bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes in Patients Meeting Cochlear Implant Criteria in Noise but Not in Quiet
Authors: Thai Anthony , Tran Emma , Swanson Austin , Fitzgerald Matthew B. , Blevins Nikolas H. , Ma Yifei , Smith Michael L. , Larky Jannine B. , Alyono Jennifer C. 
Published: October 2021

Objective:
Evaluate outcomes in cochlear implant (CI) recipients qualifying in AzBio noise but not quiet, and identify factors associated with postimplantation improvement.

Study Design:
Retrospective cohort study.

Setting:
Tertiary otology/neurotology clinic.

Patients:
This study included 212 implanted ears. The noise group comprised 23 ears with preoperative AzBio more than or equal to 40% in quiet and less than or equal to 40% in +10 signal-to-noise ratio (SNR). The quiet group included 189 ears with preoperative AzBio less than 40% in quiet. The two groups displayed similar demographics and device characteristics.

Interventions:
Cochlear implantation.

Main Outcome Measures:
AzBio in quiet and noise.

Results:
Mean AzBio quiet scores improved in both the quiet group (pre-implant: 12.7%, postimplant: 67.2%, p < 0.001) and noise group (pre-implant: 61.6%, postimplant: 73.8%, p = 0.04). Mean AzBio +10 SNR also improved in the quiet group (pre-implant: 15.8%, postimplant: 59.3%, p = 0.001) and noise group (pre-implant: 30.5%, postimplant: 49.1%, p = 0.01). However, compared with the quiet group, fewer ears in the noise group achieved within-subject improvement in AzBio quiet (≥15% improvement; quiet group: 90.3%, noise group: 43.8%, p < 0.001) and AzBio +10 SNR (quiet group: 100.0%, noise group: 45.5%, p < 0.001). Baseline AzBio quiet (p < 0.001) and Consonant-Nucleus-Consonant (CNC) scores (p = 0.004) were associated with within-subject improvement in AzBio quiet and displayed a higher area under the curve than either aided or unaided pure-tone average (PTA) (both p = 0.01).

Conclusions:
CI patients qualifying in noise display significant mean benefit in speech recognition scores but are less likely to benefit compared with those qualifying in quiet. Patients with lower baseline AzBio quiet scores are more likely to display postimplant improvement.
Auricular Cartilage Resection for Treatment-Refractory Idiopathic Chronic Chondritis: A Case Series
Authors: Gordon Steven A. , Nassiri Ashley M. , Driscoll Colin L. , Carlson Matthew L. , Patel Neil S. 
Published: October 2021

Objective:
Describe a series of cases of idiopathic chronic auricular chondritis refractory to antibiotics and steroids treated successfully with surgery.

Study Design:
Case series.

Setting:
Two tertiary academic medical centers.

Patients:
We analyzed four patients diagnosed with chronic auricular deformity, pain, and drainage for a period of 1 to 5 years who had failed prolonged treatment consisting of antibiotics, corticosteroids, and incision and drainage. All four patients were smokers, three were diabetic, and two had a history of bariatric surgery.

Interventions:
Operative subcutaneous partial auriculectomy (removal of diseased cartilage and excess skin) was performed.

Main Outcome Measures:
Resolution of pain and drainage, need for additional procedures, and reduction in narcotics required for pain control were analyzed.

Results:
Two of the four patients were given an immediate postoperative course of doxycycline and ciprofloxacin. With a minimum of 6 weeks’ follow-up, all four patients had complete resolution of pain and recurrent drainage postoperatively. One patient requiring daily narcotic medication for pain and benzodiazepine for sleep preoperatively no longer required prescription medication. All specimens revealed chronic dermal and cartilage inflammation. Three of four cases had polymicrobial infection. One case had only skin contaminant growth on culture following multiple oral and parental antibiotic regimens.

Conclusions:
Surgical excision of diseased cartilage as a result of idiopathic chronic chondritis is an effective treatment in those cases refractory to antibiotics and incision and drainage, and should be considered in the treatment algorithm for similar patients, potentially offering definitive cure.
Proton Pump Inhibitor Prescribing and Monitoring Patterns Among Gastroenterology Practitioners
Authors: Leiman David A. , Ravi Karthik , Freedberg Daniel E. , Gyawali C. Prakash 
Published: October 2021

Goals:
The aim was to quantify proton pump inhibitor (PPI) practice habits among gastroenterology (GI) practitioners.

Background:
Reports of side effects have prompted patients and practitioners alike to discontinue PPI use. Emerging evidence-based literature on PPI risks and safety seek to guide practitioners, but the impact of this literature on PPI prescribing patterns has not been evaluated.

Study:
We performed an anonymous online survey of US GI practitioners across 6 academic and community affiliated medical centers. Demographic data including practice type and number of weekly gastroesophageal reflux disease patients seen were obtained. Survey questions evaluated practitioners’ monitoring for PPI side effects, dose adjustments, and sources of information about PPI risks.

Results:
The survey response rate was 60% (256/429). The majority of respondents were male (169, 66%) attending physicians (178, 70%) practicing general GI (63, 25%). There were 92 (36%) respondents who reported testing for PPI side effects at least once a year. Most respondents (143, 56%) reported discontinuing PPIs at least 50% of the time because of patients’ concerns about PPI side effects. The majority of respondents reported getting their information regarding PPI safety from published journals (239, 98%) as well as colleagues (222, 91%).

Conclusions:
Despite best available evidence suggesting safety of long-term PPI use without routine monitoring, stopping PPIs and monitoring for potential side effects occurs frequently, even within a cohort of mostly academic GI practitioners. Alternative strategies are needed to improve adherence to best practices, especially since gastroenterologists often serve as PPI experts.
Taking Advantage of the Teachable Moment at Initial Diagnosis of Prostate Cancer—Results of a Pilot Randomized Controlled Trial of Supervised Exercise Training
Authors: Schulz Gerald B. , Locke Jennifer A. , Campbell Kristin L. , Bland Kelcey A. , Van Patten Cheri L. , Black Peter C. , Goldenberg S. Larry , Flannigan Ryan 
Published: October 2021

Background
Increased physical activity (PA) levels are associated with improved prostate cancer (PCa) outcomes. Sustainable PA has been linked to improved health-related quality of life (QoL) in cancer patients. The time of diagnosis of PCa may offer a critical time point when patients might be more likely to consider lifestyle changes. This, in turn, may contribute to sustainable PA and its likely benefits.

Objective
The aims of this study were to determine if a structured PA intervention introduced at the time of diagnosis can (1) lead to sustainable PA and (2) help improve psychosocial and QoL outcomes as compared with usual PA.

Interventions/Methods
This was a pilot randomized controlled trial enrolling patients with intermediate-risk PCa into either arm A (supervised 8- to 12-week physical exercise program; n = 10) or control arm B (usual PA; n = 10). Primary outcome was PA at 6 months. Secondary outcomes were QoL, psychological well-being, physical fitness, and functional outcomes postintervention. Change over time was compared using a nonparametric Wilcoxon test.

Results
Demographic variables were the same between arms. Comparing parameters at the start and 6 months post–radical prostatectomy, PA significantly improved in arm A (self-reported Godin score 24.7 vs 42.8 units, P < .01, objective number of chair stands [14–19, P < .01]), but not in arm B. There were no significant differences between arms in QoL and psychosocial outcomes.

Conclusions
A preoperative supervised exercise training program increases long-term PA.

Implications for Practice
Future trials should evaluate PA sustainability beyond 6 months and if this leads to improved psychosocial and QoL outcomes.
Adherence to Oral Nutritional Supplements in Patients With Gastrointestinal Cancer
Authors: Qin Liyuan , Xu Doudou , Tian Qiuju , Wu Beiwen 
Published: October 2021

Background
Oral nutritional supplements (ONS) is a cost-effective nutritional therapy in patients with gastrointestinal cancer. However, information is lacking about adherence to ONS in general clinical settings. Figuring out adherence to ONS and related factors will provide evidence for the improvement of ONS usage practice.

Objective
The aim of this study was to survey adherence to ONS in gastrointestinal cancer patients with an ONS prescription and the factors associated with it.

Methods
A mixed-method prospective study was conducted. Multivariate analysis and semistructured interviews were performed to identify factors that affected patient adherence to ONS.

Results
Of 111 gastrointestinal cancer patients provided with an ONS prescription, the median of adherence to ONS was 50.00% (interquartile range, 28.57%–91.67%). Multivariate analysis indicated that participants with low weight showed higher adherence to ONS than those with normal weight (β = −2.61, P = .011) or overweight (β = −3.25, P = .002). Semistructured interviews on 14 participants suggested that factors related to adherence to ONS were needs perception and benefits, clarity of the target daily ONS intake, tolerance to ONS, the impact of disease or treatment, personal preference, and professional support.

Conclusion
This study reveals poor adherence to ONS in patients with gastrointestinal cancer and factors related to it in current clinical settings.

Implications for Practice
Our findings could provide evidence for the development of strategies to improve ONS usage practice. It suggests that the practice in ONS should be improved from aspects of nutritional assessment, education, tolerance, and symptom management, as well as follow-up and monitoring of patients.
Family Cohesiveness: A Dying Concern for the Coparent in Families With Parents With Advanced Cancer With Dependent Children
Authors: Caparso Cinzia , Benkert Ramona A. 
Published: October 2021

Background
Dying concerns are thoughts expressed by a person diagnosed with a terminal illness or by an individual coping with the impending death of a loved one. Little is known about the dying concerns of parents with advanced cancer (PWACs) with dependent children, and even less is known about the dying concerns of the coparent. Understanding the PWACs’ dying concerns for the coparent can contribute to the overall health of the family when faced with the death of a loved one.

Objective
The aim of this pilot descriptive study was to explore the PWACs’ perspective of their dying concerns for their coparent.

Methods
Four PWACs were recruited from 2 oncology inpatient units from an urban community hospital within the same hospital system. Semistructured interviews were conducted, audio-recorded, and transcribed with 4 participants. Data analysis used directed content analysis.

Results
Parents with advanced cancer expressed concern about the repercussions of advanced cancer on family cohesiveness. Three subthemes within this general structure were “My Weakest Link,” “If I’m Not There, Where Do They Go?” and “Putting Up a Front.”

Conclusions
Parents with advanced cancer have concerns beyond their role as a parent could make a difference in the overall health of the PWACs, but also the family unit. The PWACs’ concerns are present but may be covered over by use of protective mechanisms to maintain family cohesiveness.

Implications for Practice
Understanding dying concerns may enhance nurse-initiated communications between family members and healthcare providers to improve psychological distress and enhance family functioning.
Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study
Authors: Bernhardt Christina , Hou Su-I , King Christian , Miller Ann 
Published: October 2021

Objective:
Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health.

Design:
We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey.

Setting:
Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank.

Participants:
Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview).

Main Outcome Measure:
Patient comfort discussing food insecurity with their health care providers.

Results:
Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort.

Conclusion:
To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.
Physiological and Perceptual Responses in Spinal Cord Injury Handcyclists During an Endurance Interval Training
Authors: Antunes Diego , Borszcz Fernando K. , Nascimento Eduardo M. F. , Cavalheiro Giulia Pereira , Fischer Gabriela , Brickley Gary , de Lucas Ricardo D. 
Published: October 2021

Objective
This study sought to determine the physiological (oxygen uptake, heart rate, and blood lactate concentration) and perceptual (rating of perceived exertion) responses during an endurance interval training at the critical speed in elite handcyclists with spinal cord injury.

Design
Eight handcyclists performed an incremental test, three tests to exhaustion at a constant speed to determine critical speed, and the endurance interval training. The endurance interval training consisted of 6 × 5 mins at the individualized critical speed, with passive recovery of 50 secs. All testing was performed using their own handcycles on an oversized motorized treadmill. Physiological and perceptual responses were assessed during the incremental and endurance interval training tests.

Results
There was no significant difference in average oxygen uptake from the first to the sixth repetition. The mean ∆[La−]10_last between the 10th to the 30th minute of the exercise was −0.36 mmol·l−1, and no difference was detected from the first to the sixth repetition. The heart rate also remained stable during endurance interval training, whereas rating of perceived exertion increased significantly throughout the session.

Conclusions
Repetitions of 5 mins at the critical speed in elite handcyclists are associated with cardiorespiratory and lactate steady state, whereas the perceived exertion increased systematically.
Models of Care for Postacute COVID-19 Clinics
Authors: Verduzco-Gutierrez Monica , Estores Irene M. , Graf Min Jeong P. , Barshikar Surendra , Cabrera Juan A. , Chang Lynn E. , Eapen Blessen C. , Bell Kathleen R. 
Published: October 2021

Abstract
After surviving infection with the SARS-CoV-2 virus, individuals may have persistent symptoms and prolonged impairments that may last for weeks to months. The frequency and heterogeneity of persistent post-COVID conditions have created challenges in care. Specialty clinics are being established in response to an increasing need to care for patients with postacute sequelae of SARS-CoV-2 or long COVID syndrome. Although many post-COVID conditions can be bettered through a comprehensive rehabilitation plan, various clinical settings may benefit from differing models of coordinated care. We present five models of care in varying degrees of development and compare processes and adaptations to address the unique needs of each center and their unique patient populations. Forging a path to recovery will necessitate a multidisciplinary team with physiatry involvement to meet the distinctive needs of patients with postacute sequelae of SARS-CoV-2. Furthermore, it is imperative that there be equitable access to this care and commitment from healthcare institutions to provide resources for these programs.
Hamstring Muscle Cramp Visualized on Bone Single-Photon Emission Computed Tomography/Computed Tomography Hybrid Imaging
Authors: Tsiouris Spyridon , Xourgia Xanthi , Tsironi Maria , Sakellariou Constantinos , Fotopoulos Andreas 
Published: October 2021

Abstract
It is well recognized that bone-seeking radiotracers localize in muscles sustaining an injury from various causes (e.g., strenuous physical activity, trauma, hereditary myopathies, inflammatory myositides, medications, electrical burns, etc.). This report presents the case of an active 50-yr-old man (body mass index = 29) that was recently referred to our nuclear medicine department for bone scintigraphy, for the skeletal staging of a newly diagnosed prostate adenocarcinoma. The scan findings were unremarkable for its oncological indication but revealed extraosseous radiotracer absorption in the medial region of the hamstrings bilaterally. Hybrid scintitomography (single-photon emission computed tomography) with computed tomography indicated that this uptake involved the semitendinosus muscle. On a more meticulous repeat history questioning, he recalled experiencing muscle cramps on both posterior thighs 5 days earlier, during intense work-related physical activity (plumbing) under warm environmental conditions. The combination of strenuous exercise with likely dehydration contributed to bilateral self-limiting heat cramps of the hamstrings, leading to an inconsequential localized minor rhabdomyolysis that was discovered coincidentally a few days later during a bone scan. Although extraskeletal absorption of bone-seeking radiotracers in muscles is widely documented as a result of exertion or injury, this is the first report of radiotracer absorption induced by cramping.
Patient Preferences for Rituximab Additional Risk Minimization Measures: Results From an International Online Survey
Authors: Schneiderova Kristyna , Bere Nathalie , Stenver Doris Irene , Straus Sabine M. J. M. 
Published: October 2021

Objective
Patients’ opinions are essential in optimizing risk minimization measures (RMMs) because they bring their real-life experience of disease management and medicines’ use into the regulatory assessments. The aim of the survey launched in 2018 by the European Medicines Agency, in collaboration with the Pharmacovigilance Risk Assessment Committee, was to consult targeted patient groups treated with rituximab for nononcology indications to evaluate their preferences on how to receive information on progressive multifocal leukoencephalopathy and (serious) infections. Additional RMMs such as educational materials for physicians and patients including a patient alert card (PAC) and a patient brochure (PB) are in place to minimize these risks.

Methods
A question-based online survey in English created on the EU-Survey platform and disseminated primarily via relevant European patient organizations.

Results
Most patients (47 of 61) had knowledge of these potential adverse effects. Mostly, they were informed by a healthcare professional. Both a PAC and a PB were supported as useful tools to raise awareness of these adverse effects and thus minimize the potential risks among patients. Where the participants had to choose only 1 of these educational materials, 43 of them preferred a PAC, a shorted description that is always held by the patient and reaches the relevant healthcare professional when needed.

Conclusions
Collecting patients’ preferences supports periodic assessment of additional RMMs and increase transparency of regulatory processes. Considering the limitations of this initial survey, further investigation is needed to generalize the results into patients’ safety outcomes.
Safety of High-Intensity, Low-Volume Interval Training or Continuous Aerobic Training in Adults With Metabolic Syndrome
Authors: Gallo-Villegas Jaime , Restrepo Daniel , Pérez Laura , Castro-Valencia Leonardo A. , Narvaez-Sanchez Raúl , Osorio Jorge , Aguirre-Acevedo Daniel C. , Calderón Juan C. 
Published: October 2021

Objective
The aim of the study was to evaluate the safety of high-intensity, low-volume interval training (HIIT-low volume) compared with moderate-intensity continuous aerobic training (MICT) in adults with metabolic syndrome.

Methods
This is a controlled, randomized, clinical trial in patients without history of ischemic heart disease or diabetes, who underwent a supervised, 3 sessions/week, 12-week treadmill exercise program. The HIIT-low volume (n = 29) sessions consisted of 6 intervals with 1-minute, high-intensity phases at 90% of peak oxygen consumption (VO2peak). The MICT (n = 31) trained at 60% of VO2peak for 30 minutes. A new approach to record and classify all clinical events according to possible causality based on Naranjo’s algorithm was developed.

Results
Patients were 50.8 ± 6.0 years old, 70% women, with body mass index of 30.6 ± 4.0 kg/m2 and VO2peak of 29.0 ± 6.3 mL·kg−1·min−1. In total, 60 clinical events were recorded in the HIIT-low volume group and 48 in the MICT group, with 59.3% classified as general disease. Only 21 events were classified as adverse reactions possibly related to exercise, without any serious adverse reactions. Both interventions had a similar incidence of musculoskeletal events (incidence rate ratio, 1.1; 95% confidence interval, 0.6–1.8), but HIIT-low volume had a higher incidence of cardiovascular events (incidence rate ratio, 2.9; 95% CI, 0.4–22.8) after adjusting for age, sex, and body mass index (HIIT-low volume: chest pain [n = 1] and symptoms of venous insufficiency of lower limbs [n = 2]; MICT: chest pain [n = 1]).

Conclusions
The HIIT-low volume and MICT are safe in patients with metabolic syndrome. We recommend a muscle-conditioning program prior to both and to avoid HIIT-low volume in treadmill in patients with venous insufficiency of the lower limbs.

Trial registration number NCT03087721.
Endoscopic Endonasal Reconstruction Using a Pedicled Middle Turbinate Flap for Spontaneous Cerebrospinal Fluid Rhinorrhea
Authors: Takahara Kento , Ueda Ryo , Toda Masahiro 
Published: October 2021

Abstract
Although endoscopic skull-base reconstruction protocols to reduce cerebrospinal fluid (CSF) leakage are reported, the most effective management strategies have not been determined. We describe the successful repair of a spontaneous CSF leak using a vascularized middle turbinate flap (MTF) via an endonasal endoscopic approach and also discuss the effective reconstruction with other available pedicled flaps. An 11-year-old girl had a 5-month history of intermittent CSF rhinorrhea. Endoscopic endonasal skull base reconstruction was performed using the pedicled MTF technique, which sufficiently covered the unilateral cribriform plate and ethmoidal fovea including suspicious leakage site. Middle turbinate flaps may be good for repairing spontaneous CSF leaks, which commonly have small, low-flow CSF fistulas around a cribriform plate. As spontaneous CSF leaks are known to have a higher recurrence rate, MTF may be advantageous because more of the normal structures are retained.