bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do COVID-19–Related Treatment Changes Influence Fear of Cancer Recurrence, Anxiety, and Depression in Breast Cancer Patients?
Authors: Kim Soo Yeon , Kim Sue 
Published: March 2021

Background
The worldwide spread of the coronavirus disease 2019 (COVID-19) has impacted the treatment of cancer patients. Treatment changes can negatively affect patients’ prognosis and may be psychologically burdensome.

Objective
The aim of this study was to explore whether COVID-19–related treatment changes (delays, cancellations, changes) influenced fear of cancer recurrence, anxiety, and depression in breast cancer patients.

Methods
A convenience sample (n = 154) of patients who were diagnosed with breast cancer no longer than 2 years ago was obtained from an online community and social network site. The survey content included COVID-19–related treatment experiences and psychological status. The data were analyzed using descriptive statistics, χ
2 test, independent t test, and analysis of variance.

Results
Twenty-nine patients (18.8%) had experienced COVID-19–related treatment changes, and changes of the treatment plan had a significant correlation with depression (t = 2.000, P = .047). Fear of cancer recurrence was high (mean score, 84.31 ± 24.23). Fifteen percent had moderate to severe levels of anxiety, and 24.7% had moderate to severe levels of depression. Narrative reports also identified COVID-19–related unforeseen costs.

Conclusion
In the midst of the COVID-19 pandemic, breast cancer patients experienced treatment changes, and changes in treatment plans were significantly associated with depression. Fear of recurrence, anxiety, and depression were found at high levels.

Implications for Practice
Oncology nurses should assess the psychological status of cancer patients in the early survivorship phase who appear to be especially vulnerable during the COVID-19 pandemic. Oncology nurses can also monitor whether patients are receiving timely supportive care to alleviate fears and anxiety and assess financial needs for COVID-19–related costs.
Association Between Acute Kidney Injury Duration and Outcomes in Critically Ill Children*
Authors: Alobaidi Rashid , Anton Natalie , Burkholder Shauna , Garros Daniel , Garcia Guerra Gonzalo , Ulrich Emma H. , Bagshaw Sean M. 
Published: March 2021

OBJECTIVES:
Acute kidney injury occurs frequently in children during critical illness and is associated with increased morbidity, mortality, and health resource utilization. We aimed to examine the association between acute kidney injury duration and these outcomes.

DESIGN:
Retrospective cohort study.

Settings:
PICUs in Alberta, Canada.

PATIENTS:
All children admitted to PICUs in Alberta, Canada between January 1, 2015, and December 31, 2015.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
In total, 1,017 children were included, and 308 (30.3%) developed acute kidney injury during PICU stay. Acute kidney injury was categorized based on duration to transient (48 hr or less) or persistent (more than 48 hr). Transient acute kidney injury occurred in 240 children (77.9%), whereas 68 children (22.1%) had persistent acute kidney injury. Persistent acute kidney injury had a higher proportion of stage 2 and stage 3 acute kidney injury compared with transient acute kidney injury and was more likely to start within 24 hours from PICU admission. Persistent acute kidney injury occurred more frequently in those with higher illness severity and in those admitted with shock, sepsis, or with a history of transplant. Mortality varied significantly according to acute kidney injury status: 1.8% of children with no acute kidney injury, 5.4% with transient acute kidney injury, and 17.6% with persistent acute kidney injury died during hospital stay (p < 0.001). On multivariable analysis adjusting for illness and acute kidney injury severity, transient and persistent acute kidney injury were both associated with fewer ventilation-free days at 28 days (–1.28 d; 95% CI, –2.29 to –0.26 and –4.85 d; 95% CI, –6.82 to –2.88), vasoactive support–free days (–1.07 d; 95% CI, –2.00 to –0.15 and –4.24 d; 95% CI, –6.03 to –2.45), and hospital-free days (–1.93 d; 95% CI, –3.36 to –0.49 and –5.25 d; 95% CI, –8.03 to –2.47), respectively.

CONCLUSIONS:
In critically ill children, persistent and transient acute kidney injury have different clinical characteristics and association with outcomes. Acute kidney injury, even when its duration is short, carries significant association with worse outcomes. This risk increases further if acute kidney injury persists longer independent of the degree of its severity.
Toys and Toy Accessories Strike Back
Authors: Vega Carolina , Kannikeswaran Nirupama , Farooqi Ahmad , Arora Rajan 
Published: March 2021

Abstract

Objective
The aim of the study was to examine age-associated injury trends and severe injury proportions for plush toys, toy figurines, and doll and toy accessories. We hypothesized that the proportion of severe injuries would be highest in the younger than 3-year and 3- to 5-year age groups.

Methods
We analyzed injury patterns from plush toys, toy figurines, and doll and toy accessories for ages of 0 to 18 years from 2010 to 2018 using the Consumer Product Safety Commission National Electronic Injury Surveillance System. Exclusion criteria included unspecified toy categories, adult or pet involvement, or unspecified disposition. National estimates were calculated with National Electronic Injury Surveillance System sample weights. Outcome of interest was severe injury proportions per age and toy category. Severe injury was defined as life- or limb-threatening injuries or injuries requiring admission. χ2 test was used to analyze the distribution of categorical variables.

Results
We analyzed 1360 injuries. The majority occurred in female (n = 771, 56.7%) and ages of 3 to 5 years (n = 580, 42.7%). Annual injury frequency remained stable. One fifth of injuries were severe (n = 321, 23.6%), with a national estimate of 9304.7. The majority of both total (n = 778, 57.2%) and severe injuries (n = 182, 56.7%) resulted from toy figurines. Life-threatening injury secondary to foreign body aspiration or ingestion with a risk for asphyxiation was the most common severe injury. Severe injuries were significantly more common in the younger than 3-year group (odds ratio, 3.59; 95% confidence interval, 2.40–5.36) and 3- to 5-year age group (odds ratio, 2.97; 95% confidence interval, 2.01–4.39) than the older than 5-year age group.

Conclusions
Injury frequency remained stable. The greatest proportion of injuries were in ages up to 5 years, with most injuries occurring in the 3- to 5-year age category, and a significant proportion of injuries were severe.
A Case Series of Life-Threatening Complications of Central Venous Catheter Insertion
Authors: Akkuzu Emine , Sincar Şahin , Kalkan Gökhan 
Published: March 2021

Abstract
Central venous catheters are commonly used in emergency department and the intensive care units for the treatment of critically ill patients. Reports on the rate of mechanical complications of catheter insertion are around 1%. Mechanical complications related with the insertion of the catheter mainly depend on the anatomic location, the use of ultrasound, and experience of the operator. The rate of complication is higher in places where central lines are not routinely inserted as in emergency department. Here, we report a case series of 4 patients who had life-threatening complications of central venous catheter insertion, including venous intimal injury leading to pleural effusion, kinked central venous catheter in the superior vena cava, knotted guidewire with the separation of coil and core, and a missed guidewire with their respective insertion history and imaging. Increasing the awareness of and developing strategies to prevent these rare but potentially fatal conditions may have impact on patient outcomes.
Upper Extremity Strengthening for an Individual With Dyskinetic Cerebral Palsy: A Case Report
Authors: Graber Laura , Senesac Claudia 
Published: March 2021

Purpose:
The purpose of this case is to describe an exercise program designed for an individual with athetoid cerebral palsy who had difficulties with fine motor control and shoulder girdle stability.

Summary of Key Points:
ET is a 19-year-old man with dyskinetic-type cerebral palsy with rapidly fluctuating muscle tone and movements that preclude trunk and extremity control necessary for the effective performance of functional activities. The participant underwent a 6-week intense physical therapy program aimed at strength and stability at the shoulder girdle and fine motor movements of the hand.

Conclusions:
ET had improvements on the Performance of Upper Limb Scale, myometry, and from family report after 6 weeks.

Recommendations:
A progressive exercise program aimed at improving proximal stability and fine motor function might be an appropriate intervention for persons with athetoid cerebral palsy.

Video Abstract:
For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A315.
Predictive Value of Time–Space Clusters for HIV Transmission in Washington State, 2017–2019
Authors: Erly Steven J. , Naismith Kelly , Kerani Roxanne , Buskin Susan E. , Reuer Jennifer R. 
Published: March 2021

Background:
Pillar 4 of the United States' End the HIV Epidemic plan is to respond quickly to HIV outbreaks, but the utility of CDC's tool for identifying HIV outbreaks through time–space cluster detection has not been evaluated. The objective of this evaluation is to quantify the ability of the CDC time–space cluster criterion to predict future HIV diagnoses and to compare it to a space–time permutation statistic implemented in SaTScan software.

Setting:
Washington State from 2017 to 2019.

Methods:
We applied both cluster criteria to incident HIV cases in Washington State to identify clusters. Using a repeated-measures Poisson model, we calculated a rate ratio comparing the 6 months after cluster detection with a baseline rate from 24 to 12 months before the cluster was detected. We also compared the demographics of cases within clusters with all other incident cases.

Results:
The CDC criteria identified 17 clusters containing 192 cases in the 6 months after cluster detection, corresponding to a rate ratio of 1.25 (95% confidence interval: 0.95 to 1.65) relative to baseline. The time–space permutation statistic identified 5 clusters containing 25 cases with a rate ratio of 2.27 (95% confidence interval: 1.28 to 4.03). Individuals in clusters identified by the new criteria were more likely to be of Hispanic origin (61% vs 20%) and in rural areas (51% vs 12%).

Conclusions:
The space–time permutation cluster analysis is a promising tool for identification of clusters with the largest growth potential for whom interruption may prove most beneficial.
Effects of Mandibular Distraction Osteogenesis on Three-Dimensional Upper Airway Anatomy in Newborns Affected by Isolated Pierre Robin Sequence
Authors: Mao Zhe , Ye Liang 
Published: March 2021

Background:
Effective airway management is critical to Pierre Robin Sequence treatment. The goal of this study is to assess the three-dimensional changes in airway size and shape in 117 newborns with isolated Pierre Robin sequence who underwent mandibular distraction osteogenesis.

Methods:
During the study period (11/29/2016 to 11/26/2019), 117 newborns affected by isolated Pierre Robin sequence met the inclusion criteria for the present study. All 117 included patients underwent linear distraction. Demographic variables were recorded and analyzed. Cone-beam computed tomography were performed before and after mandibular distraction osteogenesis. A systemic quantitative three-dimensional analysis of size and shape of upper airway was performed.

Results:
The mean age was 71 day (range 12 to 213). The mean weight was 3.9 kg (range 2.3–6.8). A total of 53 patients are female and 64 are male. When the distraction device was removed, the upper and lower jaws were symmetrically aligned. Pre- and post-distraction comparison clearly showed osteogenesis. For the size of the upper airway, airway volume, anteroposterior dimension of the retroglossal airway, lateral dimension of retroglossal airway, minimum retropalatal area, minimum retroglossal area, average cross-sectional area and minimum cross-sectional area increased significantly after mandibular distraction osteogenesis (P < 0.001). However, the airway length did not change significantly (P > 0.05). For the shape of the upper airway, the lateral/anteroposterior ratio in the retroglossal region and the ratio of the retropalatal airway diameter to the retroglossal airway diameter significantly decreased after mandibular distraction osteogenesis (P < 0.001). The airway uniformity significantly increased after mandibular distraction osteogenesis (P < 0.001).

Conclusion:
Mandibular distraction osteogenesis for isolated Pierre Robin sequence improved size and shape of the upper airway, further confirming mandibular osteogenesis distraction as an effective surgical modality to address the airway obstruction in newborns affected by isolated Pierre Robin sequence. Cone-beam computed tomography scanning and analysis can serve as a safe and effective examination modality for upper airway applications of PRS newborns.
Telemedicine for Sports-Related Injuries
Authors: Tam Anson , Plotsker Ethan , Kim Minji , Thaller Seth R. 
Published: March 2021

Background:
Telemedicine use has expanded rapidly since the COVID-19 pandemic in order to adhere to social distancing protocols and has been met with much enthusiasm. However, less is known about the use of telemedicine in sports and exercise medicine (teleSEM) and its utility to treat emergent craniofacial injuries. Given how common facial trauma is among athletes and its possible complications, incorporation of telemedicine in sports-related injuries may prove to be quintessential for athletes and coaches.

Methods:
A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through December 2020 with multiple search terms related to telemedicine in sports and trauma care.

Results:
Overall, teleSEM is appreciated by both patients and physicians alike. Studies show that the satisfaction rate among patients and physicians are high. Sports-related telemedicine visits can help improve resource utilization and total costs. Facial trauma studies also reveal that the level of concurrency of treatment options between telemedicine visits and in-person consultations is almost perfect. Further, there are many additional ways that teleSEM can be implemented in treating injured athletes, including possible collaboration between athletic coaches and physicians as well as mobile device applications. Telemedicine may be particularly useful in treating acute injuries in low-resourced areas with limited equipment and training.

Conclusion:
Telemedicine has been widely employed for sports-related injuries and in traumatic care. Patients and providers alike have noted its utility over other methods of communication with physicians. Our findings suggest that telemedicine has a significant potential in treating sports-related injuries and improving the efficiency of diagnoses and treatments. It may enhance outcomes for participants in athletic events. This may become a key aspect of determining whether a player can return to immediate competition.
Corneal Neurotization in the Setting of Facial Paralysis: A Comprehensive Review of Surgical Techniques
Authors: Ziai Kasra , Thomas Sydnie , Weller Christopher , Lighthall Jessyka G. 
Published: March 2021

Abstract
Neurotrophic keratopathy is characterized by decreased corneal sensitivity, decreased reflex tearing, and poor corneal healing resulting in corneal injury. Without proper sensory innervation, the cornea undergoes continuous epithelial injury, ulceration, infection and eventually results in vision loss. In situations where patients have concomitant facial paralysis, such as after resection of a large vestibular schwannoma, the ocular health is further impaired by paralytic lagophthalmos with decreased eye closure and blink reflex, decreased tearing, and potential lower eyelid malposition. In patients with a dual nerve injury, the ocular surface is in significant danger, as there is increased environmental exposure in conjunction with the inability to sense damage when it occurs. Immediate recognition and care of the eye are critical for maintaining ocular health and preventing irreversible vision loss. The first modern corneal neurotization procedure was described in 2009. The ultimate goal in corneal neurotization is to establish sub-basal plexus regeneration via transferring a healthy nerve to the corneo-limbal region. Corneal neurotization can be achieved either via a direct transfer of healthy nerve (direct approach) or via nerve graft interpositions (indirect approach). This is an emerging concept in the treatment of neurotrophic/exposure keratitis and over the past decade multiple direct and indirect approaches have been described in the attempt to restore corneal sensation and to prevent the devastating outcomes of neurotrophic keratitis. Knowledge of these techniques, their advantages, and disadvantages is required for proper management of patients suffering from neurotrophic keratitis in the setting of facial paralysis.
Association of Surgeon Representation on NIH Study Sections With Receipt of Funding by Surgeon-scientists
Authors: Lewit Ruth A. , Black Caitlin M. , Camp Lauren , Brott Nathan , Cottrell J. Macy , Herman Timothy , Holden Kylie W. , Matthews Lynley , Schneider Elizabeth , Goldstein Allan M. , Matthews Jeffrey B. , Emamaullee Juliet , Gosain Ankush 
Published: March 2021

Objective:
Our goal was to evaluate the relationship between surgeon representation on NIH study sections and success in grant funding.

Summary of Background Data:
NIH funding for surgeon-scientists is declining. Prior work has called for increased surgeon participation in the grant review process as a strategy to increase receipt of funding by surgeon-scientists.

Methods:
A retrospective review of surgeon (primary department: General, Urology, Orthopedic, Ophthalmology, Otolaryngology, Neurosurgery) representation on NIH study sections and receipt of funding was performed using NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) and 2019 Blue Ridge Institute for Medical Research data. NIH chartered study section panels and ad hoc reviewers for each 2019 review date were also obtained.

Results:
In 2019, 9239 individuals reviewed in at least 1 of the 168 study sections [190 (2.1%) surgeons, 64 (0.7%) standing members, 126 (1.4%) ad-hoc]. Most surgeons on study sections were male (65%) professors (63%). Surgeons most commonly served on bioengineering, technology, and surgical sciences (29.6% surgeons), diseases and pathophysiology of the visual system (28.3%), and surgery, anesthesiology and trauma (21%). In 2019, 773 surgeons received 1235 NIH grants (>$580 M) out of a total of 55,012 awards (2.2%). Funded surgeons were predominantly male (79%), White (68%), non-Hispanic (97%), full professors (50%), and 43% had additional advanced degrees (MPH/PhD/MBA). surgery, anesthesiology and trauma, diseases and pathophysiology of the visual system, and bioengineering, technology, and surgical sciences were the most common study sections that reviewed funded grants to surgeon-scientists. Ninety-two surgeons both received grant funding and served on study section. Study sections with higher surgeon representation were more likely to fund surgeon-scientists (P < 0.001).

Conclusions:
Surgeon representation on NIH study sections is strongly associated with receipt of funding by surgeon-scientists. Increasing NIH study section representation by surgeons may help to preserve the surgeon-scientist phenotype.
Effects of Advanced Practice Providers on Single-specialty Surgical Practice
Authors: Hollenbeck Brent K. , Kaufman Samuel R. , Oerline Mary , Modi Parth K. , Caram Megan E. V. , Shahinian Vahakn B. , Ellimoottil Chad 
Published: March 2021

Objective:
To assess the effects of adding advanced practice providers to surgical practices on surgical complications, readmissions, mortality, episode spending, length of stay, and access to care.

Summary Background Data:
There has been substantial growth in the number of nurse practitioners and physician assistants (ie, advanced practice providers) in the United States. The extent to which advanced practice providers have been integrated into surgical practice, and their impact on surgical outcomes and access is unclear.

Methods:
Using a 20% sample of national Medicare claims, we performed a retrospective cohort study of fee-for-service beneficiaries undergoing one of 4 major procedures (coronary artery bypass graft, colectomy, major joint replacement, and cystectomy) between 2010 and 2016. We limited our study population for each procedure to patients treated by single-specialty surgical groups to ensure that the advanced practice providers have direct interactions with its surgeons and patients. All outcomes were measured at the practice level for the year before and the year after the addition of the first advanced practice provider. Outcomes included: complications, readmission, mortality, episode payments, length of stay. Models were adjusted for age, race, sex, comorbidity, socioeconomic class and procedure type. Secondary outcome: practice-level office visits by surgical group type.

Results:
The number of advanced practice providers increased by 13%, from 6713 to 7596 between 2010 and 2016. The largest relative increases occurred in general (46.9%) and urologic (27.6%) surgical practices. The year after an advanced practice provider was added to a surgical practice, the odds of complications were 17% and 16% lower at 30- and 90-days postprocedure, respectively. Additionally, 90-day readmissions were 18% less likely and length of stay was 0.33 days shorter (a 7.1% reduction). Average 30-day and
90-day episode spending was $1294.73 and $1427.76 lower, respectively (P < 0.001). General surgical, orthopedic, and urology practices realized increases of 49.0 (95% CI 13.5–84.5), 112.0 (95% CI 83.0–140.5), and 205.0 (95% CI 117.5–292.0) in-office visits per surgeon, respectively.

Conclusions:
The addition of advanced practice providers to single-specialty surgical groups is associated with improvements in surgical outcomes and access. Future work should clarify the mechanisms by which advanced practice providers within surgical practices contribute to health outcomes to identify best practices for deployment.