bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Engaging Patients with Relevant Education About Long-Term Opioid Use Before Spine Surgery Affect Long-term Opioid Use? A Randomized Controlled Trial
Authors: Rhon Daniel I. , Greenlee Tina A. , Gill Norman W. , Carlson Andrew E. , Hart Allison M. , Larsen Trent H. , McLelland Alex , Mayhew Rachel J. , McCafferty Randall R. , Koppenhaver Shane L. 
Published: August 2021

Study Design.
Parallel-arm randomized controlled trial.

Objective.
To assess the effectiveness of an enhanced video education session highlighting risks of opioid utilization on longterm opioid utilization after spine surgery.

Summary of Background Data.
Long-term opioid use occurs in more than half of patients undergoing spine surgery and strategies to reduce this use are needed.

Methods.
Patients undergoing spine surgery at Brooke Army Medical Center between July 2015 and February 2017 were recruited at their preoperative appointment, receiving the singlesession interactive video education or control at that same appointment. Opioid utilization was tracked for the full year after surgery from the Pharmacy Data Transaction Service of the Military Health System Data Repository. Self-reported pain also collected weekly for 1 and at 6months.

Results.
A total of 120 participants (40 women, 33.3%) with a mean age of 45.9 ± 10.6 years were randomized 1:1 to the enhanced education and usual care control (60 per group). In the year following surgery the cohort had a mean 5.1 (standard deviation [SD] 5.9) unique prescription fills, mean total days’ supply was 88.3 (SD 134.9), and mean cumulative morphine milligrams equivalents per participant was 4193.0 (SD 12,187.9) within the year after surgery, with no significant differences in any opioid use measures between groups. Twelve individuals in the standard care group and 13 in the enhanced education group were classified with having long-term opioid utilization.

Conclusion.
The video education session did not influence opioid use after spine surgery compared to the usual care control. There was no significant difference in individuals classified as long-term opioid users after surgery based on the intervention group. Prior opioid use was a strong predictor of future opioid use in this cohort. Strategies to improve education engagement, understanding, and decision- making continue to be of high importance for mitigating risk of long-term opioid use after spine surgery.

Level of Evidence: 1
Bronchoalveolar Lavage Gram Stains for Early Bacterial Identification in Pneumonia: Should They Stay or Should They Go?
Authors: Klimko Claire V. , Sanders James M. , Monogue Marguerite L. , Tilahun Belen A. , Arasaratnam Reuben J. , Reisch Joan S. , Johns Meagan L. 
Published: August 2021

OBJECTIVES:
The primary endpoint was to determine the sensitivity and specificity of the bronchoalveolar lavage Gram stain in predicting culture results. Secondary endpoints included determining the proportion of Gram stains from bronchoalveolar lavages that accurately identify culture isolates and the duration of antibiotic treatment before bronchoalveolar lavage collection.

DESIGN:
Retrospective, observational study.

SETTING:
Four ICUs at a single academic medical center.

SUBJECTS:
Patients at least 18 years old admitted to an ICU with a diagnosis of pneumonia, collection of a bronchoalveolar lavage sample, and receipt of antibiotics.

MEASUREMENTS AND MAIN RESULTS:
Two-hundred five isolates were included. Gram stains for Gram-positive and Gram-negative isolates showed high specificity, 97.3% and 100%, respectively, but lower sensitivity at 61.9% and 54.2%, respectively. The positive predictive value and negative predictive value were 77.2% and 95.7% for Gram-positive isolates and 100% and 84.4% for Gram-negative isolates, respectively. Gram stains correctly identified isolates on the bronchoalveolar lavage culture in 61.9% of Gram-positive organisms and in 54.2% of Gram-negative organisms.

CONCLUSIONS:
Gram stains accurately identified causative organisms in a limited number of patients making the utility of the Gram stain an uncertain modality for predicting causative respiratory pathogens from bronchoalveolar lavage samples.
Medical malpractice in stress urinary incontinence management: A 30-year legal database review
Authors: Lynch Niccola B. , Xu Linhan , Ambinder David , Malik Rena D. 
Published: August 2021

Abstract

Background:
The purpose of this study is to investigate the most common reasons for and judicial outcomes of malpractice claims related to stress urinary incontinence (SUI) management.

Materials and methods:
Using the Westlaw database, a search was performed using the terms “medical malpractice” or “negligence” in combination with “stress incontinence” or “stress urinary incontinence” between January 1, 1990 and January 1, 2020. Extracted information included trial date, demographic information, defendant profession, procedure performed, procedure complications, alleged malpractice, trial outcome, and monetary award. Data were analyzed using descriptive statistics.

Results:
The Westlaw search yielded 79 case results. Of the cases, 70.4% (n = 38/54) had a defense verdict, 22.2% (n = 12/54) had a plaintiff verdict, and 7.4% (n = 4/54) were settled. The most commonly implicated procedure was mid-urethral sling (63.2%, n = 36/57). Among the plaintiffs, 48.4% (n = 61/126) claimed negligence in preoperative care, 33.3% (n = 42/126) claimed negligence in surgical performance, and 18.3% (n = 23/126) claimed negligence in postoperative care. Lack of informed consent was the most common complaint related to negligence in preoperative care (42.6%, n = 26/61). The average indemnity payment was $1,253,644 for preoperative care negligence, $1,254,491 for surgical performance negligence, and $2,239,198 for postoperative care negligence. Of the defendants, 63.4% (n = 52) were gynecologists and 36.6% (n = 30) were urologists.

Conclusions:
Negligent preoperative care, with a particular emphasis on failure to obtain informed consent, and negligent surgical performance are the leading causes of malpractice claims during SUI management. Mid-urethral sling was the most commonly litigated procedure. This study highlights key factors to consider in minimizing malpractice risk during SUI management.
Neighborhood Walkability and Mortality in a Prospective Cohort of Women
Authors: India-Aldana Sandra , Rundle Andrew G. , Zeleniuch-Jacquotte Anne , Quinn James W. , Kim Byoungjun , Afanasyeva Yelena , Clendenen Tess V. , Koenig Karen L. , Liu Mengling , Neckerman Kathryn M. , Thorpe Lorna E. , Chen Yu 
Published: August 2021

Background:
There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death.

Methods:
We geocoded baseline residential addresses of 13,832 women in the New York University Women’s Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers.

Results:
Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality.

Conclusion:
Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
Factors Influencing the Choice of Plastic Surgery as a Specialty in Saudi Arabia
Authors: Al Qurashi Abdullah A. , Shah Mardan Qutaiba N.M. , Mortada Hatan , Maddawi Hadeel , Hakami Alqassem Y. , Mrad Mohamed Amir 
Published: August 2021

Background:
Graduates of medical school must choose a specific specialty as a life-long practice from a large pool of medical specialties. This decision stands out as one of the most memorable and critical in their lifetimes. To reach such a decision with satisfaction, medical school graduates consider a variety of factors. This is the first study to explore the influential factors on pursuing plastic surgery as a career in Saudi Arabia.

Methods:
This is a cross-sectional, unicentral study based on an electronic questionnaire that has been constructed with an assistance of field experts to ensure a sufficient coverage of the influential factors. Only those with an established interest in plastic surgery were included. Institutional review board approval was obtained for this study.

Results:
Of the 695 questionnaires fully completed by third-year medical students up to intern doctors, only 32 (4.6%) expressed an interest in the pursuit of plastic surgery as a future career, with a female predominance of 62.5% (N = 20). The factors that influenced their decision of specialty choice were the geographic advantage (81.3%), predominance of nonurgent cases (71.9%), the reward associated with immediate outcome (71.9%), and prior significant events (71.9%).

Conclusions:
Certain factors, as explored by this study, strongly influence the choice of plastic surgery as a future specialty, among Saudi medical graduates. Cultivating more knowledge about plastic surgery as a specialty may help consider scientific research as an impactful factor in the future for further development in the field.
Neurologically asymptomatic patients frequently present cerebral injuries during malignant hypertension: a MRI study
Authors: Boulestreau Romain , Lucas Ludovic , Cremer Antoine , Debeugny Stéphane , Rubin Sébastien , Gaudissard Julie , Doublet Julien , Sibon Igor , Gosse Philippe 
Published: August 2021

Background:
Acute and diffuse microvascular damage characterizes malignant hypertension (MHT), the deadliest form of hypertension (HTN). Although its ophthalmological, renal and cardiological repercussions are well known, brain involvement is considered rare with few descriptions, although it is one of the main causes of death. We hypothesized that brain MRI abnormalities are common in MHT, even in patients without objective neurological signs.

Method:
We analyzed retrospectively the brain MRI of patients admitted for acute MHT between 2008 and 2018 in Bordeaux University Hospital, regardless of their neurological status. A trained operator analyzed every brain MRI, looking for posterior reversible encephalopathy syndrome (PRES), ischemic stroke, intracerebral hematoma (ICH) and microangiopathy markers. We included 58 patients without neurological signs, 66% were men, and mean age was 45.6 ± 11.3 years.

Results:
Brain MRI were normal in 26% of patients but we found at least one acute abnormality on brain MRI in 29% and an Small Vessel Disease score (SVD score) of two or higher in 52%. In patients with neurological signs, these findings were 9, 53 and 70%, respectively. A PRES was found in 16% of asymptomatic patients and 31% had an ischemic stroke and/or a cerebral hematoma.

Conclusion:
PRES, recent hematoma, ischemic stroke and severe cerebral microangiopathy are common findings in MHT patients without neurological signs on admission. The impact of these findings on patient management, and their cerebrovascular and cognitive prognostic value, should be established. Brain MRI might need to become systematic in patients suffering from MHT episodes.
Negative Corneal Fluorescein Staining as an Exceptionally Early Sign of Acanthamoeba Keratitis: A Case Report
Authors: Korkmaz Ilayda , Barut Selver Ozlem , Simsek Cem , Palamar Melis 
Published: August 2021

Objectives:
To report the negative fluorescein staining as an early sign of Acanthamoeba keratitis (AK).

Methods:
Case report and brief review of related literature.

Report of Case:
A 30-year-old, contact lens wearer, woman presented with mild irritation and pain in the right eye. The best-corrected visual acuity (BCVA) was 20/20 in both eyes. Slit-lamp examination revealed a peripheral corneal infiltration. Empirical antimicrobial therapy was initiated. Within the third day, peripheral corneal opacity regressed but a Y-shaped linear epitheliopathy with a negative fluorescein staining, because of a ridge-like epithelial irregularity, was observed in the central cornea. Clinical findings progressed rapidly. Confocal microscopy revealed hyper-reflective cysts with the typical double-ring sign consistent with AK. Therefore, topical chlorhexidine and propamidine were initiated. Clinical findings regressed subsequently. The final BCVA was 20/20 in both eyes.

Conclusion:

Acanthamoeba keratitis usually manifest as superficial epitheliopathy and progresses to the stroma. Findings may be obscure or atypical; comprehensive and careful examination may reveal mild findings in the early stages.
The Significance of Depression for Short-term Readmission and Mortality After a Pneumonia Admission
Authors: Graversen Susanne B. , Pedersen Henrik S. , Ribe Anette R. , Foss Catherine H. , Sandbaek Annelli 
Published: August 2021

Background:
Depression is highly prevalent among hospitalized patients with pneumonia. At discharge, these patients transfer to a less care-intensive home-based setting. Nevertheless, little is known on the prognosis in the postdischarge period.

Objective:
The objective of this study was to investigate the influence of depression on 30-day mortality and readmission in persons discharged after a pneumonia admission.

Design:
This was a population-based cohort study using the Danish registries.

Subjects:
All persons aged 50+ years with a pneumonia admission in 2000–2016 in Denmark.

Measures:
Mortality rate ratios for 30-day mortality and incidence rate ratios for 30-day readmission in pneumonia patients with versus without depression.

Results:
We identified 379,265 pneumonia admissions, hereof 83,257 (22.0%) with depression. The overall adjusted mortality rate ratio was 1.29 (95% confidence interval: 1.25–1.33), and the overall adjusted incidence rate ratio was 1.07 (95% confidence interval: 1.05–1.08). The mortality risk was higher for all ages and throughout the 30-day period in persons with versus without depression. This risk was modified by sociodemographic and socioeconomic characteristics (excluding sex and education), admission-related factors, comorbidities, and use of benzodiazepines, opioids, or antipsychotics. The readmission risk was higher until age 90 and tended to be higher throughout the 30-day period. This risk was modified by age, cohabitation, residency, admission-related factors, comorbidities, and use of opioids or antipsychotics. For both outcomes, the relative effect of depression was highest among the youngest, among those with a short hospital stay and among those with few comorbidities.

Conclusion:
Depression is an independent risk factor for 30-day mortality and readmission in persons who transfer from hospital care to home-based care.
Incidence and relevance of clinically indeterminate nonregional lymph nodes in the treatment of oesophageal cancer
Authors: Pucher Philip H. , White Annabelle , Padfield Olivia , Davies Andrew R. , Maisey Nick , Qureshi Asad , Subesinghe Manil , Baker Cara , Gossage James A. 
Published: August 2021

Objectives
Metastatic involvement of nonregional supraclavicular or superior mediastinal lymph nodes in distal oesophageal cancer is rare but has important implications for prognosis and management. The management of nonregional lymph nodes which appear indeterminate on CT and FDG PET-CT (subcentimeter nodes or those with preserved normal morphology, but increased FDG avidity) can present a diagnostic dilemma. This study investigates the incidence, work-up and clinical significance of nonregional clinically indeterminate FDG avid lymph nodes.

Methods
A single-centre retrospective review of all FDG PET-CT scans conducted over 5 years was conducted. Patients with mid- or distal oesophageal cancer with nonregional FDG avid nodes were identified. Subsequent work-up, management and outcomes were retrieved from electronic health records.

Results
Reports for 1189 PET-CT scans were reviewed. A total of 79 patients met the inclusion criteria. Of these, 18 (23%) were deemed to have disease and performance status potentially amenable to radical surgery and underwent further assessment. The indeterminate lymph nodes were successfully sampled via endobronchial ultrasound (EBUS) or ultrasound-guided fine-needle aspiration (US-FNA) in 100% of cases. 15/18 (83.3%) of samples were benign and proceeded to surgery. Outcomes for patients who proceeded to surgery were similar to other cohorts. None had pathology suggesting false-negative lymph node sampling.

Conclusions
EBUS and US-FNA are effective means of sampling clinically indeterminate nonregional lymph nodes, and can significantly impact prognosis, and management. Further investigations in this context are of value in this cohort and should be pursued. Nonregional clinically indeterminate lymph nodes represent a diagnostic dilemma in oesophageal cancer staging. Additional investigations in the form of endobronchial ultrasound are effective at providing additional staging information, and can substantially influence patient care.
Clonal hematopoiesis and myeloid malignancies: clonal dynamics and clinical implications
Authors: Elena Chiara , Gallì Anna , Bono Elisa , Todisco Gabriele , Malcovati Luca 
Published: August 2021

Purpose of review
Clinical and experimental studies have uncovered relevant clinical implications of clonal hematopoiesis. However, the true magnitude of this process, clonal dynamics over time and mechanisms of progression into overt malignancy remain to be largely elucidated. In this article, the consequences of clonal hematopoiesis, its significance in the context of cytopenia, and its implications in the clinical management of patients with myeloid malignancies are reviewed and discussed.

Recent findings
Clonal hematopoiesis has been associated with higher risk of hematologic cancers, as well as of death from cardiovascular causes. Clonal hematopoiesis has been proven clinically relevant in the context of disorders characterized by peripheral blood cytopenia, including aplastic anemia, cytopenia of undetermined significance, as well as unexplained anemia of the elderly.

Summary
The available evidence has been proving the utility of somatic mutational analysis in patients with unexplained cytopenia, as well as in those receiving a diagnosis of myeloid neoplasm, enabling more accurate diagnosis, risk assessment, effective therapeutic strategies and residual disease monitoring. The access to a minimally invasive assessment is paving the way for screening programs of clonal hematopoiesis in individuals with absent or mild hematologic phenotype, as well as for therapeutic targeting of preleukemia cells.
Comparative Effectiveness of Intravenous Azithromycin Versus Erythromycin Stimulating Antroduodenal Motility in Children
Authors: Mougey Edward B. , Saunders Madison , Franciosi James P. , Gomez‐Suarez Roberto A. 
Published: August 2021

ABSTRACTBackground:Azithromycin has been shown to improve gastrointestinal motility in adults and may have fewer drug interactions and reduced arrhythmogenic effects than erythromycin. We hypothesized that azithromycin is comparable to erythromycin in eliciting pharmacodynamic outcomes for antral and small bowel motility.Objective:To compare the pharmacodynamic effectiveness of azithromycin and erythromycin for eliciting antral and duodenal motility in pediatric patients who underwent antroduodenal manometry for different indications.Methods:We conducted a retrospective comparison of clinic data and manometric pharmacodynamics outcomes in patients who underwent antroduodenal manometry between 2013 and 2017.Results:Fifty‐one patients mean age (± standard deviation) 9.7 (5.4) years, received either azithromycin 3 mg/kg (n = 20) or erythromycin 2 mg/kg (n = 31) during antroduodenal manometry. For patients receiving erythromycin, mean area under the curve (AUC) across all eight pressure ports increased from median [95% confidence interval] 2256 [1585, 2602] to 8742 [5876, 11761] mmHg × s (P < 0.001) and mean motility index increased from 8.63 [7.87, 9.42] to 11.98 [11.20, 12.21] (P < 0.001). For patients receiving azithromycin, mean AUC increased from 2255 [1585, 2602] to 8254 [5649, 10470] mmHg × s (P < 0.001) and motility index increased from 8.63 [7.87,9.42] to 11.79 [11.03, 12.21] (P < 0.001). Neither mean stimulated AUC nor mean motility index was significantly different between azithromycin and erythromycin treatments. There was no significant difference in side effects between groups.Conclusions:Azithromycin and erythromycin have similar pharmacodynamic effects on antral and small bowel contractility in children. Azithromycin should be considered an acceptable alternative to erythromycin as an upper gastrointestinal tract prokinetic for children and has historically had fewer side effects than erythromycin.
Electromyographic Analysis of a Selective Exercise for the Serratus Anterior Muscle Among Patients With Frozen Shoulder and Subacromial Impingement Syndrome
Authors: Miyasaka Junsuke , Arai Ryuzo , Yoshioka Yuji , Matsumura Aoi , Hasegawa Satoshi , Kuriyama Shinichi , Nakamura Shinichiro , Ichihashi Noriaki , Matsuda Shuichi 
Published: August 2021

Objective
Patients with shoulder disorders show altered periscapular muscle activity (e.g., decreased serratus anterior and increased upper trapezius activities). We herein devised a novel method for strengthening serratus anterior without excessive upper trapezius activation, named squeezing ball exercise in which patients squeezed a ball between both elbows with maximum voluntary isometric contraction in the horizontal adduction direction with the arms elevated at a 45-degree angle. The present study aimed to investigate whether the squeezing ball exercise could produce high muscle activity in the serratus anterior in patients with frozen shoulder and subacromial impingement syndrome before the rehabilitation intervention.

Design
This is a proof-of-concept study. Serratus anterior and upper trapezius activities during squeezing ball exercise were evaluated using electromyography in 16 patients with frozen shoulders and subacromial impingement syndrome. Electromyography signals were normalized using maximal voluntary isometric contraction, and the muscle balance ratios (upper trapezius/serratus anterior) were calculated.

Results
The average serratus anterior and upper trapezius activity was 69.9% ± 30.8% and 10.2% ± 6.3% maximal voluntary isometric contraction during the squeezing ball exercise, respectively, whereas the upper trapezius–serratus anterior ratio of the affected side was 0.15 ± 0.07.

Conclusions
The high serratus anterior activation and low upper trapezius–serratus anterior ratio during squeezing ball exercise could be attributed to the limb position where shortened serratus anterior exerts itself without painful subacromial impingement. Squeezing ball exercise could be a novel rehabilitation tool for patients with frozen shoulders and subacromial impingement syndrome.