bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deductible Status in the Pediatric Population: A Barrier to Appropriate Care?
Authors: Torrecillas Vanessa F. , Neuberger Kaden , Ramirez Alexander , Knighton Andrew , Krakovitz Paul , Richards Nathan G. , Srivastava Raj , Meier Jeremy D. 
Published: April 2021

ObjectiveThe objective of this study is to evaluate the impact of high‐deductible health plans on elective surgery (tonsillectomy) in the pediatric population.Study DesignCross‐sectional study.SettingHealth claims database from a third‐party payer.MethodsData were reviewed for children up to 18 years of age who underwent tonsillectomy or arm fracture repair (nonelective control) from 2016 to 2019. Incidence of surgery by health plan deductible (high, low, or government insured) and met or unmet status of deductibles were compared.ResultsA total of 10,047 tonsillectomy claims and 9903 arm fracture repair claims met inclusion and exclusion criteria. The incidence of tonsillectomy was significantly different across deductible plan types. Patients with met deductibles were more likely to undergo tonsillectomy. In patients with deductibles ≥$4000, a 1.75‐fold increase in tonsillectomy was observed in those who had met their deductible as compared with those who had not. These findings were not observed in controls (nonelective arm fracture). For those with met deductibles, those with high deductibles were much more likely to undergo tonsillectomy than those with low, moderate, and government deductibles. Unmet high deductibles were least likely to undergo tonsillectomy.ConclusionsHealth insurance plan type influences the incidence of pediatric elective surgery such as tonsillectomy but not procedures such as nonelective repair of arm fracture. High deductibles may discourage elective surgery for those deductibles that are unmet, risking inappropriate care of vulnerable pediatric patients. However, meeting the deductible may increase incidence, raising the question of overutilization.
Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma
Authors: Farlow Janice L. , McLean Scott A. , Peddireddy Nithin , Bradford Carol R. , Malloy Kelly M. , Stucken Chaz L. , VanKoevering Kyle K. , Spector Matthew E. , Rosko Andrew J. 
Published: April 2021

ObjectiveRecent randomized data suggest that completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) improves locoregional control but does not improve survival for melanoma patients. Locoregional recurrences of head and neck cutaneous melanoma (HNCM) may result in significant morbidity. A better understanding of morbidity is thus important to inform decisions about whether to pursue completion neck dissection (ND).Study DesignCross‐sectional study.SettingAcademic tertiary care hospital.MethodsClinical data were collected for patients with HNCM seen between 2016 and 2019 who were at least 1‐year disease free. Each patient completed the Self‐administered Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), Neck Dissection Impairment Index, and SF‐36 (Short Form–36). Scores were compared by surgical treatment: wide local excision (WLE) only, SLNB, and ND. Univariate and multivariable regression was performed.ResultsOf 474 patients, 140 returned questionnaires (29.5% response rate; WLE, n = 49; SLNB, n = 76; ND, n = 15). No significant differences in SLANSS or Neck Dissection Impairment Index scores were found between the WLE and SLNB groups. SLANSS scores differed by 2 SD (P =. 001) in the ND cohort, which had a 36% rate of neuropathy. Neck impairment was worse by 1 SD (P =. 01) in the ND cohort. No differences were found in SF‐36 domains.ConclusionNeuropathy and neck impairment are components of morbidity after ND. These risks must be balanced with potential morbidity of locoregional recurrence in HNCM.
Voice Quality and Laryngeal Findings in Patients With Suspected Lung Cancer
Authors: Davis Ruth J. , Messing Barbara , Cohen Neri M. , Akst Lee M. 
Published: April 2021

ObjectiveTo describe laryngeal findings and voice quality in patients with suspected lung cancer, relative to voice quality and possible laryngeal pathology.Study DesignProspective cohort study.SettingTertiary care center.MethodsPatients with known or suspected lung cancer were approached before planned thoracic surgery, and they completed acoustic analysis, the Voice‐Related Quality of Life (V‐RQOL) questionnaire, and stroboscopy. The prevalence of dysphonia, V‐RQOL and Cepstral Spectral Index of Dysphonia (CSID) scores, and laryngeal findings were examined and compared between patients ultimately found to have lung cancer and those without cancer.ResultsSixty‐one patients (45 cancer, 16 noncancer) were analyzed. Patients with cancer were older than those without (mean ± SD, 72.3 ± 9.94 vs 62.6 ± 9.30 years; P =. 001). Otherwise, the distribution of stroboscopy findings, acoustic measures, and self‐reported voice handicap were similar between the cancer and noncancer cohorts. Prior to surgery, no patients had vocal cord paralysis or obvious neoplasm, though 4 (6.56%) had leukoplakia and 28 (45.9%) had vocal fold movement asymmetry on stroboscopy. Overall, 21 patients (35.0%) had average CSID scores >19, and 13 (21.7%) had CSID scores >24; however, only 4 self‐described their voice as not working as it should, and only 2 had a V‐RQOL score <85.ConclusionPatients with suspected lung cancer have moderate dysphonia on acoustic measures, though self‐reported impact on quality of life is low. While leukoplakia was seen in 4 patients, obvious neoplasm and occult paralysis were not seen in this cohort. Together, these findings suggest that patients with suspected lung cancer should be assessed for subjective voice dysfunction, but routine laryngeal screening may otherwise be unnecessary.
Prognostic Significance of Radiologic Extranodal Extension in Nasopharyngeal Cancer
Authors: Karakurt Eryılmaz Melek , Kadıyoran Cengiz 
Published: April 2021

ObjectiveThe aim of the present study was to evaluate the prognostic value of radiologic extranodal extension (rENE) in patients with nasopharyngeal cancer.Study DesignRetrospective review.SettingTertiary university hospital.MethodsWe identified patients with nasopharyngeal cancer and lymph node metastasis who underwent pretreatment neck computed tomography or magnetic resonance imaging and evaluated rENE from the involved lymph node. Univariate Kaplan‐Meier and multivariate Cox regression analyses were used to compare rENE+ and rENE– groups for local regional relapse–free survival, distant metastasis–free survival, and overall survival.ResultsOf 61 cases, 24 (39.3%) were rENE+ and 37 (60.7%) were rENE–. The median follow‐up was 65.5 months. The 5‐year distant metastasis–free survival and overall survival rates were lower in the rENE+ group than the rENE– group (70.8% vs 89.2%, P =. 016; 66.7% vs 89.2%, P =. 01, respectively). Differences in locoregional control between the groups were not significant (P =. 18). The 5‐year rates for local regional relapse–free survival were 87.5% for rENE+ and 91.9% for rENE–. In multivariate analysis, the presence of rENE was a significant independent adverse prognostic factor for distant metastasis–free survival and overall survival.ConclusionsWe showed that rENE is an independent prognostic factor for poor distant control and survival in patients with nasopharyngeal cancer.
Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems
Authors: Brincks John , Callesen Jacob 
Published: April 2021

Objective: To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. Design: Cross-sectional study. Setting: Outpatient clinics. Subjects: Sixty-six adults aged ⩾65 years with self-reported balance problems. Main measure: The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed “Up and Go” test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman’s rank correlation coefficient (ρ). Results: Participants had a mean (SD) age of 75.5 (6.6) years, a median ( Q1– Q3) Montreal Cognitive Assessment test score of 26 (24–27), and a median ( Q1– Q3) Falls Efficacy Scale International score of 22 (20–26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92–0.98) and 0.94 (CI: 0.86–0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = −0.62), Dynamic Gait Index (ρ = −0.55), and the Timed “Up and Go” test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). Conclusion: The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.
“Song of Life”: Results of a multicenter randomized trial on the effects of biographical music therapy in palliative care
Authors: Warth Marco , Koehler Friederike , Brehmen Martin , Weber Martin , Bardenheuer Hubert J , Ditzen Beate , Kessler Jens 
Published: April 2021

Background: Awareness for the importance of psychological and spiritual needs in patients with terminal diseases has increased in recent years, but randomized trials on the effects of psychosocial interventions are still rare. Aim: To investigate the efficacy of the “Song of Life” music therapy intervention regarding the emotional and psycho-spiritual dimensions of quality of life. Design: Patients were randomly assigned to either “Song of Life” or a relaxation intervention. “Song of Life” is a novel three-session music therapy intervention working with a biographically meaningful song. Primary outcome was the improvement in psychological quality of life. Secondary outcomes included spiritual well-being, ego-integrity, momentary distress, and global quality of life and the explorative assessment of treatment satisfaction (patient and family member version). Intention-to-treat analysis was conducted including adjustment for multiple testing in secondary outcomes. Setting/participants: Between December 2018 and August 2020, 104 patients receiving specialized palliative care were recruited from two palliative care wards. Results: No significant differences were found regarding psychological and global quality of life, but “Song of Life” participants reported significantly higher spiritual well-being ( p = 0.04) and ego-integrity ( p < 0.01), as well as lower distress ( p = 0.05) than patients in the control group. Both patients’ and family members’ treatment satisfaction was higher after “Song of Life” with large between-group effect sizes on items asking for meaningfulness ( d = 0.96) and importance ( d = 1.00). Conclusions: Our findings provide evidence that “Song of Life” is an effective and meaningful biographical music therapy intervention to facilitate psycho-spiritual integration in terminally ill patients. Trial Registration: German Clinical Trials Register (DRKS)—DRKS00015308 (date of registration: September 7th 2018).
Retinopathy of Prematurity—Using Electronic Medical Records to Efficiently Follow Patients at Multiple Hospitals
Authors: Schultz Gwendolyn , Gaffar Majida 
Published: April 2021

Purpose: To report the use of a centralized electronic medical record (EMR) to provide timely retinopathy of prematurity (ROP) screening in a previously fragmented monitoring system in a standalone children’s hospital in Connecticut. Methods: A chart review of 306 visits for ROP screening in 3 neonatal intensive care units (NICUs) over a time period of 24 months. Results: All infants born at <30 weeks gestational age or birth weight <1,500g (N = 107) at these NICUs were screened for ROP according to the American Academy of Pediatrics guidelines. Data was collected before the implementation of our centralized EMR list, during a transitional period, and once the list was established. Our analysis of the data found an improvement in delay of care from 16.85% to 10.83% of visits, and a decrease in number of visits done during off hours from 20.4% to 5% of visits. Conclusion: Our tool was a free and cost-efficient centralization of a once difficult-to-manage process for ROP screenings in Connecticut. The decrease in delay of care and improvement in physician scheduling will lead to better outcomes for our patients and better sustainability of practice for our providers.
Which exercise and behavioural interventions show most promise for treating fatigue in multiple sclerosis? A network meta-analysis
Authors: Harrison Anthony M , Safari Reza , Mercer Tom , Picariello Federica , van der Linden Marietta L , White Claire , Moss-Morris Rona , Norton Sam 
Published: April 2021

Background: Fatigue is a common, debilitating symptom of multiple sclerosis (MS) without a current standardised treatment. Objective: The aim of this systematic review with network meta-analyses was to estimate the relative effectiveness of both fatigue-targeted and non-targeted exercise, behavioural and combined (behavioural and exercise) interventions. Methods: Nine electronic databases up to August 2018 were searched, and 113 trials ( n = 6909) were included: 34 were fatigue-targeted and 79 non-fatigue-targeted trials. Intervention characteristics were extracted using the Template for Intervention Description and Replication guidelines. Certainty of evidence was assessed using GRADE. Results: Pairwise meta-analyses showed that exercise interventions demonstrated moderate to large effects across subtypes regardless of treatment target, with the largest effect for balance exercise (SMD = 0.84). Cognitive behavioural therapies (CBTs) showed moderate to large effects (SMD = 0.60), with fatigue-targeted treatments showing larger effects than those targeting distress. Network meta-analysis showed that balance exercise performed significantly better compared to other exercise and behavioural intervention subtypes, except CBT. CBT was estimated to be superior to energy conservation and other behavioural interventions. Combined exercise also had a moderate to large effect. Conclusion: Treatment recommendations for balance and combined exercise are tentative as the certainty of the evidence was moderate. The certainty of the evidence for CBT was high.
Adherence to instruction for use after endovascular repair of popliteal artery aneurysm
Authors: Wrede Axel , Lehti Leena , Eiberg Jonas Peter , Acosta Stefan 
Published: April 2021

Objectives Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. Methods The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. Results The two groups of patients treated within ( n = 10) and not within ( n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU ( n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17–2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018–2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. Conclusion The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.
Should patients receive consolidation chemotherapy before reduced intensity allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia in first complete remission?
Authors: Byun Ja Min , Shin Dong-Yeop , Koh Youngil , Hong Junshik , Kim Inho , Yoon Sung-Soo , Lee Ji Yun , Bang Soo-Mee , Lee Jeong-Ok 
Published: April 2021

Background: For acute myeloid leukemia (AML) patients, the role of bridging consolidation chemotherapy after achieving first complete remission (CR1) in the transplant setting is a frequently debated issue. The lack of data from Asian patients led us to conduct this study. Methods: We retrospectively studied outcomes of 106 patients in CR1 undergoing allogeneic stem cell transplantation (alloSCT) with reduced intensity conditioning (RIC) based on their exposure to pre-transplant consolidation chemotherapy. There were 35 in the no consolidation group versus 71 in the consolidation group. Results: The median relapse free survival (RFS) was 9 months for the no consolidation group and 51 months for consolidation group ( p = 0.023). The median overall survival was 32 months for the no consolidation group and not reached for the consolidation group ( p = 0.034). Multivariate analysis recognized consolidation and poor cytogenetics as adverse prognostic factors for RFS. Moreover, RFS was better in patients with a shorter time lapse between last chemotherapy and alloSCT in both the no consolidation group and the consolidation group. Consolidation chemotherapy did not negatively affect neutrophil and platelet engraftment, infection rates, or acute graft- versus-host disease (GVHD) incidence. On the other hand, patients undergoing consolidation chemotherapy showed trends towards a more severe degree of chronic GVHD. Conclusion: The exposure to consolidation chemotherapy in CR1 prior to alloSCT with RIC conditioning did not negatively impact the outcomes in Korean AML patients, for whom a suitable donor is rarely immediately available. Therefore, post-remission consolidation chemotherapy is a reasonable option if required.
Hepatosplenic T-cell lymphoma with hepatocytotropism in a cat
Authors: Ii Tatsuhito , Chambers James K , Segawa Kazuhito , Uchida Kazuyuki 
Published: April 2021

Case summary A 14-year 3-month-old spayed female mixed-breed cat presented with jaundice, anaemia and thrombocytopenia. Haemophagocytic syndrome associated with lymphoma was suspected after cytological examination of the spleen. Despite treatment with prednisolone, L-asparaginase and nimustine, the cat died 176 days after the initial presentation. Necropsy revealed splenomegaly and hepatomegaly, without lymphadenopathy. Histopathologically, neoplastic lymphoid cells infiltrated the hepatic sinusoid and splenic sinus. The neoplastic lymphoid cells showed marked hepatocytotropism and contained erythrocytes, which was also confirmed by electron microscopy. Immunohistochemically, neoplastic lymphoid cells were positive for CD3, TIA1 (GMP-17) and granzyme B, and negative for CD8, CD20, CD56, CD57, CD79a and Iba1. Based on these findings, the cat was diagnosed with hepatosplenic T-cell lymphoma (HS-TCL) with hepatocytotropism. Relevance and novel information This case shows cytotoxic immunophenotype of HS-TCL in a cat, which has not been demonstrated before. Severe hepatocytotropism and haemophagocytosis of the neoplastic cells were likely to be associated with jaundice and anaemia, respectively, and the poor outcome of the present case.
Complications and visual outcome of sutureless, scleral fixated intraocular lens in cases with traumatic aphakia
Authors: Deb Amit Kumar , Sarkar Sandip , Natarajan Kaviyapriya , Elamurgan Vignesh , Jayaseelan Jagadeeswari , Gokhale Tanmay , Jacob Ninan 
Published: April 2021

Purpose: The aim of this study is to describe the complications and outcome of sutureless scleral fixated intraocular lens (SFIOL) implantation in traumatic aphakia. Setting: The study was conducted in a tertiary eye care centre in South India. Design: The study involved a retrospective data analysis. Methods: Medical records of cases with traumatic aphakia who had undergone sutureless SFIOL implantation in the last 2 years were included in the study. Data on intraoperative and postoperative complications and visual outcome were collected and analysed. Results: In total, 45 cases were recruited. Mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from preoperative 1.64 ± 0.45 to 0.63 ± 0.36 at last follow-up visit, and the difference was statistically significant ( p < 0.0001). Final logMAR BCVA was worse than one in three patients who had associated posterior segment pathology. There was no incidence of intraoperative haptic rebound into the vitreous cavity or intraocular lens (IOL) drop. Four cases had hypotony, two cases had choroidal detachment, four cases had raised intraocular pressure (IOP), eight cases had transient corneal oedema and six patients had mild dispersed vitreous haemorrhage during immediate postoperative period. Six patients had postoperative cystoid macular oedema (CME). Two cases developed glaucoma. None of the patients had postoperative haptic exposure, retinal detachment (RD), iris capture of IOL or SFIOL dislocation till the last follow-up. Conclusion: Final visual outcome of sutureless SFIOL implantation in traumatic aphakia may be affected by concomitant posterior segment pathology. The immediate and late postoperative complications noted in our study were comparable with other similar studies. However, longer follow-up is needed to detect RD and angle recession glaucoma at the earliest and initiate therapy.