bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex Differences in Participation Restriction in Social Activities Among Older Stroke Survivors: A Nationwide Study
Authors: Chen Chen , Reeves Mathew J. , Lisabeth Lynda D. 
Published: December 2024

BACKGROUND:
Women experience more poststroke physical activity limitations, but sex differences in social activity participation, an important patient-reported outcome for stroke recovery, remain uncertain.

METHODS:
Incident stroke survivors aged ≥65 years were identified from the US NHATS (National Health and Aging Trends Study), 2011-2022. Participants were asked to report restricted participation in the past month in 2 formal activities (religious services and clubs/classes) and 2 informal activities (visiting friends/family and going out for enjoyment) in the year of stroke onset. Logistic regression was used to assess sex differences in any participation restrictions across the 4 activities and within each activity, without and with adjustment for potential confounders, including sociodemographic, social-environmental, technological- and service environmental, psychological, health condition–related factors, and activity limitations.

RESULTS:
Among stroke survivors (N=469; 56.6% women; 50.4% of 75–84 years of age), women were more likely to be older, widowed, live alone, not currently driving, have worse physical capacity, and have more activity limitations. Women had a higher unadjusted prevalence of any participation restriction (40.3% versus 29.4%; odds ratio, 1.90 [95% CI, 1.21–2.99]) and restriction in attending religious services (27.5% versus 19.0%; odds ratio, 1.80 [95% CI, 1.08–3.02]). These sex differences were attenuated most after individual adjustment for physical capacity, marital status, and driving mobility, followed by adjustment for comorbidities, living alone, and activity limitations. No significant sex differences were found after simultaneously adjusting for these factors (adjusted odds ratio, 1.36 [95% CI, 0.70–2.65] for any participation restrictions; adjusted odds ratio, 1.36 [95% CI, 0.74–2.49] for restrictions in religious service attendance).

CONCLUSIONS:
Social participation restrictions are prevalent among older stroke survivors, particularly for women, which appears to be attributable to sex differences in social factors and prestroke health. Future interventions targeting vulnerable subgroups, including socially isolated women and women with poorer health, should be considered.
Salience of Trust in Discussions and Recommendations of the United States’ COVID-19 Health Equity Task Force
Authors: Kloft Samantha , López-Cevallos Daniel F. 
Published: December 2024

Objective: The COVID-19 pandemic has further eroded trust in public health institutions across the United States. We examined the salience of trust in the federal government’s discussions and recommendations of the US COVID-19 Health Equity Task Force (HETF). Methods: We conducted a thematic analysis of publicly available HETF documents, including the executive order, 8 meeting minutes, and 2 final deliverables. Given that trust operates at multiple levels of the socioecological continuum, we used an interpretive analytic approach to our inquiry. Results: We found that several barriers, facilitators, and influencers to trust were discussed during HETF meetings but few were mentioned consistently across all documents. Trust was most frequently mentioned by individuals in the public comments section of HETF meetings, more so than HETF members or representatives of federal agencies. Public commenters comprised 52% of total mentions of trust. However, these mentions did not make their way into the final HETF deliverables, signaling a potential disconnect between insights from public commenters and HETF representatives. Conclusions: Our findings indicate that trust had limited prominence in HETF discussions and recommendations. To rebuild the public’s trust, it is imperative that the federal government, in collaboration with state and local partners, further develop actionable mechanisms to foster trust as a pillar of public health practice. By ensuring ethical principles are applied in decision-making and implementation, gaps in (mis)trust may be bridged, ultimately boosting the efficacy of public health emergency response.
Relationship between postoperative dietary intake and walking ability among older adults with hip fractures: A retrospective study
Authors: Kobayashi Hikaru , Nagai Koutatsu , Shimamura Yasuhiro , Hidaka Masami , Mori Akiko , Sakuma Kaoru , Ogino Tomoyuki 
Published: December 2024

Objective This study aimed to determine whether total dietary intake assessed in the acute phase after hip fracture surgery is associated with walking ability. Design The retrospective observational study. Setting A single institution. Participants Patients with hip fractures aged ≥65 years. Main measures Dietary intake was recorded daily on an 11-point scale using visual plate waste. The primary outcome was walking ability, which was assessed using functional ambulation categories at discharge. We categorised the patients into those with improved walking ability (functional ambulation categories score ≥3) and those without (<3). Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for functional ambulation categories according to total dietary intake during acute hospitalisation. Results In total, 182 patients were included with a median age of 85 years; 73.6% were women. The median dietary intake during the first week after surgery, the second postoperative week, and throughout the postoperative period were 24.5, 28.4, and 27.1 kcal, respectively. After adjusting for potential confounders, high total dietary intake (hazard ratio, 1.05; 95% confidence intervals, 1.02–1.09; P = .006) and high dietary intake after the second week (hazard ratio, 1.04; 95% confidence intervals, 1.01–1.08; P = .017) were associated with walking ability. Conclusions Total dietary intake was associated with walking ability at discharge during the acute postoperative period after hip fracture. Dietary intake following the second postoperative week may play a significant role in the recovery of walking ability.
Building a Diabetes Educator Program for Remote Patient Monitoring Billing
Authors: Bishop Franziska K. , Chmielewski Annette , Leverenz Jeannine , Lin Shannon , Conrad Barry , Martinez-Singh Anjoli , Pike Laura , Scheinker David , Prahalad Priya , Maahs David M. 
Published: December 2024

Objective: Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic’s standard of care. Methods: We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers’ licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot. Results: We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence. Conclusions: Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM.
Surgical Management of Moderate to Severe Epistaxis in Hereditary Hemorrhagic Telangiectasia: Systematic Review and Meta-Analysis
Authors: Benaim Ezer H. , Kallenberger Ethan M. , Mirmozaffari Yasine , Klatt-Cromwell Cristine , Ebert Charles S. , Kimple Adam J. , Senior Brent A. , Kasthuri Raj S. , Thorp Brian D. 
Published: December 2024

Background Epistaxis is one of the most common and debilitating symptoms of hereditary hemorrhagic telangiectasia (HHT), significantly impacting patients’ quality of life. While various medical and surgical interventions exist for managing epistaxis in patients with HHT, patients with moderate to severe epistaxis are high health-care utilizers who frequently need surgical treatment. Objective To compare the efficacy, complications, and patient-reported outcomes for common surgical interventions utilized in treating epistaxis in patients with HHT Methods Studies were identified in PubMed, Embase, Scopus, Redalyc, and LILACS databases and uploaded to Covidence. A systematic review following PRISMA guidelines was conducted on studies evaluating outcomes in adults with HHT with moderate to severe epistaxis who had undergone surgical interventions. We compared the respective outcomes for pre-operative and post-operative epistaxis severity/intensity, need for further interventions or transfusions, estimated blood loss, length of surgery, complications, and patient satisfaction. Results Twenty studies with a total of 546 patients were included. The most common surgeries studied were nasal closure and laser photocoagulation. Seven studies recorded the change in epistaxis severity score and observed a significant reduction postoperatively (3.91, [95% CI 2.73-5.09]). Eleven studies found a decrease in the number of transfusions and a rise in hemoglobin levels post-operatively. Common complications reported were partial dehiscence of a nasal closure, septal perforation, and continued bleeding requiring re-operation. Most patients report improved quality of life and satisfaction with surgical intervention. Conclusion Surgery can significantly reduce the severity of epistaxis in patients with HHT and improve quality of life. Further studies should focus on head-to-head comparisons of procedures and standardization of outcome measures.
Hypertension, intracranial arteriosclerosis, and structural brain changes in patients with TIA or ischemic stroke
Authors: Li Xi , Berghout Bernhard P , van Rooijen Gijs , Ikram Mohammad Kamran , Roozenbeek Bob , Bos Daniel 
Published: December 2024

Introduction: Hypertension is a major risk factor of structural brain changes, including atrophy and cerebral small vessel disease. Intracranial arteriosclerosis could be an underlying mechanism between hypertension and structural brain changes. This study investigated whether intracranial carotid artery calcification (ICAC), as a proxy for intracranial arteriosclerosis, explains the association between hypertension and structural brain changes in patients with TIA or ischemic stroke. Patients and methods: About 968 patients (mean age 62.7 years) with TIA or ischemic stroke from a registry who underwent non-contrast CT (NCCT) and CT-angiography (CTA) were included in this study. Presence and volume (mm3) of ICAC were assessed on CTA. Subtypes of ICAC were assessed on NCCT, where ICAC was categorized into intimal and internal elastic lamina (IEL) type calcification. Structural brain changes, indicated by atrophy, periventricular and deep white matter lesions (WML), and lacunes were assessed on NCCT. Mediation analysis was performed using ICAC, ICAC volume, and ICAC subtypes as mediators. Results: ICAC was prevalent in 67.8% of patients, with 52.6% of them exhibiting intimal calcification, and 26.5% exhibiting IEL calcification. Atrophy, periventricular WML, deep WML, and lacunes were present in 48.1%, 56.4%, 43.0% and 17.1% of patients respectively. The presence of ICAC explained 7.1% of the association of hypertension with periventricular WML, 3.6% with deep WML, and 17.6% with lacunes. Hypertension was associated with increased atrophy through ICAC (OR: 1.02, 95% CI: 1.00–1.05). In subgroup analyses, IEL calcification partly explained the association between hypertension and periventricular WML (16.8%), and atrophy (OR: 1.12, 95% CI: 1.02–1.27). Intimal calcification did not explain any association. Conclusion: ICAC partially explained the association between hypertension and atrophy, periventricular and deep WML, and lacunes. Although intimal calcification was more prevalent in ischemic stroke patients, IEL calcification takes the leading role in explaining the association between hypertension and structural brain changes.
Risk Factors for Early Major Amputation in the First Diabetic Forefoot Amputation
Authors: Seo JaeHyeon , Lee HoSeong , Choi YoungRak , Shin MyoungYeol 
Published: December 2024

Category: Diabetes; Other Introduction/Purpose: Subsequent major amputations within 1 year after initial forefoot amputations are sometimes necessary when other options for saving the foot are unavailable. Risk factors for early major amputation should be analyzed for a successful limb salvage strategy. This study aimed to analyze the risk factors for early major amputation after initial diabetic forefoot amputation. Methods: In this retrospective cohort study, clinically important variables of 808 first diabetic forefoot amputations were analyzed. Major amputations were performed in 104 patients (12.9%) throughout follow-up, and 77 (74%) of 104 patients had their major amputation within l year. Cox proportional hazards were examined to assess the risk factors for major amputation performed within 1 year. Results: In univariate analysis, 19 possible risk factors significantly differed between patients with and without early major amputation. In stepwise multivariable analysis, age, body weight, chronic renal failure (CRF), intermediate column amputation level, and C-reactive protein (CRP; mg/dl) level significantly differed. CRF showed the largest hazard ratio (HR) for early major amputation: 4.538 (95% confidence interval: 2.667-7.723, p-value < 0.0001). Age, weight, intermediate column amputation level, and CRP level had relatively low HRs: 1.032, 0.968, 1.367, and 1.078, respectively. Conclusion: CRF was a strong independent risk factor for early major amputation in the first diabetic forefoot amputation. Furthermore, patients with CRF underwent earlier and more major amputations throughout their follow-up. Before the surgical treatment, patients with CRF should be educated in terms of the high probability (>20%) of early major amputation.
Safety and Efficacy of One vs Two Incision Broström Gould with Calcaneal Osteotomy and Peroneal Tendon Debridement Surgery
Authors: Bernstein Marc , Shah Ashish , Scheinberg Mila 
Published: December 2024

Category: Hindfoot; Ankle Introduction/Purpose: Ankle sprains are a common musculoskeletal injury, and a substantial proportion of patients develop chronic ankle instability (CAI). Surgical intervention, such as the Broström-Gould (BG) procedure, is typically indicated for treatment. We are comparing the safety and efficacy between the BG with peroneal tendon debridement repair, a sliding lateralizing calcaneal osteotomy and additional adjuvant procedures performed with a single- versus double-incision approach. In this study, we aim to identify if a less invasive, single-incision procedure may result in decreased risk of wound complication and improved patient reported outcomes. Methods: Our retrospective analysis included patients who underwent the procedure of interest between 2011 and 2020. Patients were divided into two groups: undergoing either a one-incision (n=53) or a two-incision approach (n=47), both with a lateralizing calcaneal osteotomy. Demographics, complications, and PROMIS scores were collected. Statistical analysis was performed. Results: Initially, 264 patients were identified, and following application of our inclusion and exclusion criteria, 100 patients remained for the study. Most notably, a significant difference in skin bridge breakdown was observed between the two-incision (n = 6 (13%)) and one-incision groups (n = 0 (0%)). There were no significant differences in infection, deep wound dehiscence, nerve palsy, or neuroma between patients in the two groups. Furthermore, no statistically significant differences in mean PROMIS scores existed between the cohorts. Conclusion: The described modified technique BG procedure shows promise for treating CAI. While patients in both single- and double-incision groups had similar rates of postoperative complications, the decreased incidence of skin bridge breakdown in the one-incision group highlights the approach’s safety and potential benefits in reducing wound-related complications. Our research contributes valuable insights into foot and ankle surgery, offering an innovative option for patients with chronic ankle instability and potentially enhancing patient care in the management of this condition.
Safety and Exposure Area in Three Different Posteromedial Surgical Approaches for the Treatment of Ankle Fractures. A Cadaveric Study
Authors: Filippi Jorge , Palma Joaquin , Morales Sergio , Urrutia Tomas 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Posterior malleolar fractures, are common in ankle injuries. Open reduction and internal fixation show better outcomes, particularly with direct reduction. While posterolateral fractures can be managed through a posterolateral approach, the optimal approach for large posterior and posteromedial fractures is uncertain. Different posteromedial approaches exist, but concerns persist about soft tissue dissection and posteromedial neurovascular bundle (NVB) safety. This study compares three posteromedial approaches — posteromedial (PM), Modified posteromedial (MoPM), and medial posteromedial (MePM) — measuring posterior malleolar visualization, distance to the neurovascular bundle, and tension. Results aim to compare them regarding bone exposure and safety to the posteromedial NVB. Methods: We used 12 cadaveric pieces and evaluated the following approaches: PM: longitudinal incision immediately parallel to the medial border of the Achilles tendon. The FHL fascia was opened and the FHL retracted laterally. MoPM longitudinal incision halfway between the posteromedial tibia's edge and the Achilles tendon's medial edge. The PTT was mobilized medially and the FDL laterally. MePM longitudinal incision along the posteromedial edge of the tibia. The i PTT tendon was retracted posteriorly and elevated Measurements included minimal tension on the posteromedial (NVB) flap, distance from the incision to the NVB, and percentage of malleolar exposure. Tension was gauged using a digital strain gauge on a Langenbeck retractor, while exposure was determined by marking bone edges and measuring medial-to-lateral length. Distribution of the data was assessed by the t-test. A one-way repeated measures ANOVA was conducted, when a significant difference was detected, the post hoc Tukey test was applied. Results: There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV, favoring the PM approach (71,00% ±1.83 and 25.50 mm ±4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ±1.28) compared to the other two approaches. Conclusion: The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures of the posteromedial aspect of the PM.
Short Term Adverse Events Following Ankle Arthroplasty and Ankle Arthrodesis: A Matched Analysis of Recent Nationally-Representative Data
Authors: Hopper Haleigh , Nelson Chase , Satalich James , Anastasio Albert T. , O'Neill Conor N. , Patel Tejas , Hanselman Andrew , Schweitzer Karl M. , Adams Samuel B. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Surgical management of ankle osteoarthritis (AOA) includes Ankle Arthrodesis (AA) or Total Ankle Arthroplasty (TAA). Existing literature has been inconclusive regarding a clear standard of treatment for AOA. The purpose of this study was to analyze data from the National Surgical Quality Improvement Project (NSQIP) to elucidate differences in outcomes between TAA and AA. Methods: Patients who underwent TAA or AA from January 2010 to December 2020 in the NSQIP database were included in this analysis. All patients were followed for at least 30 days following surgery. The independent variable was procedure type: AA or TAA. The dependent variables were complications. Independent sample t-tests and chi square tests were used to determine if there was a difference between groups. A binary logistic regression was performed to determine the odds ratio (OR) and 95% confidence intervals. Results: The matched cohorts included 359 patients in the arthroplasty group (57.2±13.3 years, 56.8% male, 33.0±7.3 kg/m 2 ) and 359 patients in the arthrodesis group (57.4±13.9 years, 58.5% male, 32.7±7.9 kg/m 2 ). There was an increase in transfusions, UTI, and return to the operating room in the arthrodesis group compared to the arthroplasty group (1.95%, 0.28%, p=0.038; 1.11%, 0.00%, p=0.045, 3.90%, 1.11%, p=0.017). The multivariate regression revealed that length of hospital stay (OR = 1.157) and insulin dependent diabetes (OR = 6.043) had an increased risk of any adverse event. Conclusion: The overall rate of any adverse event for ankle arthroplasty or arthrodesis was relatively low at 4.18% in the 30-day postoperative period. There was no adverse event that reached statistical significance, that was more likely in the TAA group compared to the AA group. Identification of these complication rates after TAA and AA, along with patient risk factors for adverse events can assist surgeons and patients in their choice of treatment for AOA.