bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality and Accuracy of Cervical Radiculopathy-specific Information on the Internet
Authors: Truumees David , Duncan Ashley , Kunj Amin , Rajagopalan Dayal , Geck Matthew , Singh Devender , Stokes John , Truumees Eeric 
Published: June 2021

Study Design.
Cross-sectional analysis.

Objective.
This study aimed to evaluate the quality and accuracy of the content surrounding cervical radiculopathy available on the internet.

Summary of Background Data.
Those experiencing cervical radiculopathy and their families are increasingly browsing the worldwide web for medical information. As the information offered is likely to influence their health care choices, spine care providers must understand the quality and accuracy of that information.

Methods.
Independent searches were conducted on the three most commonly accessed search engines (Google, Yahoo, and Bing) using the keyword “cervical radiculopathy.” The searches were performed on June 28th, 2019. The top 50 sites from each search engines were reviewed. The websites were evaluated using quality, accuracy and usability markers.

Results.
Seventy-seven unique websites were analyzed; 54.5% were physician or medical group professional sites, 20.8% as non-physician, 10.4% as unidentified, 7.8% as academics, and 6.5% were commercial. Accuracy ranged from <25% to >75% were recorded with a mean accuracy of 3.5 signifying 50% to 75% agreement. Overall, website categories had a significant effect on Journal of American Medical Association (JAMA) score, content quality, accuracy, total summary scores, distraction index, reading ease, and grade level (P
< 0.05). Academic sites had the highest mean quality content, accuracy and total summary scores. Four of the top five websites with the highest total summary scores were physician driven. On average, Health on the Net code (HONcode) certified websites had lower grade level readability with greater reading ease and higher DISCERN and JAMA scores than uncertified sites (P < 0.05).

Conclusion.
Despite the wide number of sources available, the quality, accuracy, pertinence, and intelligibility of the information remains highly variable. Clinicians treating patients with cervical radiculopathy should direct them to verifiable sites with regulated information and, where possible, contribute high- quality information to those sites.

Level of Evidence: 4
Surgical Elbow Dislocation: Technique and Comparative Outcomes
Authors: Hoyt Benjamin W. , Clark DesRaj M. , Walsh Sarah A. , Pensy Raymond A. 
Published: June 2021

Introduction:
Surgical access to lateral column fractures of the distal humerus is difficult via traditional approaches due to limited anterior articular exposure for direct reduction and fixation. We have refined a surgical elbow dislocation approach to the articular surface of the distal humerus for fixation of lateral column injuries, which may permit improved access for operative fixation.

Materials and Methods:
We performed a retrospective review of lateral column fractures treated with open reduction internal fixation at our institution between 2009 and 2019. We divided patients into 3 cohorts based on surgical approach: surgical dislocation (n=10), lateral (n=17), and posterior (n=9). Surgical reports, radiographs, and patient records were reviewed for hardware positioning, tourniquet time, estimated blood loss, postoperative reduction quality, and patient outcomes including range of motion, neurovascular injury, development of heterotopic ossification, and pain on a visual analog scale.

Results:
With the numbers available, we were unable to detect a significant difference in outcomes including pain, range of motion, or blood loss. No patients treated with this approach experienced neurovascular injury, instability, or nonunion at follow-up.

Conclusions:
The surgical elbow dislocation is a powerful tool to aid reduction and osteosynthesis of intra-articular fractures of the lateral distal humerus. It may enable greater articular access for complex distal humerus patterns without deleterious effects on surgical or patient reported outcomes.
Proof of Concept Example for Use of Simulation to Allow Data Pooling Despite Privacy Restrictions
Authors: Filshtein Teresa J. , Li Xiang , Zimmerman Scott C. , Ackley Sarah F. , Glymour M. Maria , Power Melinda C. 
Published: June 2021

Background:
Integrating results from multiple samples is often desirable, but privacy restrictions may preclude full data pooling, and most datasets do not include fully harmonized variable sets. We propose a simulation-based method leveraging partial information across datasets to guide creation of synthetic data based on explicit assumptions about the underlying causal structure that permits pooled analyses that adjust for all desired confounders in the context of privacy restrictions.

Methods:
This proof-of-concept project uses data from the Health and Retirement Study (HRS) and Atherosclerosis Risk in Communities (ARIC) study. We specified an estimand of interest and a directed acyclic graph (DAG) summarizing the presumed causal structure for the effect of glycated hemoglobin (HbA1c) on cognitive change. We derived publicly reportable statistics to describe the joint distribution of each variable in our DAG. These summary estimates were used as data-generating rules to create synthetic datasets. After pooling, we imputed missing covariates in the synthetic datasets and used the synthetic data to estimate the pooled effect of HbA1c on cognitive change, adjusting for all desired covariates.

Results:
Distributions of covariates and model coefficients and associated standard errors for our model estimating the effect of HbA1c on cognitive change were similar across cohort-specific original and preimputation synthetic data. The estimate from the pooled synthetic incorporates control for confounders measured in either original dataset.

Discussion:
Our approach has advantages over meta-analysis or individual-level pooling/data harmonization when privacy concerns preclude data sharing and key confounders are not uniformly measured across datasets.
Menopause preparedness: perspectives for patient, provider, and policymaker consideration
Authors: Aninye Irene O. , Laitner Melissa H. , Chinnappan Shivani 
Published: June 2021

Abstract

Objective:
The aim of the study was to identify priorities to address unmet needs in clinical care, education, and access to treatment to improve quality of life for individuals during the menopause transition.

Methods:
The Society for Women's Health Research convened a working group of 13 experts to discuss updates in research, clinical practice, and policy on menopause. Participants included patient advocates, policy leaders, and clinical specialists and researchers from gynecology, reproductive endocrinology, psychiatry, and epidemiology. Overarching themes and recommendations for improving menopause care were identified and determined by consensus agreement of the participants at the conclusion of the meeting.

Results:
The Society for Women's Health Research Menopause Working Group identified gaps in clinical care, policy, and patient and provider education. Limited understanding of menopause by patients and clinicians contributes to delays in recognizing the menopause transition and engaging in symptom management. Recent studies on hormone therapy and alternative treatment options provide evidence to inform updates on existing policy recommendations and coverage.

Conclusions:
To improve care and quality of life for individuals during the menopause transition and after menopause, the working group recommends developing a more standardized approach to menopause preparedness that includes education for both patients and providers, as well as considering policy solutions to address regulatory barriers to care. Providers also need to factor in the diverse needs of individuals experiencing menopause in the development of their personalized care.
Treatment patterns and survival in patients with small cell lung cancer in Taiwan
Authors: Chiang Chi-Lu , Hsieh Wen-Ting , Tang Chao-Hsiun , Sheu Mei-Ling , Chen Yuh-Min 
Published: June 2021

Background:
Small cell lung cancer (SCLC) is the most aggressive form of lung cancer. The chemotherapy regimens and their efficacy in practice are seldom reported. We aimed to investigate treatment patterns and survival outcomes of patients with SCLC in Taiwan.

Methods:
Patients newly diagnosed with SCLC from 2011 to 2015 were identified from the Cancer Registry database. Their clinical characteristics, treatment regimens, and survival status were obtained from National Health Insurance Research database. The Kaplan–Meier method and Cox-proportional hazard model were used to analyze the survival outcomes.

Results:
Among a total of 2707 patients enrolled, 439 were in the limited stage (LS, 16.22%) and 2268 were in the extensive stage of the disease (ES, 83.78%). The median age was 66 and the majority were male (90.36%). The first-line regimen used for the patients was etoposide/cisplatin-based treatment, followed by etoposide/carboplatin-based regimen, and etoposide only. The median overall survival (OS) was 16.92 months (95% confidence interval [CI] 15.31–18.92) and 8.71 months (95% CI 8.38–9.07) in LS and ES patients, respectively. Chemotherapy regimen, Eastern Cooperative Oncology Group performance status, and history of radiotherapy were significant factors associated with OS. On the other hand, the major second-line treatment was a topotecan-based regimen (68.3%). However, this showed inferior survival outcome compared to etoposide-based regimen (5.09 months [95% CI 4.76–5.62] versus 8.77 months [95% CI 6.31–11.89], p < 0.001).

Conclusion:
Etoposide is the preferred and superior first-line chemotherapy regimen in combination with platinum, and an alternative choice of second-line regimen for Taiwanese patients with SCLC.
Clinical Decision Path for Identifying Recurrent Falls in Late Middle-Aged and Older Patients With Chronic Schizophrenia
Authors: WANG Mei-Yeh , LIU I-Chao , CHIU Chen-Huan 
Published: June 2021

ABSTRACT

Background
Falls are a major hazard for elderly patients with schizophrenia. As patients with schizophrenia may experience a more-accelerated rate of physical aging than the overall elderly population, the risk of falls may emerge during the late middle-age period in this population. Furthermore, the risk of falls is affected by multiple, interrelated risk factors.

Purpose
This study was undertaken to capture the complexity of the risk of falls in patients with schizophrenia. A cross-sectional approach was used to apply classification and regression tree (CART) analysis to generate a clinical decision path to identify the risk factors of recurrent falls in late middle-aged and older patients with schizophrenia.

Methods
Two hundred ninety-one patients aged 55 years or older were recruited from psychiatric halfway houses for assessment. Frailty, physical functional performance, depressive severity, cognitive function, and level of fatigue were measured, respectively, using the Study of Osteoporotic Fractures Frailty Index, Short Physical Performance Battery (SPPB), Center for Epidemiological Studies Depression Scale, Short Portable Mental Status Questionnaire (SPMSQ), and Chinese version of the Fatigue Severity Scale. The variables revealed by descriptive statistics to be statistically significant were further analyzed using CART analysis.

Results
The overall proportion of recurrent fallers in this study was 19.2%. CART analysis revealed eight end groups and identified four predictors: frailty, physical functional performance, cognitive function, and sex. The most prominent condition for recurrent fallers was frailty, present in 57.1% of the frail participants. In the nonfrail group (both prefrail and robust), participants with an SPPB score of less than 10 had a 29.7% chance of being a recurrent faller versus 13.6% for those with an SPPB score of 10 or more. Furthermore, an SPMSQ score of 7 was the next-best split among participants without frailty, with an SPPB score of 10 or more. Finally, among participants without frailty and with an SPPB score of 10 or more and an SPMSQ score of more than 7, the proportion of recurrent fallers was higher in women than men.

Conclusions
The results of this study indicate that assessing frailty status may be an effective, first-step approach to identifying schizophrenic patients at an increased risk of recurrent falls. Among patients with prefrailty or robust status, an SPPB score cutoff of 10, an SPMSQ score cutoff of 7, and being female may be used sequentially to identify individuals at a heightened risk of recurrent falls.
Per Oral Endoscopic Myotomy for Zenker’s Diverticulum
Authors: Kahaleh Michel , Mahpour Noah Y. , Tyberg Amy , Bareket Romy , Shahid Haroon M. , Sarkar Avik , Abdelqader Abdelhai , Gjeorgjievski Mihajlo , Marino Daniel , Kats Daniel , Gaidhane Monica , Greenberg Ian , Lee David P. , Bushe Bryce , Eke Chiemeziem , Sun Hojin , Kedia Prashant , Méndez Ana L.M. , Lambroza Arnon , Barret Maximilien , Hallit Rachel , Eleftheriadis Nikolas P. , Nieto Jose , Oleas Roberto , Robles-Medranda Carlos , Bapaye Amol 
Published: June 2021

Introduction:
Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy.

Methods:
Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed.

Results:
A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days.

Conclusions:
A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
Changes in Type 2 Diabetes Medication Utilization and Costs in the United States, 2014–2019
Authors: Neilson Lynn M. , Munshi Kiraat D. , Peasah Samuel K. , Huang Yan , Swart Elizabeth C.S. , Henderson Rochelle , Manolis Chronis , Good Chester B. 
Published: June 2021

Objective:
The objective of this study was to describe national changes in utilization and associated costs of antidiabetic medications in the United States from 2014 to 2019, across different drug classes and insurance plans.

Research Design and Methods:
This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from January 1, 2014, to December 31, 2019. Patients aged 18 years and above enrolled in commercial, Medicare, or Medicaid health plans who filled ≥1 prescription claim for an antidiabetic medication(s) during the 6-year period were included. Utilization was examined as the total number of 30-day adjusted prescription fills per user per month (PUPM). Gross costs were calculated as the sum of plan costs (net of rebates) and member out-of-pocket costs. Differences in mean utilization and costs PUPM between 2014 and 2019 for each medication class were calculated.

Results:
The final analytic sample increased from 745,290 patients in 2014 to 1,596,006 in 2019. Antidiabetic medication utilization increased by 8.8% from 2014 to 2019, driven by increases in sodium-glucose cotransporter 2 inhibitor (48.7%; P<0.001), glucagon-like peptide 1 receptor agonist (11.8%; P<0.001), insulin (8.1%; P<0.001), and metformin (2.9%; P<0.05) utilization. Average costs PUPM rose 47.5% (P<0.001), from $126.52 in 2014 to $186.58 in 2019. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and combination drugs contributed significantly to these increased costs, with 6-year cost differences of 57.3%, 46.9%, and 47.2%, respectively (all P<0.001).

Conclusion:
Our study demonstrates a shift in antidiabetic medication class utilization from 2014 to 2019, where associated costs net of rebates significantly increased to a disproportionately greater extent than the significant increase in utilization PUPM.
Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children: A Case Control Study
Authors: Ta Allison De Groot , Farrell Michael , Dillman Jonathan R. , Trout Andrew T. 
Published: June 2021

ABSTRACT

Introduction:
Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI.

Methods:
This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05.

Results:
Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114).

Conclusion:
Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.
Distinct Sleep Disturbance Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy
Authors: Lin Yufen , Bailey Donald E. , Docherty Sharron L. , Porter Laura S. , Cooper Bruce A. , Paul Steven M. , Hammer Marilyn J. , Conley Yvette P. , Levine Jon D. , Miaskowski Christine 
Published: June 2021

Background
Patients with gastrointestinal cancers experience moderate to high levels of sleep disturbance during chemotherapy that decreases their functional status and quality of life (QOL).

Objective
The objectives of this study were to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles and evaluate for differences among these subgroups in demographic, clinical, and sleep characteristics, as well as co-occurring symptoms and QOL outcomes.

Methods
Patients (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles.

Results
Three distinct sleep disturbance profiles (ie, low, high, very high) were identified. Compared with the low class, patients in the other 2 classes were significantly younger and less likely to be married and to exercise on a regular basis and received a higher number of previous treatments. Compared with the low class, patients in the other 2 classes reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain and lower levels of attentional function and QOL scores at enrollment.

Conclusions
This study is the first to use latent profile analysis to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles. Findings provide new insights on the associations between sleep disturbance and multiple co-occurring symptoms in these patients.

Implications for Practice
Clinicians can identify patients who are at the highest risk for sleep disturbance and recommend a variety of sleep hygiene interventions (eg, establishment of a bedtime routine), as well as initiate interventions for other co-occurring symptoms.
18F-FDG PET/CT Imaging of G-CSF–Producing Dedifferentiated Liposarcoma
Authors: Eizuru Yukari , Nakajo Masatoyo , Nakajo Masanori , Shinohara Naohiro , Yoshiura Takashi 
Published: June 2021

Abstract
Granulocyte colony-stimulating factor (G-CSF)–producing tumors are malignant tumors associated with a poor prognosis, and G-CSF–producing liposarcoma is particularly rare. We report a case of G-CSF–producing dedifferentiated liposarcoma. 18F-FDG PET/CT showed abnormal 18F-FDG uptake throughout the bone marrow and in the primary site. When a diffuse bone marrow 18F-FDG uptake was observed on 18F-FDG PET/CT, G-CSF–producing dedifferentiated liposarcoma should be included in the differential diagnosis.
Aberrant Morphologic Patterning of Combined Sagittal and Metopic Craniosynostosis
Authors: Dinis Jacob , Junn Alexandra , Lu Xiaona , Lopez Joseph , Persing John 
Published: June 2021

Abstract
Combined sagittal and metopic craniosynostosis is an uncommon condition that may result in a wide spectrum of cranial morphologies. This occurs as a result of the compound effects of both prematurely fused sutures. The authors present an incidence of sagittal craniosynostosis with a specific altered head morphology, and delayed diagnosis that the authors believe occurred due to structural changes associated with concurrent metopic suture synostosis This patient underscores the limitations of relying on classic diagnostic patterns and highlights the critical role of noninvasive imaging in the diagnosis of craniosynostosis.
Peripheral Dentinogenic Ghost Cell Tumor of the Maxilla
Authors: Altindis Sezen , Tokuc Berkay , Hosgor Hatice , Coskunses Fatih Mehmet 
Published: June 2021

Abstract
Dentinogenic ghost cell tumor (DGCT) is an uncommon locally invasive odontogenic tumor, representing 1.9% to 2.1% of all odontogenic tumors. The main microscopic features of DGCT are an ameloblastoma-like odontogenic epithelial proliferation with sheets of ghost cells and dentinoid material formation. The peripheral variant of this clinical rarity, which represents a less aggressive behavior than central lesions, mostly affects the anterior region of both jaws. In this case report, the authors present a DGCT that was observed in the maxillary posterior region in a 59-year-old female patient. The patient presented with pain and nodular swelling in the right maxillary molar region, which extended from the buccal vestibule to the edentulous area. Additionally, there was a destruction of the underlying bone, as seen radiographically. This case report includes the clinical, radiological, and histopathological features of the lesion, which was diagnosed as a peripheral DGCT without any evidence of recurrence in the 2 years after excision.