bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term effectiveness, safety and immunogenicity of the biosimilar SB2 in inflammatory bowel disease patients after switching from originator infliximab
Authors: Fischer Sarah , Cohnen Sarah , Klenske Entcho , Schmitt Heike , Vitali Francesco , Hirschmann Simon , Ramming Andreas , Zundler Sebastian , Rath Timo , Krebs Sabine , Dörje Frank , Uter Wolfgang , Nagore Daniel , Meyer Sebastian , Neurath Markus F. , Atreya Raja 
Published: January 2021

Background: Long-term data on inflammatory bowel disease (IBD) patients switched from originator to biosimilar infliximab SB2 are lacking. The aim of the conducted study was to investigate the effectiveness, immunogenicity and safety of a large prospectively followed-up IBD patient cohort that was entirely switched from originator infliximab to biosimilar SB2 treatment. Methods: This was a prospective, single-center, longitudinal, observational study describing clinical outcomes in IBD patients, over an 80-week period following switch from originator infliximab to SB2. Primary outcome measures were change of disease activity [Harvey-Bradshaw Index for Crohn’s disease (CD), partial Mayo Score for ulcerative colitis (UC)], C-reactive protein (CRP), infliximab trough levels (TLs), anti-drug antibodies (ADAs) and adverse events. Results: One hundred and forty-four IBD patients (94 CD, 50 UC), with median duration of 30.5 months’ (range 2–110) treatment with originator infliximab were evaluated. Mean change of disease activity compared with baseline was −0.9 (SD 2.6), –0.4 (2.2) and –0.4 (2.0) in CD; 0.1 (1.1), 0.1 (1.1) and 0.1 (1.3) in UC patients at weeks 24, 48 and 72. Median infliximab TLs were 6.2 µg/ml (interquartile range 2.3–12.2), 5.0 µg/ml (2.7–10.0), 6.6 µg/ml (3.5–12.4) and 5.1 µg/ml (2.7–10.9) at baseline and weeks 24, 48 and 72. Median CRP levels were within normal ranges throughout the study. After the switch, 9.8% of the patients developed new ADAs. Persistence on SB2 was 90% (95% confidence interval 0.85–0.95), 79% (0.72–0.86), 72% (0.64–0.80) at weeks 26, 52 and 78. Serious adverse events occurred in 11 patients. Conclusion: Over the individual patient follow-up of 80 weeks, switch to biosimilar SB2 from originator infliximab does not result in increased disease activity or changed immunogenicity patterns. The switch to SB2 was well tolerated.
Prevalence of multidrug-resistant bacteria colonisation among asylum seekers in western Switzerland
Authors: Kenfak-Foguena Alain , Nahimana Tessemo Immaculée , Bertelli Claire , Merz Laurent , Cometta Alain , Blanc Dominique , Senn Laurence , Petignat Christiane 
Published: January 2021

The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a risk of dissemination of pathogens into the local population.
The management of displaced humeral shaft fractures – A survey of UK shoulder and elbow surgeons
Authors: Ahad Abdul , Haque Aziz , Armstrong Alison , Modi Amit , Pandey Radhakant , Singh Harvinder Pal 
Published: January 2021

Introduction Indications for surgical management of displaced humeral shaft fractures are not clearly established, leading to variations in practice. The aim of this study was to determine the scale of these variations in the UK practice to help design a future national trial. Methods An online survey was sent to all surgeon members of British Elbow and Shoulder Society to help define humeral shaft fractures, fracture displacement as well as indications for operative and non-operative management. Patient and injury related factors considered important when managing humeral shaft fractures were investigated. Results The survey achieved a response rate of 32% (104/327). There was a lack of consensus on definitions for humeral shaft fractures and fracture displacement. A functional brace was the most common form of non-operative treatment (63%). Majority immobilise humeral shaft fractures for 4–8 weeks or until callus are visible (62%) with a similar number considering operative treatment if adequate signs of healing are not present at around 12–16 weeks. Around half of our respondents exclusively use plates with variations in preference of approach and a minority (2%) exclusively use intra-medullary nails. Conclusion The significant variation in management of displaced humeral shaft fractures in the UK suggests a clear need to evaluate clinical and cost effectiveness through a multi-centre randomised trial.
Outcomes and Healthcare Provider Perceptions of Real-Time Continuous Glucose Monitoring (rtCGM) in Patients With Diabetes and COVID-19 Admitted to the ICU
Authors: Chow Kenneth W. , Kelly Danielle J. , Rieff Mary C. , Skala Patricia A. , Kravets Igor , Charitou Marina M. , Morley Eric J. , Gupta Rajarsi , Miller Joshua D. 
Published: January 2021

Objective: We assessed the clinical utility and accuracy of real-time continuous glucose monitoring (rtCGM) (Dexcom G6) in managing diabetes patients with severe COVID-19 infection following admission to the intensive care unit (ICU). Methods: We present retrospective analysis of masked rtCGM in 30 patients with severe COVID-19. rtCGM was used during the first 24 hours for comparison with arterial-line point of care (POC) values, where clinicians utilized rtCGM data to adjust insulin therapy in patients if rtCGM values were within 20% of point-of-care (POC) values during the masked period. An investigator-developed survey was administered to assess nursing staff ( n = 66) perceptions regarding the use of rtCGM in the ICU. Results: rtCGM data were used to adjust insulin therapy in 30 patients. Discordance between rtCGM and POC glucose values were observed in 11 patients but the differences were not considered clinically significant. Mean sensor glucose decreased from 235.7 ± 42.1 mg/dL (13.1 ± 2.1 mmol/L) to 202.7 ± 37.6 mg/dL (11.1 ± 2.1 mmol/L) with rtCGM management. Improvements in mean sensor glucose were observed in 77% of patients ( n = 23) with concomitant reductions in daily POC measurements in 50% of patients ( n = 15) with rtCGM management. The majority (63%) of nurses reported that rtCGM was helpful for improving care for patients with diabetes patients during the COVID-19 pandemic, and 49% indicated that rtCGM reduced their use of personal protective equipment (PPE). Conclusions: Our findings provide a strong rationale to increase clinician awareness for the adoption and implementation of rtCGM systems in the ICU. Additional studies are needed to further understand the utility of rtCGM in critically ill patients and other clinical care settings.
Walking in Your Culture: A Study of Culturally Sensitive Outdoor Walking Space for Chinese Elderly Immigrants
Authors: Liu Pai , Powers Matthew , Dye Cheryl , Vincent Ellen , Padua Mary 
Published: January 2021

Objectives: This was a study conducted in Atlanta, GA, in the United States with Chinese elderly immigrants, examining the relationship between visual preference and motivation to walk in a particular outdoor space. Backgrounds: Outdoor walking promotes the well-being of older adults. However, their declined body functions impact their motivation to walk outside. For elderly immigrants living in a country with different cultural backgrounds from their homelands, it is important to find the ways to enhance their motivation of outdoor walking. Method: Visual preference survey was conducted to assess preferences of first-generation Chinese elderly immigrants attending a care facility setting. Preferences included Chinese classical walking spaces or American modern walking spaces. The data were interpreted using descriptive statistics and factorial experiment analysis. Results: A total of 95 Chinese elderly immigrants gave valid responses to the visual preference survey. Survey results revealed that respondents had a high preference for Chinese classical walking spaces even though they had an average time of 26 years as a U.S. resident. Although the functions and purposes of the walking spaces caused safety and comfort concerns, the interaction effects of design style, design function, and design purpose illustrated that Chinese classical style had high effectiveness to promote outdoor walking of Chinese elderly immigrants. Conclusions: These results support the significance of culturally sensitive care environments in promoting outdoor walking for elderly Chinese immigrants. It also indicates that spaces designed with an assigned cultural style had higher attractiveness to older adults from the same assigned cultural background.
Two-Year Outcomes of Posterior Ankle Arthroscopy: A Case Series
Authors: Rui Xiang Toh , Zhen Ning Yeo , Oon Thien Kevin Koo 
Published: January 2021

The aim of this study was to investigate the outcomes and complications after posterior ankle arthroscopy for the treatment of posterior ankle impingement syndrome, in a local population with a single surgeon series. Two-portal posterior ankle or hindfoot arthroscopy is an alternative option to open surgery in cases of posterior ankle impingement, that showed similar results but with less morbidity and faster recovery. There has been increasing interest in minimally invasive surgical techniques. Indications include extra- and intra-articular conditions and range from bony, cartilaginous to soft tissue pathology. Posterior ankle arthroscopy has been shown to be a good option in cases that are refractory to a period of conservative therapy. Posterior ankle arthroscopy also has known complications of sural nerve damage laterally and neurovascular bundle injury medially and also a steep learning curve that has been studied in the context of os trigonum excision. There have been few or no studies on the local Singaporean population and this article seeks to describe the various indications, results, and complications in the local Singaporean population by a single surgeon. Levels of Evidence: Level IV: Case series
The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland
Authors: Yesantharao Pooja S. , Jenny Hillary E. , Lopez Joseph , Chen Jonlin , Lopez Christopher D. , Aliu Oluseyi , Redett Richard J. , Yang Robin , Steinberg Jordan P. 
Published: January 2021

Study Design: Retrospective, quasi-experimental difference-in-differences investigation. Objective: Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland’s All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global hospital budgets to disincentivize low-value care and encourage preventive, community-based efforts. The objective of this study was to investigate how this reform has impacted pediatric craniofacial fracture care in Maryland. Methods: Children (≤18 years) receiving inpatient craniofacial fracture-related care in Maryland between January, 2009 through December, 2016 were investigated. New Jersey was used for comparison. Data were abstracted from the Kid’s Inpatient Database (Healthcare Cost and Utilization Project). Results: Between 2009–2016, 3,655 pediatric patients received inpatient care for craniofacial fractures in Maryland and New Jersey. Prior to APM implementation, around 20% of Maryland patients received care outside of urban teaching hospitals. After APM implementation, less than 6% of patients received care outside of urban teaching hospitals ( p = 0.003). Implementation of the APM in Maryland also resulted in fewer pediatric craniofacial fracture admissions than New Jersey, though this only reached borderline significance (adjusted difference-in-differences estimate: −1.1 fewer admissions, 95% confidence interval: −2.1 to 0.0, p = 0.05). Inpatient costs for pediatric craniofacial care and mean did not change post-APM. Conclusions: Maryland’s APM consolidated pediatric craniofacial fracture inpatient care at urban, teaching hospitals. Inpatient costs and lengths of stay did not change after policy implementation, but overall admission rates decreased. Such considerations are important when considering national expansion of global hospital budgeting.
Splenic flexure colonic lipoma causing intussusception
Authors: Moussally Moustafa , Mokalled Imad , Jamali Faek , Khalife Mohamad J 
Published: January 2021

Lesson Colonic lipomas are rare benign tumours that are usually asymptomatic. However, giant colonic lipomas tend to be symptomatic and can occasionally result in intussusception and intermittent colonic obstruction. As adult intussusception is an uncommon occurrence, the identification of the underlying aetiology is essential due to its high association with malignancy. Computed Tomography remains the tool of choice for the diagnosis of colonic lipomas. Surgical excision remains the mainstay treatment of giant symptomatic colonic lipomas. We hereby present the case of a 51-year-old male found to have a colonic lipoma causing recurrent intussusception. We discuss the approach, diagnostic tools and available treatment modalities for colonic lipomas. We also provide a brief literature review of intussusception in adults.
Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment
Authors: Blue Heather , Dahly Ashley , Chhen Susan , Lee Julie , Shadiow Adam , Van Deelen Anna G. , Palombi Laura C. 
Published: January 2021

Introduction: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. Methods: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. Results: EMS providers’ perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. Conclusion: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.
The Clinical Impact of Fracture Liaison Services: A Systematic Review
Authors: Barton David W. , Piple Amit S. , Smith C. Taylor , Moskal Sterling A. , Carmouche Jonathan J. 
Published: January 2021

Introduction: A fracture liaison service (FLS) is a coordinated system of care that streamlines osteoporosis management in the orthopaedic setting and can serve as an effective form of secondary preventative care in these patients. The present work reviews the available evidence regarding the impact of fracture liaison services on clinical outcomes. Methods: The literature was reviewed for studies reporting changes in the rates of bone mineral density scanning (DXA), antiresorptive therapy, new minimum trauma fractures, and mortality between cohorts with access to an FLS or not. Studies including intention to treat level data were retained. A Medline search for “fracture liaison” OR “secondary fracture prevention” produced 146 results, 98 were excluded based on the abstract, 38 were excluded based on full-text review. Ten level III studies encompassing 48,045 patients were included, of which 5 studies encompassing 7,086 were analyzed. Odds-ratios for DXA and anti-osteoporosis pharmacotherapy rates were calculated from data. Fixed and random effects analyses were performed using the Mantel-Haenszel method. Results: Four studies reported, on average, a 6-fold improvement in DXA scanning rates (Figure 1). Six studies reported, on average, a 3-fold improvement in antiresorptive therapy rates (Figure 2). Four large studies reported significant reductions in the rate of new fractures using time-dependent Cox proportional hazards models at 12 months (HR = 0.84, 0.95), 24 months (HR = 0.44, 0.65), and 36 months (HR = 0.67). Five large studies reported mortality improvements using time-dependent Cox proportional hazards models at 12 months (HR = 0.88, 0.84, 0.81) and 24 months (HR = 0.65, 0.67). Conclusions: The findings suggest that fracture liaison services improve rates of DXA scanning and antiresorptive therapy as well as reductions in the rates of new fractures and mortality among patients seen following minimum trauma fractures across many time points.
Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study
Authors: Bugaevsky Yulia , Levy Yochai , Hershkovitz Avital , Ocheretny Irena , Nissenholtz Adaya , Cooper Lisa , Weissman Yaara Leibovici , Weiss Avraham , Velkes Steven , Beloosesky Yichayaou 
Published: January 2021

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV
Money Multiplier Bias Due to Informal Sector: An Extension of the Existing Money Multiplier
Authors: Mughal Khurrum S. , Schneider Friedrich G. , Aslam Faheem , Tahir Alishba 
Published: January 2021

To demonstrate the impact of informal economy on the official money multiplier in currency supply, we present an extension of the basic money multiplier model. The influence of economic policies may differ if they are based only on official statistics without considering the informal sector. Since most of the activities in informal sector are hidden from authorities, it is widely assumed that these activities are based on cash transactions, a part of total currency that cannot be attracted towards deposits due to the holder’s fear of prosecution and taxation, etc. Therefore, it is expected that such currency holdings can give biased results by playing a role in the money multiplier, a phenomenon that is usually ignored while attempting to alter money supply. The article also indicates that because of informal sector, the currency deposit ratio in the money multiplier is smaller than expected (depending on size of the informal sector), leading to a larger multiplier effect. JEL Classifications: E26, E51, O17
Surgical outcomes of hysterectomy for endometriosis: Benefits of a minimally invasive approach
Authors: Mutter Olga , Ackroyd Sarah , Taylor George A , Diaz Juan 
Published: January 2021

Introduction: We aimed to evaluate surgical outcomes of hysterectomy for endometriosis performed by general obstetricians and gynecologists (OB/GYNs) based on surgical approach. Methods: Using the 2016–2018 National Surgical Quality Improvement Program (NSQIP) database, we examined surgical outcomes including 30-day complication rates based on surgical approach in patients who underwent a hysterectomy for endometriosis by OB/GYNs. Results: From 2016 to 2018, 3641 hysterectomies were performed by OB/GYNs for endometriosis. 86.0% were performed via a minimally invasive (MIS) approach, with 2882 (79.2%) via a laparoscopic and 247 (6.8%) via a vaginal approach. Compared to MIS hysterectomies, those who underwent an abdominal hysterectomy included a higher proportion of African American and a lower proportion of non-Hispanic white patients, had heavier uteri, lower parity, and were more likely obese (all p < 0.05). There were no differences in age, American Society of Anesthesiologists class, comorbidities other than obesity, or a history of prior abdominal or pelvic surgery (all p > 0.05). Women undergoing hysterectomy for endometriosis experienced an overall 9.8% complication rate. Compared to abdominal approaches, MIS had a lower rate of overall complications (8.5% vs 17.8%) including wound (2.7% vs 7.2%) and major (4.4% vs 8.8%) complications (all p < 0.001). MIS had shorter operative time (129.2 ± 60.9 vs 143.8 ± 71.9), shorter length of stay (0.9 ± 1.6 vs 2.4 ± 1.8), and fewer readmissions (2.8% vs 5.5%) (all p < 0.001). Conclusion: While hysterectomy for endometriosis is a challenging procedure to perform, OB/GYNs are performing this procedure predominantly via a minimally invasive approach with fewer complications and more favorable surgical outcomes than an abdominal approach.