bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Tonsillectomy Bleeding: A National Perspective
Authors: Dhaduk Nehal , Rodgers Ashley , Govindan Aparna , Kalyoussef Evelyne 
Published: January 2021

Objectives: Tonsillectomy is one of the most common otolaryngologic procedures. Hemorrhage after tonsillectomy is one of the most feared complications by surgeons and patients alike. The objective of this study was to analyze the risk factors associated with an increase in post-tonsillectomy hemorrhage in the pediatric population using a large national database. Methods: The Kids’ Inpatient Database (KID) from 2000 to 2012 was queried for patients between the ages of 1 to 17 years with post-tonsillectomy hemorrhage. Univariate and multivariate analyses were performed to obtain trends in patient demographics, comorbidities, and hospital information. Results: Overall 45 940 pediatric cases of tonsillectomy were identified of which 5470 (11.9%) resulted in postoperative hemorrhage. Patients with postoperative hemorrhage were significantly older with mean age of 8.62 (±4.75) compared to all patients. Females were found to have higher rates of hemorrhage when compared to males 14.6% versus 11.5% ( P < .001). The rate of white patients who had hemorrhage was 16.3% ( P < .001). The most common comorbidities significantly associated with hemorrhage were fluid and electrolyte disorders (6.6% P < .001), deficiency anemia (3.8%; P < .001), and coagulopathy (2.7%; P < .001). Urban nonteaching hospitals had higher rates of hemorrhage (19.6%; P < .001) and the Northeast was the most common region (15.2%; P < .001). On multivariate analysis, older patients and white ethnicity showed a significantly increased risk of hemorrhage. Patients with pre-existing comorbidities such as coagulopathy, deficiency anemia, and fluid and electrolyte disorders circulation were also found to have higher odds ratios of bleeding. Conclusion: Postoperative hemorrhage is a common complication following tonsillectomy with a rate of 11.9% in this study. A higher rate of hemorrhage was seen with increasing age, white race, and males overall, as well as patients with fluid and electrolyte disorders. Urban non-teaching hospitals and the Northeast region also saw increased rates of hemorrhage.
Multiple endocrine neoplasia type 1 with refractory hypoglycemia and lung and liver metastases: a case report
Authors: Wang Yong , Zhang Hui 
Published: January 2021

Background Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant genetic disease. MEN1 with multiple endocrine adenomatosis complicated by multiple endocrine tumors is often misdiagnosed or missed. Herein, we describe the first reported case of refractory hypoglycemia and liver and lung metastases in a patient with MEN1. Case presentation: A 40-year-old man presented with a 3-month history of intermittent palpitations, fatigue, and sweating. The patient had a history of prolactinoma resection and refractory hypoglycemia 2 years earlier. Analyses of blood samples showed a decrease in random and fasting blood glucose and an increase in prolactin (PRL). Computed tomography (CT) and magnetic resonance imaging scans revealed two substantial masses in the pancreas and large masses in the liver and lung. Positron emission tomography-CT images showed hypermetabolic masses in the pancreatic body and tail. The liver and lung lesions were also hypermetabolic. The pancreatic lesion was surgically removed, and pathology confirmed that the mass was MEN1. The liver and lung masses were confirmed as metastatic tumors. Conclusion If clinicians better understand MEN1, they can obtain a detailed patient and family history during the initial visit, allowing earlier diagnosis and intervention and improved prognosis.
Relationship between serum cystatin-c and coronary lesion severity in coronary artery disease patients with a normal glomerular filtration rate
Authors: Pan Junqiang , Sun Xifeng , Zhang Pengjie , Chen Haichao , Lin Jing 
Published: January 2021

Objective Cardiovascular disease is a major cause of death. This study evaluated the relationship between serum cystatin-c and coronary lesion severity in coronary artery disease (CAD) patients with a normal glomerular filtration rate. Methods Nine hundred and fifty-nine patients were retrospectively included and divided into non-CAD and CAD groups according to coronary angiography results. CAD patients were classified into three groups by Gensini score tertiles. Multivariable logistic regression was used to study the relationship between serum cystatin-c and coronary lesion severity. Results Serum cystatin-c levels were significantly higher in CAD patients than in non-CAD patients. Correlation analysis revealed significant correlations between serum cystatin-c levels with the Gensini score and the number of diseased vessels. The area under the receiver operating characteristic curve of serum cystatin-c was 0.544 and 0.555 for predicting a high Gensini score and three-vessel disease, respectively. Multivariate stepwise regression analysis demonstrated that the serum cystatin-c level was an independent predictor of a high Gensini score [odds ratio (OR) = 2.177, 95% confidence interval (CI) 1.140–3.930] and three-vessel disease (OR = 1.845, 95% CI 0.994–3.424) after adjusting for the conventional CAD risk factors. Conclusions Serum cystatin-c was elevated in CAD patients and may be an independent predictor of CAD severity.
Psychiatry after-hours: factors impacting workload and workflow
Authors: Thomson Alisha , McDermott Brett 
Published: January 2021

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. Conclusions: The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.
‘I can see clearly now’: clarifying the role of psychiatry in global disaster
Authors: Pridmore William 
Published: January 2021

Objective: First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. Method: A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. Results: Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. Conclusion: A novel framework for the psychiatrist’s contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness.
Palliative Care Services in the NeuroICU: Opportunities and Persisting Barriers
Authors: Morris Michael , Mroz Emily L. , Popescu Cristina , Baron-Lee Jacqueline , Busl Katharina M. 
Published: January 2021

Background: End-of-life (EOL) supportive care, including palliative and hospice services, is an area of increasing importance in critical care. Neurointensivists face unique challenges in providing timely supportive care to terminally ill patients expected to expire in the NeuroICU. Objective: This study explored the extent of effective utilization of, and recorded barriers to, palliative and hospice services in a dedicated 30-bed NeuroICU at a large academic medical center. Design: A retrospective chart review of patients who expired in the NeuroICU was conducted. The timeline from patient admission to arrival of palliative care services was traced. Qualitative review of chart notes was used to identify barriers to provision of palliative services. Setting: A total of 330 patients expired in the NeuroICU during the study period, including 176 from the neurology and 154 from the neurosurgical service. Results: Across services, 146 expired patients were never referred to palliative care or hospice services. Of those referred, over one-third were referred more than 4 days past admission to the NeuroICU. On average, patients were referred with less than 1 day before expiration. Common barriers to referral for supportive services were documented (e.g., patient expected to expire, family declined service). Conclusions: Despite benefits of palliative care and an in-hospital hospice opportunity, we identified lack of referral, and particularly delays in referral to services as significant barriers. Our study highlights these as missed opportunities for patients and families to receive maximum benefits from these services. Future research should solidify triggers for EOL services in this setting.
End-user perspectives on the development of an online intervention for parents of children on the autism spectrum
Authors: Hermaszewska Susannah , Sin Jacqueline 
Published: January 2021

Strong evidence suggests that parents of children on the autism spectrum face increased stressors to their physical and mental wellbeing due to the demands of caregiving and paucity of support. The disparity between the services currently offered and unmet needs indicates that accessible and flexible support through online delivery is needed for parents. This study presents the ideas and perspectives collected from five focus groups of 17 parents of autistic children, on the optimal content and implementation strategy of an online intervention. Using thematic framework analysis, we derived themes under the categories: the need for online interventions; content and design; and implementation. Parents supported the development of a multicomponent online intervention which combines psychoeducation with peer-support and access to healthcare professionals. Lay abstract Parent caregivers play an essential role in the lives of individuals on the autism spectrum. The demands of caregiving can have negative effects on the mental and physical wellbeing of parents. Different types of formal support have been developed to help parents to cope with caregiving; however, many parents struggle to access services due to limited availability and busy schedules. The Internet could offer parents more accessible and flexible support. We asked 17 parents what content they would like to include in an online resource. Parents told us about their experiences trying to access and use existing formal support and websites. They overwhelmingly supported the development of an online resource informed by their suggestions. Parents emphasised the need for easier access to information through educational components and direct access to healthcare professionals online. Parents also wanted help with finding existing services and reliable, locally relevant information. Parents stressed the need for a safe environment to meet and chat with other parents online. This research forms the first stage in the development process of an online health resource for parents.
Tenecteplase in wake-up ischemic stroke trial: Protocol for a randomized-controlled trial
Authors: Roaldsen Melinda B , Lindekleiv Haakon , Eltoft Agnethe , Jusufovic Mirza , Søyland Mary-Helen , Petersson Jesper , Indredavik Bent , Tveiten Arnstein , Putaala Jukka , Christensen Hanne , Kõrv Janika , Jatužis Dalius , Engelter Stefan T , Marco De Marchis Gian , Wilsgaard Tom , Werring David J , Robinson Thompson , Mathiesen Ellisiv B , Berge Eivind 
Published: January 2021

Background Patients with wake-up ischemic stroke who have evidence of salvageable tissue on advanced imaging can benefit from intravenous thrombolysis. It is not known whether patients who do not fulfil such imaging criteria might benefit from treatment, but studies indicate that treatment based on non-contrast CT criteria may be safe. Tenecteplase has shown promising results in patients with acute ischemic stroke. The aim of the Tenecteplase in Wake-up Ischemic Stroke Trial (TWIST) is to compare the effect of thrombolytic treatment with tenecteplase and standard care versus standard care alone in patients with wake-up ischemic stroke selected by non-contrast CT. Methods/design TWIST is an international, investigator-initiated, multi-centre, prospective, randomized-controlled, open-label, blinded end-point trial of tenecteplase ( n = 300) versus standard care ( n = 300) in patients who wake up with an acute ischemic stroke and can be treated within 4.5 h upon awakening. Seventy-seven centres in 10 countries (Denmark, Estonia, Finland, Latvia, Lithuania, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom) participate. The primary outcome is the modified Rankin Scale on the ordinal scale (0–6) at three months. Discussion TWIST aims to determine the effect and safety of thrombolytic treatment with tenecteplase in patients with wake-up ischemic stroke selected by non-contrast CT. Trial registration ClinicalTrials.gov NCT03181360. EudraCT Number 2014-000096-80.
Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi
Authors: Darcourt Jean , Garcia Cédric , Phuong Do M , Michelozzi Caterina , Bellanger Guillaume , Adam Gilles , Roques Margaux , Januel Anne C , Tall Philippe , Albucher Jean F , Olivot Jean M , Bonneville Fabrice , Payrastre Bernard , Cognard Christophe 
Published: January 2021

Background The composition of the thrombus influences its retrievability by mechanical thrombectomy. Purpose Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. Methods This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS−) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. Results Histological analysis was performed on 102 clots. Thrombi with SVS− were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases ( n = 131). Clots retrieved combined therapy-rescue were richer in fibrin/platelets 63.9% versus 50.8% for aspiration first pass strategy, p = 0.03. Logistic regression analysis showed that fibrin/platelet-poor clots (<60%) were significantly more likely to be recanalized by aspiration first pass strategy compared to fibrin/platelet-rich clots (>60%) that were more likely recanalized by combined therapy-rescue after aspiration first pass strategy failure (OR = 3.5; 95% CI = 1.2–10.8; p = 0.0054). Conclusions Our results confirm that SVS− clots are rich in fibrin/platelets and suggest that these “white clots” are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
Matching comparisons of therapeutic efficacy suggest better clinical outcomes for patients treated with peginterferon beta-1a than with glatiramer acetate
Authors: Scott Thomas F. , Su Ray , Xiong Kuangnan , Altincatal Arman , Castrillo-Viguera Carmen , Naylor Maria L. 
Published: January 2021

Background: Peginterferon beta-1a and glatiramer acetate (GA) are approved first-line therapies for the treatment of relapsing forms of multiple sclerosis, but their therapeutic efficacy has not been compared directly. Methods: Clinical outcomes at 2 years, including no evidence of disease activity (NEDA), for patients receiving peginterferon beta-1a 125 mcg every 2 weeks (Q2W) or GA 20 mg/ml once daily (QD) were compared by propensity score matching analysis using individual patient data from ADVANCE and CONFIRM phase III clinical trials. In addition, clinical outcomes at 1–3 years for patients receiving peginterferon beta-1a Q2W or GA 40 mg/ml three times a week (TIW) were evaluated using a matching-adjusted comparison analysis of individual patient data from ADVANCE and the ADVANCE extension study, ATTAIN, and aggregate patient data from the phase III GALA and the GALA extension studies. Results: Propensity-score-matched peginterferon beta-1a patients ( n = 336) had a significantly lower annualized relapse rate [ARR (0.204 versus 0.282); rate ratio = 0.724; p = 0.045], a significantly lower probability of 12-week confirmed disability worsening (10.0% versus 14.6%; hazard ratio = 0.625; p = 0.048), and a significantly higher rate of NEDA (20.3% versus 11.5%; p = 0.047) compared with GA 20 mg/ml QD patients after 2 years of treatment. Matching-adjusted peginterferon beta-1a patients (effective n = 276) demonstrated a similar ARR at 1 year (0.278 versus 0.318; p = 0.375) and significantly lower ARR at 2 years (0.0901 versus 0.203; p = 0.032) and 3 years (0.109 versus 0.209; p = 0.047) compared with GA 40 mg/ml TIW patients ( n = 834). Conclusion: Results from separate matching comparisons of phase III clinical trials and extension studies suggest that peginterferon beta-1a 125 mcg Q2W may provide better clinical outcomes than GA (20 mg/ml QD or 40 mg/ml TIW).
Compression gloves for patients with hand arthritis (C-GLOVES): A feasibility study
Authors: Hammond Alison , Prior Yeliz 
Published: January 2021

Introduction Compression gloves are frequently provided to patients with hand arthritis. Evidence for effectiveness is limited. The aim of this study was to determine feasibility of recruitment, assessment and treatment procedures, in preparation for a future compression glove trial. Methods A non-randomised feasibility study with out-patients with either undifferentiated inflammatory arthritis, rheumatoid arthritis or hand osteoarthritis, with moderate to severe hand pain. All received Isotoner™ compression gloves provided by rheumatology occupational therapists. The main outcomes were feasibility of recruitment, assessment and treatment procedures, trial outcome selection and sample size calculation. Participants were assessed at baseline and four weeks. Assessments included: numeric rating scales (0–10) of hand pain (on activity, at rest, at night) and stiffness; hand joint swelling; finger flexion; and hand function (Grip Ability Test). Results Of 318 patients screened, 86/204 (42%) of inflammatory and 68/114 (60%) of hand osteoarthritis patients were eligible. Of these, 41 (48%: age: 59.10 (SD 12.54) years) and 32 (47%: age: 60.75 (SD 8.64) years) respectively, consented. All completed four-week follow-up. Assessment and treatment protocols were feasible. Hand pain on activity and at night, stiffness, joint swelling, finger flexion and hand function improved: e.g. hand pain on activity: inflammatory arthritis change = −0.95 (SD 2.26; p = 0.01); osteoarthritis −1.57 (SD 1.78; p = 0.001). Participants reported improved hand pain, stiffness and hand function as main benefits. Conclusion Procedures tested were feasible. The most relevant primary outcome was hand pain on activity. Future trials would need 161 participants (Inflammatory arthritis) and 151 (hand osteoarthritis). Trial registration: Clinical Trials.Gov: NCT01874067
Lower Extremity Compartment Syndrome in National Football League Athletes
Authors: Lamplot Joseph D. , Wang Dean , Weiss Leigh J. , Baum Michael , Zeidler Kristina , Mack Christina , Barnes Ronnie P. , Warren Russell F. , Taylor Samuel A. , Rodeo Scott A. 
Published: January 2021

Background: The purpose of this study was to evaluate the incidence of lower extremity compartment syndrome in National Football League (NFL) athletes and report the mechanisms of injury, methods of treatment, and subsequent days missed. We review the existing literature on lower extremity compartment syndrome in athletic populations. Hypothesis: Lower extremity compartment syndrome occurs with a low incidence in NFL athletes, and there is a high return-to-play rate after surgical management of acute compartment syndrome. Study Design: Case series. Level of Evidence: Level 4. Methods: A retrospective review of recorded cases of lower extremity compartment syndrome from 2000 to 2017 was performed using the NFL Injury Surveillance System and electronic medical record system. Epidemiological data, injury mechanism, rates of surgery, and days missed due to injury were recorded. Results: During the study period, 22 cases of leg compartment syndrome in 21 athletes were recorded. Of these injuries, 50% occurred in games and 73% were the result of a direct impact to the leg. Concomitant tibial fracture was noted in only 2 cases (9.1%) and there was only 1 reported case of chronic exertional compartment syndrome. Surgery was documented in 15 of 22 cases (68.2%). For acute nonfracture cases, the average time missed due to injury was 24.2 days (range, 5-54 days), and all were able to return to full participation within the same season. Conclusion: NFL athletes with acute leg compartment syndrome treated with surgery exhibited a high rate of return to play within the same season. Clinical Relevance: Although compartment syndrome is a relatively rare diagnosis among NFL players, team physicians and athletic trainers must maintain a high index of suspicion to expediently diagnose and treat this potentially limb-threatening condition.