bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic outcomes of femur fractures following SIGN Fin nailing in low- and middle-income countries
Authors: Birner Zachary H. , Hetzel Scott J. , Wilson Nathaniel M. , Whiting Paul S. 
Published: July 2021

Abstract

Objective:
To measure the effectiveness of the Surgical Implant Generation Network (SIGN) Fin nail for achieving satisfactory postoperative radiographic alignment following femoral shaft fractures.

Methods:
Femoral shaft fractures stabilized with the SIGN Fin nail were identified using the SIGN Online Surgical Database. A random number generator was used to identify 500 femur fractures fixed within 6 weeks of injury for which postoperative radiographs were available. Fractures were classified using OTA/AO and Winquist-Hansen classification systems. Deviation from anatomic alignment was measured on anterior-posterior and lateral radiographs using an on-screen protractor tool. Other clinical variables recorded in the SIGN Online Surgical Database were also analyzed. Simple logistic regression was used to assess for associations between subject and surgical characteristics and misalignment status. Intra- and inter-rater agreement was assessed with intraclass correlation coefficient (ICC).

Results:
The overall rate of malalignment >5° was 9.4%. Factors associated with increased incidence of malalignment include older age, increased time to surgery, distal diaphyseal location, closed (vs open) reduction, degree of comminution, and fracture classification. Intra-rater ICC was 0.70 (0.52, 0.82) in the coronal plane and 0.55 (0.32, 0.72) in the sagittal plane. Inter-rater ICC was 0.37 (0.08, 0.60) and 0.32 (0.05, 0.54), respectively.

Conclusion:
The SIGN Fin nail is an effective implant for fixation of femoral shaft fractures in resource-limited regions, achieving rates of satisfactory postoperative alignment comparable to that of the standard SIGN nail as well as femoral shaft fractures treated in North American Trauma Centers. Further research is required to investigate rotational alignment and long-term clinical outcomes for the SIGN Fin nail.

Level of evidence:
IV.
Adoption of Telehealth by Pediatric Physical Therapists During COVID-19: A Survey Study
Authors: Hall Jamie B. , Luechtefeld Jessica T. , Woods Morgan L. 
Published: July 2021

Purpose:
To describe the characteristics of pediatric physical therapy telehealth practice during COVID-19.

Methods:
An anonymous, online survey was distributed to pediatric physical therapists (PTs) in the United States who transitioned to telehealth during COVID-19.

Results:
Two hundred five respondents completed all quantitative questions. Ninety-six percent reported never providing telehealth previously and only 14.6% had formal training. More than 35% reported 76% to 100% of their caseload transitioned to telehealth. Most respondents perceived that telehealth was somewhat or very effective for caregivers (90.3%) and children (77.1%) and felt somewhat or very confident providing telehealth (73.2%). However, those practicing in school-based settings rated perceived effectiveness and confidence lower than PTs in other settings. Ultimately, 76.1% of respondents would consider providing telehealth in the future.

Conclusion:
The forced transition of pediatric PTs to the telehealth model during the COVID-19 pandemic resulted in positive experiences for many, supporting wider adoption in the future.
Distal Gracilis Tear in an Equestrian
Authors: Chen Ya-Ting , Mills Catherine , von Rickenbach Kristian J. , McInnis Kelly C. 
Published: July 2021

Abstract
A 61-yr-old female equestrian presented after 2 wks of left medial thigh pain, which developed suddenly while exiting a car. She denied any history of recent trauma or falls. On examination, she was found to have tenderness at the left distal medial thigh with a palpable region of decreased tissue volume at the gracilis myotendinous junction. Point-of-care ultrasound and magnetic resonance imaging confirmed a high-grade partial thickness tear of the left distal gracilis at the myotendinous junction, as well as pes anserine bursal distention. She received physical therapy and underwent a 1-time ultrasound-guided corticosteroid injection to the left pes anserine bursa. At follow-up, her symptoms had significantly improved, and she had returned to horseback riding after 12 wks. Isolated gracilis myotendinous tear is a rare condition, and this is a unique case with an atypical mechanism of injury as gracilis injuries have only been reported during vigorous exercise-related activities rather than transitional movements. This case illustrates the potential increased risk of distal gracilis injury after repetitive corticosteroid injections (genicular nerve blocks and radiofrequency lesioning) in a patient who was also likely predisposed to gracilis microtrauma due to her equestrian activities. Gracilis injury should be considered in the differential diagnosis of distal medial thigh pain, especially in cases with similar interventional and recreational profiles.
Characterization of Medication Errors in a Medical Intensive Care Unit of a University Teaching Hospital in South Korea
Authors: Yoon Jimin , Yug Ji Seob , Ki Dae Yun , Yoon Ji-Eun , Kang Sung Wook , Chung Eun Kyoung 
Published: July 2021

Objectives
The objective of this study was to characterize the current status of medication errors (MEs) throughout the medication therapy process from prescribing to use and monitoring in a medical intensive care unit (MICU) in Korea.

Methods
Four trained research pharmacists collected data through retrospectively reviewing electronic medical records for adults hospitalized in the MICU in 2017. The occurrence of MEs was determined through interprofessional team discussion led by an academic faculty pharmacist and a medical intensivist based on the medication administration records (MARs). The type of MEs and the consequent ME-related outcome severity were categorized according to the Pharmaceutical Care Network Europe and the National Coordinating Council for Medication Error Reporting and Prevention, respectively.

Results
Overall, electronic medical records for 293 patients with 78,761 MARs were reviewed in this study. At least one type of ME occurred in 271 patients (92.5%) in association with 16,203 MARs (21%), primarily caused by inappropriate dose (35.5%), drug (27.8%), and treatment duration (25.1%). Clinically significant harmful events occurred in 24 patients (8%), including life-threatening (n = 5) and death (n = 2) cases. The 2 patients died of enoxaparin-induced fatal hemorrhage and neutropenia associated with ganciclovir and cefepime. Antibiotics were the most common culprit medications leading to clinically significant harmful events.

Conclusions
In conclusion, MEs are prevalent in the MICU in Korea, most commonly prescribing errors. Although mostly benign, harmful events including deaths may occur due to MEs, mainly associated with antibiotics. Systematic strategies to minimize these potentially fatal MEs are urgently needed.
Can Subclinical Atherosclerosis Be Assessed More Precisely in Behçet Syndrome Patients by Using a Particular Cutoff Value for Carotid Intima Media Thickness?
Authors: Uslu Yurteri Emine , Üstüner Evren , Torgutalp Murat , Yayla Müçteba Enes , Okatan Ilyas Ercan , Sezer Serdar , Keleşoğlu Dinçer Ayşe Bahar , Gülöksüz Aydemir Emine Gözde , Turgay Tahsin Murat , Kinikli Gülay , Ateş Aşkin 
Published: July 2021

Objective
Behçet syndrome (BS) is a multisystemic chronic vasculitic disease. Among previous studies, although there are some that showed increased risk of subclinical atherosclerosis in BS, there are also others that showed the opposite. The objective of this study is to evaluate subclinical atherosclerosis in BS by using the cutoff value for intima-media thickness in the 2013 European Society of Cardiology/European Society of Hypertension guideline.

Methods
We conducted a cross-sectional analysis of 100 BS patients and 30 healthy volunteers at a single center in a 4-month period. All ultrasound scans were performed in a blind manner to the clinical assessment, and they were carried out by the same researcher by a B-mode ultrasonography.

Result
When we grouped the patients based on the presence of subclinical atherosclerosis, the frequency of subclinical atherosclerosis in the BS patients was found to be higher than that in the healthy controls (32% and 7%, respectively; p = 0.006). When a cutoff is used for carotid intima-media thickness, increased atherosclerosis risk is observed in BS patients with vascular involvement (p = 0.043).

Conclusions
Although higher inflammation and increased atherosclerosis in vascular BS patients were expected, this situation was not supported much in previous studies. We think that this may have been caused by mere comparison of numerical data, and usage of a cutoff value could be more significant in distinguishing what is normal and what is abnormal as in several medical parameters.
Rheumatology Training in Latin America
Authors: Fernández-Ávila Daniel G. , Patino-Hernandez Daniela , Kowalskii Sergio , Vargas-Caselles Alfredo , Sapag Ana Maria , Cachafeiro-Vilar Antonio , Meléndez Belia , Santiago-Pastelín Carlos , Graf Cesar , Rossetto Chayanne , Palleiro Daniel , Trincado Daniela , Fernández-Ávila Diana Carolina , Arrieta Dina , Reyes Gil , Baez Jossiel Then , Ugarte-Gil Manuel F. , Cardiel Mario , Colman Nelly , Chávez Nilmo , Burgos Paula I. , Montufar Ruben , Sandino Sayonara , Fuentes-Silva Yurilis , Soriano Enrique R. 
Published: July 2021

Background/Objective
Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America.

Methods
This is a descriptive cross-sectional study. We obtained data on each country through local rheumatologists of the Pan-American League Against Rheumatism, who acted as principal investigators for participating countries. Our sample was analyzed and described through means and standard deviations or through frequencies and percentages, depending on the variable.

Results
Countries with the most rheumatology-training programs were Brazil (n = 50), Argentina (n = 18), and Mexico (n = 15). Ecuador, Honduras, and Nicaragua do not have rheumatology-training programs. The countries with the most available slots for rheumatology residents were Brazil (n = 126) and Argentina (n = 36). To be admitted into rheumatology training, candidates were required to have completed graduate studies in internal medicine in 42.1% of the programs. In 8 countries (42.1%), residents are not required to pay tuition; the median cost of tuition in the remaining countries is US $528 (interquartile range, US $2153).

Conclusions
Conditions associated with rheumatology training in Latin America vary. Significant differences exist in income and tuition fees for residents, for example, and 4 countries in Latin America do not currently offer programs. Information collected in this study will be useful when comparing the status of rheumatology services offered in Latin America with those in other countries. Most countries require a wider offering of rheumatology-training programs, as well as more available slots.
Clinical Characteristics and Outcomes of Patients With ANCA-Associated Vasculitides in a Colombian Hospital
Authors: Santacruz-Sandoval Evelyn , López-Bonilla Jorge , Guevara-Calderón Lizbeth A. , Nieto-Aristizábal Ivana , Ruiz-Ordoñez Ingrid , Cañas Carlos A. , Santos Víctor A. , Tobón Gabriel J. , Aguirre-Valencia David 
Published: July 2021

Background/Objective
Antineutrophil cytoplasmic antibody–associated vasculitides (AAVs) are uncommon systemic autoimmune diseases, of which few reports exist in Latin America. Our aim was to examine AAV evaluated in a high-complexity hospital in southwestern Colombia, with emphasis in severe forms.

Methods
A medical records review study of 67 patients was performed, and data were collected from electronic registries. Moderate and severe AAVs were defined as the presence of life-threatening complications, unfavorable Birmingham Vasculitis Activity Score outcomes, and hospitalization requirements at the time of diagnosis and by the last follow-up, between 2011 and 2019. Clinical manifestations, treatment, and outcomes were evaluated. The AAV subtypes were compared.

Results
A total of 67 cases were included. The majority were female (n = 44, 65.67%), and the median age was 52 (40–64) years. Granulomatosis with polyangiitis (GPA) was the most frequent with 42 patients (62.68%), followed by microscopic polyangiitis (MPA) and eosinophilic GPA, with 15 patients (22.38%) and 10 patients (14.92%), respectively. Forty-four patients (65.67%) presented pulmonary symptoms. The highest Birmingham Vasculitis Activity Score corresponded to MPA, with 21 (12–25) points. Fifteen patients (22.4%) were admitted to the intensive care unit throughout the course of the disease, of whom 10 had GPA. The longest stay and duration of mechanical ventilation were seen in MPA. The principal treatments were corticosteroids and cyclophosphamide, and the main outcome was end-stage renal disease.

Conclusions
In this cohort of AAV, most of cases corresponded to GPA, and pulmonary manifestations were the most common. Microscopic polyangiitis was the more severe subtype as it showed worse impairment in clinical characteristics and intensive care unit requirements.
Community Mobility and COVID-19 Dynamics in Jakarta, Indonesia
Authors: Nanda Ratih Oktri , Nursetyo Aldilas Achmad , Ramadona Aditya Lia , Imron Muhammad Ali , Fuad Anis , Setyawan Althaf , Ahmad Riris Andono 
Published: July 2021

AbstractBackgroundHuman mobility could act as a vector to facilitate the spread of infectious diseases. In response to the COVID-19 pandemic, Google Community Mobility Reports (CMR) provide the necessary data to explore community mobility further. Therefore, we aimed to examine the relationship between community mobility on COVID-19 dynamics in Jakarta, Indonesia.MethodsWe utilized the mobility data from Google from February 15 to December 31, 2020. We explored several statistical models to estimate the COVID-19 dynamics in Jakarta. Model 1 was a Poisson Regression Generalized Linear Model (GLM), Model 2 was a Negative Binomial Regression Generalized Linear Model (GLM), and Model 3 was a Multiple Linear Regression (MLR).ResultsWe found that Multiple Linear Regression (MLR) with some adjustments using Principal Component Analysis (PCA) was the best fit model. It explained 52% of COVID-19 cases in Jakarta (R-Square: 0.52, p<0.05). All mobility variables were significant predictors of COVID-19 cases (p<0.05). More precisely, about 1% change in grocery and pharmacy would contribute to a 4.12% increase of the COVID-19 cases in Jakarta. Retails and recreations, workplaces, transit stations, and parks would result in 3.11%, 2.56%, 2.26%, and 1.93% of more COVID-19 cases, respectively.ConclusionOur study indicates that increased mobility contributes to increased COVID-19 cases. This finding will be beneficial to assist policymakers to have better outbreak management strategies, to anticipate increased COVID-19 cases in the future at certain public places and during seasonal events such as annual religious holidays or other long holidays in particular.
Analysis of Blood Gene Expression Data Toward Early Detection of Alzheimer’s Disease
Authors: Gorji Hamed Taheri , Kardan Ramtin , Rezagholizadeh Neda 
Published: July 2021

AbstractAlzheimer’s Disease (AD) is a progressive neurodegenerative disorder and the most commonly diagnosed cause of dementia, and it is the fifth leading cause of death among people aged 65 and older. During the years, the early diagnosis of AD patients has been a significant concern for researchers, in view of the fact that early diagnosis not only can lead to saving lives of the AD patients but also could bring a considerable amount of saving in health and long-term care expenditures for both people and the government. Mild cognitive impairment (MCI), defined as a transitional state between being healthy and having AD, is considered an established risk factor for AD. Hence, an accurate and reliable diagnosis of MCI and, consequently, discrimination between healthy people, MCI individuals, and AD patients can play a crucial role in the early diagnosis of AD. In recent years, analysis of blood gene expression data has been grabbed more attention than the conventional AD diagnosis method because it provides the opportunity to investigate the biochemical pathways, cellular functions, and regulatory mechanisms for finding the key genes associated with MCI and AD. Therefore, in this study, we employed blood gene expression data from Alzheimer’s Disease Neuroimaging Initiative (ADNI), two feature selection methods for determining the most prominent genes related to MCI and AD, and three classifiers for the most accurate discrimination between three groups of healthy, MCI and AD. The proposed method yielded the selection of top ten genes from more than 49,000 genes and the best overall classification result between healthy and AD patients with average values of the area under the curve (AUC) of 0.77 ± 0.08. Furthermore, gene ontology (GO) analysis revealed that four genes were enriched with the GO terms of regulation of cell proliferation, negative regulation of cell population proliferation, signaling receptor binding, biological adhesion, and cytokine production.
Effect of dialysis modality on the survival of end-stage renal disease patients starting dialysis in Sabah from 2007 to 2017: a retrospective cohort study
Authors: Keowmani Thamron , Ghazali Anis Kausar , Yaacob Najib Majdi , Wong Koh Wei 
Published: July 2021

AbstractBackgroundThe effect of dialysis modality on the survival of end-stage renal disease patients is a major public health interest.MethodsIn this retrospective cohort study, all adult end-stage renal disease patients receiving dialysis treatment in Sabah between January 1, 2007 and December 31, 2017 as identified from the Malaysian Dialysis and Transplant Registry were evaluated and followed up through December 31, 2018. The endpoint was all-cause mortality. The observation time was defined as the time from the date of dialysis initiation after the onset of end-stage renal disease to whichever of the following that came first: date of death, date of transplantation, date of last follow-up, date of recovered kidney function, or December 31, 2018. Weighted Cox regression was used to estimate the effect of dialysis modality. Analyses were restricted to patients with complete data on all variables.Results1,837 patients began hemodialysis and 156 patients started with peritoneal dialysis, yielding 7,548.10 (potential median 5.48 years/person) and 747.98 (potential median 5.68 years/person) person-years of observation. 3.1% of patients were lost to follow-up. The median survival time was 5.8 years (95% confidence interval: 5.4, 6.3) among patients who started on hemodialysis and 7.0 years (95% confidence interval: 5.9, indeterminate) among those who started on peritoneal dialysis. The effect of dialysis modality was not significant after controlling for confounders. The average hazard ratio was 0.80 (95% confidence interval: 0.61, 1.05) with hemodialysis as a reference.ConclusionThere was no evidence of a difference in mortality between hemodialysis and peritoneal dialysis.
The cost-effectiveness of accelerated partner therapy (APT) compared to standard contact tracing for people with chlamydia: an economic evaluation based on the LUSTRUM population-based chlamydia transmission model
Authors: Williams EV , Okeke Ogwulu CB , Estcourt CS , Howarth AR , Copas A , Low N , Althaus C , Mapp F , Woode Owusu M , Symonds M , Roberts TE 
Published: July 2021

ABSTRACTObjectiveTo investigate the cost-effectiveness of accelerated partner therapy (APT) compared with standard contact tracing for people with sexually transmitted chlamydia infection in the United KingdomDesignEconomic evaluation using a model consisting of two components: a population-based chlamydia transmission component, to estimate the impact of APT on chlamydia prevalence, and an economic component, to estimate the impact of APT on healthcare costs and health outcomes.SettingUnited KingdomParticipantsHypothetical heterosexual population of 50,000 men and 50,000 women aged 16-34 years.Main Outcome MeasuresCost-effectiveness based on quality-adjusted life years (QALYs) gained and major outcomes averted (MOA), defined as mild pelvic inflammatory disease (PID), severe PID, chronic pelvic pain, ectopic pregnancy, tubal factor infertility and epididymitis.ResultsFor a model population of 50,000 men and 50,000 women and an APT intervention lasting 5 years, the intervention cost of APT (£135,201) is greater than the intervention cost of standard contact tracing (£116,334). When the costs of complications arising from chlamydia are considered, the total cost of APT (£370,657) is lower than standard contact tracing (£379,597). Thus, APT yields a total cost saving of approximately £9000 and leads to 73 fewer major outcomes and 21 fewer QALYs lost. Hence, APT is the dominant PN strategy. APT remained cost-effective across the full range of sensitivity analyses.ConclusionsBased on cost-effectiveness grounds APT is likely to be recommended as an alternative to standard contact tracing for chlamydia infection in the United Kingdom
Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY
Authors:   The OpenSAFELY Collaborative, Fisher Louis , Speed Victoria , Curtis Helen J , Rentsch Christopher T , Wong Angel YS , Schultze Anna , Massey Jon , Inglesby Peter , Morton Caroline E , Wood Marion , Walker Alex J , Morley Jessica , Mehrkar Amir , Bacon Seb , Hickman George , Bates Chris , Croker Richard , Evans David , Ward Tom , Cockburn Jonathan , Davy Simon , Bhaskaran Krishnan , Smith Becky , Williamson Elizabeth , Hulme William , Green Amelia , Eggo Rosalind M , Forbes Harriet , Tazare John , Parry John , Hester Frank , Harper Sam , Meadows Jonathan , O’Hanlon Shaun , Eavis Alex , Jarvis Richard , Avramov Dima , Griffiths Paul , Fowles Aaron , Parkes Nasreen , Douglas Ian J , Evans Stephen JW , Tomlinson Laurie , MacKenna Brian , Smeeth Liam , Goldacre Ben 
Published: July 2021

AbstractNational guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2021. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.