bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orbital Bone Fractures in a Central London Trauma Center: A Retrospective Study of 582 Patients
Authors: Moffatt Joanna , Hughes Declan , Bhatti Nabeel , Holmes Simon 
Published: January 2021

Abstract
The aim of the present study was to evaluate the injury patterns and etiology of orbital bone fractures treated at a busy level one trauma center.
Between 2015 and 2019, patients with orbital bone fractures from the Department of Oral and Maxillofacial Surgery at the Royal London Hospital, were evaluated in a retrospective analysis. A pro-forma was used to collect data from electronic patient records. Parameters included age, gender, maxillofacial fracture, mechanism of injury, and length of hospital admission.
Of 582 patients, 82% (n = 476) were male and 18% (n = 106) were female, with those in the age group 20 to 29 years most affected (36%; n = 212). The most common etiology was interpersonal violence (55%; n = 320), followed by falls (20%; n = 118) and road traffic accidents (12%, n = 68). The most common isolated orbital bone fracture site was the orbital floor (40%; n = 234). Of the impure orbital fractures, the zygoma was the most commonly involved structure adjacent to the orbit (19%, n = 110).
In our department, the authors see high numbers of complex orbital bone requiring surgical treatment. Interpersonal violence is a significant cause of orbital bone fractures with young males most affected. This study provides an insight into the current trends in etiology, demographics, and clinical findings of orbital fractures that will help guide prevention and treatment strategies.
A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis
Authors: Kamel George N. , McKee Ryan M. , Carbulido Kristine , Modi Rishi , Belza Caitlyn , Ewing Emily , Segal Rachel M. , O’Connor Alyson , Gholami Parham , Ryan Justin , Lance Samuel H. , Gosman Amanda A. 
Published: January 2021

Introduction:
The craniofacial asymmetry seen in unilateral lambdoid craniosynostosis may not be effectively treated by posterior cranial vault remodeling, endoscopic suturectomy, and helmet therapy, or suturectomy and distraction osteogenesis alone due to limitations in soft-tissue envelope expansion and relapse of the deformity. The authors report a series of unilateral lambdoid craniosynostosis patients treated with a posterior rotational cranial-flap technique using internal distraction osteogenesis.

Methods:
Posterior cranial vault reconstruction combined with internal distraction was used, aided by preoperative virtual surgical planning. An in situ posterior rotational flap osteotomy was utilized to maximize dural preservation. Primary outcome measures included age-adjusted volume change and age-adjusted percent volume change per mm distraction. Distraction characteristics and perioperative characteristics were also assessed.

Results:
A total of 5 patients were identified. Mean predistraction intracranial volume was 1087.5 cc (SD
= 202.3 cc) and mean postdistraction included intracranial volume was 1266.1cc (SD
= 131.8cc). Mean age-adjusted percent included intracranial volume change was 14.1% (SD
= 9.6%), and mean percent intracranial volume change per mm distraction was 0.43%/mm distraction (SD
= 0.37%/mm distraction). One patient developed a distractor site infection postoperatively that was treated successfully with oral antibiotics. All patients had a Whitaker score of 1 at one year follow up.

Conclusions:
Posterior cranial vault remodeling using osteogenesis and a rotational cranial flap technique with dural preservation can be effectively used to maximize bone flap viability and limit postoperative relapse in patients with unilateral lambdoid craniosynostosis. Long term analysis as well as comparison to open techniques will need to be interrogated.
Management of Maxillofacial Trauma in Attempt Suicide Patients During COVID-19 Pandemic
Authors: Riyadh Safaa , Abdulrazaq Saif Saadedeen 
Published: January 2021

Abstract
The maxillofacial surgeon trained well to face the surgical challenges. In case of dealing with self-inflicted trauma, the surgeon must face the surgical as well as the psychological status of the patients. Five patients received in the emergency room suffering from maxillofacial trauma resulted from suicidal attempts. Unfortunately, 1 patient died, the other patients managed by providing surgical and psychological support. The cornerstone of managing such type of trauma needs appropriate communication between the family, surgical team, and the psychiatric.
Debriefing for Simulation-Based Medical Education
Authors: Ing Louise , Cheng Adam , Lin Yiqun 
Published: January 2021

Context
Current debriefing approaches and faculty development strategies for simulation educators differ around the world. We aim to describe the status of current debriefing practice and faculty development for simulation educators in this study.

Methods
We distributed a paper-based survey during 2 international conferences to obtain data from active International Network for Simulation-based Pediatric Innovation, Research and Education members. The survey was tested to ensure content validity and consisted of the following 3 constructs: demographic characteristics, current debriefing practice, and issues related to faculty development.

Results
One hundred nine of 114 participants (96%) completed the survey. Debriefing practice differs in terms of timing, duration, framework, and conversational framework. Most debriefings were less than 30 minutes (93/109, 85%), with many educators not using objective data during debriefing (47/109, 43%). Three- or 4-phase debriefing frameworks were used most commonly (66/109, 61%). Most participants have access to some faculty development opportunities (99/109, 91%). Barriers to faculty development are related to time and resource constraints (eg, freeing up facilitator's time: 75/109, 69%, competing priorities 64/109, 59%). Most participants indicated that their needs for debriefing to improve learning outcomes were met (95/109, 87%). The desired content for future faculty development opportunities varies between educators with different levels of expertise.

Conclusions
Approaches to debriefing among members of an international pediatric simulation network vary considerably. Although faculty development opportunities were available to most participants, future simulation programs should work on addressing barriers and optimizing faculty development plans to meet the needs of their educators.
Primary and Specialty Outpatient Visits for Older Women With Urinary Incontinence: A Comparison of Nurses to the General Population
Authors: Erekson Elisabeth , Lane Giulia , Mann Jason , Austin Andrea , Carmichael Donald , Minassian Vatche A. , Grodstein Francine , Bynum Julie P.W. 
Published: January 2021

Objective
We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses’ Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population.

Methods
Medicare Fee for Service claims data for women aged 66–91 years were compared for Nurses’ Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes.

Results
The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses’ Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses’ Health Study and 10.0% in the Center for Medicare Services cohorts).

Conclusions
We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.
Impact of Genital Hiatus Size on Anatomic Outcomes After Mesh-Augmented Sacrospinous Ligament Fixation
Authors: Vaughan Monique H. , Giugale Lauren E. , Siddiqui Nazema Y. , Bradley Megan S. 
Published: January 2021

Objective
Our objective is to compare anatomic outcomes at medium term after mesh-augmented sacrospinous ligament fixation among women categorized by their preoperative and postoperative genital hiatus size.

Methods
We performed a retrospective cohort study in women undergoing Uphold mesh-augmented sacrospinous ligament fixation between 2010 and 2017. We compared 3 groups: (1) women with a wide genital hiatus preoperatively and 6 weeks postoperatively (“Persistently Wide” cohort), (2) women with a wide genital hiatus preoperatively but normal hiatus 6 weeks postoperatively (“Improved” cohort), and (3) women with a normal genital hiatus preoperatively and 6 weeks postoperatively (“Stably Normal” cohort). We defined a wide hiatus as 4 cm or greater and a normal hiatus as less than 4 cm. The primary outcome was anatomic failure, defined as recurrent prolapse beyond the hymen or retreatment for prolapse with surgery or pessary.

Results
Ninety-seven women were included in the study. Overall, mean age was 68 years (±7.15 years), mean body mass index was 28.36 kg/m2 (±5.34 kg/m2) and mean follow up time was 400 ± 216 days. Anatomic failure did not differ between groups (Persistently Wide, 15.4%; Improved, 11.1%; Stably Normal, 10.0%; P = 0.88). In logistic regression, the odds of anatomic failure remained similar among all groups (P = 0.93).

Conclusions
A persistently wide genital hiatus alone was not associated with anatomic failure in this small study cohort. Therefore, surgical reduction of the genital hiatus with level III support procedures may not affect prolapse recurrence at the time of mesh-augmented sacrospinous ligament fixation. Further studies are needed to confirm this relationship and investigate other potential mechanisms for these findings.
The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile
Authors: Clements Thomas , McCoy Cameron , Assen Scott , Cardenas Jessica , Wade Charles , Meyer David , Cotton Bryan A. 
Published: January 2021

INTRODUCTION
Recent in vitro data have shown that the hemostatic profile of whole blood (WB) degrades significantly after 14 days, yet the optimal storage remains debated. We hypothesized that arrival coagulation studies would be improved in patients receiving younger WB in the prehospital setting.

METHODS
This study was approved by our institutional institutional review board. We evaluated all trauma patients who received prehospital blood products by our helicopter service between July 2017 and July 2019. “Young” WB was defined as 14 days or less. Patients who received at least 1 U of young WB were classified as YOUNG, while the remainder was classified as OLD. Continuous data are presented as medians (25th–75th interquartile range) with comparisons performed using Wilcoxon rank sum. Assessments of clinical hemostatic potential included arrival platelet cell count and rapid thrombelastography. Multivariate regression analysis was also performed (Stata 12.1; College Station, TX).

RESULTS
A total of 220 patients received prehospital WB during the study period. Of these, 153 patients received YOUNG WB, while 67 were transfused only OLD WB units. There were no differences in demographics, prehospital or arrival physiology, or Injury Severity Score among the two groups. The measures of clot initiation (activated clotting time) and kinetics (k time) were improved, as were the measures of clot acceleration/fibrinogen function (angle) and platelet function (maximum amplitude). As well, arrival platelet count was higher in the YOUNG cohort. No significant differences in postarrival transfusion were noted (p = 0.220). Multivariate analysis showed the greatest differences in maximum amplitude and α angle but failed to reach significance.

CONCLUSION
Previous in vitro data have suggested deterioration of platelet function in cold-stored WB after 14 days. The current study demonstrated decreased global hemostasis by clinically available laboratory tests, especially related to fibrinogen and platelet interactions on univariate, but not multivariate analysis. This did not translate into increased transfusion requirements. Further studies are needed to determine the optimal storage duration for cold-stored WB for transfusion in the bleeding trauma patient, as well as rule out the presence of confounding variables.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Characteristics of survivors of civilian public mass shootings: An Eastern Association for the Surgery of Trauma multicenter study
Authors: Sarani Babak , Smith E. Reed , Shapiro Geoff , Nahmias Jeffry , Rivas Lisbi , McIntyre Robert , Robinson Bryce R.H. , Chestovich Paul J. , Amdur Richard , Campion Eric , Urban Shane , Shnaydman Ilya , Joseph Bellal , Gates Jonathan , Berne John , Estroff Jordan M. 
Published: January 2021

BACKGROUND
Firearm injury remains a public health crisis. Whereas there have been studies evaluating causes of death in victims of civilian public mass shootings (CPMSs), there are no large studies evaluating injuries sustained and treatments rendered in survivors. The purpose of this study was to describe these characteristics to inform ideal preparation for these events.

METHODS
A multicenter, retrospective study of CPMS survivors who were treated at designated trauma centers from July 1, 1999 to December 31, 2017, was performed. Prehospital and hospital variables were collected. Data are reported as median (25th percentile, 75th percentile interquartile range), and statistical analyses were carried out using Mann-Whitney U, χ2, and Kruskal-Wallis tests. Patients who died before discharge from the hospital were excluded.

RESULTS
Thirty-one events involving 191 patients were studied. The median number of patients seen per event was 20 (5, 106), distance to each hospital was 6 (6, 10) miles, time to arrival was 56 (37, 90) minutes, number of wounds per patient was 1 (1, 2), and Injury Severity Score was 5 (1, 17). The most common injuries were extremity fracture (37%) and lung parenchyma (14%). Twenty-nine percent of patients did not receive paramedic-level prehospital treatment. Following arrival to the hospital, 27% were discharged from the emergency department, 32% were taken directly to the operating room/interventional radiology, 16% were admitted to the intensive care unit, and 25% were admitted to the ward. Forty percent did not require advanced treatment within 12 hours. The most common operations performed within 12 hours of arrival were orthopedic (15%) and laparotomy (15%). The most common specialties consulted were orthopedics (38%) and mental health (17%).

CONCLUSION
Few CPMS survivors are critically injured. There is significant delay between shooting and transport. Revised triage criteria and a focus on rapid transport of the few severely injured patients are needed.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
Torque Teno Virus Load Is Associated With Subclinical Alloreactivity in Kidney Transplant Recipients: A Prospective Observational Trial
Authors: Doberer Konstantin , Haupenthal Frederik , Nackenhorst Maja , Bauernfeind Florian , Dermuth Florentina , Eigenschink Michael , Schiemann Martin , Kläger Johannes , Görzer Irene , Eskandary Farsad , Reindl-Schwaighofer Roman , Kikić Željko , Böhmig Georg , Strassl Robert , Regele Heinz , Puchhammer-Stöckl Elisabeth , Bond Gregor 
Published: January 2021

Background.
Nonpathogenic torque teno viruses (TTVs) are highly prevalent in transplant recipients and associated with immunosuppression. Studies in kidney transplant patients have proposed assessment of TTV load for risk stratification of clinically overt graft rejection. The value of TTV quantification in the context of subclinical rejection has not been evaluated.

Methods.
In this prospective trial, 307 consecutive kidney transplant recipients were subjected to per-protocol monitoring of plasma TTV. TTV was analyzed in the context of protocol biopsies (n = 82), scheduled 1 year posttransplantation.

Results.
TTV load at the time of biopsy was lower in recipients with rejection (n = 19; according to Banff, including borderline changes suspicious for acute T cell-mediated rejection) than those without rejection (n = 63) whereby each log increase in TTV copies/mL decreased the risk for rejection by 9% (risk ratio 0.91, 95% confidence interval, 0.85-0.97; P = 0.004). Development of chronic lesions (cg, cv, ci, ct, ah, ptcml) was associated with the number of days with a TTV load <1 × 106 copies/mL between months 3 and 12 posttransplant (β 0.07, 95% confidence interval, 0.01-0.14; P = 0.02).

Conclusions.
This trial demonstrates an association between TTV and subclinical graft rejection in kidney transplant recipients. A TTV load <1 × 106 copies/mL suggests suboptimal immunosuppression.
Adaptation of the City of Hope-Quality of Life-Ostomy Questionnaire From English to Brazilian Portuguese
Authors: Santos Vera Lúcia Conceição de Gouveia , Gomboski Gustavo , Freitas Noélle de Oliveira , Grant Marcia 
Published: January 2021

PURPOSE:
To culturally adapt the City of Hope-Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) from English to Brazilian Portuguese and evaluate psychometric properties of the adapted instrument (internal consistency and construct validity).

DESIGN:
Methodological study to establish reliability and validity.

SUBJECTS AND SETTING:
The sample comprised 215 persons with stomas of any etiology who attended 1 of 3 specialized outpatient care center and 2 associations for persons with ostomies. Participants were residents of the state of Rio Grande do Sul, located in southeastern Brazil.

METHODS:
Techniques for cultural adaptation were carried out based on recommendations from the literature. We then evaluated the instrument's psychometric properties. Specifically, we evaluated construct (convergent and discriminant) validity and concurrent criterion validity via comparison of the adapted version of COH-QOL-OQ versus the WHOQOL-Bref (World Health Organization Quality of Life instrument). We also evaluated the internal consistency of the adapted COH-QOL-OQ, a measure of reliability.

RESULTS:
The internal consistency of the items was high with a Cronbach α of 0.92 for the total score and values ranging from 0.79 to 0.86 for the various domains of the COH-QOL-OQ. Confirmatory factorial analysis identified adjustment indexes to the acceptable model of adjustment for the COH-QOL-OQ model. Strong correlations between the COH-QOL-OQ and WHOQOL-Bref instrument domains confirmed the validity of the convergent construct. For the analysis of the concurrent criterion validity, the correlation coefficients between the score of item 16 and the other domains of COH-QOL-OQ ranged from 0.26 to 0.66. Analysis of the discriminate validity indicated that it was possible to isolate groups based on the temporal character of the stoma and time since ostomy surgery.

CONCLUSIONS:
The adapted version of COH-QOL-OQ demonstrates construct (convergent and discriminant) validity, concurrent criterion validity, and internal consistency (a measure of reliability) for evaluating health-related quality of life of persons with ostomies living in Brazil.
Reducing Peripheral Intravenous Catheter Extravasation in Neonates
Authors: Boyar Vita , Galiczewski Colleen 
Published: January 2021

PURPOSE
Our objective was to reduce total and severe peripheral intravenous extravasation (PIVE) incidence by 40% in our neonatal intensive care unit.

SETTING/APPROACH:
This quality improvement initiative was performed at an academic, free-standing suburban children's hospital, in a level 4 neonatal intensive care unit from June 2017 to April 2018. Baseline extravasation data for a period of 6 months prior to the initiative were reviewed, along with a nursing knowledge questionnaire and random audits of catheter stabilization techniques. A Pareto chart and a key driver diagram were created to identify the most common causes of extravasations and lead to a series of process changes. We implemented 4 Plan-Do-Study-Act (PDSA) cycles: (1) dressing protocol for peripheral intravenous vascular (PIV) catheter securement that instituted standardized securement and safer equipment; (2) education on PIV assessment and maintenance, concentrating on hourly evaluation and documentation; (3) guidance algorithm for PIVE identification and treatment; and (4) escalation policy, limiting the number of placement attempts and increased use of a “superuser” team.

OUTCOMES:
The overall prevalence of extravasations decreased by 54%, from 73 preintervention to 40 at postintervention. At baseline, 52% (38/73) extravasations were severe; however, those in the severe category decreased by 35% (14/40) postintervention. The overall rate of adherence to the PIV catheter management algorithm approached 95%; whereas adherence to the securement guideline fluctuated between 80% and 98%.

IMPLICATION FOR PRACTICE:
The implementation of these new practice recommendations along with the education has resulted in a decreased rate and severity of extravasation. Frequent audits and reinforcements are integral to sustainment and to ensure accountability for the implemented procedures.