bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction
Authors: Friedman James M. , Su Favian , Zhang Alan L. , Allen Christina R. , Feeley Brian T. , Souza Richard , Li Xiaojuan , Ma C. Benjamin , Lansdown Drew A. 
Published: January 2021

Background: The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR. Hypothesis: Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T1ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T1ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T1ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T1ρ relaxation times. Significance was defined as P < .05. Results: Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration ( P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment. Conclusion: Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.
Survey of Health-System Pharmacy Leadership Pathways: A 10-Year Revisit
Authors: Jones Adam M. , Deloney Sacha Pollard , Clark John S. 
Published: January 2021

Objective: To compare health-system pharmacy leadership pathways and opinions in the last decade. Methods: A 33 question survey was recreated from the 2009 survey of health-system pharmacy leadership pathways and reviewed and modified by the original creators. In November 2019, investigators sent two invites to complete a QualtricsXM survey to individuals listed on the ASHP Connect Pharmacy Practice Leaders listserver. The survey closed on December 15, 2019. Results: Two-hundred-thirteen pharmacy leaders responded to the survey. Survey respondents identified completing a pharmacy practice (PGY1) residency as the most common health-system pharmacy leadership pathway. Respondents stated on-the-job experience contributed most to their leadership development. Interpersonal skills (20%), human resource management (19%), and finance and budget management (13%) were classified as the most valuable skill-sets to a health-systems leader. Thirty-nine percent of eligible respondents stated they were interested in seeking a health-system pharmacy director position and 23% stated they may be interested. The majority of directors stated that they preferred to hire those with previous on-the job experience into leadership positions. Conclusion: Regardless of leadership pathway, those interested in pursuing health-system pharmacy leadership positions should pursue as much on-the-job experience as possible, build relationships through networking, and find a strong, helpful mentor.
A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: A retrospective study of 75 patients
Authors: Schofield Jill R , Hughes Hannah N , Birlea Marius , Hassell Kathryn L 
Published: January 2021

Objective It has been reported that patients with antiphospholipid antibodies (aPL) and refractory migraine may experience symptomatic improvement with antithrombotic therapy, but this phenomenon has not been well studied. This study was undertaken to detail the response to trials of antithrombotic therapy in these patients. Methods This is a retrospective study of 75 patients with refractory migraine and aPL who were given a 2–4 week trial of aspirin, clopidogrel and/or anticoagulation. Major response was defined as 50–100% improvement in frequency and/or severity of migraine; minor response: 25–49% improvement; no response: <25% improvement. Results 66 patients were given a trial of aspirin: 47% responded (21% major); 60 patients were given a trial of clopidogrel: 83% responded (67% major); and 34 patients were given a trial of anticoagulation (usually apixaban): 94% responded (85% major). The response rate to any anti-thrombotic therapy was 89% (83% major). Many patients also noted improvement in non-headache symptoms. No patient experienced stroke. There was no major bleeding during any 2–4 week treatment trial and only 3 of 69 patients maintained on an antithrombotic regimen for a median follow up of 29.9 months (5–100) experienced major bleeding. Conclusions There was a high rate of symptomatic response to antithrombotic therapy in this context and long-term follow up suggested an individualized symptom-derived antithrombotic regimen may be associated with a low bleeding risk. Our data support consideration of a 2–4 week trial of antithrombotic therapy, usually starting with antiplatelet therapy, in aPL-positive patients with refractory migraine, particularly if other treatment options have been exhausted. As a retrospective study, our data provide only Class IV level of evidence, but they suggest randomized controlled trials are warranted to validate these encouraging findings.
The influence of obesity on hydroxychloroquine blood levels in lupus nephritis patients
Authors: Pedrosa Tatiana , Kupa Léonard de Vinci Kanda , Pasoto Sandra Gofinet , Aikawa Nádia Emi , Borba Eduardo Ferreira , Duarte Nilo JC , Leon Elaine Pires , Silva Clovis Artur , Bonfá Eloisa 
Published: January 2021

Introduction In 2016 the American Academy of Ophthalmology(2016-AAO) recommended a maximum daily HCQ use of 5.0 mg/kg real body weight(RBW) taking into consideration minimizing eye toxicity. Retinopathy in systemic lupus erythematosus(SLE) patients was recently associated with obesity and this condition is progressively more common in these patients. However, the impact of obesity in HCQ blood levels remains controversial. Objective To determine if the 2016-AAO recommendation based on RBW with and without maximum daily dose restriction results in adequate and safe blood levels in obese lupus nephritis(LN) patients. Methods A cross-sectional study was performed with 108 LN patients under the prescribed 2016-AAO dose for at least 3 months. LN patients were assessed for demographic characteristics, body mass index(BMI), disease parameters, HCQ dose, concomitant treatment and HCQ blood levels measured by liquid chromatography-tandem mass spectrometry. Obesity was defined as BMI ≥30kg/m2. Results Obesity was identified in 35/108(32%) LN patients. The calculation of HCQ daily dosage revealed that obese patients were under a lower prescribed daily dose according to the real body weight (RBW) [4.4(2.9-5.4) vs. 4.9(4-5.5)mg/Kg/day, p < 0.001] due to the maximum limit used. Regardless of that the median of HCQ blood levels was significantly higher in obese compared to non-obese patients (1562 ± 548.6 vs. 1208 ± 448.9 ng/mL, p = 0.002). Further analysis of patients under the 20016-AAO recommendation by RBW without the restriction of maximum daily dose confirmed that in spite of comparable daily dose in 14 obese patients and 61 non-obese patients [4.8 (4.5-5.4) vs. 5.0(4.5-5.5) mg/kg, p = 0.312], the median of HCQ blood levels was significantly higher in obese patients than in non-obese (1734 ± 457.3 vs. 1189 ± 449.4 ng/mL, p < 0.001). Conclusion Obese patients under the 2016-AAO prescribed dose of HCQ based on RBW with and without maximum daily dose restriction have a very high HCQ blood levels compared to non-obese patients, with a potential increased risk of ocular toxicity. The use of 2016-AAO dose of HCQ according to the ideal body weight for this group of patients should be considered.Clinicaltrials.gov #NCT0312243.
Cumulative effects of therapies on disability in relapsing multiple sclerosis
Authors: Rollot Fabien , Casey Romain , Leray Emmanuelle , Debouverie Marc , Edan Gilles , Wiertlewski Sandrine , Vukusic Sandra , Laplaud David-Axel 
Published: January 2021

Background: Long-term effectiveness of treatment remains a key question in multiple sclerosis (MS) and the cumulative effects of past treatment have not been investigated so far. Objective: Explore the relationship between treatment exposure and disability risk in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: A total of 2285 adult patients from the French nationwide cohort were included. Outcomes were irreversible EDSS4, and conversion to secondary progression of multiple sclerosis (SPMS). Associations between treatments and risk of disability were assessed using a novel weighted cumulative exposure model, assuming a 3-year lag to account for reverse causality. This flexible approach accounts for past exposure in a multivariate Cox proportional hazards model by computing a weight function. Results: At baseline, mean ± standard deviation age of patients was 33.4 ± 8.9 years and 75.0% were women. A 15-year continuous treatment starting 20 years ago was associated with a decrease in risk of 26% for irreversible EDSS4, and 34% for SPMS compared to a 5-year treatment starting 10 years ago. The risk of disability decreased with increasing duration of exposure to disease-modifying treatment (DMT). Conclusion: Long-term use of treatments in RRMS has a stronger beneficial cumulative impact than only early uses and delays the occurrence of moderate disability and conversion to SPMS.
Autistic parents’ views and experiences of talking about autism with their autistic children
Authors: Crane Laura , Lui Lok Man , Davies Jade , Pellicano Elizabeth 
Published: January 2021

Little is known about how parents talk about autism with their autistic children, particularly among families in which both a parent and child are autistic. Using an online survey, we gathered quantitative and qualitative data from 34 autistic parents (most of whom had told their children about their diagnosis) to address this knowledge gap. There was considerable overlap between the views and experiences of the autistic parents in this study and the largely non-autistic parent samples in previous research. Specifically, parents emphasised the importance of being open and honest about the diagnosis, disclosing the diagnosis as early as possible, individualising discussions to children’s needs and framing the diagnosis positively. There were, however, areas in which the views and experiences of the current sample differed from previous research on non-autistic samples. First, our sample of autistic parents outlined the benefits of their own experiential expertise, which they felt resulted in heightened understanding and empathy with their children. Second, our sample tended not to express concerns about disclosure potentially having a negative impact. Finally, our participants did not express a want or need for professional support with disclosure. Instead, they reported feeling well equipped to support their children using their own knowledge and lived experience. Lay abstract Previous research examining how parents talk about autism with their children has tended to focus on parents who are not autistic themselves. We collected information on this topic from 34 autistic parents of autistic children (most of whom had told their children about their diagnosis). We found similarities, but also differences, between the views and experiences of autistic parents in this research and those reported in previous research (in studies of largely non-autistic parents). Similarities include the following: it is important to be open and honest about the diagnosis; the diagnosis should be introduced/discussed as early as possible; discussions should be tailored to each individual child’s needs; and we should not overlook the challenges associated with autism, but it is important to focus on positive aspects too. Differences include the following: autistic parents used personal experiences in conversations about autism, which was felt to result in increased understanding and empathy with their children; autistic parents overwhelmingly focused on more positive aspects of an autism diagnosis; our sample did not express concerns that discussions could have negative consequences too (e.g. making children more anxious); and autistic parents did not want or need professional support to talk about autism with their children (instead, they felt confident in using their own knowledge/experiences to guide discussions).
Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives
Authors: Hossain Muhammad Z , Chew-Graham Carolyn A , Sowden Emma , Blakeman Tom , Wellwood Ian , Tierney Stephanie , Deaton Christi 
Published: January 2021

Objectives To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF). Methods Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data. Results Themes presented reflect four inter-related challenges: GPs’ 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages. Discussion HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.
Robotic cystectomy histopathology outcomes in patients who have ‘failed’ Bacillus Calmette–Guérin: A case series
Authors: Hart Edward JM , Kavanagh Liam E , Guy Alexandra M , Lindsey Bronagh , Walters Jo , Haagsma Ben , Patil Krishna , Perry Matthew JA 
Published: January 2021

Objective: Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time. Methods: A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B). Results: A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases. Conclusion: RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients. Level of evidence: Level 4.
Constructionist Learning in School Mathematics: Implications for Education in the Fourth Industrial Revolution
Authors: Ng (吴蔼蓝) Oi-Lam , Tsang (曾咏琪) Wing Ki 
Published: January 2021

Highlights Amid rapid technological development in the Fourth Industrial Revolution, this article engages with an important question, especially in the context of science, technology, engineering, and mathematics (STEM) education: Can technology transform STEM teaching and learning? Constructionist learning responds to the current “maker movement,” which draws upon the innate human desire to make things with our hands. Two important elements of constructionist learning—technology literacy and engineering design—have implications for meeting the global need for expertise in the STEM disciplines. This article discusses how constructionist learning can play an important role in teaching and learning school mathematics via a transdisciplinary approach to STEM education. Two examples of the authors’ empirical research on constructionist learning in school mathematics classrooms with 3D printing are illustrated. Findings suggest that the 3D Printing Pens played an active role in the construction of artifacts (physical) and mathematical meaning (cognitive).
Management and Mid-Term Outcome After “Real SCIWORA” in Children and Adolescents
Authors: Freigang Viola , Butz Katja , Seebauer Caroline Theresa , Karnosky Julia , Lang Siegmund , Alt Volker , Baumann Florian 
Published: January 2021

Study Design: Retrospective analysis. Objective: The SCIWORA Syndrome (Spinal Cord Injury Without Radiographic Abnormalities) is a rare but potentially severe injury with a peak in childhood and adolescence. With a better understanding of injury patterns and advances in MRI, there is ongoing discussion regarding the “Real SCIWORA” syndrome, a clinical picture of neurologic deficits on clinical examination but absence of radiographic pathologies even on MRI. The purpose of this study was to evaluate mid-term clinical outcome and the psychological impact of the “Real SCIWORA.” Methods: In this retrospective analysis, we evaluated 32 patients treated for “Real SCIWORA” between 2007-2019. Inclusion criteria were: neurologic deficit after trauma, no other cerebral or skeletal injury and a lack of pathological findings in spinal MRI. All patients were followed until complete recovery from initial symptoms. 25/32 patients were re-evaluated after 6.9 years (1-14 years) using the Oswestry Disability Index, the Frankel Score, the EQ-5D score, and the Breslau Short Screening Scale for PTSD. Results: Initial neurologic presentation ranged from Frankel Grade A-D. All patients recovered neurologically during 1-13 days to a Frankel Grade E. The analysis of HR-QoL revealed no difference between the cohort of SCIWORA patients and the German population norm, Oswestry Disability Index showed only minimal disabilities. 4/25 patients showed signs of PTSD. Conclusions: The “Real SCIWORA” syndrome is a diagnosis per exclusionem requiring a full spinal MRI to ensure exclusion of structural and potentially serious reasons of the neurologic impairment. Further clinical re-evaluation, psychological support seems to be essential. Level of Evidence: IV—retrospective study.
Machine Learning Approaches to Define Candidates for Ambulatory Single Level Laminectomy Surgery
Authors: Li Qiyi , Zhong Haoyan , Girardi Federico P. , Poeran Jashvant , Wilson Lauren A. , Memtsoudis Stavros G. , Liu Jiabin 
Published: January 2021

Study Design: retrospective cohort study. Objectives: To test and compare 2 machine learning algorithms to define characteristics associated with candidates for ambulatory same day laminectomy surgery. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent single level laminectomy in 2017 and 2018. The main outcome was ambulatory same day discharge. Study variables of interest included demographic information, comorbidities, preoperative laboratory values, and intra-operative information. Two machine learning predictive modeling algorithms, artificial neural network (ANN) and random forest, were trained to predict same day discharge. The quality of models was evaluated with area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) measures. Results: Among 35,644 patients, 13,230 (37.1%) were discharged on the day of surgery. Both ANN and RF demonstrated a satisfactory model quality in terms of AUC (0.77 and 0.77), accuracy (0.69 and 0.70), sensitivity (0.83 and 0.58), specificity (0.55 and 0.80), PPV (0.77 and 0.69), and NPV (0.64 and 0.70). Both models highlighted several important predictive variables, including age, duration of operation, body mass index and preoperative laboratory values including, hematocrit, platelets, white blood cells, and alkaline phosphatase. Conclusion: Machine learning approaches provide a promising tool to identify candidates for ambulatory laminectomy surgery. Both machine learning algorithms highlighted the as yet unrecognized importance of preoperative laboratory testing on patient pathway design.