bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health-Related Quality of Life Following Delirium in the PICU*
Authors: Dervan Leslie A. , Killien Elizabeth Y. , Smith Mallory B. , Watson R. Scott 
Published: August 2021

OBJECTIVES:
To evaluate whether delirium during pediatric critical illness is associated with post-discharge health-related quality of life.

DESIGN:
Retrospective cohort study.

SETTING:
Academic tertiary care center.

PATIENTS:
Children 1 month to 18 years old admitted to the PICU or cardiac ICU and enrolled in the Seattle Children’s Hospital Outcomes Assessment Program.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Delirium was assessed twice daily using the Cornell Assessment of Pediatric Delirium; a score greater than or equal to 9 (with fluctuating level of arousal for children with developmental disability) indicated delirium. Baseline (pre-admission) and post-discharge health-related quality of life were assessed by the Pediatric Quality of Life Inventory (Mapi Research Trust, Lyon, France) or the Functional Status II-R (for children with developmental disability). Among 534 patients, delirium was common (44%), as was clinically important decline in health-related quality of life (≥ 4.5 points) from baseline to follow-up (22%), measured at median 6.6 weeks post-hospital discharge (interquartile range, 5.1–8.5). On univariate analysis, children with delirium had similar likelihood of health-related quality of life decline compared with those without (25.5% vs 19.7%; p = 0.1). Using multivariable logistic regression adjusting for age, medical complexity, predicted risk of mortality, admission diagnosis, receipt of noninvasive ventilation, hospital length of stay, time to follow-up, and parent age, delirium was independently associated with health-related quality of life decline among children assessed by the Pediatric Quality of Life Inventory (adjusted odds ratio, 2.0; 95% CI, 1.1–3.5). Among children evaluated with the Functional Status II-R, delirium was not independently associated with health-related quality of life decline (odds ratio, 1.4; 95% CI, 0.6–3.2). In both groups, longer time to follow-up was also independently associated with improvements in health-related quality of life.

CONCLUSIONS:
Delirium during the ICU stay is associated with decline in health-related quality of life from baseline to post-discharge follow-up among children assessed by the Pediatric Quality of Life Inventory, who were generally characterized by normal baseline cognitive function and less medical comorbidity. This association was not present among children assessed by the Functional Status II-R, potentially due to their higher overall risk of health-related quality of life decline, or other clinical differences that modify the effects of delirium in this group.
Temperature Management and Health-Related Quality of Life in Children 3 Years After Cardiac Arrest
Authors: Magee Aidan , Deschamps Rachel , Delzoppo Carmel , Pan Kevin C. , Butt Warwick , Dagan Misha , Forrest Anri , Namachivayam Siva P. 
Published: August 2021

OBJECTIVES:
Therapeutic hypothermia minimizes neuronal injury in animal models of hypoxic-ischemic encephalopathy with greater effect when used sooner after the insult. Clinical trials generally showed limited benefit but are difficult to perform in a timely manner. In this clinical study, we evaluated the association between the use of hypothermia (or not) and health-related quality of life among survivors of pediatric cardiac arrest as well as overall mortality.

DESIGN:
Single-center, retrospectively identified cohort with prospective assessment of health-related quality of life.

SETTING:
PICU of a pediatric hospital.

PATIENTS:
Children with either out-of-hospital or in-hospital cardiac arrest from January 2012 to December 2017.

INTERVENTIONS:
Patients were assigned into two groups: those who received therapeutic hypothermia at less than or equal to 35°C and those who did not receive therapeutic hypothermia but who had normothermia targeted (36–36.5°C). The primary outcome was health-related quality of life assessment and the secondary outcome was PICU mortality.

MEASUREMENTS AND MAIN RESULTS:
We studied 239 children, 112 (47%) in the therapeutic hypothermia group. The median (interquartile range) of lowest temperature reached in the 48 hours post cardiac arrest in the therapeutic hypothermia group was 33°C (32.6–33.6°C) compared with 35.4°C (34.7–36.2°C) in the no therapeutic hypothermia group (p < 0.001). At follow-up, 152 (64%) were alive and health-related quality of life assessments were completed in 128. Use of therapeutic hypothermia was associated with higher lactate and lower pH at baseline. After regression adjustment, therapeutic hypothermia (as opposed to no therapeutic hypothermia) was associated with higher physical (mean difference, 15.8; 95% CI, 3.5–27.9) and psychosocial scores (13.6 [5.8–21.5]). These observations remained even when patients with a temperature greater than 37.5°C were excluded. We failed to find an association between therapeutic hypothermia and lower mortality.

CONCLUSIONS:
Out-of-hospital or in-hospital cardiac arrest treated with therapeutic hypothermia was associated with higher health-related quality of life scores despite having association with higher lactate and lower pH after resuscitation. We failed to identify an association between use of therapeutic hypothermia and lower mortality.
Effect of Time of Daily Data Collection on the Calculation of Catheter-associated Urinary Tract Infection Rates
Authors: Donnelly Lane F. , Wood Matthew , Loh Ling , Tekic Natasa , Shin Andrew Y. , Scheinker David 
Published: August 2021

Introduction:
According to the National Healthcare Safety Network (NHSN) definitions for Catheter-associated urinary tract infections (CAUTI) rates, determination of the number of urinary catheter days must occur by calculating the number of catheters in place “for each day of the month, at the same time of day” but does not define at what time of day this occurs. The purpose of this review was to determine if a data collection time of 11 am would yield a greater collection of urinary catheter days than that done at midnight.

Methods:
During a 20-month period, the number of urinary catheter days was calculated using once-a-day electronic measurements to identify a urinary catheter presence. We used data collected at 11 am and collected at midnight (our historic default) in comparing the calculated urinary catheter days and resultant CAUTI rates.

Results:
There were 7,548 patients who had a urinary tract catheter. The number of urinary catheter days captured using the 11 am collection time was 15,425, and using the midnight collection time was 10,234, resulting in a 50.7% increase. The CAUTI rate per 1,000 urinary catheter days calculated using the 11 am collection method was 0.58, and using the midnight collection method was 0.88, a reduced CAUTI rate of 33.6%.

Conclusion:
The data collection time can significantly impact the calculation of urinary catheter days and on calculated CAUTI rates. Variations in how healthcare systems define their denominator per current National Healthcare Safety Network policy may result in significant differences in reported rates.
Disparities between Operative Time and Relative Value Units for Plastic Surgery Procedures
Authors: Blau Jared A. , Marks Caitlin E. , Phillips Brett T. , Hollenbeck Scott T. 
Published: August 2021

Background:
Plastic surgeons are evaluated not only by the number of patients served but also by relative value, quantified by the Medicare relative value unit system, which can affect advancement and compensation. Procedures that demand a high operative time without an increase in relative value units are, by definition, inefficient. The purpose of this study was to determine whether the number of relative value units actually corresponds to operative time.

Methods:
The National Surgical Quality Improvement Program data sets over a 9-year period were queried for plastic surgery operations. The primary CPT codes representing the 100 most common operations were compared for operative time and total relative value units.

Results:
A total of 53,701 cases were included. There was a high degree of correlation between operative time and number of relative value units (Pearson correlation coefficient, 0.82). The average efficiency was 10.201 ± 3.386 relative value units per hour. Pressure ulcer excisions and breast reconstruction were among the most efficient (e.g., Excision, sacral pressure ulcer, CPT 19357, generated 20.819 relative value units per hour). Skin excisions, débridements, and flap delays were among the least efficient (e.g., Excision, excessive skin and subcutaneous tissue, CPT 15847, generated 1.752 relative value units per hour).

Conclusions:
As a general trend, the most common plastic surgical procedures requiring longer operative times are associated with more relative value units. Cases with higher relative value units assigned tended to be more efficient. For the 100 most common procedures, relative value units and operative time are not evenly distributed. These data suggest modifications to the current relative value unit designation system to more equally allocate these units based on effort and time.
Refining Indications for Orbital Floor Fracture Reconstruction: A Risk-Stratification Tool Predicting Symptom Development and Need for Surgery
Authors: Basta Marten N. , Rao Vinay , Roussel Lauren O. , Crozier Joseph W. , Liu Paul Y. , Woo Albert S. 
Published: August 2021

Background:
Challenges in orbital floor fracture management include delayed symptom onset and controversial surgical indications based on radiographic findings. This study assessed which imaging characteristics most reliably predict symptomatology to generate a tool quantifying individual need for surgery on initial presentation.

Methods:
The clinical course for all patients with isolated orbital fractures at a single institution from 2015 to 2017 were reviewed. Trauma mechanism, computed tomographic scan findings, and symptoms necessitating surgery (diplopia, enophthalmos) were noted. Univariable and multivariable regression modeling was used to generate a predictive risk model for operative fractures.

Results:
One hundred twenty-one patients with isolated orbital fractures were identified. Mechanism of injury included falls (41 percent), assault (37 percent), and vehicular trauma (17 percent). Patient follow-up averaged 4.4 ± 4.8 months. Average orbital floor fracture area was 2.4 cm2 (range, 0.36 to 6.18 cm2), and orbital volume herniation averaged 0.70 cm3 (range, 0.01 to 4.23 cm3). Twenty-one patients (17.3 percent) required surgical intervention for symptomatic fractures. The strongest predictors of symptoms were orbital volume increase greater than 1.3 cm3 (OR, 10.5; p = 0.001) and inferior rectus displacement within/below the fracture line (OR, 3.7; p = 0.049). Mechanical fall was risk-reducing (OR, 0.08; p = 0.005). Symptom risk was stratified from low (3.6 percent) to high risk (71 percent) (C-statistic = 0.90). The volume of herniated orbital contents was significantly more predictive of symptoms than fracture area (C-statistic = 0.81 versus C-statistic = 0.66; p = 0.02).

Conclusions:
The proposed risk tool allows highly accurate, early prediction of symptomatic orbital floor fractures. Findings suggest that orbital volume change, not fracture area, more reliably informs operative indications, along with inferior rectus muscle caudal malposition. A simplified stepwise decision algorithm demonstrates the potential utility of this risk-assessment tool.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Mentorship in Plastic Surgery: A Critical Appraisal of Where We Stand and What We Can Do Better
Authors: Myers Paige L. , Amalfi Ashley N. , Ramanadham Smita R. 
Published: August 2021

Summary:
Mentorship is a critical tool for professional development and career success. In academic surgery, supportive mentorship affords higher job satisfaction, academic productivity, and diversity and inclusion. It protects against burnout and increasing academic surgery attrition rates. Women, underrepresented minorities, and junior plastic surgeons report lower job satisfaction and fewer mentorship opportunities. Given the unique challenges these groups face in a constantly changing health care system, the importance of mentorship cannot be overstated. Through a survey of American Society of Plastic Surgeons members, this study evaluated different aspects of mentorship to describe the current state in plastic surgery. Despite 94.05 percent of plastic surgeons believing that mentorship is valuable, only 15.16 percent reported a structured mentorship system, often without evaluation. Male and female participants agree that mentorship is needed for both professional (clinical judgment) and personal (work-life balance) development. Interestingly, women plastic surgeons felt it was important for mentees to have gender and race/ethnicity concordance to their mentors (p < 0.001). There was no agreement regarding the most effective method to implement mentorship programs, highlighting the challenges of this problem. Through thoughtful planning and commitment, mentorship programs can be instituted to benefit not just the mentee, but the mentor as well.
A Minimally Invasive Full Endoscopic Approach to Tibial Nerve Neurolysis in Diabetic Foot Neuropathy: An Alternative to Open Procedures
Authors: Uemura Tetsuji , Watanabe Hidetaka , Yanai Tetsu , Kawano Hiroshige , Yoshida Aya , Okutsu Ichiro 
Published: August 2021

Background:
Dellon et al. have reported that chronic nerve compression of the tibial nerve inside the tarsal tunnel, caused by diabetes mellitus, can be relieved following open decompression surgery. However, the large skin incision resulting from Dellon’s procedure may cause wound healing problems. The authors report the possibility of a minimally invasive full endoscopic procedure.

Methods:
Operations were performed under local anesthesia without a pneumatic tourniquet. An anesthetic agent was applied at the proximal part of the flexor retinaculum of the foot, and a hypodermic needle was advanced into the tarsal tunnel. Tarsal tunnel pressure and blood circulation of the tibial nerve using indocyanine green assessment were measured preoperatively. One 1-cm portal skin incision was made at the anesthetized area and the Universal Subcutaneous Endoscope system was inserted into the tarsal tunnel. The flexor retinaculum, tibial nerve, blood vessels, and abductor hallucis muscle fascia were identified under endoscopic observation. After decompression of the tarsal tunnel, the authors measured tarsal tunnel pressure and blood circulation of the tibial nerve for analysis of the effectiveness of the endoscopic decompression during the procedure.

Results:
Fourteen operations were compiled and analyzed. Postoperative clinical status was improved based on the preoperative modified Toronto Clinical Neuropathy Score. The mean tarsal tunnel pressure dropped to 4.5 mmHg during surgery from the initial preoperative 49.4 mmHg in resting position. Endoscopic indocyanine green assessment showed more than 30 percent improvement of the vascularity surrounding the tibial nerve.

Conclusion:
The authors’ minimally invasive full endoscopic procedure is a viable alternative approach for tarsal tunnel syndrome patients with diabetic foot neuropathy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Firearm injuries during legal interventions: Nationwide analysis
Authors: Liasidis Panagiotis K. , Lewis Meghan , Jakob Dominik A. , Inaba Kenji , Demetriades Demetrios 
Published: August 2021

INTRODUCTION
There is limited literature on firearm injuries during legal interventions. The purpose of this study was to examine the epidemiology, injury characteristics, and outcomes of both civilians and law enforcement officials (LEOs) who sustained firearm injuries over the course of legal action.

METHODS
Retrospective observational study using data from the National Trauma Data Bank (2015–2017) was performed. All patients who were injured by firearms during legal interventions were identified using the International Classification of Disease, Tenth Revision, external cause of injury codes. The study groups were injured civilian suspects and police officers. Demographics, injury characteristics, and outcomes were analyzed and compared between the groups. Primary outcomes were the clinical and injury characteristics among the victims.

RESULTS
A total of 1,411 patients were included in the study, of which 1,091 (77.3%) were civilians, 289 officers (20.5%), and 31 bystanders (2.2%). Overall, 95.2% of patients were male. Compared with LEOs, civilians were younger (31 vs. 34 years, p = 0.007) and more severely injured (median Injury Severity Score, 13 vs. 10 [p = 0.005]; Injury Severity Score >15, 44.4% vs. 37.1% [p = 0.025]). Civilians were more likely to sustain severe (Abbreviated Injury Scale, ≥3) intra-abdominal injuries (26.8% vs. 16.1%, p < 0.001) and spinal fractures (13.0% vs. 6.9%, p = 0.004). In-hospital mortality and overall complication rate were similar between the groups (mortality: civilians, 24.7% vs. LEOs, 27.3% [p = 0.360]; overall complications: civilians, 10.3% vs. LEOs, 8.4% [p = 0.338]).

CONCLUSION
Firearm injuries during legal interventions are associated with significant injury burden and a higher mortality than the reported mortality in gunshot wounds among civilians. The mortality and overall complication rate were similar between civilian suspects and law enforcement officials.

LEVEL OF EVIDENCE
Epidemiologic, level IV.
SARS-CoV-2 susceptibility and ACE2 gene variations within diverse ethnic backgrounds
Authors: Vadgama Nirmal , Kreymerman Alexander , Campbell Jackie , Shamardina Olga , Brugger Christiane ,   Genomics England Research Consortium, Lee Richard T. , Penkett Christopher J. , Gifford Casey A. , Mercola Mark , Nasir Jamal , Karakikes Ioannis 
Published: August 2021

ABSTRACTBackgroundHost genetics play a major role in COVID-19 susceptibility and severity. Here, we analyse an ethnically diverse cohort of National Health Service (NHS) patients in the United Kingdom (UK) to assess the association between variants in the ACE2 locus and COVID-19 risk.MethodsWe analysed whole-genome sequencing (WGS) data of 6,274 participants who were tested for SARS-CoV-2 from the UK’s 100,000 Genomes Project (100KGP) for the presence of ACE2 coding variants and expression quantitative trait loci (eQTLs).FindingsWe identified a splice site variant (rs2285666) associated with increased ACE2 expression with an overrepresentation in SARS-CoV-2 positive patients relative to 100KGP controls (p = .015), and in hospitalised European patients relative to outpatients in intra-ethnic comparisons (p = .029). We also compared the prevalence of 288 eQTLs, of which 23 were enriched in SARS-CoV-2 positive patients. The eQTL rs12006793 had the largest effect size (d = 0.91), which decreases ACE2 expression and is more prevalent in controls, thus potentially reducing risk of COVID-19. We identified three novel nonsynonymous variants predicted to alter ACE2 function, and showed that three variants (p.K26R, p.H378R, p.Y515N) alter receptor affinity for the viral Spike (S) protein. Variants p.K26R and p.N720D are more prevalent in the European population (p < .001), but Y497H is less prevalent compared to East Asians (p = .020).InterpretationOur results demonstrate that the spectrum of genetic variants in ACE2 may inform risk stratification of COVID-19 patients and could partially explain the differences in disease susceptibility and severity among different ethnic groups.FundingThe 100KGP is funded by the National Institute for Health Research and NHS England. Funding was also obtained from Stanford University, Palo Alto.
The WORC database: MRI and CT scans, segmentations, and clinical labels for 930 patients from six radiomics studies
Authors: Starmans Martijn P.A. , Timbergen Milea J.M. , Vos Melissa , Padmos Guillaume A. , Grünhagen Dirk J. , Verhoef Cornelis , Sleijfer Stefan , van Leenders Geert J.L.H. , Buisman Florian E. , Willemssen Francois E.J.A. , Koerkamp Bas Groot , Angus Lindsay , van der Veldt Astrid A.M. , Rajicic Ana , Odink Arlette E. , Renckens Michel , Doukas Michail , de Man Rob A. , IJzermans Jan N.M. , Miclea Razvan L. , Vermeulen Peter B. , Thomeer Maarten G. , Visser Jacob J. , Niessen Wiro J. , Klein Stefan 
Published: August 2021

AbstractThe WORC database consists in total of 930 patients composed of six datasets gathered at the Erasmus MC, consisting of patients with: 1) well-differentiated liposarcoma or lipoma (115 patients); 2) desmoid-type fibromatosis or extremity soft-tissue sarcomas (203 patients); 3) primary solid liver tumors, either malignant (hepatocellular carcinoma or intrahepatic cholangiocarcinoma) or benign (hepatocellular adenoma or focal nodular hyperplasia) (186 patients); 4) gastrointestinal stromal tumors (GISTs) and intra-abdominal gastrointestinal tumors radiologically resembling GISTs (246 patients); 5) colorectal liver metastases (77 patients); and 6) lung metastases of metastatic melanoma (103 patients). For each patient, either a magnetic resonance imaging (MRI) or computed tomography (CT) scan, collected from routine clinical care, one or multiple (semi-)automatic lesion segmentations, and ground truth labels from a gold standard (e.g., pathologically proven) are available. All datasets are multicenter imaging datasets, as patients referred to our institute often received imaging at their referring hospital. The dataset can be used to validate or develop radiomics methods, i.e., using machine or deep learning to relate the visual appearance to the ground truth labels, and automatic segmentation methods. See also the research article related to this dataset: Starmans et al.,Reproducible radiomics through automated machine learning validated on twelve clinical applications, Submitted.Specifications Table