities.
Do Impedance Changes Correlate With a Delayed Hearing Loss After Hybrid L24 Implantation?
Authors: Konrad Simon , Framke Theodor , Kludt Eugen , Büchner Andreas , Lenarz Thomas , Paasche Gerrit 
Published: August 2020

Objectives:
Preservation of residual hearing is one of the main goals in present cochlear implantation surgery. Especially for this purpose, smaller and softer electrode carriers were developed that are to be inserted through the round window membrane to minimize trauma. By using these electrodes and insertion technique, residual hearing can be preserved in a large number of patients. Unfortunately, some of these patients with initially preserved residual hearing after cochlear implantation lose it later on. The reason for this is unknown but it is speculated about a correlation with an increase in impedance, since increased impedance values are linked to intracochlear inflammation and tissue reaction. Our hypothesis for this study design was that an increase in impedance predicts changes in residual hearing under clinical conditions.

Design:
Data of all adult patients (N = 122) receiving a Hybrid-L24 cochlear implant at our center between 2005 and early 2015 were retrospectively evaluated. Impedance values in Common Ground mode as measured during clinical routine and referring audiological test data (audiometric thresholds under headphones) were collected. Changes between consecutive measurements were calculated for impedance values and hearing thresholds for each patient. Correlations between changes in impedances and acoustic hearing thresholds were calculated. Average values were compared as well as patients with largest impedance changes within the observation period were evaluated separately.

Results:
Group mean values of impedances were between 5 and 7 kΩ and stable over time with higher values on basal electrode contacts compared with apical contacts. Average hearing thresholds at the time of initial fitting were between 40 to 50 dB (250 Hz) and 90 dB (1 kHz) with a loss of about 10 dB compared with preoperative values. Correlation between impedance changes and threshold changes was found, but too inconsistently to imply a true relationship. When evaluating the 20 patients with the largest impedance changes during the observation period (all >1 kΩ from one appointment to the next one), some patients were found where hearing loss is timely connected and highly correlated with an unusual impedance change. But large impedance changes were also observed without affecting hearing thresholds and hearing loss was found without impedance change.

Conclusions:
Changes in impedance as measured during clinical routine cannot be taken as an indicator for a late acoustic hearing loss.
Distal Femoral Physeal Bar Resection Combined With Guided Growth for the Treatment of Angular Limb Deformity Associated With Growth Arrest: A Preliminary Report
Authors: Masquijo J. Javier , Allende Victoria , Ferreyra Andrés , Hernández Bueno Juan C. 
Published: August 2020

Purpose:
Distal femoral growth arrest can result in progressive deformities and functional disability. The treatment is challenging given the significant growth potential of the distal femoral physis. This study addresses the short-term outcomes after distal femoral physeal bar resection combined with guided growth for the treatment of angular limb deformity.

Methods:
We conducted a retrospective analysis of patients treated with distal femoral physeal bar resection, fat graft interposition, and growth modulation with a tension-band plate. Data recorded included patient demographics, growth arrest cause, physeal bar size, time-to-surgery, details of the operative procedure, and complications. The mechanical axis zones, tibiofemoral angle, and the anatomic lateral distal femoral angle were assessed on 51-inch anteroposterior standing radiographs.

Results:
Five patients (3 male individuals) with valgus (n=4) and varus deformities (n=1) due to physeal arrests of the distal femur were analyzed. The cause of the physeal arrest was trauma (n=3) and infection (n=2). The average age at the time of surgery was 6.6 years (range: 2 to 11 y). Average size of the physeal bar was 413.4 mm2, which represented 16.8% of the total distal femoral physis (range: 12% to 26%). Four of the 5 patients had a total correction of the deformity in 14.3 months (range: 9 to 22 mo). One patient required correction by osteotomy and external fixation. Postoperatively, 1 patient presented no improvement, and 4 had restoration of the longitudinal bone growth and alignment. Two patients had rebound valgus: one is being observed and another has undergone a repeat guided growth procedure.

Conclusions:
Distal femoral physeal bar resection combined with tension-band hemiepiphysiodesis provides a viable option for the correction of angular deformities associated with physeal arrest. Longer follow-up is required to evaluate future growth of the distal femoral physis after this combined procedure.

Level of Evidence:
Level IV—therapeutic study.
An Explainable Artificial Intelligence Predictor for Early Detection of Sepsis
Authors: Yang Meicheng , Liu Chengyu , Wang Xingyao , Li Yuwen , Gao Hongxiang , Liu Xing , Li Jianqing 
Published: August 2020

Objectives:
Early detection of sepsis is critical in clinical practice since each hour of delayed treatment has been associated with an increase in mortality due to irreversible organ damage. This study aimed to develop an explainable artificial intelligence model for early predicting sepsis by analyzing the electronic health record data from ICU provided by the PhysioNet/Computing in Cardiology Challenge 2019.

Design:
Retrospective observational study.

Setting:
We developed our model on the shared ICUs publicly data and verified on the full hidden populations for challenge scoring.

Patients:
Public database included 40,336 patients’ electronic health records sourced from Beth Israel Deaconess Medical Center (hospital system A) and Emory University Hospital (hospital system B). A total of 24,819 patients from hospital systems A, B, and C (an unidentified hospital system) were sequestered as full hidden test sets.

Interventions:
None.

Measurements and Main Results:
A total of 168 features were extracted on hourly basis. Explainable artificial intelligence sepsis predictor model was trained to predict sepsis in real time. Impact of each feature on hourly sepsis prediction was explored in-depth to show the interpretability. The algorithm demonstrated the final clinical utility score of 0.364 in this challenge when tested on the full hidden test sets, and the scores on three separate test sets were 0.430, 0.422, and –0.048, respectively.

Conclusions:
Explainable artificial intelligence sepsis predictor model achieves superior performance for predicting sepsis risk in a real-time way and provides interpretable information for understanding sepsis risk in ICU.
Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review
Authors: Shah Payal , Rieder Evan A. 
Published: August 2020

BACKGROUND
Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions.

OBJECTIVE
The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck.

PATIENTS, METHODS AND MATERIALS
PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations.

RESULTS
These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency.

CONCLUSION
The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk–benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.