bluuebunny/crossref_metadata_2025_split huggingface dataset:
862 Volume-Assured Pressure Support improves outcomes in a patient with Congenital Central Hypoventilation Syndrome
Authors: Ianus Vlad , Grigg-Damberger Madeleine , Diaz Shanna , Cutrufello Nicholas 
Published: May 2021

Abstract

Introduction
Congenital Central Hypoventilation Syndrome (CCHS) is a condition caused by a mutation of the PHOX2B gene and an incidence of 1 in 50,000 live births. Clinically the condition is characterized by autonomic nervous system dysfunction, the most prominent feature of which is the failure of respiratory homeostasis during sleep. In patients severely affected, life-long ventilatory support is required. This might start as early as the newborn period. Subsequent adjustments are required due to their growth and development. The role of Volume-Assured Pressure Support (VAPS) ventilation in treatment of CCHS was only described in a couple reports before.

Report of case(s)
A 17-year-old female patient born at term and diagnosed with CCHS at birth at our center with a PHOX2B mutation confirmed. Her daytime ventilatory support was weaned at age 18 months and the tracheostomy was removed at age 10 years old. She relocated to another state, was lost to follow-up, and returned this year for adjustments of her ventilator whose settings had not been adjusted for several years. She was on a Trilogy 100 ventilator, in pressure-controlled mode with settings of EPAP 5, IPAP 20, and a rate of 22/min without supplemental oxygen. Her measured weight is 69kg, body mass index (BMI) 27. The patient complained of difficulty breathing while on those settings and reported decreased desire to use the machine. The patient was empirically switched to VAPS due to titration availability limitations during the COVID-19 pandemic. Initial AVAPS settings were: EPAP 4–7, PS 3–12, breath rate 16/min, TV 350mL. Upon implementing the changes, the patient reported improved comfort and increased usage. Average minute ventilation decreased from 10.5 to 5.8 L/min, patient triggered breaths increased from 1.1% to 12.3%, average breaths per minute decreased from 22.0/min to 16.2/min, the average peak flow 31.8 to 26.2L/min, tidal volume decreased from 463 to 355mL.

Conclusion
AVAPS ventilation can be successfully used in managing patients with CCHS, and it might be superior to pressure-controlled mode in certain cases, improving patient comfort and compliance.

Support (if any)
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
Patient and surgical factors affect postoperative opioid prescription for orthopaedic trauma patients undergoing single-admission, single-surgery fracture fixation: a retrospective cohort study
Authors: Mickley John , Roebke Austin J. , Everhart Joshua S. , Goyal Kanu S. , Ly Thuan V. 
Published: May 2021

Background:
The authors sought to determine patient and surgical factors associated with increased postoperative opioid prescription requirements as an inpatient, during the first 6 wk, and beyond 6 wk for orthopaedic trauma patients undergoing single-admission, single-surgery fracture fixation.

Methods:
Two hundred patients who underwent fixation of isolated fractures (pelvis n=50, hip n=50, periarticular n=50, long bone n=50) were included in the study. Multivariate regression modeling was utilized to determine predictors of inpatient opioid usage.

Results:
Patients were prescribed an average of 7.9±9.1 5-milligram (mg) pills of oxycodone during the last 24 hr of inpatient opioid administration, 131±132.1 pills during 6-week outpatient period, and 23 (11%) patients continued to be prescribed opioids beyond 6 wk. Twenty-nine (14.5%) patients received opioids from a provider other than the treating surgeon or emergency department. Seventy-eight (39%) patients received at least one additional prescription for opioids after the initial discharge prescription. Predictors of increased inpatient opioid requirements during the last 24 hr were: younger age, baseline opioid use, longer length of surgery, and tobacco use. Predictors of higher 6-week outpatient opioid prescription amounts were younger age, increased operative time, baseline opioid use, unemployment, pelvic fractures, and inpatient opioid use during the 24 hr before discharge. Baseline opioid use, tobacco use, and pelvic fracture were all independent risk factures for opioid prescription beyond the 6-week follow-up period.

Conclusions:
Opioid use and prescription for orthopaedic trauma patents following single-admission, single-surgery fracture fixation is strongly predicted by surgical and patient factors.

Level of Evidence:
Level III.
Conservative management of posterior cruciate ligament avulsion with a large bony fragment: a prospective cohort study
Authors: Bagherifard Abolfazl , Jabalameli Mahmoud , Khezri Mahsa , Hadi Hosseinali , Mirzaei Alireza , Yahyazadeh Hooman 
Published: May 2021

Background:
Internal fixation is the standard choice for treatment of posterior cruciate ligament (PCL) avulsion with a large bony fragment. However, it is not without complication. This study investigated PCL avulsions with large bony fragments to determine if conservative management resulted in acceptable outcomes.

Methods:
In a prospective cohort study, the outcome of conservative management of PCL avulsion with large bony fragment was evaluated in 40 patients. The inclusion criteria were a fracture size of more than 20 mm and a displacement of less than 2 mm. The outcomes were evaluated after 12 mo and included the evaluation knee range of motion and scoring of the modified Lysholm questionnaire and the International Knee Documentation Committee. Knee instability was checked by the drawer test and confirmed by stress radiography.

Results:
The mean patient age was 36.9±16.1 yr. The mean final knee range of motion (ROM) was 125.6±8.2 degrees. The mean Lysholm score was 92.3±6.1 points. Accordingly, the excellent, good, and fair results were observed in 29 (72.5%), eight (20%), and three (7.5%) patients, respectively. The mean International Knee Documentation Committee score of the patients was 94.2±5.3 points. Postoperative instability was seen in two patients. Nonunion was observed in two other patients. The size of the bony fragment was 30 and 32 mm in patients with nonunion.

Conclusions:
Conservative management of the PCL avulsion with a large bony fragment could result in acceptable outcome. However, application of this technique needs further characterization, particularly with respect to the size of bony fragment.

Level of Evidence:
Level II.
Racial and socioeconomic disparities among patients undergoing hip arthroplasty: a New York State population analysis
Authors: Darbandi Aria 
Published: May 2021

Background:
Hip arthroplasty places a large economic burden on the United States healthcare system, and there is a need to better understand influencing factors to help prepare for and limit expenditures. We aimed to assess racial and socioeconomic factors that influence hospital charges and length of stay using the New York State population.

Methods:
This study used the publicly available New York Statewide Planning and Research Cooperative System (SPARCS) database to identify hip replacement cases from 2013 to 2016 in New York State. Multivariable logistic regression models were used to examine characteristic differences between white and black patients. Multivariable linear models were used to identify predictive variables for hospital charges and length of stay.

Results:
White patients had lower mean length of stay (3.61 vs. 4.35, P<0.0001) and hospital charges ($55,988 vs. $67,742, P<0.0001). Medicaid patients were more likely to be black compared to the privately insured (OR: 4.37, CI: 4.08 to 4.68). Black race predicted higher hospital charges and length of stay (P<0.0001). Medicaid predicted longer length of stay (P<0.0001).

Conclusions:
Racial and insurance-based disparities exist among hip replacement patients, and these factors influence length of stay and hospital charges. These tendencies should be noted by healthcare administrators to limit the economic burden of hip arthroplasty.

Level of Evidence:
Level III
Enhancing Self-Advocacy After Traumatic Brain Injury: A Randomized Controlled Trial
Authors: Hawley Lenore , Morey Clare , Sevigny Mitch , Ketchum Jessica , Simpson Grahame , Harrison-Felix Cynthia , Tefertiller Candace 
Published: May 2021

Objective:
To evaluate the efficacy of a novel intervention aimed at enhancing self-advocacy in individuals living with traumatic brain injury (TBI).

Setting:
Community.

Participants:
Sixty-seven (35 allocated to treatment, 32 to control) community-dwelling adults 9 months or more post-TBI (mean of 8.9 years postinjury); previously discharged from inpatient or outpatient TBI rehabilitation; able to travel independently in the community, indicating a level of independence needed to engage in self-advocacy.

Design:
Longitudinal randomized 2-arm controlled trial (NCT no. 03385824). Computer-generated block randomization allocated participants to treatment/intervention or control/no-intervention. All outcome assessments completed by blinded study staff.

Intervention:
A manualized group intervention, Self-Advocacy for Independent Life (SAIL), addressing the self-efficacy beliefs, knowledge, and skills for self-advocacy following TBI.

Main Outcome Measures:
The Self-Advocacy Scale (SAS) (primary); General Self-Efficacy Scale (GSE); Personal Advocacy Activity Scale (PAAS); Satisfaction With Life Scale (SWLS).

Results:
The treatment group showed significantly greater improvement than controls from baseline to posttreatment on the primary measure (SAS) of self-efficacy specific to self-advocacy after TBI (effect size = 0.22). Similar improvements were found on secondary measures of general self-efficacy and satisfaction with life from baseline to posttreatment. However, significant between-groups gains for primary and secondary measures were not maintained over 6- and 12-week follow-up.

Conclusions:
Individuals living with chronic TBI sequelae can increase self-efficacy specific to self-advocacy, general self-efficacy, and satisfaction with life, through a TBI-specific intervention aimed at empowering individuals to advocate for their own needs and wishes. Sustaining gains over time may require ongoing community collaboration and support. This could involve community-based systems of self-advocacy education, resources, and peer support.
Mini-DSAEK for Macro Corneal Perforations
Authors: Vasquez-Perez Alfonso , Din Nizar , Phylactou Maria , Kriman Nunez Jaime , Allan Bruce 
Published: May 2021

Purpose:
We present a technique that preserves good vision in paracentral macroperforations and avoids challenges of tectonic lamellar or penetrating keratoplasty in eyes with poor visual potential.

Method:
A wet laboratory was implemented for mini-Descemet stripping endothelial keratoplasty to seal macroperforations ab interno. This included a suture support technique designed to prevent graft herniation. We also present 3 cases who were treated successfully with this technique.

Results:
The laboratory test confirmed that mini-Descemet stripping endothelial keratoplasty can successfully seal macroperforations without the need of large incisions. The minidisc is introduced through the perforation, and a double mattress suture prevents graft herniation. The technique allowed us to preserve 20/15 unaided vision in a case with paracentral macroperforation. It also restored eye globe integrity and achieved long-term stability in 2 cases with limbal stem-cell deficiency.

Conclusions:
Mini-Descemet stripping–automated endothelial keratoplasty technique can be an alternative approach to avoid poor visual outcomes of tectonic keratoplasty in paracentral perforations. It also offers host tissue preservation in eyes with high risk of rejection for tectonic grafts.
Role of Reverse Transcriptase Polymerase Chain Reaction in Cornea Donors During the COVID-19 Pandemic
Authors: Arora Ritu , Sharda Shipra , Sahu Jigyasa , Manchanda Vikas , Jain Parul , Gupta Isha , Gotmare Nikhil , Bharti Nisha 
Published: May 2021

Purpose:
The purpose of this study was to report the analysis of reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal (NP) samples of cornea donors dying because of causes unrelated to severe acute respiratory coronavirus (SARS-CoV-2).

Methods:
A retrospective analysis of all cornea donors dying from causes other than SARS-CoV-2 between August 2020 and December 2020 was performed. Informed consent was obtained from the next of kin of the deceased for RT-PCR testing from NP swabs. Rapid antigen testing from all the deceased was performed before in situ cornea excision. In addition, NP samples in viral transport media for RT-PCR were also collected for SARS-CoV-2 analysis. Corneas were released from the eye bank only after a negative RT-PCR report.

Result:
One hundred eighteen corneas from 59 donors were obtained by the eye bank. Eleven donors (18.64%) were positive for SARS-CoV-2 on RT-PCR testing. Six of these 11 donors had a Ct value of E gene less than 25.

Conclusions:
NP samples of cornea donors dying due to causes other than coronavirus disease-19 were positive for SARS-CoV-2 on RT-PCR. This implicates that donors could be having asymptomatic/undetected coronavirus disease infection. We recommend adding the routine testing of NP samples of all cornea donors in the eye banking protocol in this ongoing SARS-CoV-2 pandemic.
Cardiovascular Disease Incidence and Risk in Family Caregivers of Adults With Chronic Conditions
Authors: Ahn Soojung , Esquivel Jill Howie , Davis Eric M. , Logan Jeongok G. , Chung Misook Lee 
Published: May 2021

Background
Family caregivers experience psychological distress or physical strain that may lead to an increased risk of cardiovascular disease (CVD) morbidity and mortality.

Objective
This systematic review aimed to describe the current evidence and gaps in the literature on measures used to assess CVD outcomes in family caregivers, the association of caregiving with CVD incidence/risk outcomes, and associated factors in family caregivers of patients with chronic disease.

Methods
Medline, PubMed, CINAHL, Web of Science, and Google Scholar were searched for English-language, peer-reviewed studies published from 2008 to 2020 that examined CVD incidence and risk among family caregivers of adults with chronic conditions.

Results
Forty-one studies were included in this review. The measures used to assess CVD risk were categorized into biochemical, subclinical markers, components of metabolic syndrome, and global risk scores. Compared with noncaregivers, caregivers were more likely to have higher CVD incidence rates and objectively measured risk. Cardiovascular disease risks were also increased by their caregiving experience, including hours/duration of caregiving, caregivers' poor sleep status, psychological symptoms, poor engagement in physical/leisure activities, and care recipient's disease severity.

Conclusions
Although there were limited longitudinal studies in caregivers of patients with diverse health conditions, we found evidence that caregivers are at high risk of CVD. Further research for various caregiver groups using robust methods of measuring CVD risk is needed. Caregiver factors should be considered in developing interventions aimed at reducing CVD risk for caregivers.
Yield and Risk Factors for Advanced Colorectal Neoplasia and Long-term Outcomes in Veterans With 3 or More Nonadvanced Adenomas
Authors: Ha John , Walker Megan J. , Myers Laura E. , Ballard Carrie J. , Imperiale Thomas F. 
Published: May 2021

Background and Aims:
Until recently, guidelines recommended a 3-year surveillance colonoscopy for persons with 3 to 10 nonadvanced adenomas (NAA). In this study, we quantify yield for metachronous advanced neoplasia (AN); attempt to identify risk factors for AN; and measure colorectal cancer (CRC) incidence and mortality.

Methods:
We used natural language processing to screen an existing data set for Veterans with 3 to 10 NAA. We manually reviewed colonoscopy and pathology reports to verify baseline findings and determine results of subsequent colonoscopy (sCY). Baseline features were extracted from the electronic medical record (EMR) and a national data set, CRC incidence was obtained from the Veterans Affairs cancer registry, and CRC mortality from the National Death Index through September 30, 2017. CRC incidence and mortality were compared between Veterans who did versus did not have sCY.

Results:
Natural language processing identified 3673 Veterans who potentially had 3 to 10 NAA, of which 1672 were excluded after EMR review. In the analytical cohort of 2001 subjects, 1178 (59%) had sCY at a mean (SD) follow-up of 4.3 (2.2) years. The sCY group was younger (mean age: 61 vs. 67 y; P<0.01) and were less likely to have diabetes (27% vs. 31%; P=0.02) and congestive heart failure (4% vs. 9%; P<0.01). sCY showed AN in 182 subjects (15.5%). Baseline features were no different between those with versus without metachronous AN. Subjects with sCY had a greater CRC incidence (n=7 vs. n=0; P=0.046), but there was no difference in CRC mortality (0 for both subgroups).

Conclusions:
Among patients with 3 to 10 NAA on index colonoscopy who underwent sCY, AN was present in 15.5% at mean follow-up of 4.3 years. No risk factors for AN were identified. CRC incidence, but not CRC mortality, was higher among those with sCY.
Coronavirus disease 2019 respiratory disease in children: clinical presentation and pathophysiology
Authors: Steffes Lea C. , Cornfield David N. 
Published: May 2021

Purpose of review
Pediatric coronavirus disease 2019 (COVID-19) respiratory disease is a distinct entity from adult illness, most notable in its milder phenotype. This review summarizes the current knowledge of the clinical patterns, cellular pathophysiology, and epidemiology of COVID-19 respiratory disease in children with specific attention toward factors that account for the maturation-related differences in disease severity.

Recent findings
Over the past 14 months, knowledge of the clinical presentation and pathophysiology of COVID-19 pneumonia has rapidly expanded. The decreased disease severity of COVID-19 pneumonia in children was an early observation. Differences in the efficiency of viral cell entry and timing of immune recognition and response between children and adults remain at the center of ongoing research.

Summary
The clinical spectrum of COVID-19 respiratory disease in children is well defined. The age-related differences protecting children from severe disease and death remain incompletely understood.
Severe acute respiratory syndrome coronavirus 2 infection and critically ill children
Authors: Damania Rahul , Moore Whitney , Viamonte Heather C. , Kamat Pradip , Basu Rajit K. 
Published: May 2021

Purpose of review
Amidst an ongoing pandemic, the delineation of the pediatric consequence of infection from the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus is emerging. This review summarizes available pediatric data and covers the aspects of epidemiology, critical illness with acute infection [coronavirus disease 2019 (COVID-19)], the discovered multi-inflammatory syndrome in children (MIS-C), and management options.

Recent findings
The available data from the source of the initial viral transmission and then through Europe, Africa, and the Western Hemisphere identifies important aspects of the SARS-CoV2 pandemic: 1) Pediatric infection occurs commonly, is likely underestimated, and transmission patterns remain incompletely described, 2) Pediatric patients suffer multiple end-organ injuries but COVID-19 is not the same prevalence in terms of severity as in adults, 3) MIS-C is a novel and life-threatening manifestation of exposure to the virus, 4) Management using a combination of supportive care, standard practice intensive care management, and anti-inflammatory agents is associated with recovery, 5) Long-term sequelae of viral exposure is unknown at this time.

Summary
Emerging evidence suggests pediatric patients are at risk for severe and life-threatening effects of exposure to SARS-CoV2. As the pandemic continues, further research is warranted – particularly as a vaccine is not yet available for use in children.
Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits
Authors: Moran Christopher J. , Aryee Emmanuel , Perrin James M. 
Published: May 2021

ABSTRACTIntroduction:Inflammatory bowel disease (IBD) commonly presents during adolescence and may affect health care utilization. This study aimed to assess rates of health maintenance examinations (HMEs) in adolescents with IBD with their primary care physicians (PCPs).Methods:This is a single center, case–control study of adolescents with IBD who received their IBD care and primary care within the same healthcare system. Adolescents diagnosed with IBD between 13 and 17 years of age were matched 1:1 by age, gender, race/ethnicity, and insurance status to healthy controls. Patient demographics, IBD characteristics, and health outcomes were extracted from the medical record. HME rate was defined as having one HME with a PCP during a 12‐month period.Results:This study included 150 IBD‐control matched pairs. HME rates were similar at baseline between cases and controls (83% vs 85%, P = 0.53) but approached significance in year 1 post‐diagnosis (77% vs 85%, P = 0.056). In year 2 post‐diagnosis, IBD patients had less frequent HME (62% vs 74%, P = 0.0486). Disease severity did not affect HME rates. IBD patients from under‐represented minority groups had lower rates than matched controls (46.2% vs 91.7%, P = 0.03). Meningococcal and human papilloma vaccination rates were lower in cases versus controls (79% vs 94%, P = 0.0005 and 60% vs 84%, P < 0.0001).Conclusion:Adolescents with IBD have less frequent HME and lower rates of certain vaccinations than their peers. Those from underrepresented minority groups are at particular risk. Given the important issues addressed at HMEs, gastroenterologists should recommend that adolescents with IBD have ongoing PCP engagement to optimize health outcomes.