bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Supraglottic Airway Devices With Endotracheal Intubation in Low-Risk Patients for Cesarean Delivery: Systematic Review and Meta-analysis
Authors: White L.D. , Thang C. , Hodsdon A. , Melhuish T.M. , Barron F.A. , Godsall M.G. , Vlok R. 
Published: February 2021

(Anesth Analg. 2020;131:1092–1101)
While there are guidelines and protocols in place for safe intubation during cesarean delivery, failed intubation occurs in 2.3 of every 1000 general anesthetics, and 1 in 60 failed intubation results in maternal death. Reattempting intubation is associated with certain risks, like aspiration, and other options include using a supraglottic airway (SGA) or using neuraxial blockade. SGA has been demonstrated to be reasonably safe in low-risk, elective cesareans. This meta-analysis aimed to compare the first-pass success rate and insertion time of SGA with that of endotracheal intubation in elective cesarean delivery, as well as identify the rate of airway related adverse events using SGA compared with endotracheal intubation.
Electrical Stimulation Test for Epidural Catheter Placement After Receiving Intrathecal Local Anesthetic During a Combined Spinal-epidural Technique for Cesarean Delivery: Confirmation of the Spinal Nerve Root as Epidural Site of Action
Authors: Stewart M. , Carvalho B. , Tsui B.C.H. 
Published: February 2021

(Can J Anesth/J Can Anesth. 2020;67:498–499)
For the prediction of adequate epidural analgesia following abdominal surgery, the epidural stimulation test (EST) has been shown to have a higher sensitivity than the local anesthetic test dose. This test could confirm proper epidural catheter placement for combined spinal epidurals (CSEs) in either laboring women or women having a cesarean delivery. As epidural failure is a known complication of the CSE procedure, confirmation of the epidural catheter placement is a crucial step following a full spinal dose CSE for cesarean delivery. This case describes using EST to confirm CSE placement in a woman having cesarean delivery.
The impact of obesity on immune function in pediatric asthma
Authors: Hay Ceire , Henrickson Sarah E. 
Published: February 2021

Purpose of review
Pediatric obese asthma is a complex disease that remains poorly understood. The increasing worldwide incidence of both asthma and obesity over the last few decades, their current high prevalence and the challenges in treating obese asthmatic patients all highlight the importance of a better understanding of the pathophysiological mechanisms in obese asthma. While it is well established that patients with obesity are at an increased risk of developing asthma, the mechanisms by which obesity drives the onset of asthma, and modifies existing asthma, remain unclear. Here, we will focus on mechanisms by which obesity alters immune function in asthma.

Recent findings
Lung parenchyma has an altered structure in some pediatric obese asthmatics, known as dysanapsis. Central adiposity is linked to reduced pulmonary function and a better predictor of asthma risk in children than BMI. Obesity in young children is associated with an increased risk of developing asthma, as well as early puberty, and hormonal alterations are implicated in obese asthma. Obesity and asthma each yield immunometabolic dysregulation separately and we are learning more about alterations in these pathways in pediatric obese asthma and the potential impact of bariatric surgery on those processes.

Summary
The recent progress in clarifying the connections between childhood obesity and asthma and their combined impacts on immune function moves us closer to the goals of improved understanding of the pathophysiological mechanisms underpinning obese asthma and improved therapeutic target selection. However, this common inflammatory disease remains understudied, especially in children, and much remains to be learned.
A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools
Authors: Vasquez Guzman Cirila Estela , Sussman Andrew L. , Kano Miria , Getrich Christina M. , Williams Robert L. 
Published: February 2021

Purpose
Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training.

Method
Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012–2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students’ preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula.

Results
Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied.

Conclusions
There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
Pregnant Patients Using Opioids: Treatment Access Barriers in the Age of COVID-19
Authors: Lensch Ashley C. , Hairston Essence , Carter Ginny , Jones Hendrée E. 
Published: February 2021

Objectives:
Before the COVID-19 pandemic, many pregnant patients experienced barriers in accessing opioid use disorder (OUD) medication. This project surveyed buprenorphine treatment clinics to determine how many accepted pregnant women before and then during the pandemic. Of those clinics accepting pregnant patients during the pandemic, respondents were asked what services were provided and what forms of payment they accepted.

Methods:
Between July and September 2020, phone contact was made with every sixth unduplicated clinic in North Carolina listed in the Substance Abuse and Mental Health Administration treatment locator (N = 490 clinics). The response rate was 53%.

Results:
Of the 128 clinics responding, 62 clinics (48%) failed to treat pregnant patients both before and during the pandemic, whereas 66 clinics (52%) accepted pregnant patients before the COVID-19 pandemic, with only 44 (66%) of these clinics accepting pregnant patients during the pandemic. Thus, 33% fewer clinics accepted pregnant women for OUD treatment. Of these 44 clinics, 52% provided same-day intake, 45% prescribed naltrexone, and 57% offered detoxification with opioid agonists. Self-pay (95%), private insurance (77%), and Medicaid (55%) were accepted as payment. Clinics commonly reported providing individual counseling (86%). No clinics provided childcare or transportation.

Conclusions:
Almost half of the buprenorphine clinics in North Carolina turned away pregnant patients before the pandemic. During the pandemic, only 34% accepted pregnant patients, with 33% clinics that had provided medication treatment before the pandemic declining to treat pregnant patients for OUD. Thus, it is critical that policymakers ensure OUD treatment clinics accept pregnant patients.
Pattern of Tobacco Smoking Among Egyptian Patients With Bipolar Disorder
Authors: Shorub Eman , ElShahawi Heba , Abdel Maksooud Menan , Wagdy Mohamed , Eid Maissa 
Published: February 2021

Background:
Individuals with bipolar disorder (BD) have a higher prevalence of tobacco smoking than the general population. In Egypt, the accurate data about the pattern of tobacco smoking and prevalence of nicotine dependence among BD patients are still scarce.

Objective:
The objective of this study was to detect the pattern of tobacco smoking and to assess the occurrence of nicotine dependence syndrome among Egyptian cigarette and waterpipe smoker patients suffering from BD.

Methods:
A cross-sectional study using a semistructured interview to assess 100 patients with BD at the inpatient department and the outpatient mood clinic of The Institute of Psychiatry, Ain Shams University. The assessment tools included the Mini-International Neuropsychiatric Interview, Sixth Edition (M.I.N.I.), the Young Mania Rating Scale (YMRS), the Fagerström Test for Nicotine Dependence (FTND), and the Lebanon Waterpipe Dependence Scale (LWDS-11).

Results:
Of the 100 recruited bipolar patients (43% women and 57% men), it was found that 45% of bipolar cases were cigarette smokers, 18% were waterpipe smokers, and 17% smoked both cigarette and waterpipe with a statistically significant difference. Bipolar I in the acute phase showed the most prevalent type of BDs with moderate (31%) and high (13.8%) nicotine dependence. Bipolar II cases have never smoked neither cigarette nor waterpipe; 5% of patients with bipolar I smoked waterpipe during disease activity.

Conclusion:
Patients with BD have a relatively high frequency of nicotine (cigarettes and waterpipe) dependence (17%) in relation to the general population (1.0%), especially bipolar I type.
Predictors of Drug Abuse Relapse for Iranian Addicted Women: An Application of Social Cognitive Theory
Authors: Bashirian Saeid , Barati Majid , Mohammadi Younes , Ghazanfari Zarnagh Hadi , Bagheri Sharareh 
Published: February 2021

Objectives:
Substance abuse prevalence has risen over the past decade among women, and accordingly, sex-specific barriers impede women’s access and participation in treatment programs, while the chief issue in providing treatment programs for women with substance abuse is the high relapse rate seen in the subjects. With all these in mind, the present study was conducted with the objective of recognizing the sociocognitive factors that concern the relapse of substance abuse in women.

Methods:
Two hundred women subjects under treatment in outpatient addiction treatment and rehabilitation centers in Kurdistan province in 2019 participated in this descriptive study. Data were obtained by means of a questionnaire that included demographic questions, history of substance use, and structures of social cognitive theory. Data were analyzed by SPSS software version 21 that further used logistic regression, χ2, and independent t tests.

Results:
The average age of the respondents was estimated 37.75±10.49. The relapse rate amounted to 80% among the participants. Logistic regression test analysis designated that the structures of situational perception, social support, and self-efficacy act as the factors that predict substance abuse relapses in women (R=0.42; P<0.05).

Conclusions:
Social cognitive theory is considered a valid theoretical method for deciphering the relation observed between substance abuse relapse predictors in women. Therapists’ consciousness on gaining social support and strengthening self-efficacy in the subjects may serve to improve the aftermaths of substance abuse treatment programs in women.
Low Back Pain Flares
Authors: Costa Nathalia , Smits Esther J. , Kasza Jessica , Salomoni Sauro E. , Ferreira Manuela , Hodges Paul W. 
Published: February 2021

Objective:
The term flare is commonly used to describe low back pain (LBP) fluctuations, but individuals with LBP consider that it does not always correspond to increased pain. This case cross-over study aimed to: (1) determine the extent to which days with a flare identified according to a multidimensional definition (self-reported flare, SRF) corresponded to days with greater than average pain (pain-defined flare, PDF) and (2) to investigate whether physical and psychosocial features differ between PDF and SRF.

Materials and Methods:
Individuals with LBP for ≥3 months (N=126) provided data on flares, physical, and psychosocial features daily for 28 days using a smartphone application.

Results:
Most days with SRF (68%) did not have greater than average pain (ie, PDF), but most days with greater than average pain (64%) were reported as an SRF. On days with SRF-only all physical and psychosocial features were worse than nonflare days. SRF+PDF had lower sleep quality and higher pain intensity, fatigue, disability, pain catastrophizing, and fear avoidance than SRF-only. SRF+PDF had higher pain in the afternoon and evening, disability and pain catastrophizing than PDF-only. Self-efficacy at work and during leisure activities was worse on SRF+PDF days than SRF-only and PDF-only days.

Discussion:
These findings highlight that when individuals with LBP consider they have a flare, they do not always have greater than average pain, but have worse psychosocial features. This emphasizes that flare has broader dimensions than pain alone. Consideration of flare according to broad dimensions is important when investigating symptom fluctuations across different LBP trajectories.
Pain and Disability in Low Back Pain Can be Reduced Despite No Significant Improvements in Mechanistic Pain Biomarkers
Authors: Palsson Thorvaldur S. , Christensen Steffan W.M. , De Martino Enrico , Graven-Nielsen Thomas 
Published: February 2021

Objective:
Altered balance in nociception in response to noxious stimuli is commonly reported in chronic low back pain (LBP). However, it is unclear whether an improvement in the clinical presentation is contingent on a reduction in pain sensitivity. This study investigated whether the quantitative sensory testing (QST) profile changes in people undergoing rehabilitation for LBP.

Design:
A prospective, observational case-control study.

Methods:
Forty males and females, 18 to 40 years’ old (20 with LBP) participated in 2 sessions. QST was performed at baseline and after discharge from rehabilitation (LBP) or after 3 to 8 weeks (controls). The QST battery consisted of determining pressure-pain thresholds at the low back and shoulder, temporal summation of pain, and conditioned pain modulation. Questionnaire data was used to determine pain (Numeric Rating Scale [NRS]), disability (Roland-Morris Questionnaire [RMQ]), Fear Avoidance Beliefs (FABQ), and The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) at baseline and discharge. The treatment effect was determined by calculating the Cohen d.

Results:
No significant group×time interactions or main factor effect was found for any of the QST measures. The LBP group reported a significant reduction in NRS (P<0.0002, d=1.23), RMQ (P<0.0001, d=1.58), FABQ (P<0.001, d=0.87), and in the ÖMPSQ (P<0.00001, d=1.44).

Conclusions:
The results indicate that an improvement of clinical LBP is not contingent upon changes in the pain sensory profile. The value of screening pain sensitivity in LBP patients in primary care, needs to be investigated further, due to the patient population heterogeneity and the sensitivity of assessment methods.
Decreased Reemerging Auditory Brainstem Responses Under Ipsilateral Broadband Masking as a Marker of Noise-Induced Cochlear Synaptopathy
Authors: Giraudet Fabrice , Labanca Ludimila , Souchal Marion , Avan Paul 
Published: February 2021

Objectives:
In mammals, a 2-hr exposure to an octave-band noise (OBN) at 100 to 108 dB SPL induces loss of synaptic ribbons between inner hair cells and auditory nerve fibers with high thresholds of response (hiT neurons), that encode high-intensity sounds. Here, we tackle the challenge of diagnosing this synaptopathy by a noninvasive functional audiological test, ultimately in humans, despite the expected absence of auditory-threshold elevation and of clear electrophysiological abnormality, hiT neuron contributions being hidden by those of more sensitive and robust neurons.

Design:
The noise-induced synaptopathy was replicated in mice (at 94, 97, and 100 dB SPL; n = 7, 7, and 8, respectively, against 8 unexposed controls), without long-lasting auditory-threshold elevation despite a twofold decrease in ribbon-synapse number for the 100-dB OBN exposure. Auditory brainstem responses (ABRs) were collected using a simultaneous broadband noise masker just able to erase the ABR response to a 60-dB tone burst. Tone burst intensity was then increased up to 100 dB SPL for eliciting reemerging ABRs (R-ABRs), dependent on hiT neurons as more sensitive neurons are masked.

Results:
In most ears exposed to 97-dB-SPL and all ears exposed to 100-dB-SPL OBN, contrary to controls, R-ABRs from the overexposed region have vanished, whereas standard ABR distributions widely overlap.

Conclusions:
R-ABRs afford an individual noninvasive marker of normal-auditory-threshold cochlear synaptopathy. A simple modification of standard ABRs would allow hidden auditory synaptopathy to be searched in a patient.

Abbreviations:
ABR: auditory brainstem response; dB SPL: decibel sound pressure level; DPOAE: distortion-product otoacoustic emission; hiT neuron: high-threshold neuron; IHC: inner hair cell; loT neuron: low-threshold neuron; OBN: octave-band noise; OHC: outer hair cell; PBS: phosphate buffer saline; R-ABR: reemerging ABR
Optimized Diagnostic Approach to Patients Suspected of Superior Semicircular Canal Dehiscence
Authors: Noij Kimberley S. , Remenschneider Aaron K. , Herrmann Barbara S. , Guinan John J. , Rauch Steven D. 
Published: February 2021

Objectives:
Current methods of diagnosing superior semicircular canal dehiscence syndrome (SCDS) include a clinical exam, audiometric testing, temporal bone computer tomography (CT) imaging, and vestibular evoked myogenic potential (VEMP) testing. The main objective of this study was to develop an improved diagnostic approach to SCDS optimized for accuracy, efficiency, and safety that utilizes clinical presentation, audiometric testing, CT imaging, high-frequency cervical VEMP (cVEMP) testing, and patient treatment preference. A secondary aim was to investigate the cost associated with the current versus proposed diagnostic paradigms.

Design:
All patients who underwent cVEMP testing since introduction of the 2 kHz cVEMP in our clinical protocol in July 2018 were screened. Patients suspected of SCDS based upon symptoms who also had available audiogram, CT scan, and 2 kHz cVEMP were included (58 ears). Patients were categorized as dehiscent, thin, or not dehiscent based on their CT scan. Symptom prevalence and cVEMP outcomes were analyzed and compared for all groups. The accuracy of the 2 kHz cVEMP was calculated using CT imaging as the standard. Using a combination of patient symptomatology, audiometric, CT and 2 kHz cVEMP data, as well as patient preference, a best clinical practice approach was developed. The cost associated with this approach was calculated and compared with cost of the current SCDS diagnostic workup using Medicare reimbursement rates.

Results:
In the overall patient population suspected of SCDS based on clinical presentation, the sensitivity and specificity of 2 kHz cVEMP were 76% and 100%, respectively, while the positive and negative predictive values were 100% and 84.6%, assuming that the CT scan finding was correct. Autophony was the most common symptom in patients who had both superior semicircular canal dehiscence on CT imaging plus abnormal 2 kHz cVEMP (p < 0.001). Combining patient symptomatology, 2 kHz normalized peak to peak cVEMP amplitude, and patient treatment preference to determine, which patients should undergo CT scanning resulted in a potential cost reduction between 45% and 61%.

Conclusion:
In patients suspected of SCDS based on their clinical presentation, the combination of symptomatology, 2 kHz cVEMP data, and patient preference can be used to determine which patients should undergo CT scanning, resulting in a diagnostic cost reduction and reduced patient radiation exposure.
Long-term Functional Outcomes and Complications in Operative Versus Nonoperative Treatment for Displaced Midshaft Clavicle Fractures in Adolescents: A Retrospective Comparative Study
Authors: Riiser Martin O. , Molund Marius 
Published: February 2021

Introduction:
Traditionally, midshaft clavicular fractures in adolescents are treated nonoperatively. In later years, a trend toward operative treatment can be observed. Documentation of the benefit of surgery in this group is scarce. The purpose of this study is to evaluate the long-term patient reported functional outcomes and complications for patients treated operatively and nonoperatively for displaced midshaft clavicular fractures. Using the same outcomes we also compared the operative methods.

Methods:
One hundred nine adolescents aged 12 to 18 years sustaining displaced midshaft clavicular fractures in the period 2010 to 2016 were identified in our computerized files. Sixty-one were treated nonoperatively, 48 operatively (22 plate and 26 intramedullary nail). Their radiographs and patient journals were examined for fracture classification, wound infection, sensory affection, surgery duration, hardware removal, and nonunion (n=109). Long-term function, pain, and satisfaction were measured with Quick Disability of Arm, Shoulder, and Hand (QuickDASH), Oxford Shoulder Score and Visual Analogue Scale (n=87).

Results:
Operative treatment: We could find no difference in functional score outcomes. The main outcome QuickDASH was excellent in both groups (median 0 nail vs. 2.26 plate). Surgery duration was shorter with intramedullary nail. We found 2 infections and 2 sensory affections in the plate group, and 1 infection and 1 sensory affection in the intramedullary nail group. There were 2 refractures in the nail group. Operative versus nonoperative treatment: there were no differences in functional outcomes between the operative and nonoperative groups. For the main outcome QuickDASH both groups scored excellently (median 1.12 operative vs. 0 nonoperative). The nonoperative group was more satisfied with the cosmetic result. There was 1 nonunion in the nonoperative group that later was operated.

Conclusions:
Adolescents aged 12 to 18 years with displaced midshaft clavicular fractures show good long-term functional results after plate fixation, intramedullary nail, and nonoperative treatment. No additional benefit is demonstrated for surgery in our material. Nonoperatively treated patients are more satisfied with the cosmetic results. Little difference is seen between the operative methods in our study. We conclude that surgery should rarely be the choice of treatment for displaced midshaft clavicular fractures in adolescents.

Level of Evidence:
Level III study—retrospective comparative study.