bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center
Authors: Braswell Matthew , Wally Meghan K. , Kempton Laurence B. , Seymour Rachel B. , Hsu Joseph R. , Karunakar Madhav , Afetse K. Eddie , Bailey Gisele , Bosse Michael , Brownrigg Maggie , Cuadra Mario , Dixon Amy , Girardi Cara , Grochowski Erica , Hysong Alexander , Jolissaint Josef , Macknet David , Mayberry R. Miles , Moody Patrick , Peterson Katheryn , Phelps Kevin D. , Pollock Hannah , Posey Samuel L. , Reid Risa , Roe Kris , Scannell Brian , Sims Stephen , Stanley Amber , Wohler Andrew D. 
Published: October 2021

Abstract

Objectives:
Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.

Design:
Retrospective chart review.

Setting:
Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic.

Intervention:
Virtual visits utilizing the Doxy.me platform.

Main Outcome Measures:
Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Methods:
All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Results:
Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 (P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes (P = .028).

Conclusion:
A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.
Accuracy of Urea Nitrogen and Creatinine Measurements in Postmortem Serum and Pericardial Fluid Compared With Antemortem Data
Authors: Takasu Shojiro , Matsumoto Sari , Kodama Saki , Sakamoto Kana , Shimmura Suzuka , Iwadate Kimiharu 
Published: October 2021

Abstract
Although several studies have measured urea nitrogen (UN) and creatinine (Cr) concentrations in postmortem serum and pericardial fluid, no recent antemortem biochemical data have been available for forensic autopsy, thereby making the evaluation of the accuracy of postmortem data difficult. This study compared antemortem (from emergency room results before the declaration of death) and postmortem serum UN and Cr concentrations, as well as postmortem serum and pericardial fluid values, in 51 forensic autopsy cases (postmortem interval within 87 hours). Postmortem UN concentrations were strongly correlated with antemortem data. Moreover, no significant difference between pericardial fluid UN concentrations and antemortem data was observed. Postmortem serum and pericardial fluid Cr values were also correlated with antemortem data, although postmortem values were significantly higher than antemortem ones. Given our observation of early postmortem elevation in Cr concentrations, such an elevation was attributed to rigor mortis. In conclusion, the current study demonstrated the utility of postmortem UN and Cr concentrations, in particular of those measured in the pericardial fluid.
Thirteen Cases of Valeryl Fentanyl in Michigan
Authors: Ton Erinn , Stevens Christine , Moorman Paul , Markey Michael , Hunter Brian , Bush Russell , Jones Prentiss 
Published: October 2021

Abstract
In this report, we describe 13 cases of drug overdose in Michigan in which valeryl fentanyl was found in postmortem blood. Valeryl fentanyl is a schedule I opioid that is rarely found in drug overdoses in the United States. Although little data exist on the mortality and morbidity associated with valeryl fentanyl, its molecular structure indicates that it would be less potent than fentanyl.
When analyzing blood samples for valeryl fentanyl, samples from peripheral sites were sometimes negative for quantitative levels; however, samples from central sites in the same decedent were positive. This could indicate unique pharmacokinetics for valeryl fentanyl, which could have implications for other fentanyl analogs. Given the paucity of pharmacodynamic information, the prohibition of its use, the potential to buttress law enforcement efforts in monitoring drug trafficking trends, and to determine the efficacy of current regulations, laboratories should test for valeryl fentanyl. When testing for valeryl fentanyl, and likely other fentanyl analogs, the site of sample collection is important: central sources of blood are preferred to peripheral sources.
Point-of-Care Ultrasound Identification of Portal Vein Thrombosis in a Pediatric Patient
Authors: Ong Yoon Nee , James Vigil , Lau Kiew Siong , Chor Yek Kee , Ong Gene Yong-Kwang 
Published: October 2021

Abstract
Abdominal pain is one of the most common presenting complaints encountered in the pediatric emergency department. The use of point-of-care ultrasonography by emergency physicians has been shown to expedite the diagnosis of a large variety of conditions and can be used to accurately identify intra-abdominal pathology in children. We describe the case of a pediatric patient who presented to the pediatric emergency department with acute abdominal pain, in whom point-of-care ultrasonography helped expedite the diagnosis of acute portal vein thrombosis and liver abscess.
Factors Associated With Burnout in Physical Medicine and Rehabilitation Residents in the United States
Authors: Bean Allison C. , Schroeder Allison N. , McKernan Gina P. , Mesoros Matthew , Silver Julie K. , Verduzco-Gutierrez Monica , Cuccurullo Sara , Franzese Kevin 
Published: October 2021

Objectives
The aims of the study were to determine the prevalence of burnout in physical medicine and rehabilitation residents in the United States and to identify the personal- and program-specific characteristics most strongly associated with residents reporting burnout.

Design
This was a cross-sectional survey of US physical medicine and rehabilitation residents. Emotional exhaustion, depersonalization, and burnout were assessed using two validated items from the Maslach Burnout Inventory. Associations of burnout with demographics and personal factors, residency program characteristics, perceived program support, and work/life balance were evaluated.

Results
The survey was completed by 296 residents (22.8%), with 35.8% of residents meeting the criteria for burnout. Residents’ perception of not having adequate time for personal/family life was the factor most strongly associated with burnout (χ2 = 93.769, P < 0.001). Residents who reported inappropriate clerical burden and working more than 50 hrs/wk on inpatient rotations were most likely to report that they did not have adequate time for personal/family life. Faculty support (χ2 = 41.599, P < 0.001) and performing activities that led residents to choose physical medicine and rehabilitation as a specialty (χ2 = 93.082, P < 0.001) were protective against burnout.

Conclusions
Residents reporting having inadequate time for their personal/family life was most strongly associated with physical medicine and rehabilitation resident burnout, although many personal and program characteristics were associated with burnout.
Comparison of Radial Extracorporeal Shock Wave Therapy and Local Corticosteroid Injection Effectiveness in Patients With Carpal Tunnel Syndrome
Authors: Öztürk Durmaz Havva , Tuncay Figen , Durmaz Himmet , Erdem Hatice Rana 
Published: October 2021

Objective
The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome.

Design
A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale–pain, a Visual Analog Scale–numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment.

Results
Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale–pain, Visual Analog Scale–numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale–pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups.

Conclusions
Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection.
Implementation of a Framework for Telerehabilitation in Clinical Care Across the Continuum During COVID-19 and Beyond
Authors: Kim Soo Yeon , Daley Kelly , Pruski April D. , AlFarra Tariq , Azola Alba , Gonzalez Fernandez Marlis , Keszler Mary S. , Friedel Stacey , Haaf Hayley , Segall Harrison , Lien Peiting , Cypher Jacklyn , Mazariegos Julia , Raghavan Preeti 
Published: October 2021

Abstract
The COVID-19 pandemic has propelled an unprecedented global implementation of telemedicine and telerehabilitation as well as its integration into the healthcare system. Here, we describe the clinical implementation of the A3E framework for the deployment of telerehabilitation in the inpatient and outpatient rehabilitation continuum by addressing accessibility, adaptability, accountability, and engagement during the COVID-19 pandemic. By using an organized, coordinated, and stratified approach, we increased our telerehabilitation practice from 0 to more than 39,000 visits since the pandemic began. Learning from both the successes and challenges can help address the need to increase access to rehabilitation services even beyond the COVID-19 pandemic.
Mortality in Systemic Sclerosis–Associated Interstitial Lung Disease in Brazil
Authors: de Oliveira Martins Lucas Victória , Oliveira Sandra Maximiano , Silvatti Juliana , de Amorim Fernanda Godinho , Agapito Tito Cecilia V. , Kayser Cristiane 
Published: October 2021

Objectives
The aim of this study was to identify risk factors associated with mortality in patients with systemic sclerosis (SSc), particularly those with interstitial lung disease (ILD), over a long-term follow-up in a large Brazilian SSc cohort.

Methods
We conducted a medical records review study of 380 scleroderma patients from 1982 to 2019. Systemic sclerosis ILD was considered in those with evidence of ILD on chest high-resolution computed tomography (HRCT). Causes of death were determined.

Results
Among the 380 SSc patients, SSc-ILD on chest HRCT was observed in 227 patients (59.7%). Seventy-two patients (18.9%) died during a mean follow-up of 7.2 years since the SSc diagnosis; among them, 57 (79.2%) had SSc-ILD, compared with 15 (20.8%) without SSc-ILD (p < 0.001). Of the 72 deaths, 51.4% were considered related to SSc, and ILD was the leading cause of death. The overall survival rates at 5, 10, and 15 years were 87.9%, 81.5%, and 74.9%, respectively. Kaplan-Meier analysis showed a significantly worse prognosis among patients with SSc-ILD than among those without ILD (p < 0.001). Among patients with SSc-ILD, disease duration of less than 4 years (p < 0.001), forced vital capacity <80% at baseline (p = 0.017), and pulmonary systolic arterial pressure ≥40 mm Hg on echocardiography (p < 0.001) were significantly associated with mortality by multivariate analysis.

Conclusions
In Brazilian SSc patients, the presence of ILD was associated with a worse prognosis. The higher mortality among SSc-ILD patients, especially those with a shorter disease duration and forced vital capacity <80%, highlights the need for early screening and closer monitoring before irreversible lung function deterioration occurs.
Transorbital Debulking of Sphenoid Wing Meningioma
Authors: Smith Claire S. , Karlin Justin N. , Cohen Liza M. , Rootman Daniel B. 
Published: October 2021

Objective:
To describe the clinical features and outcomes of patients who underwent transorbital debulking of sphenoid wing meningioma.

Methods:
Patients with a diagnosis of sphenoid wing meningioma who underwent transorbital debulking were included in this series. Preoperative and postoperative symptoms and examination findings, including best corrected visual acuity (BCVA) and proptosis were extracted from patient charts. All imaging studies, records of additional surgical and medical management, and complications of surgery were collated.

Results:
Eight patients were included. The most common symptoms at presentation were blurred vision (6/8) and proptosis (6/8). The most common clinical findings at presentation were decreased visual acuity and proptosis. Mean BCVA preoperatively was 0.93 in logMARunits andmeanrelative proptosis preoperatively was 4.88 mm. All patients underwent orbitotomy with or without bone flap with decompression of hyperostotic bone and subtotal resection of soft tissue mass. Mean follow-up time was 14months. Five of eight patients experienced postoperative improvement in BCVA, for mean change of 0.32. All patients demonstrated reduction in proptosis postoperatively with a mean reduction of 3.63 mm.

Conclusions:
Sphenoid wing meningioma can present with decreased visual acuity and/or proptosis. It is possible to address both of these problems in selected patients with transorbital debulking, an approach that avoids the aesthetic and functional consequences of craniotomy. The aim of this technique is not surgical cure, but rather improvement in vision and disfigurement.
Clinical Study of Cranioplasty Combined With Ipsilateral Ventriculoperitoneal Shunt in the Treatment of Skull Defects With Hydrocephalus
Authors: Yan Zhengcun , Zhang Hengzhu , Zhang Zhen , Wang Xiaodong , Wei Min , Wang Xingdong 
Published: October 2021

Objective:
To explore the clinical effect and safety of cranioplasty combined with ipsilateral ventriculoperitoneal shunts in the treatment of skull defects with hydrocephalus.

Methods:
The clinical data of 78 patients with skull defects with hydrocephalus were analyzed retrospectively. All patients were treated with cranioplasty and ventriculoperitoneal shunts in 1 stage, including 35 cases of cranioplasty combined with ipsilateral ventriculoperitoneal shunts (ipsilateral operation group) and 43 cases of contralateral operations (contralateral operation group).

Results:
The incision length (28.97 ± 4.55 cm), operation time (139.00 ± 42.27 minutes), and intraoperative hemorrhage (174.57 ± 79.35 mL) in the ipsilateral operation group were significantly better than those in the contralateral operation group (respectively they were 37.15 ± 5.83 cm, 214.07 ± 34.35 minutes, and 257.21 ± 72.02 mL), and the difference was statistically significant (t = 6.786, 8.656, and 4.815, all P < 0.05). The degree of postoperative hydrocephalus was significantly improved in both groups, but there was no statistically significant difference in the degree of hydrocephalus between the 2 groups (P > 0.05). Among the postoperative complications, there was no statistically significant difference in infection, epilepsy, subdural effusion, titanium plate effusion, or excessive cerebrospinal fluid drainage between the 2 groups (P > 0.05), but the incidence of intracranial hemorrhage in the ipsilateral operation group (2.86%) was significantly lower than that in the contralateral operation group (20.93%, χ
2 = 4.138, P = 0.042). The postoperative Glasgow Coma Scale scores of the 2 groups were improved compared with those before the operation (P < 0.05), and there was no statistically significant difference in the postoperative Glasgow Coma Scale scores (P > 0.05). At 6 months after surgery, there was no statistically significant difference in Glasgow Outcome Scale effectiveness between the 2 groups (χ
2 = 0.005, P = 0.944).

Conclusions:
Cranioplasty combined with ipsilateral ventriculoperitoneal shunt has the same therapeutic effect as a contralateral operation, but it has the advantage of a short operation time, less intraoperative trauma, less bleeding, and less risk of intracranial hemorrhage, which is suitable for clinical applications.
Application of One Piece Autologous Rib Cartilage Graft in Hollow Space of Complete Naso-Ethmoid Orbital Fracture
Authors: Kim Tae Wook , Kim Min Ji 
Published: October 2021

Background:
Complete naso-orbital-ethmoid (NOE) complex fractures including hollow space defects are difficult to treat. A proper bone fragment should be maintained for bony rearrangement and reconstruction; however, no guidelines are available for the treatment of the NOE complex. In patients with empty bone fragment from NOE fractures, implantation of autologous rib grafts may be an option for recreating the orbital rim.

Methods:
A 57-year-old man with open complete NOE fracture. Computed tomography (CT) revealed complete loss of bone fragments within the NOE area, including the inferior orbital rim and maxillary wall. A bone was harvested from the right fifth rib. The grafted bone mimicked the inferomedial orbital rim and was stabilized with mid plates.

Results:
Follow-up CT and three-dimensional (3D) volumetry were performed at 1, 3, 6, and 12 months. A well-positioned rib graft and orbital wall were observed. In 3D volumetry analysis, we noted that the absorption rate of the rib cartilage was 7.84% at 6 months. The absorption rate of rib cartilage was evaluated using CT images, which were reconstructed with a 3D image reconstruction program (Α-VIEW, Coreline soft, Seoul, Korea).

Conclusions:
Complete NOE fractures, especially fractures involving loss of the buttress for plating, may pose a burden to surgeons. In such cases, implantation of an autologous rib cartilage graft is a good option for bony frame reconstruction, without any concerns of bony resorption.
Fecal Putative Uropathogen Abundance and Antibiotic Resistance Gene Carriage in Women With Refractory Recurrent Urinary Tract Infection Treated With Fecal Microbiota Transplantation
Authors: Jeney Sarah E. S. , Avelar-Barragan Julio , Whiteson Katrine , Chang Jenny , Dutta Sonia , Lane Felicia 
Published: October 2021

Objective
The aims of this study were to describe the fecal relative abundance of potentially uropathogenic bacteria and to analyze antibiotic resistance genes before and after fecal microbiota transplantation in women with recurrent urinary tract infection (UTI).

Methods
Shotgun sequencing was performed on fecal samples from 3 donors and 4 women with recurrent UTI who underwent transplantation. Recipient samples were sequenced at baseline and at 4 time points through 6 months postintervention. Relative fecal uropathogen abundance was analyzed by species and participant using descriptive statistics. Antibiotic resistance gene abundance was assigned, normalized, and compared between donors and recipients at baseline and postintervention using an abundance bar plot, nonmetric multidimensional scaling, and pairwise permutational multivariate analysis of variance.

Results
The median (range) relative abundance of Escherichia coli in all fecal samples from women with recurrent UTI was 0% (0%–5.10%); Enterococcus faecalis, 0% (0%–0.20%); Enterococcus faecium, 0% (0%–1.90%); Klebsiella pneumoniae, 0% (0%–0.10%); and Pseudomonas aeruginosa, 0% (0%–0.10%). Gut microbes carried genes conferring resistance to antibiotics used for UTI. No significant difference was seen in antibiotic resistance gene carriage after transplantation compared with baseline (P=0.22, R
2=0.08 at 3 months). Antibiotic gene composition and abundance were significantly associated with the individual from whom the sample came (P=0.004, R
2=0.78 at 3 months).

Conclusions
Exploratory analysis of gut microbiomes in women with recurrent UTI identifies no or low relative putative uropathogen abundance for all species examined. Antibiotic resistance gene carriage persisted after fecal microbiota transplantation, although conclusions are limited by small sample size.
Evidence for Early Cyclosporine Treatment for Hunner Lesion Interstitial Cystitis
Authors: Vollstedt Annah , Tennyson Lauren , Turner Katherine , Hasenau Deborah , Saon Md , McCartney Teresa , Beck Dana , Gilleran Jason , Peters Kenneth 
Published: October 2021

Objectives
The objective of this study was to evaluate our experience using cyclosporine A (CyA) in the treatment of Hunner lesion interstitial cystitis (HLIC).

Methods
Retrospective chart review was performed on patients with HLIC treated with CyA from August 2012 to September 2019. Demographic and clinical variables, number of interstitial cystitis therapies, frequency, nocturia, and bladder pain visual analog scores before and after CyA treatment were collected, as well as the Global Response Assessment (GRA) and the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index. CyA responders were defined as those with moderately or markedly improved GRA scores.

Results
A total of 51 patients with HLIC treated with CyA were identified. Mean follow-up was 3 years (0.36–6.8 years). Seventy-six percent (28 of 37) were female; mean age was 68 years (51–84 years). Before CyA treatment, an average of 8 previous therapies were tried and patients reported an average of 8 of 10 bladder pain. Daytime frequency was 11–20 times per day, and nocturia was 7 times per night. Per the GRA, 84% (31 of 37) were considered CyA responders. Posttherapy Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index scores were lower in responders compared with nonresponders (8.9 ± 5.7 vs 21.3 ± 7.0, P = 0.001). Bladder pain, number of hydrodistentions/fulgurations, nocturia, and daytime frequency improved significantly after CyA treatment.

Conclusions
The cyclosporine A response rate was 84%, with most of these patients reporting marked improvement. Bladder pain, daytime frequency, and nocturia were significantly improved after CyA treatment, and the number of interventions after CyA treatment decreased. Cyclosporine A should be considered earlier than fifth-line therapy in HLIC.