bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hydroxocobalamin in Refractory Septic Shock: A Retrospective Case Series
Authors: Sacco Alicia J. , Cunningham Cody A. , Kosiorek Heidi E. , Sen Ayan 
Published: April 2021

Objectives:
Refractory septic shock is associated with high morbidity and mortality. Hydroxocobalamin is used to treat postoperative vasoplegia; however, data supporting its use in the setting of refractory septic shock is limited and restricted to case reports. This study evaluates the effect of hydroxocobalamin on mean arterial pressure and vasopressor requirements in a series of patients with refractory septic shock.

Design:
Single-center, retrospective analysis.

Setting:
Urban, tertiary-care ICU.

Patients:
Adult ICU patients with refractory septic shock treated with hydroxocobalamin between August 2018 and January 2020.

Interventions:
Hydroxocobalamin 5 g IV infusion.

MEASUREMENTS AND MAIN RESULTS:
Twenty-six patients were included for the analysis. Administration of hydroxocobalamin was associated with an increase in mean arterial pressure at 1, 6, and 24 hours postdose (+16.3, +14.3, and +16.3 mm Hg, respectively; p < 0.001). Increase in mean arterial pressure from baseline remained statistically significant when controlling for sex, age, and comorbid conditions. There was no change in the norepinephrine equivalents patients required 1 hour following hydroxocobalamin administration, but a statistically significant decrease in norepinephrine equivalent was observed at 6 and 24 hours postdose (p < 0.001).

Conclusions:
Hydroxocobalamin provides sustained hemodynamic benefit at 24 hours in patients with refractory septic shock.
Surgical Margin Mapping of Melanoma In Situ Using In Vivo Reflectance Confocal Microscopy Mosaics
Authors: Durkin John R. , Tchanque-Fossuo Catherine N. , Rose Alexander N. , Elwood Hillary R. , Stepenaskie Shelly , Barbosa Naiara S. 
Published: April 2021

BACKGROUND
Melanoma in situ (MIS) can have poorly defined borders and subclinical extension that makes margin control challenging. Reflectance confocal microscopy (RCM) is a promising noninvasive technique that can be used to assess subclinical spread.

OBJECTIVE
To optimize surgical margins of histology-proven MIS using RCM mosaics.

MATERIALS AND METHODS
Prospective review of 22 patients with histology-proven MIS who underwent RCM margin mapping prior to staged excision, between August 1, 2018, and August 13, 2020, at the Department of Dermatology, University of New Mexico, School of Medicine.

RESULTS
Twenty patients (91%) had tumor clearance on the first stage using a 3-mm surgical margin after confocal margin mapping.

CONCLUSION
Reflectance confocal microscopy margin mapping using the mosaic device tends to clear MIS in one stage, and the use of the handheld device may improve the accuracy for difficult anatomic areas. Current Procedural Terminology codes for RCM do not reflect the time required and complexity of the procedure. Reflectance confocal microscopy margin mapping prior to excision has the potential to decrease the number of stages needed for melanoma removal, reduce treatment time, and cost.
Pragmatic trials of pain therapies: a systematic review of methods
Authors: Hohenschurz-Schmidt David , Kleykamp Bethea A. , Draper-Rodi Jerry , Vollert Jan , Chan Jessica , Ferguson McKenzie , McNicol Ewan , Phalip Jules , Evans Scott R. , Turk Dennis C. , Dworkin Robert H. , Rice Andrew S.C. 
Published: April 2021

Abstract
Pragmatic randomised clinical trials aim to directly inform clinical or health policy decision making. Here, we systematically review methods and design of pragmatic trials of pain therapies to examine methods, identify common challenges, and areas for improvement. Seven databases were searched for pragmatic randomised controlled clinical trials that assessed pain treatment in a clinical population of adults reporting pain. All screening steps and data extractions were performed twice. Data were synthesised descriptively, and correlation analyses between prespecified trial features and PRECIS-2 (PRagmatic–Explanatory Continuum Indicator Summary 2) ratings and attrition were performed. Protocol registration: PROSPERO-ID CRD42020178954. Of 57 included trials, only 21% assessed pharmacological interventions, the remainder physical, surgical, psychological, or self-management pain therapies. Three-quarters of the trials were comparative effectiveness designs, often conducted in multiple centres (median: 5; Q1/3: 1, 9.25) and with a median sample size of 234 patients at randomization (Q1/3: 135.5; 363.5). Although most trials recruited patients with chronic pain, reporting of pain duration was poor and not well described. Reporting was comprehensive for most general items, while often deficient for specific pragmatic aspects. Average ratings for pragmatism were highest for treatment adherence flexibility and clinical relevance of outcome measures. They were lowest for patient recruitment methods and extent of follow-up measurements and appointments. Current practice in pragmatic trials of pain treatments can be improved in areas such as patient recruitment and reporting of methods, analysis, and interpretation of data. These improvements will facilitate translatability to other real-world settings—the purpose of pragmatic trials.
Association between attentional bias to experimentally induced pain and to pain-related words in healthy individuals: the moderating role of interpretation bias
Authors: Broadbent Philippa , Schoth Daniel E. , Liossi Christina 
Published: April 2021

Abstract
Attentional bias to pain-related information may contribute to chronic pain maintenance. It is theoretically predicted that attentional bias to pain-related language derives from attentional bias to painful sensations; however, the complex interconnection between these types of attentional bias has not yet been tested. This study aimed to investigate the association between attentional bias to pain words and attentional bias to the location of pain, as well as the moderating role of pain-related interpretation bias in this association. Fifty-four healthy individuals performed a visual probe task with pain-related and neutral words, during which eye movements were tracked. In a subset of trials, participants were presented with a cold pain stimulus on one hand. Pain-related interpretation and memory biases were also assessed. Attentional bias to pain words and attentional bias to the pain location were not significantly correlated, although the association was significantly moderated by interpretation bias. A combination of pain-related interpretation bias and attentional bias to painful sensations was associated with avoidance of pain words. In addition, first fixation durations on pain words were longer when the pain word and cold pain stimulus were presented on the same side of the body, as compared to on opposite sides. This indicates that congruency between the locations of pain and pain-related information may strengthen attentional bias. Overall, these findings indicate that cognitive biases to pain-related information interact with cognitive biases to somatosensory information. The implications of these findings for attentional bias modification interventions are discussed.
Demographics, Preventive Services Compliance, Health, and Healthcare Experiences of Lesbian, Gay, and Bisexual Employed Adults
Authors: Burton Wayne N. , Schultz Alyssa B. , Quinn Colin 
Published: April 2021

Objective:
This study examined demographics, health risks and conditions, preventive services, and health care experiences of lesbian, gay, bisexual, transgender, or questioning (LGBTQ) adults who are employed in the United States.

Methods:
Male and female gay, lesbian, or bisexual employees (N = 1191) from seven companies participated in an online survey.

Results:
Differences were observed in the characteristics of gays, lesbians, and bisexuals on a number of demographic, health, and preventive services measures. Differences were also seen compared to previous studies about LGBTQ adults in the general population.

Conclusions:
Employers have a vested interest in making sure their employees have access to quality health care that addresses their unique needs. There is much room for improvement in this area, since a large percentage of respondents reported negative health care experiences, avoiding or postponing care, and difficulty finding an LGBTQ-experienced healthcare provider.
Thrombotic storm in inflammatory bowel disease
Authors: Alkhathami Mohammed , Alshehri Fayez , Nasiri Abdulrahman M. 
Published: April 2021

Abstract

Rationale:
Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD) and are recognized causes of gastrointestinal diseases. Thromboembolism is known to be one of the extraintestinal complications of IBD. However, there have been no reports of a “thrombotic storm,” which is a rare form of thromboembolism, as the first manifestation of a case of previously unknown IBD. In this report, we describe a case of thrombotic storm as the initial presentation of IBD.

Patient concerns:
A 15-year-old girl with no known history of chronic medical illnesses presented to our clinic with complaints of infrequent loose bowel movements associated with occasional rectal bleeding 4 months prior.

Diagnoses:
Abdominal examination revealed tenderness upon superficial and deep palpation of the epigastrium and left lower quadrant of the abdomen. Digital rectal examination revealed no tenderness or masses in the rectal canal, but bloody stools were noted; imaging revealed extensive thrombosis. Sigmoidoscopy findings and histology were consistent with those of ulcerative colitis.

Interventions:
Anticoagulation therapy was initiated for the treatment of the thrombosis. Sigmoidoscopy and biopsy were also performed to ensure that an accurate diagnosis was made. The patient was placed on a therapy of methylprednisolone, mesalazine, and enoxaparin.
Outcomes: During follow-up, the patient's symptoms were found to have subsided, her test results had improved, and no further flare-ups of the ulcerative colitis were noted.

Lessons
: This case highlights the fact that thrombosis can precede IBD and can make the accurate diagnosis of such cases more challenging. The risk of thrombus propagation also poses a challenge in such cases.
Ecthyma gangrenosum with Pseudomonas aeruginosa bacteremia in an immunocompromised patient
Authors: Pereira Gabriela Sobreira , Tinoco Mariana Gomes , Fernandes Carlos Manuel Guimarães Simões , Cotter Jorge Berkeley 
Published: April 2021

Abstract

Rationale:
Ecthyma gangrenosum is an uncommon cutaneous manifestation and recognized for its association with Pseudomonas aerugninosa sepsis in immunocompromised patients, particularly if there is neutropenia. These lesions follow a certain pattern of presentation, from erythematous nodules to necrotizing ulcers with surrounding erythema.

Patient concerns:
We describe a case of an immunocompromised woman with recent breast cancer diagnosis, under chemotherapy treatment, who on admission presented painful erythematous nodules on her right thigh with 5 days of evolution and hemodynamically stable. The computed tomography scan of chest, abdomen, and pelvis showed nodular areas of densification of the subcutaneous tissue predominantly in the abdominal wall and nodular peripheral lesions in the pulmonary parenchyma, with recent onset, suggestive of possible septic embolization.

Diagnosis:
The diagnosis of ecthyma gangrenosum was confirmed after the isolation of Pseudomonas aeruginosa from the blood and wound culture samples, while a punch biopsy excluded other possible etiologies.

Interventions:
The patient completed 30 days of antibiotherapy, initially with piperacillin/tazobactam that was narrowed after 14 days of treatment to ciprofloxacin.

Outcomes:
Favorable evolution with complete clinical resolution was observed after 3months.

Lessons:
The early recognition and the prompt treatment with broad spectrum empiric antibiotic are the key for a good outcome in patients with ecthyma gangrenosum.
Comparative Effectiveness of Risk-adjusted Cumulative Sum and Periodic Evaluation for Monitoring Hospital Perioperative Mortality
Authors: Massarweh Nader N. , Chen Vivi W. , Rosen Tracey , Dong Yongquan , Richardson Peter A. , Axelrod David A. , Harris Alex H.S. , Wilson Mark A. , Petersen Laura A. 
Published: April 2021

Background:
National surgical quality improvement (QI) programs use periodic, risk-adjusted evaluation to identify hospitals with higher than expected perioperative mortality. Rapid, accurate identification of poorly performing hospitals is critical for avoiding potentially preventable mortality and represents an opportunity to enhance QI efforts.

Methods:
Hospital-level analysis using Veterans Affairs (VA) Surgical Quality Improvement Program data (2011–2016) to compare identification of hospitals with excess, risk-adjusted 30-day mortality using observed-to-expected (O-E) ratios (ie, current gold standard) and cumulative sum (CUSUM) with V-mask. Various V-mask slopes and radii were evaluated—slope of 2.5 and radius of 1.0 was used as the base case.

Results:
Hospitals identified by CUSUM and quarterly O-E were identified midway into a quarter [median 47 days; interquartile range (IQR): 24–61 days before quarter end] translating to a median of 129 (IQR: 60–187) surgical cases and 368 (IQR: 145–681) postoperative inpatient days occurring after a CUSUM signal, but before the quarter end. At hospitals identified by CUSUM but not O-E, a median of 2 deaths within a median of 5 days triggered a signal. In some cases, these clusters extended beyond CUSUM identification date with as many as 8 deaths undetected using O-E. Sensitivity and negative predictive values for CUSUM relative to O-E were 71.9% (95% confidence interval: 66.2%–77.1%) and 95.5% (94.4%–96.4%), respectively.

Conclusions:
CUSUM evaluation identifies hospitals with clusters of mortality in excess of expected more rapidly than periodic analysis. CUSUM represents an analytic tool national QI programs could utilize to provide participating hospitals with data that could facilitate more proactive implementation of local interventions to help reduce potentially avoidable perioperative mortality.
Comparing the Ecological Niches of Chlamydial and Gonococcal Infections in Winnipeg, Canada: 2007–2016
Authors: Shaw Souradet Y. , Elliott Lawrence J. , Nowicki Deborah L. , Green Christopher G. , Ross Craig P. , Reimer Joss N. , Wylie John L. , Plourde Pierre J. , Aral Sevgi O. , Becker Marissa L. , Blanchard James F. 
Published: April 2021

Background
Previous studies have shown substantial differences in geographic clustering of sexually transmitted infections (STI), such as chlamydia (CT) and gonorrhea (NG), conditional on epidemic phase. Chlamydia and NG have recently shown resurgent epidemiology in the northern hemisphere. This study describes the recent epidemiology of CT and NG in Winnipeg, Canada, combining traditional surveillance tools with place-based analyses, and comparing the ecological niches of CT and NG, in the context of their evolving epidemiology.

Methods
Data were collected as part of routine public health surveillance between 2007 and 2016. Secular trends for CT and NG, and CT/NG coinfection were examined. Gini coefficients and population attributable fractions explored the distribution, and concentration of infections over time and space.

Results
Rates of CT increased from 394.9/100,000 population to 476.2/100,000 population from 2007 to 2016. Gonorrhea rates increased from 78.0/100,000 population to 143.5/100,000 population during the same period. Each pathogen had its own ecological niche: CT was widespread geographically and socio-demographically, while NG was clustered in Winnipeg's inner-core. CT/NG co-infections had the narrowest space and age distribution. NG was shown to be undergoing a growth phase, with clear signs of geographic dispersion. The expansion of NG resembled the geographic distribution of CT.

Conclusions
We demonstrated that NG was experiencing a growth phase, confirming theoretical predictions of geographic dispersion during a growth phase. During this phase, NG occupied similar geographic spaces as CT. Knowledge of different ecological niches could lead to better targeting of resources for subpopulations vulnerable to STIs.
Genital Human Papillomavirus Prevalence Over the Lifespan Among Females and Males in a National Cross-Sectional Survey, United States, 2013–2016
Authors: Lewis Rayleen M. , Gargano Julia W. , Unger Elizabeth R. , Querec Troy D. , Markowitz Lauri E. 
Published: April 2021

Background
Patterns of human papillomavirus (HPV) prevalence by age differ by sex. To further the descriptive epidemiology of genital HPV, we analyzed prevalence by age for nonvaccine (non–4vHPV) type and vaccine (4vHPV) type HPV by sex using 2013–2016 National Health and Nutrition Examination Survey data, the first 4 years of national data from both sexes.

Methods
Penile and cervicovaginal swabs were self-collected from 15- to 59-year-olds and tested for 37 HPV types. The 4vHPV-type (6/11/16/18) and non–4vHPV-type (any of 33 other types) prevalences were estimated by 3-year age group and participant characteristics. Average percent changes (APCs) in prevalence were estimated using segmented log-binomial regression.

Results
Among females, a positive relationship between non–4vHPV-type prevalence and age was seen from 15–17 to 21–23 years (APC, 56.5), followed by a negative relationship through 30–32 years (APC, −13.2); thereafter, prevalence was not related to age. The 4vHPV-type prevalence was positively related to age through 24–26 years (APC, 56.9), then negatively related through 57–59 years (APC, −6.0). Among males, non–4vHPV-type prevalence had a positive relationship with age through 21–23 years (APC, 102.4) with a smaller positive relationship through 57–59 years (APC, 1.4). For both sexes, modeled joinpoints for 4vHPV-type prevalence occurred at older ages compared with joinpoints for non–4vHPV-type prevalence.

Conclusions
Sex differences in age-specific non–vaccine-type HPV prevalence may reflect natural history and sexual behavior. Differences in vaccine-type and non–vaccine-type modeling results suggest vaccine impact as joinpoints occur in mid-late 20s for vaccine-type HPV but early 20s for nonvaccine types. These data can assist in refining HPV vaccination models and inform HPV vaccination practices and policy.
The Likelihood of an Occult Fracture in Skeletal Surveys Obtained in Children More Than 2 Years Old With Concerns of Physical Abuse
Authors: McNamara Caitlin R. , Panigrahy Ashok , Sheetz Michael , Berger Rachel P. 
Published: April 2021

Objectives
Skeletal surveys are necessary in the evaluation for physical abuse in children less than 2 years old, but when to obtain a skeletal survey in older children is less clear.

Methods
A retrospective study of patients older than 2 years who underwent skeletal survey over a 3-year period after implementation of an electronic health record physical abuse order set was conducted. Data were analyzed using descriptive statistics and compared with data from a cohort before order set implementation. The radiation dose of a skeletal survey in a 5-year old was calculated using a previously published technique.

Results
There were 325 skeletal surveys, a marked increase in the rate of skeletal surveys compared with before order set implementation. Less than 2% (6/325) of skeletal surveys demonstrated an occult fracture. Of the 6 patients with occult fractures, 4 were physically abused; in each case, the diagnosis of abuse was evident before the skeletal survey. The other 2 patients fell from windows. The radiation exposure was 0.34 mSv.

Conclusions
The rate of occult fractures on skeletal survey is significantly lower than previously reported. This is likely because our population included all children who underwent skeletal survey and not the subset referred to a child abuse pediatrician. In addition, our data demonstrate that in children older than 2 years, skeletal surveys are unlikely to assist in making a diagnosis of physical abuse. The radiation exposure in a 5-year-old is 70% greater than in an infant, but still a dose, which represents a negligible health risk.
Phase-Adapted Rehabilitation for Acute Coronavirus Disease-19 Patients and Patient With Long-term Sequelae of Coronavirus Disease-19
Authors: Gutenbrunner Christoph , Nugraha Boya , Martin Lidia Teixido 
Published: April 2021

Abstract
Since the beginning of the COVID-19 pandemic in early 2020, many papers have highlighted the need for the rehabilitation of patients with SARS-CoV-2 infection. Most papers refer to the need for respiratory rehabilitation in the acute phase; however, the fact that the infection also affects other organ systems has to be considered in rehabilitation interventions. Long-term symptoms in many cases severely limit activity and participation and alter quality of life, leading to rehabilitation needs. This article proposes a phase-adapted model of linking the acute, postacute, and long-term symptoms of COVID-19 with the well-established matrix of acute, postacute, and long-term rehabilitation services. A review of currently available recommendations for phase-adapted rehabilitation strategies, including the relevance of prehabilitation within this context, is provided.
Electrophysiological Study of the Tibial Nerve Across the Tarsal Tunnel in Distal Symmetric Diabetic Polyneuropathy
Authors: Mondelli Mauro , Aretini Alessandro , Ginanneschi Federica 
Published: April 2021

Objective
The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes.

Design
One hundred twenty-four consecutive patients (mean age = 66.6 yrs, 62.1% male) with distal symmetric diabetic polyneuropathy clinically diagnosed were prospectively enrolled. Nerve conduction studies of deep peroneal, tibial, superficial peroneal, medial plantar, and sural nerves and standard needle electromyography in the lower limbs were performed. Demographic, anthropometric, and clinical findings were collected.

Results
Motor conduction velocity of the tibial nerve across tarsal tunnel was slowed in 60.5% of patients; another 4% showed conduction block across tarsal tunnel without reduction of motor conduction velocity. Overall percentage of abnormalities across tarsal tunnel (64.5%) exceeds that of the sensory conduction velocities of proximal sural and superficial peroneal nerves. Abnormal tibial motor conduction velocity across tarsal tunnel represents the most common abnormality among all motor nerve conduction study parameters and significantly correlates with hemoglobin level, diabetic neuropathic index score, and diabetic complications frequency.

Conclusions
Tibial conduction abnormalities across tarsal tunnel are the most sensitive motor parameter in distal symmetric diabetic polyneuropathy, second only to conduction abnormalities of sensory/mixed distal nerves of the feet. The use of nerve conduction studies across tarsal tunnel of the tibial nerve may be useful in the electrophysiological protocol to confirm the diagnosis of distal symmetric diabetic polyneuropathy.