bluuebunny/crossref_metadata_2025_split huggingface dataset:
Success of Masking 5% Povidone-Iodine Treatment: The Reducing Adenoviral Patient Infected Days Study
Authors: Whiteside Meredith M. , Shorter Ellen S. , Margolis Mathew S. , Alvi Fatima , Huecker Julia B. , Than Tammy P. , Migneco Mary K. , Harthan Jennifer S. , Morettin Christina E. , Hartwick Andrew T. E. , Johnson Spencer D. , Perera Chamila D. , Gordon Mae O. 
Published: May 2021

SIGNIFICANCE
The effectiveness of masking is rarely evaluated or reported in single- or double-masked clinical trials. Knowledge of treatment assignment by participants and clinicians can bias the assessment of treatment efficacy.

PURPOSE
This study aimed to evaluate the effectiveness of masking in a double-masked trial of 5% povidone-iodine for the treatment of adenoviral conjunctivitis.

METHODS
The Reducing Adenoviral Patient Infected Days study is a double-masked, randomized trial comparing a one-time, in-office administration of 5% povidone-iodine with artificial tears for the treatment of adenoviral conjunctivitis. Masking was assessed by asking participants and masked clinicians at designated time points if they believed the treatment administered was povidone-iodine or artificial tears, or if they were unsure. Adequacy of masking was quantified using a modified Bang Blinding Index.

RESULTS
Immediately after treatment, 34% of participants who received povidone-iodine and 69% of those who received artificial tears guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.31 and −0.38, respectively). On day 4, 38% of the povidone-iodine participants and 52% of the artificial tear participants guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.24 and −0.05, respectively), indicating adequate and ideal masking. On days 1, 4, 7, 14, and 21, masked clinicians guessed incorrectly or were unsure of treatment in 53%, 50%, 40%, 39%, and 42% among povidone-iodine participants compared with 44%, 35%, 38%, 35%, and 39% among artificial tears participants, respectively. The modified Bang Indices for clinician masking in the povidone-iodine group ranged from −0.05 to 0.25 and from 0.13 to 0.29 in the artificial tears group.

CONCLUSIONS
Masking of participants and clinicians was adequate. Successful masking increases confidence that subjective measurements are not biased. We recommend quantitative assessment and reporting the effectiveness of masking in ophthalmic clinical trials.
Median Nerve’s Microcirculation in Carpal Tunnel Syndrome: Superb Microvascular Imaging
Authors: Yildiran Gokce , Seher Nusret , Sutcu Mustafa , Nayman Alaaddin , Akdag Osman , Tosun Zekeriya 
Published: May 2021

Background:
The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging.

Methods:
Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared.

Results:
The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p < 0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p > 0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression.

Conclusions:
Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, IV.
Incidence, Impact, and Management of Incidentalomas on Preoperative Computed Tomographic Angiograms for Breast Cancer Patients with and without Genetic Mutations
Authors: Lu Stephen M. , Waldman Leah E. , Boudiab Elizabeth M. , Lopez Christopher D. , Bassiri-Tehrani Brian , DelMauro Matthew A. , Israeli Ron , Bank Jonathan , Machnicki Stephen C. , Lerman Oren Z. 
Published: May 2021

Background:
Preoperative abdominal computed tomographic angiograms for free flap breast reconstruction improve operative safety and efficiency, but incidental findings are common and potentially affect management. In addition, the authors hypothesized that patients with genetic mutations might have a higher rate of significant findings. The authors present the largest series of computed tomographic angiogram “incidentalomas” in these two populations and an evidence-based algorithm for managing common findings.

Methods:
All patients undergoing free flap breast reconstruction at Northwell Health between 2009 and 2017 were eligible. Medical history, perioperative details, and radiology reports were examined with abnormal findings recorded. Published literature was reviewed with radiologists to develop standardized guidelines for incidentaloma management.

Results:
Of 805 patients included, 733 patients had abdominal imaging. One hundred ninety-five (27 percent) had a completely negative examination. In the remaining 538 patients, benign hepatic (22 percent) and renal (17 percent) findings were most common. Sixteen patients (2.2 percent) required additional imaging (n = 15) or procedures (n = 5). One finding was concerning for malignancy—renal cell carcinoma—which interventional radiology ablated postoperatively. Seventy-nine patients (10.8 percent) had a genetic mutation but were not found to have a statistically significant higher rate of incidentalomas.

Conclusions:
The authors’ rate of computed tomographic angiography incidental findings (73 percent) is consistent with previous studies, but the rate requiring further intervention (2.2 percent) is lower. Incidental findings were no more common or pathologic among genetic mutation carriers. The authors also introduce an evidence-based algorithm for the management of common incidentalomas. Using these guidelines, plastic surgeons can reassure patients, regardless of mutation status, that incidentalomas are most commonly benign and have minimal impact on their surgical plan.
Rethinking Farkas: Updating Cephalic Index Norms in a Large, Diverse Population
Authors: Phelan Alannah L. , Gu Garrick , McCarthy Melissa , Barton Bruce A. , McIntyre Joyce K. , Lalikos Janice F. 
Published: May 2021

Background:
Cephalic index, the ratio of head width to length, is one normative indicator used by insurers to derive criteria for plagiocephaly helmet authorization. Current norms were established by a small sample of white children in the 1987 Farkas and Munro data set. This study establishes updated cephalic index values for infants and children in a large, diverse patient population.

Methods:
Children aged 0 to 3 months, 3 to 6 months, 9 to 12 months, 2 to 3 years, and 12 to 14 years were recruited at their well-child appointment. Cephalic index was calculated for each age group and compared to previously established norms.

Results:
Eight hundred seventy patients met inclusion criteria. The means for boys and girls between 0 and 6 months were 83.5 (n = 155, SD 6.01) and 83.5 (n = 191, SD 5.80), respectively. Established means for boys and girls between 0 and 6 months were 74.4 (n = 38, SD 5.2) and 74.3 (n = 49, SD 6.1), respectively. The difference between norms is highly statistically significant (p < 0.0001). For this age range, insurance criteria for a helmet is >83.7 for boys and >82.7 for girls. Using previous norms, 74 boys (44.6 percent) and 104 girls (54.5 percent) would meet criteria for a helmet under current guidelines.

Conclusions:
The mean cephalic index of children has changed. The reasons could include diversifying populations in the United States and the introduction of the Back to Sleep campaign. Over 50 percent of children may inappropriately meet criteria for a helmet based on prior norms. Updating norms could change the definition of plagiocephaly for a helmet orthosis.
Breast Augmentation with Microtextured Anatomical Implants in 653 Women: Indications and Risk of Rotation
Authors: Weltz Tim K. , Larsen Andreas , Hemmingsen Mathilde N. , Ørholt Mathias , Rasmussen Louise E. , Andersen Peter S. , Sarmady Faye , Elberg Jens J. , Vester-Glowinski Peter V. , Herly Mikkel 
Published: May 2021

Background:
Anatomical implants provide a wide range of options in terms of implant dimensions for breast augmentation. Nevertheless, many surgeons choose not to use anatomical implants due to the risk of rotation malposition and because their advantages over round implants are not clearly defined.

Methods:
A retrospective review of medical records was performed on all women who underwent breast augmentation or implant exchange with microtextured anatomical implants from 2012 to 2019 in a single private clinic. The authors focused on the outcomes of a subgroup of women with glandular ptosis and nipple placement below the inframammary fold who underwent breast augmentation with anatomical implants. Furthermore, the incidence and risk factors for implant rotation were analyzed.

Results:
In total, 653 women underwent primary breast augmentation (n = 529) or implant exchange (n = 124) with anatomical implants. The median follow-up period was 2.7 years (interquartile range, 1.6 to 3.9 years). The incidence of implant rotation was 14 (2.6 percent) in the primary augmentation group and four (3.2 percent) in the implant exchange group. Implant rotation was not associated with type of surgery (p = 0.76), implant projection (p = 0.23), or implant height (p = 0.48). The authors successfully used anatomical implants to elevate the nipple in 92.9 percent of the women with glandular ptosis without using a mastopexy.

Conclusions:
The study results indicate that the rotation risk with microtextured implants is similar to that with macrotextured implants. Furthermore, the authors found that high-projection anatomical implants can be used as an alternative to augmentation-mastopexy in women with glandular ptosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Using an electronic health record alert to prompt blood-borne virus testing in primary care
Authors: Chadwick David , Forbes Gareth , Lawrence Chris , Lorrimer Susan , van Schaik Paul 
Published: May 2021

Background:
Late diagnosis of HIV, hepatitis B (HBV) and hepatitis C (HCV) remains relatively common in the UK and many people who present late have missed opportunities for testing in primary care. The objective was to assess the effectiveness and acceptance of a prototype application (BBV_TP1), embedded in a primary care electronic health record (EHR), to increase real-time blood-borne virus (BBV) testing.

Methods:
This prospective cohort study assessed BBV_TP1 in 14 general practices in North East England, in comparison with 54 similar practices in 2019. Rates of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in practices were measured before and after the application was activated. Patient and clinician acceptance of the technology was assessed by surveys.

Results:
In the 6 months following the intervention, HIV testing rates increased 555% and combined HBV/HCV testing rates increased 362%. No significant differences were observed for any BBV testing rates in the nonintervention practices over the same period. Monthly testing rates declined towards baseline after initial increases. Clinician's perceptions of the prompt system were positive, with average additional time required for BBV test discussion in consultations estimated at 2 min. The patient survey also showed high acceptance of the technology.

Conclusion:
This pilot study demonstrated that BBV_TP1 increased BBV testing rates in primary care via targeted screening, although testing rates subsequently fell whilst the application remained active. Such systems can potentially reduce late diagnoses, while having high acceptance by clinicians and patients. Larger studies with longer follow-up are needed to demonstrate efficacy and cost-effectiveness.
Comparison Between Veteran and Non-Veteran Populations With Clinical Stage I Non-small Cell Lung Cancer Undergoing Surgery
Authors: Heiden Brendan T. , Eaton Daniel B. , Chang Su-Hsin , Yan Yan , Schoen Martin W. , Patel Mayank R. , Kreisel Daniel , Nava Ruben G. , Meyers Bryan F. , Kozower Benjamin D. , Puri Varun 
Published: May 2021

Objective:
The aim of this study was to compare quality of care and outcomes between Veteran and non-Veteran patients undergoing surgery for clinical stage I non-small cell lung cancer (NSCLC).

Background:
Prior studies and the lay media have questioned the quality of care that Veterans with lung cancer receive through the VHA. We hypothesized Veterans undergoing surgery for early-stage NSCLC receive high quality care and have similar outcomes compared to the general population.

Methods:
We performed a retrospective cohort study of patients with clinical stage I NSCLC undergoing resection from 2006 to 2016 using a VHA dataset. Propensity score matching for baseline patient- and tumor-related variables was used to compare operative characteristics and outcomes between the VHA and the National Cancer Database (NCDB).

Results:
The unmatched cohorts included 9981 VHA and 176,304 NCDB patients. The VHA had more male, non-White patients with lower education levels, higher incomes, and higher Charlson/Deyo scores. VHA patients had inferior unadjusted 30-day mortality (VHA 2.1% vs NCDB 1.7%, P = 0.011) and median overall survival (69.0 vs 88.7 months, P < 0.001). In the propensity matched cohort of 6792 pairs, VHA patients were more likely to have minimally invasive operations (60.0% vs 39.6%, P < 0.001) and only slightly less likely to receive lobectomies (70.1% vs 70.7%, P = 0.023). VHA patients had longer lengths of stay (8.1 vs 7.1 days, P < 0.001) but similar readmission rates (7.7% vs 7.0%, P = 0.132). VHA patients had significantly better 30-day mortality (1.9% vs 2.8%, P < 0.001) and median overall survival (71.4 vs 65.2 months, P < 0.001).

Conclusions:
Despite having more comorbidities, Veterans receive exceptional care through the VHA with favorable outcomes, including significantly longer overall survival, compared to the general population.
Chemoradiotherapy Followed by Active Surveillance Versus Standard Esophagectomy for Esophageal Cancer
Authors: van der Wilk Berend J. , Eyck Ben M. , Hofstetter Wayne L. , Ajani Jaffer A. , Piessen Guillaume , Castoro Carlo , Alfieri Rita , Kim Jong H. , Kim Sung-Bae , Furlong Heidi , Walsh Thomas N. , Nieboer Daan , Wijnhoven Bas P. L. , Lagarde Sjoerd M. , Lanschot J. Jan B. van 
Published: May 2021

Objective:
To compare overall survival of patients with a cCR undergoing active surveillance versus standard esophagectomy.

Summary of Background Data:
One-third of patients with esophageal cancer have a pathologically complete response in the resection specimen after neoadjuvant chemoradiotherapy. Active surveillance may be of benefit in patients with cCR, determined with diagnostics during response evaluations after chemoradiotherapy.

Methods:
A systematic review and meta-analysis was performed comparing overall survival between patients with cCR after chemoradiotherapy undergoing active surveillance versus standard esophagectomy. Authors were contacted to supply individual patient data. Overall and progression-free survival were compared using random effects meta-analysis of randomized or propensity score matched data. Locoregional recurrence rate was assessed. The study-protocol was registered (PROSPERO: CRD42020167070).

Results:
Seven studies were identified comprising 788 patients, of which after randomization or propensity score matching yielded 196 active surveillance and 257 standard esophagectomy patients. All authors provided individual patient data. The risk of all-cause mortality for active surveillance was 1.08 [95% confidence interval (CI): 0.62–1.87, P = 0.75] after intention-to-treat analysis and 0.93 (95% CI: 0.56–1.54, P = 0.75) after per-protocol analysis. The risk of progression or all-cause mortality for active surveillance was 1.14 (95% CI: 0.83–1.58, P = 0.36). Five-year locoregional recurrence rate during active surveillance was 40% (95% CI: 26%–59%). 95% of active surveillance patients undergoing postponed esophagectomy for locoregional recurrence had radical resection.

Conclusions:
Overall survival was comparable in patients with cCR after chemoradiotherapy undergoing active surveillance or standard esophagectomy. Diagnostic follow-up is mandatory in active surveillance and postponed esophagectomy should be offered to operable patients in case of locoregional recurrence.
Single dose of BNT162b2 mRNA vaccine against SARS-CoV-2 induces high frequency of neutralising antibody and polyfunctional T-cell responses in patients with myeloproliferative neoplasms
Authors: Harrington Patrick , de Lavallade Hugues , Doores Katie J. , O’Reilly Amy , Seow Jeffrey , Graham Carl , Lechmere Thomas , Radia Deepti , Dillon Richard , Shanmugharaj Yogita , Espehana Andreas , Woodley Claire , Saunders Jamie , Curto-Garcia Natalia , O’Sullivan Jennifer , Raj Kavita , Kordasti Shahram , Malim Michael H. , Harrison Claire , McLornan Donal 
Published: May 2021

AbstractEncouraging results have been observed from initial studies evaluating vaccines targeting the novel beta coronavirus which causes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, concerns have been raised around the efficacy of these vaccines in immunosuppressed populations, including patients with haematological malignancy. Myeloproliferative neoplasms (MPN), in particular myelofibrosis (MF), are associated with heterogenous immune defects which are influenced by patient age, disease subtype and the use of cytoreductive therapies. Patients with a WHO defined diagnosis of an MPN presenting to our clinic were recruited following first injection of 30μg BNT162b2. A positive anti-S IgG ELISA was seen in 76.1% (16) of patients following vaccination with positive neutralising antibodies detected in 85.7% (18) of patients. A memory T cell response was observed in 80% (16) of patients, with a CD4+ T cell response in 75% (15) and a CD8+ T cell response in 35% (7). These results, for the first time, provide some reassurance regarding the initial immune response to the BNT162b2 vaccine amongst patients with MPN, with response rates similar to that observed in the general population.
Physical activity promotion is lacking in local treatment protocols for patients hospitalized with myocardial infarction: A cross-sectional study
Authors: van Oorsouw R. , Koenders N. , Seeger J.P. , Hoogeboom T.J. 
Published: May 2021

AbstractObjectivesTo describe the content and methodological quality of local physiotherapy and nursing treatment protocols specifically regarding physical activity promotion in patients hospitalised with myocardial infarction.DesignCross-sectional study comprising the analysis of 18 physiotherapy and 14 nursing protocols.SettingProtocols from twenty Dutch hospitals were used.Main outcome measuresData were extracted from protocols for patients hospitalised with myocardial infarction according to a standardized data-extraction procedure. Descriptive statistics were used to describe the content of protocols, in specific, treatment goals, interventions, clinimetrics and discharge criteria. Methodological quality of the protocols was examined using the AGREE-II tool.ResultsTherapeutic goals concerning physical activity were described in 83% of the physiotherapy protocols and in 7% of the nursing protocols. Therapeutic interventions concerning physical activity were described in 100% of the physiotherapy protocols and in 57% of the nursing protocols. Two (14%) of the fourteen interventions described in the physiotherapy protocols and none in the nursing protocols, were interpreted as physical activity promotion. All protocols were rated as having low methodological quality, mainly due to a lack of supporting scientific evidence. The overall quality was rated with an average score of 3 out of 7 (range: 1-5).ConclusionsPhysiotherapy and nursing protocols for hospitalized patients with myocardial infarction are primarily aimed at physical activity under supervision, rather than physical activity promotion. Our work provides physiotherapists and nurses insights in how to further improve the content and methodological quality of their local treatment protocols for patients hospitalised with myocardial infarction.
Risk of COVID-19 infection and work place exposure of front-line mass media professionals
Authors: Tahura Sarabon , Banu Bilkis , Akter Nasrin , Hossain Sarder Mahmud , Mahumud Rashidul Alam , Ahmed Md Rishad 
Published: May 2021

ABSTRACTIntroductionMass media plays a crucial role in creating awareness and knowledge sharing in this Corona virus disease 2019 (COVID-19) pandemic. However, the risk of exposure and extent of COVID-19 infection among media professional are less elucidated yet. Therefore, this study was intended to investigate the workplace-related risk of COVID-19 exposure and the association between exposure to COVID-19 and participant’s characteristics, including various forms of respiratory protection for mass-media professionals.MethodsThis closed web-based cross-sectional survey was conducted among 199 mass-media professionals in Bangladesh by snowball sampling approach. A multivariate logistic regression model was used for the analytical exploration. Adjusted and Unadjusted Odds Ratio (OR) with 95% confidence intervals (95% CI) were calculated for the specified exposures. Chi-square test was used to observe the association. Ethical issues were maintained according to the guidance of the declaration of the Helsinki.ResultsOf all, 39.2% of mass-media professionals were tested positive for COVID-19, whereas 6% of symptomatic or suspected participants did not do the test. Mass media professionals who worked in electronic media reported more COVID-19 infection (adjusted odds ratio, AOR= 6.25; 95% Confidence interval: Lower limit 1.43, upper limit 27.43; P =0.02). However, no significant relationship was found between the type of job role and COVID-19 infection. Furthermore, infected colleagues (OR/P=1.92/0.04) were identified as significant contact of acquiring infection. However, the study result showed that reused/new medical mask, homemade/cloth-made mask (vs. use of respirator mask) was not significantly (p=0.82) associated with mass media professional’s infection.ConclusionsProfessionals working in electronic media were at higher risk of being infected by COVID-19 and mostly acquired from infected colleagues. Using a respirator mask was not associated with a lower risk of test positive infection in mass media professionals. This study will aid the policy maker and public health authorities during the COVID-19 pandemic to make proper implementation strategies.