bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Improvement Between the First Two Waves of the Coronavirus Disease 2019 Pandemic in a Single Tertiary-Care Hospital in Belgium
Authors: Lambermont Bernard , Rousseau Anne-Françoise , Seidel Laurence , Thys Marie , Cavalleri Jonathan , Delanaye Pierre , Chase J. Geoffrey , Gillet Pierre , Misset Benoit 
Published: May 2021

Objectives:
To compare patient management and outcome during the first and second waves of the coronavirus 2019 pandemic.

Design:
Single-center prospective cohort study.

Setting:
Tertiary-care University Hospital.

Patients:
All adult patients admitted in either the first (from March 15 to May 15, 2020) or second (from October 1 to November 30, 2020) wave of coronavirus disease 2019.

Interventions:
None.

Measurements and Main Results:
Primary outcome was 30-day mortality. During the second wave of the coronavirus disease 2019 pandemic, 33 patients (4.8%) were transferred due to overcrowding and excluded from analysis. There were 341 (first wave of the coronavirus disease 2019 pandemic) and 695 (second wave of the coronavirus disease 2019 pandemic) coronavirus disease 2019 patients admitted to the hospital, with median age first wave of the coronavirus disease 2019 pandemic as 68 (57–80) and second wave of the coronavirus disease 2019 pandemic as 71 (60–80) (p = 0.15), and similar admission severity. For the first wave of the coronavirus disease 2019 pandemic versus second wave of the coronavirus disease 2019 pandemic, 30-day mortality was 74/341 (22%) and 98/662 (15%) (p = 0.007). In the ward, 11/341 (3.2%) and 404/662 (61%) received dexamethasone (p < 0.001); 6/341 (2%) and 79/662 (12%) received high-flow nasal oxygen (p < 0.0001); 2/341 (0.6%) and 88/662 (13.3%) received remdesivir (p < 0.0001); 249/341 (73%) and 0/662 (0%) received hydroxychloroquine (p < 0.0001); and 87/341 (26%) and 128/662 (19%) (p = 0.024) patients were transferred to ICU. On ICU admission, median Sequential Organ Failure Assessment was 6 (3–7) and 4 (3–6) (p = 0.02). High-flow nasal oxygen was given to 16/87 (18%) and 102/128 (80%) (p < 0.001); 69/87 (79%) and 56/128 (44%) received mechanical ventilation (p < 0.001) with durations 17 days (10–26 d) and 10 days (5–17 d) (p = 0.01). Median ICU length of stay was 14 days (5–27 d) and 6 days (3–11 d) (p < 0.001). Finally, 16/87 (18%) and 8/128 (6%) received renal replacement therapy (p = 0.0055); and 64/87 (74%) and 51/128 (40%) needed vasopressor support (p < 0.001).

Conclusions:
The main therapeutic changes between the first wave of the coronavirus disease 2019 pandemic and the second wave of the coronavirus disease 2019 pandemic were use of steroids, unrestrictive use of high-flow nasal oxygen for hypoxemic patients, and transfer of patients to other geographic areas in the case of ICU overcrowding. These changes were associated with a decrease in 30-day mortality, ICU admission, and organ support.
An Innovative Approach for Preoperative Perforator Flap Planning Using Contrast-enhanced B-flow Imaging
Authors: Heneweer Carola , Zirk Matthias , Safi Ali , Smeets Ralf , Malter Wolfram , Kröger Nadja , Zöller Joachim E. , Maintz David , Zinser Max 
Published: May 2021

SUMMARY
Precise perforator mapping of the epifascial and subcutaneous course of the perforator flaps, including the precise detection of the skin point, is mandatory for successful preoperative flap design and planning of supramicrosurgery. We investigated the effectiveness of contrast-enhanced B-flow (BCEUS) imaging for perforator mapping and preoperative perforator flap planning and compared it with B-flow ultrasound, contrast-enhanced ultrasound, and color Doppler ultrasound. Sixteen patients who received an individualized perforator flap reconstruction were included in the study. Preoperative perforator mapping includes the following structures: subfascial course of the pedicle, fascial penetration point, subcutaneous course (epifascial and subcutaneous), and perforator skin point. The precision of the preoperative perforator mapping was analyzed for color Doppler ultrasound, contrast-enhanced ultrasound, B-flow ultrasound, and BCEUS. Each technique was able to precisely display the subfascial course of the vascular pedicle, including the fascial penetration point. However, only BCEUS enabled precise mapping of the epifascial and subcutaneous (suprafascial) course, including the skin point of the perforators with a clear delineation. Precise knowledge of the suprafascial course of the perforators is mandatory for successful supermicrosurgery and perforator flap planning. BCEUS imaging facilitates full perforator mapping, which improves the safety of flap harvesting. However, BCEUS is technically demanding and requires an experienced sonographer.
SUBRETINAL ENDOSCOPIC SURGERY FOR METASTATIC CHOROIDAL TUMOR
Authors: Kaga Tatsushi , Kojima Takashi , Mori Toshio , Yokoyama Sho , Hattori Yukinori , Ichikawa Kazuo 
Published: May 2021

Purpose:
To report a case of a metastatic choroidal tumor treated with subretinal endoscopic surgery.

Methods:
A single case report.

Results:
A 68-year-old woman presented with a metastatic choroidal tumor in the right eye and an intraocular pressure of 54 mmHg. Chemotherapy and radiotherapy were ineffective in eliminating her eye pain. Subretinal endoscopic surgery was performed to remove the metastatic choroidal tumor with the complex retinal detachment attached to the posterior surface of the lens. The day after subretinal endoscopic surgery, the patient's intraocular pressure decreased to 7 mmHg and her pain subsided. The chemotherapeutic strategy was modified according to the pathological findings. Survival prognosis improved from 3 to 18 months. Twenty-one months after the surgery, the retinal detachment was reattached under silicone oil with a best-corrected visual acuity of 20/1,000 and an intraocular pressure of 15 mmHg.

Conclusion:
In this case, subretinal endoscopic surgery preserved visual function, eliminating the need for enucleation.
ASYMPTOMATIC OCULAR MANIFESTATIONS OF ACERULOPLASMINEMIA IN TWO ADULT WHITE SIBLINGS: A MULTIMODAL IMAGING APPROACH
Authors: Furashova Olga , Mielke Stefan , Lindner Uwe 
Published: May 2021

Purpose:
To report ocular manifestations of aceruloplasminemia in two adult White siblings.

Methods:
The ocular findings were investigated using a multimodal imaging approach including color fundus photography, fluorescein angiography, autofluorescence imaging, and spectral-domain optical coherence tomography.

Results:
A 43-year-old woman and a 39-year-old man were diagnosed with aceruloplasminemia based on clinical symptoms, laboratory tests, liver biopsy, and genetic examination of the ceruloplasmin gene confirming the homozygotic mutation G708S. Both patients had no ophthalmologic symptoms, unremarkable anterior segment, and visual acuity of 20/20 in both eyes. Indirect ophthalmoscopy of the fundus revealed subtle yellowish color with punctate inhomogeneous pigmentation in the whole retina. The autofluorescence images demonstrated remarkable punctate hyperfluorescence involving the central and peripheral retina. Spectral-domain optical coherence tomography images showed normal retinal structure in the macular area with intact outer retinal layers. Fluorescein angiography showed a slightly inhomogeneous pattern of hypofluorescence and hyperfluorescence from the early until late angiography phase.

Conclusion:
We describe two adult cases of ocular manifestations of a rare hereditary condition with systemic iron overload. Retinal degeneration in aceruloplasminemia might be overlooked on a routine ophthalmic examination and requires at least an autofluorescence image because initial damage at the level of retinal pigment epithelium is not always visible on ophthalmoscopy.
Factors affecting nurse practitioners' integration of evidence into practice
Authors: Hamilton Krista E. , Jones Stacey J. , Gardner Carrie L. 
Published: May 2021

ABSTRACT

Background:
Evidence-based clinical practice guidelines bridge the gap between clinical practice and research, improve patient outcomes, promote consistency of care, and enhance quality of care. However, guideline adherence varies widely among individual providers and organizations.

Purpose:
To identify factors that facilitate or impede nurse practitioners' integration of guideline recommendations into practice.

Methods:
Every nurse practitioner in Alabama was invited to complete an online 45-question survey evaluating beliefs and attitudes regarding evidence-based guidelines, facilitators and barriers to implementation, and utilization of information resources in patient care.

Results:
The five most commonly identified barriers to evidence-based guideline implementation in participants' current work settings are patients with multiple comorbidities, time constraints, pressure from patients to provide nonrecommended care, insufficient staffing, and inadequate financial resources. The five most commonly identified facilitators in participants' current work settings are easy access to guidelines, support from leadership, free access to guidelines, in-person education regarding a guideline, and clinical decision support software programs. Participants expressed a desire for free and easy access to evidence-based practice (EBP) guidelines and clinical decision support programs, as well as education regarding guidelines and opportunities to discuss evidence with colleagues.

Implications for practice:
The barriers and facilitators of guideline implementation that were identified in this study should be useful in the development and refinement of future studies and interventions to enhance guideline implementation among individuals and organizations.
Facial Transplantation: Principles and Evolving Concepts
Authors: Kantar Rami S. , Alfonso Allyson R. , Diep Gustave K. , Berman Zoe P. , Rifkin William J. , Diaz-Siso J. Rodrigo , Sosin Michael , Gelb Bruce E. , Ceradini Daniel J. , Rodriguez Eduardo D. 
Published: May 2021

Learning Objectives:
After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date.

Summary:
This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date.
Comparison of patient-reported and functional outcomes following transition from mechanical to microprocessor knee in the low-activity user with a unilateral transfemoral amputation
Authors: Davie-Smith Fiona , Carse Bruce 
Published: May 2021

Background:
The Scottish Specialist Prosthetics Service has provided microprocessor knees (MPKs) through the National Health Service since 2014, predominantly to high-activity transfemoral amputations (TFAs). Benefits of MPKs to the lower-activity TFA are less established in the literature.

Objectives:
This study aimed to compare patient-reported and functional measures in low-activity TFAs transitioning from a mechanical knee to a MPK.

Study Design:
This is a retrospective cohort analysis of low-activity individuals with a unilateral TFA provided with an MPK.

Methods:
Patient-reported measures were recorded in routine clinical care before and 6 months after MPK provision. These included HR-QoL (EQ-5D-5L Health Index), Activities Balance Confidence score, Prosthetic Limb User Survey of Mobility, falls frequency, use of walking aids, and Socket Comfort Score. Functional measures included the two-minute walk test (2MWT), L-test, and Amputee Mobility Predictor score, and three-dimensional gait analysis was used to generate a Gait Profile Score (GPS). The primary outcomes were HR-QoL and GPS.

Results:
Forty-five participants fulfilled the inclusion criteria. Thirty-one had pre-MPK and post-MPK measures, of which 15 had three-dimensional gait analysis. The mean age (n = 31) was 60 years (SD 11), and 68% were male. HR-QoL and GPS did not significantly improve with MPK provision (p = 0.014 and p = 0.019); Amputee Mobility Predictor score, L-Test, 2MWT, falls, and Activities Balance Confidence score showed a significant improvement with MPK provision (p < 0.001).

Conclusions:
Although no statistically significant change in the primary outcomes was measured, there were sufficient data to support MPK provision in low-activity prosthetic users with participants demonstrating improvements in balance, 2MWT, falls frequency, and confidence.
Two 11-Years Periods Statistics and Trends of Enucleation and Evisceration
Authors: Furdova Alena , Horkovicova Kristina , Furda Robert , Sramka Miron , Rybar Jan , Kusenda Pavol , Pridavkova Zuzana 
Published: May 2021

Purpose:
The indications for evisceration and enucleation are still evolving and controversial. The study aims to describe trends of enucleation versus evisceration in one center.

Methods:
In period 1998–2019 were 353 patients were included in the study. Statistical results and Chi-square test for pair-wise comparisons for the statistical significance in comparing two subgroups (years periods 1998–2008 and 2009–2019) per category have been evaluated.

Results:
The enucleation was performed in 306 patients, and the evisceration was performed in 47 patients. In 221 patients with the tumor exclusively enucleation was indicated. For the operation technique, the authors got a chi-square value of 0.027, and the associated P value is at 0.8695, then the number of evisceration and enucleation in subgroups have not confirmed independency. For the tumor presence, the authors got a chi-square value of 5.4, and the associated P value is at 0.02, then the number of validated/nonvalidated tumor presence in subgroups confirmed independency.

Conclusions:
The performed enucleations had 98% cases uveal melanoma, 1% of cases of another type of malignancy (lymphoma non-Hodgkin type), and 1% cases with benign tumor. Enucleation is also today most frequently due to malignant intraocular tumors, whereas evisceration if most frequently for the phthisis eye after a trauma or a previous intraocular surgery. In our study in 22 years interval also in the second period, there was an increased trend of enucleation due to intraocular malignancy. It can have many reasons, especially, that patients are sent to oncology centers late in the advanced stage of tumor.
Efficacy of Sofosbuvir plus Ledipasvir in Egyptian patients with COVID-19 compared to standard treatment: Randomized controlled trial
Authors: Elgohary Mohamed Abdel-Salam , Hasan Eman Medhat , Ibrahim Amany Ahmad , Ahmed Abdelsalam Mohamed Farouk , Abdel-Rahman Raafat Zaher , Zaki Ashraf Ibrahim , Elaatar Mohamed Bakr , Elnagar Mohamed Thabet , Emam Mohamed Emam , Hamada Mahmoud Moustafa , Abdel-Hamid Taimour Mohamed , Abdel-Hafez Ahmad Samir , Seadawy Mohamed G. , Fatoh Ahmad Rashad , Elsaied Mohamed Ali , Sakr Marwa Abdel-Rahman , Elkady Ahmed Omar , Shehata Mohamed Muawad , Nawar Osama Mohamed , Selem Mohamed Abu-elnaga , Abd-aal Mohamed Saeed , Lotfy Hany Hafez , Elnagdy Tarek Refaat , Helmy Sherine , Mubark Magdy Amin 
Published: May 2021

AbstractBackgroundCOVID-19 is a pandemic disease caused by SARS-CoV-2, which is an RNA virus similar to HCV in the replication process. Sofosbuvir/ledipasvir is an approved drug by the FDA to treat HCV infection. This study investigates the efficacy of Sofosbuvir/ledipasvir as a treatment for patients with moderate COVID-19 infection..MethodsThis is a single-blinded parallel-randomized controlled trial. The participants were randomized equally into the intervention group received Sofosbuvir/ledipasvir (S.L. group), and the control group received Oseltamivir, Hydroxychloroquine, and Azithromycin (OCH group). The primary outcomes were the cure rate over time and the incidence of serious adverse events. The secondary outcomes included the laboratory findings.ResultsTwo hundred and fifty patients were divided equally into each group. Both groups were similar regarding gender, but age was higher in the S.L. group (p=0.001). In the S.L. group, 89 (71.2%) patients were cured, while only 51 (40.8%) patients were cured in the OCH group. The cure rate was significantly higher in the S.L. group (RR=1.75, p<0.001). Kaplan-Meir plot showed a considerably higher cure over time in the S.L. group (Log-rank test, p=0.032). There were no deaths in the S.L. group, but there were six deaths (4.8%) in the OCH group (RR=0.08, p=0.013). Seven patients (5.6%) in the S.L. group and six patients (4.8%) in the OCH group were admitted to ICU (RR=1.17, P=0.776). There was no significant difference between treatment groups regarding Total Leukocyte Count, Neutrophils count, Lymph and Urea.ConclusionSofosbuvir/ledipasvir is suggestive of being effective in treating patients with moderate COVID-19 infection. Further studies are needed to compare Sofosbuvir/ledipasvir with the new treatment protocols.
A COVID-19 Community Vulnerability Index to drive precision policy in the
US
Authors: Smittenaar Peter , Stewart Nicholas , Sutermaster Staci , Coome Lindsay , Dibner-Dunlap Aaron , Jain Mokshada , Caplan Yael , Campigotto Christine , Sgaier Sema K. 
Published: May 2021

Abstract

Background
In April 2020 we released the US COVID-19 Community Vulnerability Index
(CCVI) to bring to life vulnerability to health, economic, and social impact
of COVID-19 at the state, county, and census tract level. Here we describe
the methodology, how vulnerability is distributed across the U.S., and
assess the impact on vulnerable communities over the first year of the
pandemic.

Methods
The index combines 40 indicators into seven themes, drawing on both
public and proprietary data. We associate timeseries of COVID-19 cases,
deaths, test site access, and rental arrears with vulnerability.

Results
Although overall COVID-19 vulnerability is concentrated in the South,
the seven underlying themes show substantial spatial variability. As of May
13, 2021, the top-third of vulnerable counties have seen 21% more cases and
47% more deaths than the bottom-third of vulnerable counties, despite
receiving 27% fewer tests (adjusted for population). Individual
vulnerability themes vary over time in their relationship with mortality as
the virus swept across the country. Over 20% of households in the top
vulnerability tercile have fallen behind on rent. Poorer test site access
for rural vulnerable populations early in the pandemic has since been
alleviated.

Conclusion
The CCVI captures greater risk of health and economic impact. It has
enjoyed widespread use in response planning, and we share lessons learned
about developing a data-driven tool in the midst of a fast-moving pandemic.
The CCVI and an interactive data explorer are available at
precisionforcovid.org/ccvi.

What is already known on this topic

Various communities across the United States will
experience the adverse effects of public health crises to
different degrees of severity.

Composite indicators, such as the CDC Social
Vulnerability Index, have proven to be valuable to
policymakers by turning complex data sets into easily
digestible and actionable information. However, the
indicators within the Social Vulnerability Index do not
fully contextualize the negative impacts spurred by the
current pandemic.

What this study adds

The U.S. COVID-19 Community Vulnerability Index captures
vulnerabilities spanning health, social, and economic
dimensions that have been felt by every community in the US
differently.

Vulnerable populations have experienced more cases and
deaths, higher unemployment, and a lack of access to
critical support such as testing sites.

Precision policies targeting vulnerable populations need
to be designed and enacted to decrease the gap in negative
consequences experienced in this and future pandemics, and
the COVID-19 Community Vulnerability Index is a tool to
highlight where and why these inequities occur.
REGEN-COV Antibody Cocktail Clinical Outcomes Study in Covid-19 Outpatients
Authors: Weinreich David M. , Sivapalasingam Sumathi , Norton Thomas , Ali Shazia , Gao Haitao , Bhore Rafia , Xiao Jing , Hooper Andrea T. , Hamilton Jennifer D. , Musser Bret J. , Rofail Diana , Hussein Mohamed , Im Joseph , Atmodjo Dominique Y. , Perry Christina , Pan Cynthia , Mahmood Adnan , Hosain Romana , Davis John D. , Turner Kenneth C. , Baum Alina , Kyratsous Christos A. , Kim Yunji , Cook Amanda , Kampman Wendy , Roque-Guerrero Lilia , Acloque Gerard , Aazami Hessam , Cannon Kevin , Simón-Campos J. Abraham , Bocchini Joseph A. , Kowal Bari , DiCioccio Thomas , Soo Yuhwen , Stahl Neil , Lipsich Leah , Braunstein Ned , Herman Gary , Yancopoulos George D. ,   for the Trial Investigators
Published: May 2021

ABSTRACTBackgroundREGEN-COV antibody cocktail (casirivimab with imdevimab) rapidly reduced viral load and decreased medically-attended visits in the phase 1/2 portion of this trial; REGEN-COV, retains activity in vitro against emerging SARS-CoV-2 variants of concern.MethodsThe phase 3 portion of this adaptive, randomized, master protocol, included 4,057 Covid-19 outpatients with one or more risk factors for severe disease. Patients were randomized to a single treatment of intravenous placebo, or various doses of REGEN-COV, and followed for 28 days. The prespecified hierarchical analysis first compared REGEN-COV 2400mg dose vs concurrent placebo, then compared the 1200mg dose vs concurrent placebo, for endpoints assessing risk of hospitalization or death, and time to symptom resolution. Safety was evaluated in all treated patients.ResultsBoth REGEN-COV 2400mg and 1200mg significantly reduced Covid-19-related hospitalization or all-cause death compared to placebo (71.3% reduction [1.3% vs 4.6%; p<0.0001] and 70.4% reduction [1.0% vs 3.2%; p=0.0024], respectively). The median time to resolution of Covid-19 symptoms was 4 days shorter in both dose arms vs placebo (10 vs 14 days; p<0.0001). Efficacy of REGEN-COV was consistent across subgroups, including patients who were SARS-CoV-2 serum antibody-positive at baseline. REGEN-COV more rapidly reduced viral load than placebo. Serious adverse events occurred more frequently in the placebo group (4.0%) than in the 1200mg (1.1%) and 2400mg (1.3%) groups and grade ≥2 infusion-related reactions were infrequent (<0.3% in all groups).ConclusionsTreatment with REGEN-COV was well-tolerated and significantly reduced Covid-19-related hospitalization or all-cause death, rapidly resolved symptoms, and reduced viral load.(Funded by Regeneron Pharmaceuticals and the Biomedical and Advanced Research and Development Authority of the Department of Health and Human Services; ClinicalTrials.gov number, NCT04425629.)