bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unicompartmental versus total knee arthroplasty for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trial
Authors: Wang Huan , Ma Qiong , Ma Baoan 
Published: March 2021

Objective:
To evaluate the operative time, intraoperative blood loss, incision length, length of hospital stay, postoperative joint function recovery, and complications of unicompartmental knee arthroplasty (UKA) and total knee replacement (total knee arthroplasty, TKA) in order to compare the differences between the 2 methods in the treatment of single-compartment knee osteoarthritis.

Materials and methods:
Computer retrieval Pubmed, Embase, the Cochrane, Sinomed, CNKI, WangFang, and VIP database of UKA and TKA osteoarthritis knee single room curative effect comparison, retrieval time limit for a library to November 2020, consult the reference index can be obtained at the same time. Two researchers independently screened the retrieved literature according to the established inclusion and exclusion criteria. Operative time, incision length, intraoperative blood loss, length of hospital stay, postoperative hospital for special surgery score, American knee society knee score, and excellent rateof pain relief were used as the main evaluation indexes, postoperative flexion degree, postoperative visual analogue scale score, time required for active kneeling to 90 degrees, and hemoglobin decrease in 72 hours and postoperative complications were used as secondary evaluation indexes. The methodological quality was evaluated and meta-analysis was performed using Stata 16.0 software.

Results:
A total of 54 articles were included, including a total of 4577 patients. Meta-analysis results showed that the UKA group was superior to the TKA group in terms of early postoperative knee function score, postoperative pain relief, hemoglobin reduction at 72 hours and complications, and the differences were statistically significant (P<0.05). At the same time, the amount of intraoperative blood loss, length of hospital stay, operative time, incision length and the time required for active kneeling to 90 degrees in the UKA group were less than those in the TKA group, and the differences were statistically significant (P<0.05). The UKA group had fewer early complications but higher long-term revision rate than the TKA group.

Conclusion:
UKA is superior to TKA in the treatment of single-compartment knee osteoarthritis during surgery and in early stage patients, but patients with UKA are at high risk of long-term revision.
Women with Type 1 diabetes (T1D) experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women's Health Across the Nation (SWAN)
Authors: Yi Yan , El Khoudary Samar R. , Buchanich Jeanine M. , Miller Rachel G. , Rubinstein Debra , Matthews Karen , Orchard Trevor J. , Costacou Tina 
Published: March 2021

Abstract

Objective:
Evidence suggests that insulin deficiency and hyperglycemia may disrupt the female reproductive system's normal function, leading to delayed menarche and premature ovarian aging. We thus compared the length of the reproductive period of women with type 1 diabetes (T1D) to women without diabetes.

Methods:
Women with childhood-onset T1D (diagnosed in 1950-80) from the prospective Epidemiology of Diabetes Complications (EDC) study and nondiabetic women from the Pittsburgh site of the Study of Women's Health Across the Nation (SWAN) were studied. Exclusion criteria comprised not having reached natural menopause, hysterectomy/oophorectomy before menopause, and sex hormone therapy during the menopausal transition. Reproductive history was self-reported. The historical and Women's Ischemia Syndrome Evaluation hormonal algorithms were also used to assess menopause status.

Results:
Women in the T1D cohort (n = 105) were younger, more likely to be White, never smokers, with lower BMI and higher high-density lipoprotein cholesterol levels (all P values < 0.05) compared with women without diabetes (n = 178). After covariate adjustment, T1D women were also older at menarche (0.5-y delay, P = 0.002) but younger at natural menopause (−2.0 y, P < 0.0001). Women with T1D thus experienced 2.5 fewer reproductive years compared to those without diabetes (P < 0.0001). These findings were restricted to the subgroup of women who were diagnosed with T1D before reaching menarche (n = 80).

Conclusion:
Women with T1D onset before menarche have a shorter reproductive period compared with nondiabetic women, exhibiting delayed menarche and earlier natural menopause. Factors that may be related to a shorter reproductive period in T1D should be investigated.
Improving Diabetic Retinopathy Screening Among Patients With Diabetes Mellitus Using the Define, Measure, Analyze, Improve, and Control Process Improvement Methodology
Authors: Kollipara Usha , Varghese Shilu , Mutz Jackie , Putra Joseph , Bajaj Puneet , Mirfakhraee Sasan , Tessnow Alex , Fish Jason , Ali Sadia 
Published: March 2021

ABSTRACT
Diabetic retinopathy, a complication of diabetes mellitus (DM), is the leading cause of blindness in the United States. Early detection and appropriate timely treatment would result in 50–70% reduction in blindness due to DM, with a positive economic impact on patients and the healthcare system. The purpose of our project is to improve screening rates for retinopathy among patients with DM seen in a large endocrinology clinic applying the Lean Six Sigma Define, Measure, Analyze, Improve, and Control project framework and clinical decision support tools embedded in the electronic health record (EHR). Retinopathy screening rates improved from 49% to 72% by the end of the project. Interventions included identifying care gaps using a population registry, patient outreach through the electronic medical record patient portal, placing referrals to ophthalmology, improving documentation in health maintenance, and tracking improvement for sustainability. Our results demonstrate that process improvement methodologies and EHR tools can be successfully applied to improve care and clinical outcomes in patients with DM.
The clinical black, white, and gray lessons
Authors: Pulipati Vishnu Priya , Davidson Michael H. 
Published: March 2021

Purpose of review
This review examines recent contradictory large, well-controlled randomized control trials assessing the effects of omega-3 fatty acids and colchicine on cardiovascular (CV) outcomes.

Recent findings
The Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT) and Statin Residual Risk Reduction with Epanova in high Cardiovascular Risk patients with Hypertriglyceridemia (STRENGTH) trial assessed the CV outcomes using high-dose omega-3 fatty acids in statin-treated patients with moderate hypertriglyceridemia and high-risk for CV disease with differing results. Similarly, Colchicine Cardiovascular Outcomes trial, (COLCOT) second Low Dose Colchicine (LoDoCo2), and Colchicine in patients with Acute Coronary Syndrome (COPS) assessed the CV outcomes using low-dose colchicine in patients with coronary artery disease with inconsistent results. These contradictory findings among studies assessing similar questions with the same drug or a drug within the same class challenge the scientific validity and clinical applicability of the derived conclusions.

Summary
A comprehensive review revealed many differences between the trials, which could have contributed to observed divergent results. Consistent findings across multiple trials help strengthen the evidence for specific endpoints or sub-populations, and these findings must be included in guidelines. Large prospective cohort studies with diligent study protocols are warranted in the future to resolve unanswered dilemmas.
Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes
Authors: Zogg Cheryl K. , Metcalfe David , Sokas Claire M. , Dalton Michael K. , Hirji Sameer A. , Davis Kimberly A. , Haider Adil H. , Cooper Zara , Lichtman Judith H. 
Published: March 2021

Objective:
The aim of this study was to critically evaluate whether admission at the beginning versus end of the academic year is associated with increased risk of major adverse outcomes.

Summary Background Data:
The hypothesis that the arrival of new residents and fellows is associated with increases in adverse patient outcomes has been the subject of numerous research studies since 1989. Methods: We conducted a systematic review and random-effects meta-analysis of July Effect studies published before December 20, 2019, looking for differences in mortality, major morbidity, and readmission. Given a paucity of studies reporting readmission, we further analyzed 7 years of data from the Nationwide Readmissions Database to assess for differences in 30-day readmission for US patients admitted to urban teaching versus nonteach-ing hospitals with 3 common medical (acute myocardial infarction, acute ischemic stroke, and pneumonia) and 4 surgical (elective coronary artery bypass graft surgery, elective colectomy, craniotomy, and hip fracture) conditions using risk-adjusted logistic difference-in-difference regression.

Results:
A total of 113 studies met inclusion criteria; 92 (81.4%) reported no evidence of a July Effect. Among the remaining studies, results were mixed and commonly pointed toward system-level discrepancies in efficiency. Metaanalyses of mortality [odds ratio (95% confidence interval): 1.01 (0.98–1.05)] and major morbidity [1.01 (0.99–1.04)] demonstrated no evidence of a July Effect, no differences between specialties or countries, and no change in the effect over time. A total of 5.98 million patient encounters were assessed for readmission. No evidence of a July Effect on readmission was found for any of the 7 conditions.

Conclusion:
The preponderance of negative results over the past 30 years suggests that it might be time to reconsider the need for similarly-themed studies and instead focus on system-level factors to improve hospital efficiency and optimize patient outcomes.
Outcomes of 100 Patients More Than 4 Years After POEM for Achalasia
Authors: Campagna Ryan A. J. , Cirera Arturo , Holmstrom Amy L. , Triggs Joseph R. , Teitelbaum Ezra N. , Carlson Dustin A. , Pandolfino John E. , Hungness Eric S. 
Published: March 2021

Objective:
We aim to describe the long-term follow-up data from our institution's POEM experience.

Summary Background Data:
Per-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited.

Methods:
Patients older than 4 years removed from POEM for treatment of achalasia were studied. Clinical success was defined as an Eckardt Symptom (ES) score ≤3 and freedom from reintervention for achalasia. Patients underwent esophagogastroduodenoscopy (EGD), high-resolution manometry, impedance planimetry, and timed barium esophagram (TBE) preoperatively and at least 4 years postoperatively. Objective gastroesophageal reflux disease (GERD) was defined LA Grade B or worse esophagitis on EGD.

Results:
One hundred and nineteen consecutive patients were included. Five patients died or had catastrophic events unrelated to achalasia or POEM. One hundred of the remaining patients (88%, 100/114) had long-term data available. Clinical follow-up for all patients was greater than 4 years postoperatively and the mean was 55 months. Mean current ES was significantly improved from preop (n = 100, 1 ± 1 vs 7 ± 2, P < 0.001). Overall clinical success was 88% and 92%. Five patients had a current ES >3 and 4 patients required procedural reintervention on the lower esophageal sphincter. Reinterventions were successful in 75% of patients (3/4), with current ES ≤3. The rate of objective GERD was 33% (15/45). Esophageal physiology was improved with a decrease in median integrated relaxation pressure (11 ± 4 vs 33 ± 15 mm Hg, P < 0.001), a decrease in median TBE column height (3 ± 3 vs 13 ± 8 cm, P < 0.001), and an increase in median distensibility index (5.1 ± 2 vs 1.1 ± 1 mm2/mm Hg, P < 0.001).

Conclusions:
POEM provides durable symptom relief and improvement in physiologic esophagogastric junction relaxation parameters over 4.5 years postoperatively. Reinterventions are rare and effective.
Is Nocturia Associated With Detrusor Underactivity?
Authors: Ryles Hannah T. , Sansone Stephanie A. , Levin Pamela J. , Andy Uduak U. , Harvie Heidi S. , Arya Lily A. 
Published: March 2021

Objectives
Detrusor underactivity (DU) is diagnosed using urodynamic testing. We hypothesized that nocturia is associated with detrusor underactivity.

Methods
We performed a retrospective chart review of all women who underwent urodynamic testing at our institution between 2016 and 2018. Uroflowmetry and pressure-flow study parameters were compared between women with nocturia (≥2 voids/night) and without nocturia (0–1 void/night). Detrusor underactivity was diagnosed using 3 different criteria: (1) bladder voiding efficiency (BVE) of <90%, (2) bladder contractility index of <100, and (3) a composite of three urodynamic measures (Gammie criteria).

Results
Of 358 women, 172 (48%) were in the nocturia group and 186 (52%) were in the no nocturia group. On uroflowmetry, median postvoid residual volume was similar (20 mL) in both groups. Median maximum flow rate (15 vs 17 mL/s, P < 0.05) and average flow rate (6 mL/s vs 7 mL/s, P < 0.05) were significantly lower in the nocturia group compared with the no nocturia group. During pressure-flow study, a significantly greater proportion of women with nocturia were unable to void around the catheter (30% vs 27%, P < 0.01). The overall rate of DU varied with the criteria used: BVE (54%), bladder contractility index (41%), and Gammie criteria (7%). The rate of DU using the BVE criteria was significantly higher in the nocturia group (63% vs 48%, P < 0.01), but no significant differences were noted using the other criteria.

Conclusions
Nocturia is associated with reduced voiding efficiency in women. The diagnosis of DU using urodynamics is challenging.
The Genetic Architecture of Alzheimer’s Disease Risk: A Genomic Structural Equation Modelling Study
Authors: Foote Isabelle F , Jacobs Benjamin M , Mathlin Georgina , Watson Cameron J , Bothongo Phazha LK , Waters Sheena , Dobson Ruth , Noyce Alastair J , Bhui Kamaldeep S , Korszun Ania , Marshall Charles R 
Published: March 2021

AbstractBackgroundTargeting modifiable risk factors may have a role in the prevention of Alzheimer’s disease. However, the mechanisms by which these risk factors influence Alzheimer’s risk remain incompletely understood. Genomic structural equation modelling can reveal patterns of shared genetic architecture that provide insight into the pathophysiology of complex traits.MethodsWe identified genome-wide association studies for Alzheimer’s disease and its major modifiable risk factors: less education, hearing loss, hypertension, high alcohol intake, obesity, smoking, depression, social isolation, physical inactivity, type 2 diabetes, sleep disturbance and socioeconomic deprivation. We performed linkage disequilibrium score regression among these traits, followed by exploratory factor analysis, confirmatory factor analysis and structural equation modelling.ResultsWe identified complex networks of linkage disequilibrium among Alzheimer’s disease risk factors. The data were best explained by a bi-factor model, incorporating a Common Factor for Alzheimer’s risk, and three orthogonal sub-clusters of risk factors, which were validated across the two halves of the autosome. The first sub-cluster was characterised by risk factors related to sedentary lifestyle behaviours, the second by traits associated with reduced life expectancy and the third by traits that are possible prodromes of Alzheimer’s disease. Alzheimer’s disease was more genetically distinct and displayed minimal shared genetic architecture with its risk factors, which was robust to the exclusion ofAPOE.ConclusionShared genetic architecture may contribute to epidemiological associations between Alzheimer’s disease and its risk factors. Understanding the biology reflected by this communality may provide novel mechanistic insights that could help to prioritise targets for dementia prevention.
On Cross-ancestry Cancer Polygenic Risk Scores
Authors: Fritsche Lars G. , Ma Ying , Zhang Daiwei , Salvatore Maxwell , Lee Seunggeun , Zhou Xiang , Mukherjee Bhramar 
Published: March 2021

AbstractPolygenic risk scores (PRS) can provide useful information for personalized risk stratification and disease risk assessment, especially when combined with non-genetic risk factors. However, their construction depends on the availability of summary statistics from genome-wide association studies (GWAS) independent from the target sample. For best compatibility, it was reported that GWAS and the target sample should match in terms of ancestries. Yet, GWAS, especially in the field of cancer, often lack diversity and are predominated by European ancestry. This bias is a limiting factor in PRS research. By using electronic health records and genetic data from the UK Biobank, we contrast the utility of breast and prostate cancer PRS derived from external European-ancestry-based GWAS across African, East Asian, European, and South Asian ancestry groups. We highlight differences in the PRS distributions of these groups that are amplified when PRS methods condense hundreds of thousands of variants into a single score. While European-GWAS-derived PRS were not directly transferrable across ancestries on an absolute scale, we establish their predictive potential when considering them separately within each group. For example, the top 10% of the breast cancer PRS distributions within each ancestry group each revealed significant enrichments of breast cancer cases compared to the bottom 90% (odds ratio of 2.81 [95%CI: 2.69,2.93] in European, 2.88 [1.85, 4.48] in African, 2.60 [1.25, 5.40] in East Asian, and 2.33 [1.55, 3.51] in South Asian individuals). Our findings highlight a compromise solution for PRS research to compensate for the lack of diversity in well-powered European GWAS efforts while recruitment of diverse participants in the field catches up.
Systematic development of an mHealth app to prevent healthcare-associated infections by involving patients: Participatient
Authors: Bentvelsen R.G. , van der Vaart R. , Veldkamp K.E. , Chavannes N.H. 
Published: March 2021

ABSTRACTIntroductionIn hospital care, urinary catheters are frequently used, causing a substantial risk for catheter-associated urinary tract infections (CAUTI). Patient awareness and evaluation of appropriateness of their catheter through mHealth could decrease these healthcare-associated infections. However, patient engagement via mHealth in infection prevention is still limited. Therefore, we describe the systematic development and usability evaluation of the mHealth intervention Participatient, to prevent CAUTI, aiming for optimal adoption of the app in the clinical setting.MethodThe CeHRes roadmap was used as development guideline, operationalizing phases for (1) contextual inquiry (observations and interviews), (2) value specification (interviews with probing) and (3) design in multiple steps and in co-creation with end-users. During phases 1 and 2, semi-structured interviews were conducted with fifteen patients and three nurses. The design phase was combined with the minimum viable product development strategy, with a focus on early cyclic steps of prototyping.ResultsIn phase 1, patients acknowledged the risks of catheter use. Patients in phase 2 valued endorsement of a mHealth application by healthcare workers and reported to own a smartphone. Both patients and nurses recognized the need for useful modules in the app besides catheter care. Based on the needs and values as found in phase 2, the Participation app was developed. Based on usability tests in phase 3, content, text size, plain language, and navigation structures were further amended, and images were added.ConclusionThis study provides real-world insight in the developmental strategy for mHealth interventions by involving both patients and care providers. Development of an app using thorough needs-assessment provided understanding for its content and design. By developing an app providing patients with reliable information and daily checklists, we aim to provide a tailored tool for communication and awareness on catheter use for the whole ward, and a potential blueprint for mHealth development.
High failure rate of ChAdOx1 in healthcare workers during Delta variant surge: A case for continued use of masks post-vaccination
Authors: Ujjainiya Rajat , Tyagi Akansha , Sardana Viren , Naushin Salwa , Bhatheja Nitin , Kumar Kartik , Barman Joydeb , Prakash Satyartha , Kutum Rintu , Bhaskar Akash K , Singh Prateek , Chaudhary Kumardeep , Loomba Menka , Khanna Yukti , Walecha Chestha , Ahmed Rizwan , Yadav Ashutosh , Bajaj Archana , Malik Gaurav , Qureshi Sahar , Waghdhare Swati , Siddiqui Samreen , Trehan Kamal Krishan , Mani Manju , Dang Rajiv , Das Poonam , Dougall Pankaj , Mahajan Monica , Sonar Sudipta , Jakhar Kamini , Kumar Reema , Tiwari Mahima , Mani Shailendra , Bhattacharyya Sankar , Budhiraja Sandeep , Agrawal Anurag , Dash Debasis , Jha Sujeet , Sengupta Shantanu 
Published: March 2021

AbstractImmunization is expected to confer protection against infection and severe disease for vaccinees, while reducing risks to unimmunized populations by inhibiting transmission. Here, based on serial serological studies, we show that during a severe SARS-CoV2 Delta-variant outbreak in Delhi, 25.3% (95% CI 16.9 - 35.2) of previously uninfected, ChAdOx1-nCoV19 double vaccinated, healthcare-workers (HCW) were infected within a period of less than two months, based on serology. Induction of anti-spike response was similar between groups with breakthrough infection (541 U/ml, IQR 374) or not (342 U/ml, IQR 497), as was induction of neutralization activity to wildtype. Most infections were unrecognized. The Delta-variant thus causes frequent unrecognized breakthrough infections in adequately immunized subjects, reducing any herd-effect of immunity, and requiring reinstatement of preventive measures such as masking.
Prevalence of SARS-CoV-2 antibodies among workers of the public higher education institutions of Porto, Portugal
Authors: Meireles Paula , Amaro Joana , Costa Joana Pinto , Lopes Mariana Mendes , Varandas Tatiana , Norton Pedro , Guimarães João Tiago , Severo Milton , Barros Henrique 
Published: March 2021

AbstractObjectivesTo assess the prevalence of SARS-CoV-2 specific immunoglobulin (Ig) M and IgG antibodies among workers of the three public higher education institutions of Porto, Portugal, up to July 2020.MethodsA rapid point of care test for specific IgM and IgG antibodies of SARS-CoV-2 was offered to all workers. Testing was performed to and a questionnaire was completed by 4592 workers on a voluntary basis. We computed the apparent IgM, IgG, and combined IgM or IgG prevalence, along with the true prevalence and 95% credible intervals (95% CI) using Bayesian inference.ResultsWe found an apparent prevalence of 3.1% for IgM, 1.0% for IgG, and 3.9% for either antibody class. The estimated true prevalence was 2.0% (95% CI 0.1-4.3) for IgM, 0.6% (95% CI 0.0-1.3) for IgG and 2.5% (95% CI 0.1-5.3) for IgM or IgG. A SARS-CoV-2 molecular diagnosis was reported by 21 (0.5%) workers, and of these, 90.5% had a reactive IgG result. Seroprevalence was higher among those reporting known contacts with confirmed cases, having been quarantined, having a previous molecular negative test, or having had symptoms.ConclusionsThe seroprevalence among workers from the three public higher education institutions of Porto after the first wave of the SARS-CoV-2 infection was relatively low. However, the estimated true seroprevalence was approximately five times higher than the reported SARS-CoV-2 infection based on a molecular test result.