bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creating a culture of quality: our experience with providing feedback to frontline hospitalists
Authors: Becker Brittany , Nagavally Sneha , Wagner Nicholas , Walker Rebekah , Segon Yogita , Segon Ankur 
Published: March 2021

BackgroundOne way to provide performance feedback to hospitalists is through the use of dashboards, which deliver data based on agreed-upon standards. Despite the growing trend on feedback performance on quality metrics, there remain limited data on the means, frequency and content of feedback that should be provided to frontline hospitalists.ObjectiveThe objective of our research is to report our experience with a comprehensive feedback system for frontline hospitalists, as well as report the change in our quality metrics after implementation.Design, setting and participantsThis quality improvement project was conducted at a tertiary academic medical centre among our hospitalist group consisting of 46 full-time faculty members.Intervention or exposureA monthly performance feedback report was distributed to provide ongoing feedback to our hospitalist faculty, including an individual dashboard and a peer comparison report, complemented by coaching to incorporate process improvement tactics into providers’ daily workflow.Main outcomes and measuresThe main outcome of our study is the change in quality metrics after implementation of the monthly performance feedback reportResultsThe dashboard and rank order list were sent to all faculty members every month. An improvement was seen in the following quality metrics: length of stay index, 30-day readmission rate, catheter-associated urinary tract infections, central line-associated bloodstream infections, provider component of Healthcare Consumer Assessment of Healthcare Providers and Systems scores, attendance at care coordination rounds and percentage of discharge orders placed by 10:00.ConclusionsImplementation of a monthly performance feedback report for hospitalists, complemented by peer comparison and guidance on tactics to achieve these metrics, created a culture of quality and improvement in the quality of care delivered.
Strength development according with age and position: a 10-year study of 570 soccer players
Authors: Scoz Robson Dias , Alves Bruno Mazziotti Oliveira , Burigo Ricardo Lima , Vieira Edgar Ramos , Ferreira Luciano Maia Alves , da Silva Rubens Alexandre , Hirata Rogerio Pessoto , Amorim Cesar Ferreira 
Published: March 2021

Background/aimThe purpose of this study was to compare the isokinetic peak torque profiles from the quadriceps and hamstrings muscles during concentric and eccentric contractions in elite Brazilian soccer players across different field positions and age categories. Our hypothesis was that soccer players from different field positions are subjected to different ageing-related effects on their isokinetic peak torque.MethodsThis is a retrospective study based on professional elite-level soccer players between the years 2009 and 2019. It included 570 adult males who played for at least 5 years on first or second Brazilian divisions. Playing positions were divided as: goalkeepers, defenders, sidebacks, midfielders and forwards. Age categories were also divided as: G1 (17–20 years old), G2 (21–24 years old), G3 (25–28 years old), G4 (29–32 years old) and G5 (33 years old or more).ResultsThe results indicate a moderate effect of age (F(4545)=8.197; p<0.001; η2=0.057) and a small effect of playing position (F(4545)=2.993; p<0.05; η2=0.021) on torque of concentric extensors; mainly from midfielders and goalkeepers with 29 years or more.ConclusionsSoccer players from different field positions are subjected to different ageing related effects on their muscular performance during their career special attention should be given to these players to avoid reduction in physical performance.
The Irreplaceable Utility of Sequential Data Assimilation for Numerical Weather Prediction System Development: Lessons Learned from an Experimental HWRF System
Authors: Poterjoy Jonathan , Alaka Ghassan J. , Winterbottom Henry R. 
Published: March 2021

AbstractLimited-area numerical weather prediction models currently run operationally in the United States and follow a “partially cycled” schedule, where sequential data assimilation is periodically interrupted by replacing model states with solutions interpolated from a global model. While this strategy helps overcome several practical challenges associated with real-time regional forecasting, it is no substitute for a robust sequential data assimilation approach for research-to-operations purposes. Partial cycling can mask systematic errors in weather models, data assimilation systems, and data preprocessing techniques, since it introduces information from a different prediction system. It also adds extra heuristics to the model initialization steps outside the general Bayesian filtering framework from which data assimilation methods are derived. This study uses a research-oriented modeling system, which is self-contained in the operational Hurricane Weather Research and Forecasting (HWRF) Model package, to illustrate why next-generation modeling systems should prioritize sequential data assimilation at early stages of development. This framework permits the rigorous examination of all model system components—in a manner that has never been done for the HWRF Model. Examples presented in this manuscript show how sequential data assimilation capabilities can accelerate model advancements and increase academic involvement in operational forecasting systems at a time when the United States is developing a new hurricane forecasting system.
The Impact of Training on Teamwork and Simulated Debriefings on Real-Life Cardiopulmonary Arrest Events
Authors: Hunt Tara Mahramus , Anderson Mindi , Vo Mai , Penoyer Daleen Aragon 
Published: March 2021

Background Prior to the study, debriefings post-real-life cardiopulmonary arrest at the associated hospital were conducted only 3% of the time. However, debriefings post-cardiopulmonary arrests are recommended by multiple entities to improve team performance. Methods A course on teamwork, education on a structured method of debriefing, and debriefing practice via simulated role-play were provided to resuscitation team members. A prospective, mixed methods study including team member perceptions of debriefings and the number of debriefings conducted post-cardiopulmonary arrests were measured after the intervention. Results Debriefings increased from 3% to 39%. Debriefings were valued by all team members. Themes generated from team members’ comments included improvement, communication, and team function. Conclusions Debriefings post-real-life cardiopulmonary arrest events are feasible in a hospital setting. Teamwork principles training with simulated role-play of debriefing can impact the process of whether debriefings occur and are highly regarded by multidisciplinary team members.
Telehealth utilization among multi-ethnic patients with obesity during the COVID-19 pandemic
Authors: Almandoz Jaime P , Xie Luyu , Schellinger Jeffrey N , Mathew M Sunil , Edwards Khary , Ofori Ashley , Kukreja Sachin , Schneider Benjamin , Messiah Sarah E 
Published: March 2021

Introduction The science of telemedicine has shown great advances over the past decade. However, the field needs to better understand if a change in care delivery from in-person to telehealth as a result of the COVID-19 pandemic will yield durable patient engagement and health outcomes for patients with obesity. The objective of this study was to examine the association of mode of healthcare utilization (telehealth versus in-person) and sociodemographic factors among patients with obesity during the COVID-19 pandemic. Methods A retrospective medical chart review identified patients with obesity from a university outpatient obesity medicine clinic and a community bariatric surgery practice. Patients completed an online survey (1 June 2020–24 September 2020) to assess changes in healthcare utilization modality during subsequent changes in infection rates in the geographic area. Logistic regression analysis examined the association of mode of healthcare utilization and key sociodemographic characteristics. Results A total of 583 patients (87% female, mean age 51.2 years (standard deviation 13.0), mean body mass index 40.2 (standard deviation 6.7), 49.2% non-Hispanic white, 28.7% non-Hispanic black, 16.4% Hispanic, 7% other ethnicity, 33.1% completed bariatric surgery) were included. Adjusted logistic regression models showed older age was inversely associated with telehealth use (adjusted odds ratio = 0.58, 95% confidence interval 0.34–0.98) and non-Hispanic black were more likely to use telehealth compared to non-Hispanic white (adjusted odds ratio = 1.72, 95% confidence interval 1.05–2.81). Conclusions The COVID-19 pandemic is impacting access to healthcare among patients with obesity. Telehealth is an emerging modality that can maintain healthcare access during the pandemic, but utilization varies by age and ethnicity in this high-risk population.
Endovascular treatment of an ilio-iliac arteriovenous fistula accompanied by venous thromboembolism presenting with multiple organ failure – A case report and literature review
Authors: Wang Tiehao , Zhao Jichun , Yuan Ding 
Published: March 2021

Objectives Multiple organ failure is a rare manifestation of ilio-iliac arteriovenous fistula which can lead to a high rate of misdiagnosis and death. Methods We reported a 61-year-old man presenting with multiple organ failure rapidly after right lower limb swelling. Computed tomography angiography showed an ilio-iliac arteriovenous fistula caused by right common iliac artery aneurysm, and venous thrombosis of bilateral common iliac veins. A bifurcated stent-graft with coil embolization of right internal iliac artery was used for repair. Results The patient recovered rapidly and was discharged without complications. Although arteriovenous fistula persisted due to type II endoleak, aneurysm sac and inferior vena cava significantly shrunk at six months follow-up. Conclusions This report demonstrated that multiple organ failure may appear when the distal outflow tracts of arteriovenous fistula are obstructed. Moreover, endovascular repair is effective for reversal of multiple organ failure caused by arteriovenous fistula, even if arteriovenous fistula persists due to type II endoleak.
Lack of association between erythropoietin treatment and risk of depression in patients with end-stage kidney disease on maintenance dialysis: a nationwide database study in Taiwan
Authors: Lin Pao-Yen , Li Lung-Chih , Wang Liang-Jen , Yang Yao-Hsu , Hsu Chih-Wei 
Published: March 2021

Background: Patients with end-stage kidney disease (ESKD), have been associated with higher risk of developing depression. Erythropoietin (EPO), frequently used for the treatment of anemia in ESKD patients, has been shown to have neuroprotective and antidepressant effects. In this study, we examined whether EPO treatment changed the risk of depression in ESKD patients. Methods: In a nationwide population-based cohort in Taiwan from 1998 to 2013, patients with a diagnosis of ESKD on maintenance dialysis and aged greater than 18 years were classified into EPO treatment group or non-EPO treatment group. All patients were followed up until the diagnosis of depressive disorder or the end of the study period. Results: In this cohort (13,067 patients in the EPO and 67,258 patients in the non-EPO group), 5569 patients were diagnosed as depressive disorder in the follow-up period. We found the risk of depression in EPO group was not significantly different from that in non-EPO group (adjusted hazard ratio = 0.98, 95% confidence interval 0.92–1.04, p = 0.499) after adjusting for sex, age, certification year of catastrophic illness for ESKD, physical co-morbidities, and use of benzodiazepines. Conclusion: In summary, using the nationwide reimbursement data in Taiwan, we found that EPO treatment in ESKD patients was not associated with their general risk of developing depression.
Relationship Between Patellar Morphology and Known Anatomic Risk Factors for Patellofemoral Instability
Authors: Jimenez Andrew E. , Levy Benjamin J. , Grimm Nathan L. , Andelman Steven M. , Cheng Chris , Hedgecock Jon P. , Cohen Andrew , Pace J. Lee 
Published: March 2021

Background: Patellar instability (PI) is a common problem among pediatric, adolescent, and young adult patients. Recent literature has shown a correlation between pathoanatomy and PI. Purpose/Hypothesis: The purpose of this study was to determine if there is any difference in patellar shape in patients with and without PI and if there is any association between the shape of the patella and the shape of the trochlea. Our hypothesis was that there would be no association between the shape of the patella and the likelinhood of having PI and that the shape of the trochlea would not be associated with patellar morphology. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging (MRI) scans were analyzed for 97 study patients with PI and 100 control patients with anterior cruciate ligament tears. Radiologic measurements of trochlear morphology were collected via MRI; 15 measurements of patellar morphology were then measured using axial MRI scans. Comparisons between the control and PI groups were performed using a 2-tailed t test. Regression analysis was performed to determine if associations existed between the 15 patellar morphology measurements and the trochlear dysplasia measurements. Results: There were no statistically significant differences between the PI and control groups for the majority of patellar morphology measurements. With regression analysis, there were no statistically significant associations between the majority of patellar morphology measurements and the trochlear dysplasia measurements. Conclusion: Patellar morphology is highly variable in knees with and without PI. There was a minimal association between measurements of patellar morphology and trochlear dysplasia.
Medical Malpractice Trends in Foot and Ankle Surgery
Authors: Kadakia Rishin J. , Orland Keith , Sharma Akhil , Chen Jie , Akoh Craig C. , Parekh Selene G. 
Published: March 2021

Category: Other Introduction/Purpose: Medical malpractice lawsuits can place significant economic and psychologic burden on a provider. Orthopaedic surgery is one of the most common subspecialties involved in malpractice claims. There is currently no study examining malpractice lawsuits within foot and ankle surgery. Accordingly, the purpose of this work is to examine trends in malpractice claims in foot and ankle surgery. Methods: The Westlaw legal database was queried for lawsuits pertaining to foot and ankle surgery from 2008 to 2018. Only cases involving medical malpractice were included for analysis. All available details pertaining to the cases were collected. This included plaintiff demographic and geographic data. Details regarding the cases were also collected such as anatomical location, pathology, complications, and case outcomes. Results: Forty nine malpractice lawsuits pertaining to foot and ankle were identified. Most plaintiffs in these cases were adult females, and the majority of cases occurred in the northeast (53.1%). The most common anatomical region involved in claims involved the forefoot (29%). The majority of these claims involved surgery (65%). Infection was the most common complication seen in claims (22%). The jury ruled in favor of the defendant surgeon in most cases (73%). Conclusion: This is the first study to examine trends in medical malpractice within foot and ankle surgery. Infection was the most frequent complication seen in claims and forefoot surgery was the most common anatomic location. A large portion of claims resulted after nonoperative treatment. A better understanding of the trends within malpractice claims is crucial to developing strategies for prevention.
Clinical Safety and Outcomes of a Novel Ultrasound Assisted Bioabsorbable Suture Anchor in Foot and Ankle Surgeries
Authors: Chen Jie , Sharma Akhil , Akoh Craig C. , Kadakia Rishin J. , Parekh Selene G. 
Published: March 2021

Category: Sports Introduction/Purpose: Bioabsorbable suture anchors have been popularized due to potential for osseous integration, less interference with diagnostic imaging, and ease of use. Recently, ultrasound assisted suture anchor systems have been introduced with the benefits of obtaining interdigitation with cancellous bone while maintaining a minimal footprint. In a cadaveric study, ultrasound assisted suture anchors demonstrated a similar pullout strength and less system displacement when compared to a benchmark bioabsorbable anchor system. However, the failure and complication rates of ultrasound assisted bioabsorbable anchors has never been demonstrated in a clinical setting. We studied the Stryker SonicAnchor by examining complication rates in foot and ankle procedures and secondarily determined the efficacy by evaluating clinical outcomes of surgeries using this anchor system. Methods: A retrospective analysis was performed on all patients treated by the primary investigator using the Stryker SutureAnchor between the dates of May 2016 and February 2018. We included all patients for which the anchor was used during surgery with at least 2 year followup including VAS and FAOS scores. We recorded baseline demographic information as well as the type of surgery patients underwent. We recorded all intraoperative and postoperative complications for these surgeries. In addition, we compared preoperative and postoperative clinical scores. Results: 57 patients met inclusion criteria. On average, patients were 53 years old at the time of surgery. Mean followup was 32.8 months. Mean BMI was 30.36. Three patients reported current tobacco use (5.3%), four patients (7.0%) had type II diabetes mellitus at the time of their surgery, and only one patient (1.8%) had osteoporosis. Common procedures were Achilles repair including Haglund’s resection, peroneal surgery, and lateral ligament reconstruction. There were two deep infections requiring reoperation, one medial malleolus stress fracture following total ankle replacement, one metatarsal stress fracture not involving the surgery site, and one DVT. No reports of anchor pullout or soft tissue repair failure. VAS and FAOS scores improved from 6.2 to 1.2 and 54.3 to 93.9. Conclusion: In our review of 57 patients operated on with the SonicAnchor with at least two year followup, there were zero cases of complications stemming from the anchor including anchor pullout or soft tissue repair failure. Overall, patients improved tremendously in their clinical outcome scores across a wide range of different procedures. Previous studies have demonstrated the biomechanical strength of the SonicAnchor and our review supports its clinical safety and efficacy in long-term clinical followup.
Arthrodesis Tarsometatarsal in Lisfranc Fracture: Comparison of Different Fixing Methods
Authors: Muñoz Mario , Verschae Gregorio I. , Drago Sebastian , De la Paz Valenzuela Joaquín A. , Fuentes Jose M. Rojas 
Published: March 2021

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc fractures are rare, but with a high degree of morbidity. Post-traumatic degenerative changes that result in pain and deformity, are common; with arthrodesis being a treatment option. There are several implants for midfoot arthrodesis, but with little literature regarding the best method for achieve bone fusion. We analice the fusion rates, comparing different joint stabilization techniques. Methods: A retrospective descriptive study of 20 patients with post traumatic osteoarthritis of the midfoot was performed, who underwent midfoot arthrodesis, between January 2016 - January 2018. The comparison between arthrodesis techniques with compression plate (CP) vs plates and / or screws (PS) was made. Data analysis was performed with SPSS software. Results: The fusion times were compared between the 2 groups, CP 18.7 (+- 8.01) vs PT 16.86 (+- 11.5) weeks, without significant differences. There were also no significant differences when comparing the discharge times between the 2 groups, CP 8 (+- 1.84) vs PS 9 weeks (+- 2.36) (p = 0.312). However, when comparing the proportion of complications between both groups, the CP group has lesser than the PS group (42.8% vs 83.3%). This difference was not statistically significant (p = 0.95) although there is a tendency for CP to have fewer complications. In addition, the proportion of complications in primary vs. secondary arthrodesis, 25% vs. 75% respectively, was compared, finding statistically significant differences (p = 0.028) Conclusion: At the moment, there is a lack of evidence to recommend the exclusive use of implants. However, when comparing complications between both groups, there would be a tendency that the use of compression plates would have fewer complications. In addition, it could be inferred that in patients with lesions with greater joint destruction, primary arthrodesis is valid as an option.
Diagnostic yield of genetic testing in a heterogeneous cohort of 1376 HCM patients
Authors: Hathaway Julie , Heliö Krista , Saarinen Inka , Tallila Jonna , Seppälä Eija H. , Tuupanen Sari , Turpeinen Hannu , Kangas-Kontio Tiia , Schleit Jennifer , Tommiska Johanna , Kytölä Ville , Valori Miko , Muona Mikko , Sistonen Johanna , Gentile Massimiliano , Salmenperä Pertteli , Myllykangas Samuel , Paananen Jussi , Alastalo Tero-Pekka , Heliö Tiina , Koskenvuo Juha 
Published: March 2021

AbstractBackgroundGenetic testing in hypertrophic cardiomyopathy (HCM) is a published guideline-based recommendation. The diagnostic yield of genetic testing and corresponding HCM-associated genes have been largely documented by single center studies and carefully selected patient cohorts. Our goal was to evaluate the diagnostic yield of genetic testing in a heterogeneous cohort of patients with a clinical suspicion of HCM, referred for genetic testing from multiple centers around the world.MethodsA retrospective review of patients with a suspected clinical diagnosis of HCM referred for genetic testing at Blueprint Genetics was undertaken. The analysis included syndromic, myopathic and metabolic etiologies. Genetic test results and variant classifications were extracted from the database. Variants classified as pathogenic (P) or likely pathogenic (LP) were considered diagnostic.ResultsA total of 1376 samples were analyzed. Three hundred and sixty-nine tests were diagnostic (26.8%); 373 P or LP variants were identified. Only one copy number variant was identified. The majority of diagnostic variants involved genes encoding the sarcomere (85.0%) followed by 4.3% of diagnostic variants identified in the RASopathy genes. Two percent of diagnostic variants were in genes associated with a cardiomyopathy other than HCM or an inherited arrhythmia. Clinical variables that increased the likelihood of identifying a diagnostic variant included: an earlier age at diagnosis (p < 0.0001), a higher maximum wall thickness (MWT) (p < 0.0001), a positive family history (p < 0.0001), the absence of hypertension (p = 0.0002), and the presence of an implantable cardioverter-defibrillator (ICD) (p = 0.0004).ConclusionThe diagnostic yield of genetic testing in this heterogeneous cohort of patients with a clinical suspicion of HCM is lower than what has been reported in well-characterized patient cohorts. We report the highest yield of diagnostic variants in the RASopathy genes identified in a laboratory cohort of HCM patients to date. The spectrum of genes implicated in this unselected cohort highlights the importance of pre-and post-test counseling when offering genetic testing to the broad HCM population.