bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidental Durotomy Following Surgery for Degenerative Lumbar Disease and the Impact of Minimally Invasive Surgical Technique on the Rate and Need for Surgical Revision: A Case Series
Authors: Mueller Kyle B , Garrett Coleman T , Kane Stephen , Sandhu Faheem A , Voyadzis Jean-Marc 
Published: August 2021

Abstract

BACKGROUND
Incidental durotomy (ID) is a common complication during lumbar spine surgery. A paucity of literature has studied the impact of minimally invasive surgery (MIS) on durotomy rates and strategies for repair as compared to open surgery.

OBJECTIVE
To examine the impact that MIS techniques have on the durotomy rate, repair techniques, and need for surgical revision following surgery for degenerative lumbar disease as compared to open technique.

METHODS
A single-center retrospective review of consecutive cases between 2013 and 2016 was performed. All patients underwent lumbar decompression with or without instrumented fusion for degenerative pathology using either open posterior or MIS techniques. ID rate, closure technique, and need for surgical revision related to the durotomy were recorded.

RESULTS
A total of 1,196 patients were included with an overall ID rate of 6.8%. There was no difference between open or minimally invasive surgical techniques (P = .14). There was a higher durotomy rate with open technique in patients that underwent decompression with fusion (P = .03) as well as in revision cases (P = .02). Primary repair was feasible more frequently in the open group (P = .001), whereas use of dural substitute (P < .001) was more common in the MIS group. Fibrin sealant was used routinely in both groups (P = .34). There were no failed repairs, regardless of technique used.

CONCLUSION
MIS techniques may reduce durotomies in cases involving instrumentation or revisions. Use of dural substitute onlay and fibrin sealant was effective at preventing reoperation. Both MIS and open techniques result in a low rate of future surgical revision when a durotomy occurs.
Peroral Trigeminal Rhizotomy Using a Novel 3-Dimensional Printed Patient-Specific Guidance Tool
Authors: Oertel Markus F , Sarnthein Johannes , Regli Luca , Stieglitz Lennart H 
Published: August 2021

Abstract

BACKGROUND
Ganglion Gasseri rhizotomy is a viable therapeutic option for trigeminal pain (TP). For this neurosurgical procedure, different potential operative and technical nuances exist.

OBJECTIVE
To evaluate a novel peroral trigeminal rhizotomy method and 3-dimensional printed patient-specific guidance tool (3D-PSGT) with respect to their applicability and safety.

METHODS
Between March 2018 and February 2021, 20 peroral balloon compression rhizotomy procedures with a 3D-PSGT were performed in 18 consecutive TP patients (13 female, mean age 58 yr). We registered the procedure duration, side effects, complications, and trigeminal function. The therapeutic effect was gauged from reduction of TP and use of analgesics.

RESULTS
All catheter insertions and rhizotomy procedures were successful at the first attempt. Apart from fluoroscopy, no auxiliary material was necessary. The average length of surgery was 19 min (range, 11-27 min). In total, 8 patients indicated complete analgesia and 6 patients pain relief; in 4 patients, persistence of TP was observed during follow-up examinations of up to 20 mo. In total, 6 patients reported of new mild to moderate facial hypesthesia affecting the trigeminal branches V2, V3, or V1-3. No masticatory musculature or corneal affections and device-related complications occurred.

CONCLUSION
The peroral 3D-PSGT trigeminal rhizotomy is straightforward for the neurosurgeon. This operative approach allows for rapid, safe, and simple foramen ovale cannulation in TP patients and reduces the use of additional equipment, radiation exposure, and procedure time.
Delayed Surgery Does Not Reduce Transfusion Rates in Low-Energy Hip Fractures on Direct Oral Anticoagulants
Authors: Levack Ashley E. , Moore Harold G. , Stephan Stephen , Jo Sally , Schroeder Ian , Garlich John , Hadad Aidan , Little Milton T.M. , Miller Anna N. , Lyman Stephen , Lane Joseph 
Published: August 2021

Objectives:
To compare transfusion rates in patients on direct oral anticoagulants (DOACs) with nonanticoagulated patients undergoing hip fracture surgery and, secondarily, to determine whether time to surgery or complications differ between these groups.

Design:
Multicenter retrospective cohort.

Setting:
Three tertiary care, academic, Level I trauma centers.

Patients:
Acute, operatively treated, low-energy hip fracture patients 55 years of age and older were included. Anticoagulated patients were matched in a 1:2 ratio to “control” nonanticoagulated hip fracture patients using propensity score matching.

Main Outcome Measurements:
The primary outcome was incidence of perioperative transfusion. The secondary outcomes included time to surgery, length of stay, and 90-day complications, readmissions, reoperations, and mortality.

Results:
One hundred thirty-two patients with hip fracture admitted on DOACs were identified (107 factor Xa inhibitors, 25 dabigatran) and were matched to 262 “control” nonanticoagulated patients. There was no difference in overall transfusion rates between anticoagulation and control groups (43.2%; n = 57 DOAC vs. 39.7%; n = 104 control; P = 0.517). The median time from admission to surgery was 41.7 hours in the DOAC group and 26.0 hours in the control group (P < 0.001). There were no differences in 90-day complication, readmission, reoperation, or mortality rates between DOAC and control groups. Comparing DOAC patients undergoing surgery within 24 hours and after 24 hours, there were no differences in transfusion rates (P = 0.558) or overall complication rates (P = 0.179).

Conclusions:
This study supports growing evidence that DOAC use should not be a determining factor in delaying surgery for patients with hip fracture who are otherwise medically optimized.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
External Fixation Characteristics Drive Cost of Care for High-Energy Tibial Plateau Fractures
Authors: Albright Patrick , Only Arthur , Parikh Harsh R. , McCreary Dylan L. , Hayek Kevin , Siljander Breana , Kibble Kendra , Cunningham Brian P. 
Published: August 2021

Objective:
To determine the total cost for a 30-day episode of care for high-energy tibial plateau fractures and the aspects of care associated with total cost.

Design:
Time-driven activity-based costing analysis.

Setting:
One Level 1 adult trauma center.

Patients:
One hundred twenty-one patients with isolated, bicondylar tibial plateau fractures undergoing staged treatment were reviewed.

Primary Outcome:
Total cost.

Results:
A total of 85 patients were included and most sustained Schatzker VI fractures (n = 66, 77%). All patients were treated with biplanar external fixation before definitive fixation. A total of 26 patients (31%) were discharged to skilled nursing facilities, and 37 patients (43%) were not discharged between procedures. Total cost for a 30-day episode of care was $22,113 ± 4056. External fixation components ($5952, 26.9%), length of hospital stay ($5606, 25.4%), discharge to skilled nursing facility (SNF) ($3061, 13.8%), and definitive fixation implants ($2968, 13.4%) contributed to the total cost. The following were associated with total cost: patient discharged to SNFs (P < 0.001), patient remaining inpatient after external fixation (P < 0.001), days of admission for open reduction internal fixation (ORIF) (P = 0.005), days spent with external fixation (P < 0.001), days in a SNF after ORIF (P < 0.001), and external fixation component cost (P < 0.001).

Conclusions:
External fixation component selection is the largest contributor to cost of a 30-day episode of care for high-energy bicondylar tibial plateau fractures. Reduction in cost variability may be possible through thoughtful use of external fixation components and care pathways.

Level of Evidence:
Economic analyses Level IV. See Instructions for Authors for a complete description of levels of evidence.
Lifestyle and quality of life in patients with early-stage breast cancer receiving adjuvant endocrine therapy
Authors: Di Meglio Antonio , Soldato Davide , Presti Daniele , Vaz-Luis Ines 
Published: August 2021

Purpose of review
A comprehensive approach to survivorship care for women with early-stage, hormone-receptor positive breast cancer should systematically include the proactive assessment and adequate management of endocrine therapy-associated symptoms, in order to assure optimal balance between preserving quality of life (QOL) and maximizing treatment adherence. We reviewed the recent literature focused on lifestyle factors, including physical activity, diet and nutrition, weight management, smoke, and alcohol behavior, and their link with symptomatology and QOL among women receiving adjuvant endocrine therapy.

Recent findings
Recent studies confirm the safety, feasibility, and effectiveness of lifestyle interventions in mitigating several common endocrine therapy-related effects, including musculoskeletal pain, fatigue, and insomnia, and in improving physical and emotional wellbeing as well as overall health-related QOL among women with early-stage breast cancer.

Summary
Healthy lifestyle behaviors have the potential to modulate the downstream impact of endocrine therapy and improve QOL among women with early-stage breast cancer. Considerations for real-world clinical care implementation emerged, including a need to evaluate the long-term uptake of healthy behaviors and facilitate the postintervention maintenance of an improved lifestyle. Some facilitators to health promotion in breast cancer survivors were also suggested, such as individualized and one-to-one supervised programs, and digital solutions providing real-time feedback, building on personalized, direct patient engagement.
Impact of Mentorship, by Gender, on Career Trajectory in an Academic Anesthesiology Department: A Survey Study
Authors: Warner Lindsay L. , Gali Bhargavi , Oxentenko Amy S. , Schroeder Darrell R. , Arendt Katherine W. , Moeschler Susan M. 
Published: August 2021

Introduction:
Mentorship has been identified as a key component of success in business and in academic medicine.

Methods:
After institutional review board approval of the study, an email survey was sent to anesthesiologists in one anesthesiology department to assess mentorship status. A survey link was sent to nonrespondents at 2 weeks and 4 weeks. All participants were deidentified. The identification of a mentor was compared by gender, academic rank, and years of practice.

Results:
Among 233 anesthesiologists, 103 (44.2%) responded to the survey. More than 90% of survey respondents agreed or strongly agreed that having a mentor is important to career success. Of the 103 respondents, 31 (30%) indicated they had a mentor. Overall, 84% of the identified mentors were men; however, this percentage differed significantly between men and women respondents (95% versus 60%; P = .03). Characteristics associated with having a mentor included younger age (P = .007), fewer years since finishing training (P = .004), and working full time (P = .02). For respondent age and years since finishing training, there was some evidence that the association was dependent on the gender of the respondent (age-by-gender interaction, P = .08; experience-by-gender interaction, P = .08).

Discussion:
Anesthesiologists in this department believed that mentorship led to more academic success. Few women mentors were reported, and women were unlikely to identify a mentor once advanced past an assistant professor rank. Most respondents believed that mentorship was important for overall career success, but only approximately one-third identified a mentor at the time of the survey.
Expanding Access to Medications for Opioid Use Disorder Treatment Through Incentivized Continuing Education
Authors: Salisbury-Afshar Elizabeth , Smithenry Dennis , Boley Randy A. , Hill Kristin , Karnik Niranjan S. 
Published: August 2021

Introduction:
Buprenorphine treatment for opioid use disorder (OUD) has positive outcomes including reducing opioid-related morbidity and mortality. In March 2018, 58 of 102 counties in Illinois lacked access to medication for OUD.

Methods:
Rush University created a fellowship training program with financial incentives to help expand buprenorphine treatment in Illinois. Fellows first completed an online waiver course, then attended an in-person intensive training weekend, and finally participated in a 9-month webinar series. Demographic and prescribing data were collected from fellows, as well as a comparison group of providers outside the fellowship who only completed a waiver training.

Results:
At the fellowship's end, 31 of 37 fellows (84%) reported they were actively prescribing buprenorphine. Of the 23 fellows who were not prescribing at the fellowship's beginning, 17 (74%) initiated prescribing by the end. Among the 16 nonfellowship subjects who only completed a waiver training, just two (13%) reported they were prescribing buprenorphine at the study period's end.

Discussion:
Our study indicates that providers need more training beyond the waiver to initiate buprenorphine prescribing. When resources are available to address a health crisis such as OUD, this model offers an innovative mechanism for delivering continuing medical education that produces outcomes quickly.
Documenting Educational Impact in the Promotion Dossier with an Enhanced Curriculum Vitae
Authors: Hobson Wendy L. , Gordon Rachel J. , Cabaniss Deborah L. , Richards Boyd F. 
Published: August 2021

Abstract:
Faculty with a career focus on education in the health professions often have difficulty representing their academic accomplishments for due consideration in promotion decisions at their respective institutions. This problem occurs because the traditional curriculum vitae (CV) format which is most often used tends to focus on peer-reviewed accomplishments easily presented in lists, such as grants and publications. In some institutions, an educator portfolio is required in place of or in addition to the CV. However, creating or reviewing such a narrative-oriented document takes large amounts of time—time that most faculty or reviewers do not have. Having to use an educator portfolio also calls out the educator as different from the traditional research faculty member. To address this problem, we propose the solution of an Enhanced CV. The Enhanced CV includes much of what is presented in an educator portfolio but in a format closer to the traditional CV. Unlike a traditional CV, the Enhanced CV includes categories inclusive of educational contributions (eg, teaching, mentoring, and course leadership) and includes brief descriptions and/or impact statements to clarify the significance of the listed accomplishments. The Enhanced CV has been adopted at two very different institutions, where evidence is accumulating regarding the viability of the Enhanced CV as a solution to educators' problem of presenting their accomplishments for promotions. The lessons learned from these institutions illustrate how the Enhanced CV can increase the ability of educators to present their accomplishments and advance in rank in their academic careers.
Local Control and Use of External Beam Parametrial Boost in the Era of Image-Guided Brachytherapy for Locally Advanced Cervical Cancer
Authors: Arya Ritu , Giurcanu Mihai , Jutzy Jessica M. , Peters Pamela , Daily Ellen W. , Golden Daniel W. , McCall Anne R. , Howard Andrew R. , Hasan Yasmin , Son Christina H. 
Published: August 2021

Objective:
Historically, external beam parametrial boost (EBPB) has been used in locally advanced cervical cancers to supplement radiation dose. However, it has become controversial in the era of image-guided brachytherapy. Modern 3D imaging and brachytherapy techniques have improved delineation and coverage of tumor. Outcomes with and without parametrial boost were analyzed.

Methods:
Women with cervical cancer involving the parametria (clinically or radiographically) diagnosed between 2001 and 2017 were identified. Clinicopathologic and treatment features, survival and patterns of failure data were collected. Univariate and multivariable data analysis was performed to evaluate association of these variables, including parametrial boost, with local failure-free survival and overall survival. Competing risks analysis was performed for cumulative incidence of local failure, with death and other failures treated as competing events.

Results:
A total of 100 women were identified (median follow-up 26.8 mo). Forty-one (41%) received EBPB; these patients were less likely to have received magnetic resonance imaging, positron emission tomography, interstitial, or high-dose rate brachytherapy. Magnetic resonance imaging, positron emission tomography, dose rate, and treatment era were highly correlated (Cramer’s V: 0.43 to 0.68, P<0.01). Two-year overall survival and local failure were 78% and 12% for the entire cohort. While the use of EBPB was not associated with any outcome on multivariable analysis, treatment year after 2009 was highly associated with improved outcomes in all models.

Conclusions:
In this study, omission of EBPB did not compromise local control or survival in the modern era, supporting a decreased need for standardized use of parametrial boost.
Maternal Stress and Early Neurodevelopment: Exploring the Protective Role of Maternal Growth Mindset
Authors: Elansary Mei , Pierce Lara J. , Wei Wendy S. , McCoy Dana Charles , Zuckerman Barry , Nelson Charles A. 
Published: August 2021

ABSTRACT:

Objective:
The purpose of this study was to test associations between maternal stress, maternal mindset, and infant neurodevelopment at 12 months of age. Specifically, we sought to examine the extent to which maternal growth mindsets may serve to attenuate the negative associations between maternal stress and infants' neurodevelopment.

Methods:
The current exploratory study leverages data from a longitudinal cohort study following mother-infant dyads. Maternal-perceived stress, maternal mindset, and infant electroencephalography (EEG) recordings were collected when infants were 12 months of age. The final analytic sample included 33 dyads.

Results:
Results revealed no statistically significant main effects of maternal stress or maternal mindset for any of the infant EEG frequency band outcomes. After including interactions between maternal stress and mindset, statistically significant positive interactions were detected for all EEG frequency bands. Simple slope tests revealed significant negative associations between maternal stress and each of the 6 EEG frequency bands for mothers with more fixed-oriented mindsets. Associations between maternal stress and infant EEG outcomes for mothers with more growth-oriented mindsets did not differ from 0.

Conclusion:
These findings suggest that infants raised by mothers with growth mindsets may be protected against the neurodevelopmental consequences of higher maternal stress.
The predominant role of glucose as a building block and precursor of reducing equivalents
Authors: Sobotka Lubos , Sobotka Ondrej 
Published: August 2021

Purpose of review
Stores of glucose (Glc) in our body are small compared with protein and lipid. Therefore, at times of famines or trauma/disease-related starvation, glucose utilization must be limited only to pathways that can only run with glucose carbon as substrate. We will try to outline how insulin resistance drives these pathways and inhibits glucose oxidation in the stressed organism.

Recent findings
Glc is a basic substrate for a variety of other biomolecules like nucleic acids, amino acids, proteoglycans, mucopolysaccharides and lipids. It is essential for the formation of reducing equivalents, indispensable for anabolic, antioxidative, regulatory and immune processes. As a result, a continuous Glc turnover/cycle is essential to secure at all times the Glc requirements for nonoxidative pathways mentioned above but then requires introduction of extra glucose or other intermediates into the cycle. The production of ATP through complete Glc oxidation occurs only when Glc intake is higher than required for its nonoxidative metabolism. Insulin resistance and decreased Glc oxidation indicate that requirements of Glc for anabolic pathways are high.

Summary
Glc is an important building block for anabolic reactions and substrate for reducing equivalents formation. Insulin resistance prevents irreversible Glc oxidation and stimulates Glc production during stress or growth. Glc is only oxidized when intake is in excess of its anabolic requirements.
Celiac disease: clinical update
Authors: Uche-Anya Eugenia , Lebwohl Benjamin 
Published: August 2021

Purpose of review
This review highlights literature from the past year and explores the impact on current understanding of celiac disease pathogenesis, diagnosis, and management.

Recent findings
In contrast to earlier clinical trials, recent data suggests that early gluten introduction may protect against the development of celiac disease. Celiac disease is underdiagnosed, associated with high burden of disease and linked to excess mortality risk, yet, there remains considerable uncertainty regarding the utility of mass screening in asymptomatic individuals. The gut microbiome is increasingly implicated in celiac disease pathogenesis, although the exact mechanism is undefined. Probiotics have been proposed as a disease-modifying option for celiac disease but most studies assessing efficacy are of low-quality. Patients with celiac disease do not appear to be at increased risk of contracting or developing adverse outcomes from COVID-19. Little is known about the pathogenesis of nonceliac gluten sensitivity; however, recent findings suggest an autoimmune basis for the condition.

Summary
Current understanding of celiac disease continues to advance, though significant knowledge gaps remain. Large, rigorous, prospectively designed studies are needed to further characterize celiac disease pathogenesis, management and therapeutic options.
Improved Patient Safety and Quality Outcomes With Amiodarone Infusions
Authors: Woods Carri , Hughes Penny , Wood Michelle , Ryan Susan , Powers Jan 
Published: August 2021

Background:
Amiodarone is a common intravenous medication and a known irritant to the vessel wall when administered peripherally.

Local Problem:
Nurses identified an increase in phlebitis associated with peripheral amiodarone leading to multiple catheter replacements and interruptions in drug therapy. Central venous access is recommended by the manufacturer but not practical for a short-term infusion based on the risk to the patient, time, and cost.

Methods:
A 4-phased approach was used to identify a more suitable peripheral intravenous catheter.

Interventions:
A collaborative effort between bedside nurses and the vascular access team evolved to look at alternative products for peripheral intravenous catheters.

Results:
The extended dwell peripheral catheter decreased phlebitis from 54% to 5%. It also decreased interruptions in drug therapy and improved patient comfort and satisfaction.

Conclusions:
A practice change was implemented utilizing extended dwell peripheral catheters for intravenous amiodarone and disseminated to other units.