bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Accuracy of Anti-CN1A on the Diagnosis of Inclusion Body Myositis. A Hierarchical Bivariate and Bayesian Meta-analysis
Authors: Mavroudis Ioannis , Knights Mark , Petridis Foivos , Chatzikonstantinou Symela , Karantali Eleni , Kazis Dimitrios 
Published: August 2021

Abstract
Sporadic inclusion body myositis (IBM) is an acquired muscle disease and the most common idiopathic inflammatory myopathy over the age of 50. It is characterized by male predominance, with a prevalence rate between 1 and 71 cases per million, reaching 139 cases per million over the age of 50 globally. The diagnosis of IBM is based on clinical presentation and muscle biopsy findings. However, there is increasing evidence for the role of genetics and serum biomarkers in supporting a diagnosis. Antibodies against the cytosolic 5′-nucleotidase 1A (Anti-CN1A), an enzyme catalyzing the conversion of adenosine monophosphate into adenosine and phosphate and is abundant in skeletal muscle, has been reported to be present in IBM and could be of crucial significance in the diagnosis of the disease. In this study, we investigated the diagnostic accuracy of anti-CN1A antibodies for sporadic IBM in comparison with other inflammatory myopathies, autoimmune disorders, motor neurone disease, using a hierarchical bivariate approach, and a Bayesian model taking into account the variable prevalence. The results of the present analysis show that anti-CN1A antibodies have moderate sensitivity, and despite having high specificity, they are not useful biomarkers for the diagnosis of IBM, polymyositis or dermatomyositis, other autoimmune conditions, or neuromuscular disorders. Neither the hierarchical bivariate nor the Bayesian analysis showed any significant usefulness of anti-CN1A antibodies in the diagnosis of IBM.
Mononeuropathy Multiplex After COVID-19
Authors: Carberry Nathan , Badu Helen , Ulane Christina M. , Beckley Akinpelumi , Rosenberg Samuel J. , Brenner Keith , Brannagan Thomas H. 
Published: August 2021

Abstract

Objectives:
COVID-19 is a novel coronavirus that emerged in 2019 and is responsible for a global pandemic. Numerous neurologic manifestations have been described in the literature regarding COVID-19, but most studies are focused on the central nervous system. The authors have noted an association between prior COVID-19 infection and the development of a systemic neuropathy that manifests with asymmetric sensorimotor loss in the peripheral nervous system. We describe 4 cases of mononeuropathy multiplex that were diagnosed after COVID-19 infection.

Methods:
All patients included were treated for severe COVID-19 infection at New York Presbyterian Hospital and subsequently referred to the Columbia Peripheral Neuropathy Center for persistent neuropathy.

Results:
Patient history, COVID-19 disease course, and mononeuropathy multiplex diagnostic evaluation of the 4 patients are recounted.

Conclusions:
We postulate a connection between COVID-19 and the development of mononeuropathy multiplex with implications in prognostication, rehabilitation strategies, and future treatments.
Punctate Pattern and Pemphigus: Is There Any Evidence of Punctate Pattern Among Iranian Patients?
Authors: Esmaili Nafiseh , Kamyab Kambiz , Hatami Parvaneh , Behrouzifar Shirin , Daneshpazhooh Maryam , Tavakolpour Soheil , Goodarzi Azadeh , Mortazavi Hossein , Aryanian Zeinab 
Published: August 2021

Pemphigus is an autoimmune blistering disease. Direct immunofluorescence (DIF) of the perilesional skin is one of the most effective techniques and probably the gold standard in the diagnosis of pemphigus. A specific punctate immunofluorescence pattern has been recently reported.

Aim:
To examine the prevalence of this novel pattern among Iranian patients with pemphigus and peruse the relationship between the presence of a punctate pattern with clinical severity of disease and histopathological findings.

Methods:
One hundred recently diagnosed patients with pemphigus were enrolled. DIF evaluation and routine light microscopy were performed on their biopsy specimens. Disease severity was determined using the Pemphigus Disease Area Index. Serum samples were collected to measure autoantibody titers using enzyme-linked immunosorbent assay.

Results:
All the samples evaluated by DIF showed a continuous linear pattern of intercellular IgG deposition, whereas none of them had a punctate pattern. Despite a significant correlation between the Pemphigus Disease Area Index score and autoantibody values, no association between histopathological findings and disease severity has been found.

Conclusion:
We could not detect any punctate pattern among Iranian patients with pemphigus. The importance of this pattern in the diagnosis of pemphigus might be different among patients with different ethnic and genetic factors.
Early Erythema Migrans: Do Not Count on Plasma Cells
Authors: Brem Candice E. , Goldberg Lynne J. 
Published: August 2021

Abstract:
Three hundred thousand new cases of Lyme disease are diagnosed annually in the United States. The earliest manifestation of the disease, erythema migrans, occurs earlier than serologic conversion, and skin biopsies can be very helpful in suggesting the diagnosis. Histopathologic findings vary depending on where in the lesion the specimen is taken, but typically consist of a superficial and deep perivascular and interstitial lymphocytic infiltrate with eosinophils centrally and with histiocytes and plasma cells at the periphery. Rare cases with interstitial histiocytes and rare-to-sparse plasma cells exist. We present a 67-year-old man whose skin biopsy, taken on day 2 of his eruption, demonstrated a subtle perivascular and interstitial infiltrate of histiocytes without plasma cells. Dermatopathologists need to be aware of this pattern and consider the diagnosis of erythema migrans, despite negative initial serologic testing.
Use of Absorbable Dermal Stapler in Reduction Mammoplasty: Assessing Technical, Quality-of-Life, and Aesthetics Outcomes
Authors: Patel Viren , Green Jason L. , Christopher Adrienne N. , Morris Martin P. , Weiss Eric S. , Broach Robyn B. , Butler Paris D. 
Published: August 2021

Introduction:
Reduction mammaplasty is a mainstay in the treatment of symptomatic macromastia, with a well-described positive impact on patient quality-of-life (QoL). Absorbable dermal staplers have the potential to improve the efficiency of skin closure in reduction mammoplasties, but a more comprehensive assessment of its impact on key outcomes has not been fully elucidated.

Methods:
A retrospective review of patients undergoing reduction mammoplasty between November 2018 and December 2020 was conducted. Patients were included if they had undergone a wise-pattern reduction with a superomedial pedicle and completed 3 months of follow-up. Patient demographics, operative information, clinical and aesthetic outcomes, and QoL were compared between patients that had INSORB stapler-assisted and suture-only closures.

Results:
Seventy-five patients met the inclusion criteria, with 34 patients (45%) in the stapler cohort. Total procedure time was significantly reduced with the use of the dermal stapler (stapler: 154 vs. suture: 170 minutes; p = 0.003). The incidence of major complications was similar between cohorts (stapler: 8.8% vs. suture: 12%; p = 0.64), as was the incidence of minor complications (stapler: 44% vs. suture: 41%; p = 0.82). Regardless of closure technique, patients demonstrated significant increases in all QoL domains (p <0.001). Lastly, 10 independent raters found no difference in the cosmetic appearance of breasts from either cohort, when judging overall breast appearance, shape, scars, volume and the nipple-areolar complex (all p > 0.05).

Conclusions:
The dermal stapler improves efficiency of closure during reduction mammoplasty without increasing the incidence of wound healing complications. Additionally, cosmetic outcomes are not affected, and patients demonstrate similar post-operative satisfaction with the result regardless of closure technique.
A Randomized Controlled Trial to Assess the Cost-effectiveness of a Novel, Simple Modification to the Negative Pressure Wound Therapy System
Authors: Albayati Waleed K. , Youha Sarah Al , Ali Ali A. , Fakhra Zainab 
Published: August 2021

Background:
Negative pressure wound therapy (NPWT) has shown remarkable adaptation in wound management worldwide. Numerous studies have provided evidence that demonstrates both the medical and financial advantages of NPWT. In this study, the VAC Therapy System, one of the leading commercially used NPWT systems, has been utilized to treat patients with either acute or chronic wounds requiring surgical intervention, with the aim of demonstrating the efficacy of using a modified version of the VAC system while reducing the total associated cost.

Method:
The patients were divided into two randomly selected groups using randomization generator software. A modification was made by replacing the disposable canister provided by Kinetic Concepts Inc., with an alternative reusable canister (Baxter, Inc.); one group was assigned to use the conventional VAC Therapy System, and the other was assigned to use the modified version. Our study aimed to investigate whether this modification would lower the cost of the VAC Therapy System while still achieving the desired outcome.

Results:
The VAC Therapy System contributed to improving the wound bed score in both groups, which supports previous findings on the effectiveness of NPWT while reflecting that the modification did not negatively impact the functionality and the integrity of the VAC Therapy System. Furthermore, the average daily consumables cost was markedly reduced in the modified group compared with the standard group, which reduced the overall cost of treatment.

Conclusion:
It is possible to use the VAC Therapy System to its full advantage, while minimizing the financial burden of using it.
ARE THERE TWO FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME?
Authors: Essilfie Juliet , Bacci Tommaso , Abdelhakim Aliaa H. , Ramtohul Prithvi , Turchi Federica , Freund K. Bailey , Yannuzzi Lawrence A. 
Published: August 2021

Purpose:
To analyze the nature of multiple evanescent white dot syndrome (MEWDS) and differentiate an idiopathic or primary form of MEWDS from a secondary form that is seen in association with other clinical conditions affecting the posterior segment of the eye.

Methods:
Clinical and multimodal imaging findings including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography of patients with secondary MEWDS are presented.

Results:
Twenty consecutive patients with secondary MEWDS were evaluated. Fifteen patients were female. Most were young adults aged between 20 to 40 years with myopia (less than −6 diopters). Pathologic conditions associated with the secondary MEWDS reaction were high myopia (greater than −6 diopters) in two eyes, previous vitreoretinal surgery for rhegmatogenous retinal detachment in 2 eyes, and manifestations of multifocal choroiditis in 18 eyes. In all eyes, the MEWDS lesions followed a course of progression and resolution independent from the underlying condition.

Conclusion:
Secondary MEWDS seems to be an epiphenomenon (“EpiMEWDS”) that may be seen in association with clinical manifestations disruptive to the choriocapillaris–Bruch membrane–retinal pigment epithelium complex.
Giant Fornix Syndrome: How Much Conjunctiva Should Be Resected?
Authors: Lam Stacey C. , Szeto Simon K. H. , Yuen Hunter K. L. 
Published: August 2021

Purpose:
To characterize clinical profiles of Chinese patients with giant fornix syndrome (GFS), compare surgical outcomes with amount of Müller’s muscle-conjunctival resection (MMCR), and elicit risk factors for those who have prolonged recovery after MMCR.

Methods:
Retrospective, observational, interventional cohort study on GFS eyes. Two treatment groups were established: limited MMCR—as defined by 8 mm or less resection; maximal MMCR—as defined by 10–12 mm resection. Good responders were defined as eyes exhibiting disease resolution within 3 months after surgery. Primary outcome was disease resolution, secondary outcome was ptosis improvement.

Results:
Mean age was 81.9 years old (range, 76–89), with 6 (75%) females and 2 (25%) males. All 10 eyes presented with discharge, partial ptosis, and conjunctival injection. In the limited MMCR group, time to symptom resolution was longer at 5.56 months, while maximal MMCR group was 2.02 months (p = 0.004). Limited MMCR group also had lower primary surgical success and required additional surgery compared with maximal MMCR group (p = 0.008). At mean follow up of 34.4 months (range, 11–65 months), all eyes achieved disease resolution, no recurrence, and ptosis improvement.

Conclusions:
In the largest series on Chinese eyes with GFS to date, GFS is mainly a disease in elderly females. Maximal MMCR has a higher rate of surgical success with no additional complications. For those who underwent MMCR, additional treatment such as topical steroids and fortified antibiotics do not affect time to recovery. These findings may help ophthalmologists consider maximal MMCR as a definitive surgical treatment in GFS eyes.
Scrutinizing the causal relationship between schizophrenia and vitamin supplementation: a Mendelian randomization study
Authors: Fahira Aamir , Zhu Zijia , Li Zhiqiang , Shi Yongyong 
Published: August 2021

Objective:
Observational studies have reported malnutrition and vitamin deficiency in patients with schizophrenia (SZ), which can lead to serious metabolic syndromes and decrease anti-psychiatric drug outcomes. Whereas, vitamin intake along with psychiatric medication can enhance the medication outcomes. However, it is still unknown if SZ induces vitamin deficiency. Herein, we conduct the Mendelian randomization analysis to explore the causal relationship between schizophrenia and vitamins supplementation.

Methods:
We retrieved the genome-wide summary statistical data for schizophrenia from recent SZ GWAS data (43,175 cases and 65,166 controls) and vitamins supplementation GWAS data from Neale’s GWAS datasets (more than 337,000 samples from the European population) and performed a two-sample Mendelian randomization analysis to determine the causal association of SZ with vitamin supplementation, in addition, we conduct the sensitivity analysis to obtain reliable results and remove confounding bias.

Results:

SZ have causal relationships with vitamins A, B, C, D, and E (SZ/vitamin A: β = 0.002, se= 0.001, 95% confidence interval (CI): 0.001 to 0.004,
P
= 1.41E-05, heterogeneity
P
= 0.4486; SZ/vitamin B: β= 0.004, se= 0.001, 95% CI: 0.002-0.005,
P
= 7.0E-05, heterogeneity
P
= 0.2217; SZ/vitamin C: β= 0.004, se= 0.001, 95% CI: 0.002-0.007,
P
= 0.001, heterogeneity
P
= 0.1349; SZ/vitamin D: β= 0.003, se= 0.001, 95% CI: 0.002-0.005,
P
= 0.001, heterogeneity
P
= 0.433; SZ/vitamin E: β= 0.003, se= 0.001, 95% CI: 0.002-0.005,
P
= 5.0E-05, heterogeneity
P
= 0.1382).

Conclusion:
Our findings suggest that vitamin levels and supplementation should be carefully controlled in patients with SZ, which in turn may enhance the therapeutic effects of antipsychotic drug treatments.
Value of Nurse Practitioner Inpatient Hospital Staffing
Authors: Aiken Linda H. , Sloane Douglas M. , Brom Heather M. , Todd Barbara A. , Barnes Hilary , Cimiotti Jeannie P. , Cunningham Regina S. , McHugh Matthew D. 
Published: August 2021

Background:
Evidence indicates hospitals with better registered nurse (RN) staffing have better patient outcomes. Whether involving more nurse practitioners (NPs) in inpatient care produces better outcomes is largely unknown.

Objective:
The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing.

Research Design:
This was a 2015–2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [<1 NP/100 beds (N=132), 1–2.99 NPs/100 beds (N=279), and 3+ NPs/100 beds (N=168)].

Subjects:
RNs randomly sampled nurses from licensure lists yielded 22,273 RNs in study hospitals; discharge data for 1.4 million surgical patients; HCAHPS data for 86% of study hospitals.

Measures:
Mortality, readmissions, lengths of stay, MSPB, patient experience, and quality reported by patients and nurses.

Results:
After adjustments, patients in hospitals with 3+ NPs/100 beds had lower odds than patients in hospitals with <1 NP/100 beds of 30-day mortality [odds ratio (OR)2=0.76; 95% confidence interval (CI)=0.67–0.82; P<0.001] and 7-day readmissions (OR2=0.90; 95% CI=0.86–0.96; P<0.001), shorter average length of stay (incident rate ratio2=0.92; 95% CI=0.88–0.96; P<0.001) and 5.4% lower average MSPB (95% CI=3.8%–7.1%). Patients and nurses in the hospitals with higher NP/bed ratios were significantly more likely to report better care quality and safety, and nurses reported lower burnout, higher job satisfaction, greater intentions of staying in their jobs.

Conclusions:
Having more NPs in hospitals has favorable effects on patients, staff nurse satisfaction, and efficiency. NPs add value to existing labor resources.
The Baptist Health Lexington Nursing Orientation Progression Tool
Authors: Rogers Allison , Fultz Julia , Clements-Hickman Alyssa L. , Davies Claire C. 
Published: August 2021

OBJECTIVE
The purpose of this study was to develop and test a tool to monitor a nursing orientee's progress to competence.

BACKGROUND
The literature suggests that, during orientation, consistent documentation and communication among educators, preceptors, and nurse leaders facilitate a timely progression to independent practice for new nurses.

METHODS
A 2-phase methodological study was conducted. Nurse educators clarified goals, identified essential competencies, and developed the Baptist Health Lexington Nursing Orientation Progression Tool (OPT). The tool was used to monitor orientees' progression through orientation.

RESULTS
Content validity assessment of the OPT (content validity index = 0.98) demonstrated strong validity. Testing of the tool revealed 31 nurses completed orientation early, 12 completed orientation on time, and 18 nurses required extended orientation time. All requiring an extension were new graduates.

CONCLUSION
The OPT guided preceptors to facilitate timely completion of orientation among newly hired nurses. Findings suggest that new graduates may need more assistance than experienced nurses.
Evaluating Meaningful Levels of Financial Toxicity in Gynecologic Cancers
Authors: Esselen Katharine McKinley , Gompers Annika , Hacker Michele R. , Bouberhan Sara , Shea Meghan , Summerlin Sarah S. , Rucker Lindsay R. , Huh Warner K. , Pisu Maria , Liang Margaret I. 
Published: August 2021

(Abstracted from Int J Gynecol Cancer 2021;31:801–806)
“Financial toxicity” is a term used to define financial hardship and associated stress that patients with cancer often experience due to the costs of care. The Comprehensive Score for Financial Toxicity (COST) is a validated 11-item tool used to measure financial toxicity as it relates to cancer diagnosis and treatment.
Adverse Cardiovascular Events Associated With Female Pelvic Reconstructive Surgery
Authors: Roberts Kasey , Slopnick Emily , Chapman Graham , Mangel Jeffrey , Sheyn David 
Published: August 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:230–237)
The lifetime risk of having female pelvic reconstructive surgery (FPRS) is estimated to be approximately 20% for American women. Most PRS occur in women aged 60 to 69 years.
Diagnosis Documentation of Critically Ill Children at Admission to a PICU*
Authors: Vivtcharenko Victoria Y. , Ramesh Sonali , Dukes Kimberly C. , Singh Hardeep , Herwaldt Loreen A. , Reisinger Heather Schacht , Cifra Christina L. 
Published: August 2021

OBJECTIVES:
Multidisciplinary PICU teams must effectively share information while caring for critically ill children. Clinical documentation helps clinicians develop a shared understanding of the patient’s diagnosis, which informs decision-making. However, diagnosis-related documentation in the PICU is understudied, thus limiting insights into how pediatric intensivists convey their diagnostic reasoning. Our objective was to describe how pediatric critical care clinicians document patients’ diagnoses at PICU admission.

DESIGN:
Retrospective mixed methods study describing diagnosis documentation in electronic health records.

SETTING:
Academic tertiary referral PICU.

PATIENTS:
Children 0–17 years old admitted nonelectively to a single PICU over 1 year.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One hundred PICU admission notes for 96 unique patients were reviewed. In 87% of notes, both attending physicians and residents or advanced practice providers documented a primary diagnosis; in 13%, primary diagnoses were documented by residents or advanced practice providers alone. Most diagnoses (72%) were written as narrative free text, 11% were documented as problem lists/billing codes, and 17% used both formats. At least one rationale was documented to justify the primary diagnosis in 91% of notes. Diagnostic uncertainty was present in 52% of notes, most commonly suggested by clinicians’ use of words indicating uncertainty (65%) and documentation of differential diagnoses (60%). Clinicians’ integration and interpretation of information varied in terms of: 1) organization of diagnosis narratives, 2) use of contextual details to clarify the diagnosis, and 3) expression of diagnostic uncertainty.

CONCLUSIONS:
In this descriptive study, most PICU admission notes documented a rationale for the primary diagnosis and expressed diagnostic uncertainty. Clinicians varied widely in how they organized diagnostic information, used contextual details to clarify the diagnosis, and expressed uncertainty. Future work is needed to determine how diagnosis narratives affect clinical decision-making, patient care, and outcomes.