bluuebunny/crossref_metadata_2025_split huggingface dataset:
Basketball vs. Hockey—The Changing Face of Sport-Related Injuries in Canada
Authors: Axelrod Daniel , Ziegler Teresa , Pincus Daniel , Widdifield Jessica , Marks Paul , Paterson Michael , Wasserstein David 
Published: April 2021

Objective:
To characterize and compare the incidence of basketball-related, soccer-related, and hockey-related injuries over a 10-year period.

Design:
Cohort analysis of sport-related injuries using multiple Ontario healthcare databases.

Setting:
Emergency department visits in Ontario, Canada.

Patients:
Any patient who sustained musculoskeletal injuries sustained while playing basketball, soccer, or hockey between 2006 and 2017 were identified.

Assessment of Risk Factors:
Sport of injury, age, sex, rurality index, marginalization status, and comorbidity score.

Main Outcome Measures:
Annual Incidence Density Rates of injury were calculated for each sport, and significance of trends was analyzed by assessing overlap of 95% confidence intervals.

Results:
One lakhs eighty five thousand eighty hundred sixty-eight patients (median age: 16 years, interquartile range 13-26) received treatment for sport-related injuries (basketball = 55 468; soccer = 67 021; and hockey = 63 379). The incidence of basketball-related and soccer-related injuries increased from 3.4 (3.3-3.5) to 5.6 (5.5-5.7) and 4.4 (4.3-4.5) to 4.9 (4.8-5) per 10 000 person years, respectively, whereas the incidence of hockey-related injuries decreased from 4.7 (4.6-4.8) to 3.7 (3.6-3.8). Patients with basketball injuries were more marginalized (3.01 ± 0.74) compared with patients with soccer and hockey injuries (2.90 ± 0.75 and 2.72 ± 0.69, respectively).

Conclusions:
Accurate regional epidemiologic information regarding sports injuries can be used to guide policy development for municipal planning and sport program development. The trends and demographic patterns described highlight general and sport-specific injury patterns in Ontario. Populations with the highest incidence of injury, most notably adolescents and men older than 50, may represent an appropriate population for injury risk prevention.
Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review
Authors: Toomey Clodagh M. , Whittaker Jackie L. , Richmond Sarah A. , Owoeye Oluwatoyosi B. , Patton Declan A. , Emery Carolyn A. 
Published: April 2021

Objective:
To determine whether high or low adiposity is associated with youth sport-related injury.

Data Sources:
Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury.

Main Results:
Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation.

Conclusions:
Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.
Comfort Level of Current Physical Therapist Students in Addressing Sexual Issues With Patients
Authors: Dockter Mary , Ulmer Emma , Wulf Cailey , Gunderson Morgan , Bornhorst Jordan , Joneson Alissa , Abraham Karen , Reisch Rebecca 
Published: April 2021

Background:
Scarce evidence has been found on factors that determine physical therapist (PT) students' comfort level in addressing sexual issues with patients. Determining influential factors and barriers may help educators adjust their curriculum to better prepare students.

Objectives:
To identify the comfort level of PT students in addressing sexual issues with patients, demographic factors that impact the students' comfort level, and barriers to PT students addressing sexual issues with patients.

Study Design:
A cross-sectional survey design.

Methods:
A survey was sent to current PT students enrolled at 3 Doctorate of Physical Therapy (DPT) programs. The survey consisted of demographic and scenario questions related to the students' comfort level in addressing sexual issues. Wilcoxon signed rank tests were performed to compare the differences in the comfort levels for male and female students. A χ2 analysis was performed to determine which demographic factors were significantly (P < .05) associated with the respondent's comfort level.

Results:
First-, second-, and third-year students (N = 106) completed the survey and represented programs from diverse geographic locations and religious affiliations. Less than half (41.5%) agreed that they had the necessary skills to address sexual issues, and only 23.58% of respondents were likely to initiate discussion. While students were most comfortable addressing issues with their own gender, collectively there was increased comfort level with conversations with females. Main barriers included lack of experience and knowledge, fear of patient misunderstanding, and patient comfort level.

Conclusion:
PT students lack comfort in addressing sexual issues due to multiple barriers. Demographic information, including geological location and religious background, was not significantly associated with comfort level (see the Video, Supplemental Digital Content 1, which summarizes this study available at: http://links.lww.com/JWHPT/A44).
Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid
Authors: Bensken Wyatt P. , Navale Suparna M. , Andrew Angeline S. , Jobst Barbara C. , Sajatovic Martha , Koroukian Siran M. 
Published: April 2021

Background:
For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care.

Objective:
Examine markers of quality care for newly diagnosed PWE.

Methods:
Using Medicaid claims data (2010–2014) for 15 states we identified adults 18–64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models.

Results:
Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs.

Conclusions:
There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE.
Comparison of treatment response assessed by 18F-FDG PET/CT with the histopathological response using tumor regression grading on surgically resected specimen following neoadjuvant chemotherapy in squamous cell carcinoma of esophagus
Authors: Kumar Naveen , Deo Suryanarayana , Bhoriwal Sandeep , Sharma Atul , Pramanik Raja , Kumar Rakesh , Das Prasenjit , Arora Saurabh , Kumar Sunil 
Published: April 2021

Background
For the response assessment after chemotherapy, gold standard is always the histopathological response. However, metabolic response can also guide further treatment. Herein, this study aimed to evaluate metabolic response assessment to neoadjuvant chemotherapy in squamous cell carcinoma esophagus using PET response criteria in solid tumors (PERCIST) criteria with taking histopathological response by tumor regression grading as the standard method.

Methods
Total fifty-seven patients with squamous cell carcinoma esophagus were enrolled between April 2017 to December 2018 for this prospective study. All patients were undergone for baseline PET scan before going for neoadjuvant chemotherapy. Repeat PET scan was done after neoadjuvant chemotherapy. Operable patients were taken for surgery. Final histological response was assessed by Mandard grading. Three metabolic tools [maximum standardized uptake value (SUVmax), tumor regression grading, PERCIST] were compared.

Results
The mean SULpeak of the primary lesion was 11.7 ± 5.5 (median, 10.2, range 5.5–31.8). The average percentage change (%Δ) in SUVmax was 42.9 ± 26.3. On histopathology, 5 (13.1%) patients showed complete pathological response, whereas grade II, III, IV and V in 8 (21.1%), 12 (31.6%), 10 (26.3%) and 3 (7.8%) respectively. On comparison of PERCIST with Mandard grading, agreement analysis showed that there was moderate agreement (k, 0.48). %ΔSUV peak change showed a strong correlation with %ΔSUVmax (P = 0.01) and percentage tumor to liver ratio change (P = 0.01). On comparison, these metabolic response tools showed a weak agreement (k, 0.28 with tumor to liver ratio, k, 0.38 with SUVmax).

Conclusion
After neoadjuvant chemotherapy, 18F-fluorodeoxyglucose PET/CT can help to assess the response and guide the treatment. However, a larger study is warranted to evaluate their correlation with pathological response.
Assessing parent–child interaction in infant deafness
Authors: Curtin Martina , Herman Ros , Cruice Madeline , Morgan Gary 
Published: April 2021

Purpose of review
To highlight the importance of parent–child interaction (PCI) in infant deafness and address the lack of robust assessment tools in clinical practice.

Recent findings
Most deaf babies are born to hearing parents with little experience in deafness. Deafness can reduce access to spoken language. Despite advancements in amplification technology, deaf children still present with delays in attention and communication skills at the start of nursery. Research reports that hearing parents of deaf infants can be more directive during interaction, spend less time following the child's focus of attention, and have more difficulty achieving successful turn-taking in conversation. Much research tells us that these factors impact on the quality and quantity of PCI. Good PCI, in all infants, but especially so in deafness, is a strong predictor of child language outcomes. Teachers of the Deaf and Speech and Language Therapists are the first professionals to support families in the home. For these professionals, having an objective way of assessing PCI would greatly assist and standardise their practice. However, to date, there are no deaf-specific assessments to observe and appraise a parent's communication behaviours when interacting with their deaf child.

Summary
Intervention studies with families of deaf children have shown success in improving parental sensitivity and facilitative language techniques. An observational assessment in parent–deaf child interaction would ensure that communication interventions are appropriately targeted on the individual family's needs.
Learning Pediatric Point-of-Care Ultrasound
Authors: Kwan Charisse , Weerdenburg Kirstin , Pusic Martin , Constantine Erika , Chen Aaron , Rempell Rachel , Herman Joshua E. , Boutis Kathy 
Published: April 2021

Objectives
Using an education and assessment tool, we examined the number of cases necessary to achieve a performance benchmark in image interpretation of pediatric soft tissue, cardiac, lung, and focused assessment with sonography for trauma (FAST) point-of-care ultrasound (POCUS) applications. We also determined interpretation difficulty scores to derive which cases provided the greatest diagnostic challenges.

Methods
Pediatric emergency physicians participated in web-based pediatric POCUS courses sponsored by their institution as a credentialing priority. Participants deliberately practiced cases until they achieved diagnostic interpretation scores of combined 90% accuracy, sensitivity, and specificity.

Results
Of the 463 who enrolled, 379 (81.9%) completed cases. The median (interquartile range) number of cases required to achieve the performance benchmark for soft tissue was 94 (68–128); cardiac, 128 (86–201); lung, 87 (25–118); and FAST, 93 (68–133) (P < 0001). Specifically, cases completed to achieve benchmark were higher for cardiac relative to other applications (P < 0.0001 for all comparisons). In soft tissue cases, a foreign body was more difficult to diagnose than cobblestoning and hypoechoic collections (P = 0.036). Poor cardiac function and abnormal ventricles were more difficult to interpret with accuracy than normal (P < 0.0001) or pericardial effusion cases (P = 0.01). The absence of lung sliding was significantly more difficult to interpret than normal lung cases (P = 0.028). The interpretation difficulty of various FAST imaging findings was not significantly different.

Conclusions
There was a significant variation in number of cases required to reach a performance benchmark. We also identified the specific applications and imaging findings that demonstrated the greatest diagnostic challenges. These data may inform future credentialing guidelines and POCUS learning interventions.
Point-of-Care Ultrasound Findings in Multisystem Inflammatory Syndrome in Children
Authors: Kennedy Thomas M. , Dessie Almaz , Kessler David O. , Malia Laurie , Rabiner Joni E. , Firnberg Maytal T. , Ng Lorraine 
Published: April 2021

Objectives
Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 is a novel pediatric condition with significant morbidity and mortality. The primary objective of this investigation was to describe the point-of-care ultrasound (POCUS) findings in patients evaluated in the emergency department (ED) who were diagnosed with MIS-C.

Methods
A retrospective cross-sectional study was conducted including patients <21-years-old who had POCUS performed for clinical care in a pediatric ED and were diagnosed with MIS-C. Point-of-care ultrasound studies were performed by pediatric emergency medicine attending physicians or fellows. Data abstracted by chart review included patient demographics, clinical history, physical examination findings, diagnostic test results, the time POCUS studies and echocardiograms were performed, therapies administered, and clinical course after admission.

Results
For the 24 patients included, 17 focused cardiac ultrasound, 9 lung POCUS, 7 pediatric modified rapid ultrasound for shock and hypotension, 1 focused assessment with sonography for trauma, 1 POCUS for suspected appendicitis, and 1 ocular POCUS were performed by 13 physicians. Point-of-care ultrasound identified impaired cardiac contractility in 5 patients, large intraperitoneal free fluid with inflamed bowel in 1 patient, and increased optic nerve sheath diameters with elevation of the optic discs in 1 patient. Trace or small pericardial effusions, pleural effusions, and intraperitoneal free fluid were seen in 3 patients, 6 patients, and 4 patients, respectively.

Conclusions
This study demonstrates the spectrum of POCUS findings in MIS-C. Prospective studies are needed to help delineate the utility of incorporating POCUS into an ED management pathway for patients with suspected MIS-C.
Efficacy of Fecal Calprotectin Combined With Stool Hemoglobin in Differentiating Bacterial Origin in Acute Gastroenteritis
Authors: Kim Hyun Jin 
Published: April 2021

Objectives
Differentiating bacterial origin in acute gastroenteritis (AGE) is important to improve outcomes. Fecal calprotectin is a sensitive screening tool for gut mucosal inflammation. This study aimed to evaluate the diagnostic efficacy and cutoff level of fecal calprotectin in distinguishing bacterial origin in pediatric AGE.

Methods
Patients who were diagnosed with AGE at 1 to 18 years between January 2015 and January 2020 were retrospectively analyzed. A polymerase chain reaction test was applied to stool samples to detect viruses and bacteria. The level of fecal calprotectin was determined using an enzyme-linked immunosorbent assay test.

Results
Eighty patients were enrolled in this study. The most common viral pathogen was norovirus, and bacterial pathogen was Clostridium perfringens. The median fecal calprotectin level was 686 μg/g (interquartile range [IQR], 140–1192 μg/g) in all patients, 560 μg/g (IQR, 60–669 μg/g) in patients with viral pathogens, and 985 μg/g (IQR, 272–1984 μg/g) in those with bacterial pathogens (P = 0.019). The stool hemoglobin concentration (337.29 vs 84.83 ng/mL, P = 0.016) and C-reactive protein (4.06 vs 0.45 mg/dL, P = 0.082) levels were higher in patients with bacterial pathogens than in those with viral pathogens. For identifying bacterial pathogens, the area under the receiver operating characteristic curve of fecal calprotectin was 0.739 (95% confidence interval, 0.584–0.894); combination with stool hemoglobin improved diagnostic efficacy, and the area under the receiver operating characteristic curve was 0.870. The optimal cutoff values of fecal calprotectin and stool hemoglobin were 815 μg/g and 158 ng/mL, respectively.

Conclusions
The combination of stool hemoglobin and fecal calprotectin may be a useful marker for detecting bacterial etiology in pediatric AGE.
Tele-Rehabilitation with Virtual Reality
Authors: Cornejo Thumm Pablo , Giladi Nir , Hausdorff Jeffrey M. , Mirelman Anat 
Published: April 2021

Abstract
Physical training in Parkinson disease improves motor performance, alleviates nonmotor symptoms, and enhances cognition and quality of life. Nonetheless, adherence to exercise is low and travel costs and time may limit participation and compliance. Training at home can help avoid these burdens and, as needed during the recent global pandemic (COVID-19), reinforce social distancing and reduce the risk of infection. However, training at home requires motivation and self-control and telerehabilitation is time-consuming for both patient and therapist. In recent years, there is growing use of virtual reality and exergaming to increase motivation and adherence for exercising with evidence of improvements in mobility and balance after using virtual reality in the clinic. Here, a novel telerehabilitation training program using a treadmill–virtual reality system for simultaneous training of two patients with Parkinson disease in their homes is described. Remote monitoring software enabled visual and auditory communication with the two patients, allowing the trainer to adapt the settings remotely and provide feedback. Participants received weekly training sessions over 1 yr. The findings show high adherence to training, increased walking duration throughout the sessions, and increased patient confidence, gait speed, and mobility. Training multiple participants simultaneously was feasible, enabling an individualized treatment approach while conserving therapist time.
Ambulatory Virtual Care During a Pandemic: Patient Safety Considerations
Authors: Mullur Jyotsna , Chen Yih-Chieh , Wickner Paige , Licurse Adam , Desai Sonali 
Published: April 2021

Background
The COVID-19 pandemic prompted sudden and fundamental changes in health care, including a rapid rise in the utilization of telehealth services in the ambulatory setting. With the unprecedented and significant decline in traditional office-based visits and procedures, novel patient safety risks and challenges emerged.

Methods
The ambulatory practices at our quaternary care, academic medical center experienced a 200-fold increase in virtual visit volume between February and April 2020. We convened a multidisciplinary working group dedicated to evaluating quality and safety when providing virtual visits during a pandemic. Our primary outcome was patient experience with virtual care delivery, which was assessed by leveraging patient complaint data and patient satisfaction survey data.

Results
For our main focus of patient experience and satisfaction, survey data were analyzed from the approximately 76,616 virtual visit encounters that occurred between March 1, 2020, and April 21, 2020. During this period, 5 patient complaints were filed to the Patient Advocacy Department. Overall, patient satisfaction with telehealth remained stable and high at >93% from February to May 2020. As we assessed these data each month, our working group developed risk mitigation strategies in response to the novel challenges presented by the use of telemedicine due to the COVID-19 pandemic while working to maintain patient satisfaction with care. We identified quality and safety issues around patient factors including optimal triage of patients and use of technology. We also evaluated accessibility to virtual platforms and logistics such as coordination of care for diagnostic testing. Finally, a guidance document was created and communicated to our diverse ambulatory practices to support clinicians.

Conclusions
Ambulatory virtual care delivery requires a dynamic, flexible model of care through continuous rapid-cycle process improvement to mitigate patient safety risks during a pandemic, incorporating both provider and patient perspectives.
Realizing the Power of Text Mining and Natural Language Processing for Analyzing Patient Safety Event Narratives: The Challenges and Path Forward
Authors: Fong Allan 
Published: April 2021

Abstract
Patient safety event (PSE) reports are a useful lens to understand hazards and patient safety risks in healthcare systems. However, patient safety officers and analysts in healthcare systems and safety organizations are challenged to make sense of the ever-increasing volume of PSE reports, including the free-text narratives. As a result, there is a growing emphasis on applying text mining and natural language processing (NLP) approaches to assist in the processing and understanding of these narratives. Although text mining and NLP in healthcare have advanced significantly over the past decades, the utility of the resulting models, ontologies, and algorithms to analyze PSE narratives are limited given the unique difference and challenges in content and language between PSE narratives and clinical documentation. To promote the application of text mining and NLP for PSE narratives, these unique challenges must be addressed. Improving data access, developing NLP resources to practically use contributing factor taxonomies, and developing and adopting shared specifications for interoperability will help create an infrastructure and environment that unlocks the collaborative potential between patient safety, research, and machine learning communities, in the development of reproducible and generalizable methods and models to better understand and improve patient safety and patient care.