bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient phenotyping in clinical trials of chronic pain treatments: IMMPACT recommendations
Authors: Edwards Robert R. , Dworkin Robert H. , Turk Dennis C. , Angst Martin S. , Dionne Raymond , Freeman Roy , Hansson Per , Haroutounian Simon , Arendt-Nielsen Lars , Attal Nadine , Baron Ralf , Brell Joanna , Bujanover Shay , Burke Laurie B. , Carr Daniel , Chappell Amy S. , Cowan Penney , Etropolski Mila , Fillingim Roger B. , Gewandter Jennifer S. , Katz Nathaniel P. , Kopecky Ernest A. , Markman John D. , Nomikos George , Porter Linda , Rappaport Bob A. , Rice Andrew S.C. , Scavone Joseph M. , Scholz Joachim , Simon Lee S. , Smith Shannon M. , Tobias Jeffrey , Tockarshewsky Tina , Veasley Christine , Versavel Mark , Wasan Ajay D. , Wen Warren , Yarnitsky David 
Published: January 2021

Abstract
There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for “precision medicine” or personalized pain therapeutics (ie, empirically based algorithms that determine the optimal treatments, or treatment combinations, for individual patients) that would presumably improve both the clinical care of patients with pain and the success rates for putative analgesic drugs in phase 2 and 3 clinical trials. However, before implementing this approach, the characteristics of individual patients or subgroups of patients that increase or decrease the response to a specific treatment need to be identified. The challenge is to identify the measurable phenotypic characteristics of patients that are most predictive of individual variation in analgesic treatment outcomes, and the measurement tools that are best suited to evaluate these characteristics. In this article, we present evidence on the most promising of these phenotypic characteristics for use in future research, including psychosocial factors, symptom characteristics, sleep patterns, responses to noxious stimulation, endogenous pain-modulatory processes, and response to pharmacologic challenge. We provide evidence-based recommendations for core phenotyping domains and recommend measures of each domain.
Examination of the Wrist
Authors: Reavey Patrick L. , Hammert Warren C. 
Published: January 2021

Learning Objectives:
After reading this article and reviewing the supplemental videos, the participant should be able to: 1. Identify common wrist conditions that may be encountered on evaluation. 2. Describe provocative maneuvers used to confirm a diagnosis of wrist disorder. 3. Develop a systematic approach to examination of the wrist. 4. Determine appropriate diagnostic maneuvers for radial, central, and ulnar wrist pain.

Summary:
The wrist is a complex structure, and providers caring for hand and upper extremity conditions need to have an understanding of the wrist examination and provocative maneuvers for conditions that are encountered. Fractures, tendonitis, arthritis, and instabilities are all commonly encountered, and the provider should have an idea of the diagnosis based on clinical examination and use imaging as needed to confirm or stage a diagnosis.
Five Wrist Operations That Give the Best Results
Authors: Maldonado Andres A. , Pulos Nicholas , Rhee Peter C. , Shin Alexander Y. 
Published: January 2021

Learning Objectives:
After reading this article and viewing the videos, the participant should be able to: 1. Recognize the following five wrist operations as consistent options for different wrist injuries: carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis. 2. Know the state-of-the-art of these five procedures. 3. State the indications of each operation. 4. List the surgical steps of these five procedures.

Summary:
The wrist is a complex joint that concentrates different types of tissues (e.g., bone, cartilage, ligaments, nerves, vessels) and a broad different spectrum of diseases. Treatment of wrist injuries has improved during recent years, mainly because of improvement in strategy, techniques, microsurgical equipment, understanding anatomy and improvements in technology. In this article, we present the five operations (i.e., carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis) that have consistently given good outcomes in patients suffering from different wrist injuries/maladies.
Press Ganey: Patient-Centered Communication Drives Provider and Hospital Revenue
Authors: Abu-Ghname Amjed , Davis Matthew J. , Shook Joan E. , Reece Edward M. , Hollier Larry H. 
Published: January 2021

Background:
Spurred on in part by government policies that base a portion of reimbursement around patient satisfaction, in 2016, Texas Children’s Hospital instituted a patient-focused communication course entitled Breakthrough Communication. The aim of this study is to examine the effect of this training on provider-specific Press Ganey scores within the Department of Surgery, and to assess whether changes in Press Ganey scores correlate to hospital volume and revenue.

Methods:
The intervention period was defined as calendar year 2017. Full-time faculty between 2016 and 2018 who completed the course in 2017 and had at least 10 returned Press Ganey surveys before and after the course were included in this study. Patient volume and revenue were analyzed. A subgroup analysis was conducted to compare participant against nonparticipant plastic surgeons.

Results:
For the 56 surgeons who met the inclusion criteria, mean provider Press Ganey ratings increased from 92.0 to 94.3 following participation (p = 0.003). When compared to before intervention, clinical encounters increased by 26.2 percent, the number of patients increased by 26.0 percent, payments increased by 25.2 percent, and charges increased by 21.2 percent. In our subgroup analysis, there was a relative increase of 11 percent in the number of patients and 10 percent in the number of encounters for participant plastic surgeons. Participants reported 113 percent increases in charges and 71 percent increases in payments, whereas nonparticipants had decreases of 10 percent in charges and 4 percent in payments.

Conclusion:
The authors’ findings indicate that improving surgeons’ patient-centered communication skills is associated with an increase in patient satisfaction and an accompanying increase in both volume and reimbursements.
An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery: A Randomized Prospective Study
Authors: Newman Ashley , Davison Steven P. 
Published: January 2021

Background:
Prescription opioid misuse has been recognized as a national epidemic. The implications of this problem are especially important to consider, as postoperative opioid abuse can give rise to true addiction for surgical patients. The concept of enhanced recovery after surgery is increasingly used across various specialties to decrease the overabundance of postoperative opioid use.

Methods:
This study prospectively examined 143 patients undergoing cosmetic elective surgery. Patients were randomized into one of two groups based on postoperative pain management regimen: multimodal (enhanced recovery after surgery) analgesia or traditional opioid analgesia. Data regarding postoperative pain scores, amount of postoperative opioids consumed, and duration of postoperative pain pill use were analyzed.

Results:
Multimodal (enhanced recovery after surgery) regimen patients experienced a 13.0 percent reduction in their pain scores after admission to the postanesthesia care unit and a 34.2 percent reduction in pain score at discharge, compared with traditional opioid patients (p = 0.049 and p = 0.0036, respectively). Enhanced recovery after surgery patients experienced a 35 percent reduction in the number of pills taken in the postoperative period and an 18.4 percent reduction in the duration of consumption (p = 0.0007 and p = 0.0539, respectively).

Conclusions:
The results demonstrate that multimodal postoperative pain management is an important tool for decreasing the amount of opioids prescribed and needed in the postoperative period. The overprescribing of opioids after surgery is a precursor to abuse and the increase in the national opioid reservoir.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Use of Immediate Obturator Prosthesis as a Rehabilitation Option in Cases of Squamous Cell Carcinoma
Authors: Ramirez Iago , Munhoz Maira F.V. , Freitas Deyves J. , Haddad Marcela F. 
Published: January 2021

Abstract
Maxillary defects caused by surgical resection generate abnormal communication between the nasal and oral cavities, hindering proper eating and phonetics, and causing aesthetic damage. Prosthetic intervention is necessary to rehabilitate these patients, in order to block communication and allow correct speech and swallowing functions. This article reports the manufacture of an immediate palatal obturator prosthesis after hemimaxillectomy due to the surgical removal of an intraoral squamous cell carcinoma, which guaranteed better conditions for postoperative recovery, as well as better adaptation to the definitive prosthesis and the use of the prosthetic apparatus.
Practice Habits, Knowledge, and Attitudes of Hepatologists to Alcohol Use Disorder Medication: Sobering Gaps and Opportunities
Authors: Cotter Thomas G. , Ayoub Fares , King Andrea C. , Reddy Kapuluru Gautham , Charlton Michael 
Published: January 2021

Background:
The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease is increasing in the United States. Efficacious AUD pharmacotherapies, while available, are, for protean reasons, underutilized. Hepatology providers may be in a position to bridge the pharmacotherapeutic gap between availability and utilization of AUD pharmacotherapies. Our aim was to ascertain the current practice, knowledge and attitudes of hepatology physicians in the United States, and identify opportunities on how to increase AUD medication prescribing.

Methods:
A web-based survey, developed by an expert panel, was administered to hepatology physicians working at all transplant centers in the United States.

Results:
The survey response rate was 131/658 (20%). There was significant support (two-thirds of respondents) for hepatology providers prescribing AUD medications; however, only 1 in 4 was comfortable prescribing these medications. The majority felt additional education is needed to prescribe AUD medications. The practice of hepatology providers prescribing AUD medications is common, with >50% of respondents having done so. Baclofen was the most popular medication prescribed. Hepatology providers perceived suboptimal ancillary addiction services. Although AUD prescribers had higher rates of AUD pharmacotherapy knowledge compared with nonprescribers, approximately 50% still had inadequate knowledge.

Conclusions:
AUD medication prescribing is a common practice among hepatology providers who appear eager to increase this practice through more education as they attempt to bridge the pharmacotherapeutic gap. This informative survey provides guidance for professional societies on how best to disseminate the requisite education required to optimize the care of patients with AUD.
Donor-derived Cell-free DNA and the Prediction of BK Virus-associated Nephropathy
Authors: Kant Sam , Bromberg Jonathan , Haas Mark , Brennan Daniel 
Published: January 2021

Background.
Approximately 15% of kidney transplant recipients (KTRs) develop BK viremia (BKV), with 1%–10% developing BK virus-associated nephropathy (BKVAN), which histologically resembles rejection. The Diagnosing Acute Rejection in Kidney Transplant Recipients (DART) study showed that donor-derived cell-free DNA (dd-cfDNA) levels <1% have a negative predictive value of 85% for active allograft rejection. Using data from this study, we evaluated the association of dd-cfDNA with plasma BK viral loads and biopsy findings to determine if dd-cfDNA can distinguish asymptomatic BKV from BKVAN.

Methods.
Data on dd-cfDNA, plasma BK viral loads, and biopsy findings from patients from the DART study were retrospectively examined. BKV was defined as 500–10 000 copies/mL. Presumptive BKVAN was defined as BK >10 000 copies/mL.

Results.
Of 102 participants with biopsies, 10 patients with BKV and BKVAN had paired dd-cfDNA, and viral loads available for analysis. Patients diagnosed with BKV and BKVAN had a median dd-cfDNA of 0.58% (IQR 0.43–1.15) and 3.38% (IQR 2.3–4.56, P = 0.001), respectively. dd-cfDNA titers correlated with BK PCR viral loads (R = 0.874, P = 0.01) and the presence of histologic evidence of BKVAN (100% sensitivity, 50% specificity). Five of 7 patients with BKVAN, but only 2 of 7 with BKV, had biopsies meeting Banff criteria for T-cell–mediated rejection. Median dd-cfDNA in nonrejection patients was 0.43% versus 2.84% in rejection patients (P = 0.001).

Conclusion.
Higher dd-cfDNA titers were associated with higher BK viral loads, biopsy-diagnosed BVAN, as well histologic changes meeting Banff criteria for as T-cell–mediated rejection. dd-cfDNA may be a useful noninvasive test to assess for progression of BKV to BKVAN.
Donor HLA−DR Drives the Development of De Novo Autoimmunity Following Lung and Heart Transplantation
Authors: Jankowska−Gan Ewa , Agashe Vrushali V. , Lema Diego A. , Zhou Ying , Gonzalez Bosc Laura , Sullivan Jeremy A. , Greenspan Daniel S. , Burlingham William J. 
Published: January 2021

Background.
Individuals harbor preexisting HLA−DR/DQ−restricted responses to collagen type V (ColV) mediated by Th17 cells under Treg control, both specific to peptides that bind to inherited HLA class II antigens. Yet after transplant, the donor−DR type somehow influences graft outcome. We hypothesized that, long after a lung or heart allograft, the particular HLA−DR type of the mismatched transplant donor transforms the specificity of the “anti−self” response. This could explain why, over long term, certain donor DRs could be more immunogenic than others.

Methods.
We analyzed 7 HLA−DR15neg patients who had received a lung allograft from a DR15+ donor. To determine the mechanism of acquired specificity in self−reactivity, we analyzed the kinetics of DR1 (host) and DR15 (donor) peptide restriction in a heart transplant model using DR−transgenic mice.

Results.
Beyond 1.5 years post-lung transplant, all patients tested had acquired DR15−restricted immune responses to ColV peptides. These responses were either unrestrained Th17 type (n = 4) or Th17 controlled by Treg arising early (<5 y) or late (>7 y) after transplant (n = 4). Treg suppression via conventional (transforming growth factor−β [TGF−β]) and extracellular vesicle−associated (IL−35) cytokines correlated with superior outcomes. Naïve DR1 and DR15 transgenic mice had preexisting DR−restricted responses, exclusively to ColV fragments containing DR1− or DR15−binding peptides. When HLA−DR1 transgenic recipients of a HLA−DR15 heart developed ColV reactivity post-transplant, mice that acutely rejected (20–25 d) responded only to the DR1−restricted ColV peptide epitope. In animals whose grafts survived long term, we could detect acquisition of DR from the transplant donor onto the surface of recipient dendritic cells, and immune responses against a donor DR15–restricted ColV peptide.

Conclusions.
These results might explain how certain donor HLA−DR types redirect host immune responses to novel peptides of critical self−antigens. Unless regulated, such responses may predispose the allograft to chronic rejection.
Ethical Decision Diagrams on Donation After Cardiocirculatory Death Heart Transplantation Considering Organ Preservation Techniques
Authors: Saemann Lars , Karck Matthias , Korkmaz-Icöz Sevil , Wenzel Folker , Szabó Gábor 
Published: January 2021

Background.
To overcome organ shortage, some centers accept hearts from cardiocirculatory determined death (DCD) donors for heart transplantation (HTx). DCD-HTx is attached with special ethical conflicts on the donor, family, and recipient side. Ethically motivated decisions also have to be made considering organ preservation techniques. However, ethical decision diagrams, which can be applied to find a final answer on the complex field of ethical questions, have not been developed yet.

Methods.
In an interdisciplinary group of clinical ethicists, transplantation surgeons, transplantation researchers, and perfusionists, after review of relevant literature, we focused on crucial ethical aspects on DCD-HTx in general and separated ethical conflicts with regard to the individual perspective of the donor, family, and recipient.

Results.
The leading aspect of discussion in the donor perspective mainly deals with the standoff period and with the definition of death. The perspective of recipients focuses on the wish to say farewell after the patient is deceased. In the recipient perspective ethical questions regarding organ procurement techniques occur.

Conclusions.
Ethical decision-making on DCD-HTx is complex, but it can be processed in a structured way by applying the decision diagrams that we have developed.
Early Detection of Alzheimer’s Disease with Low-Cost Neuropsychological Tests: A Novel Predict-Diagnose Approach using Recurrent Neural Networks
Authors: Mukherji Devarshi , Mukherji Manibrata , Mukherji Nivedita ,   Alzheimer’s Disease Neuroimaging Initiative
Published: January 2021

AbstractAlzheimer’s Disease (AD) is the most expensive and currently incurable disease that affects a large number of the elderly globally. One in five Medicare dollars is spent on AD-related tests and treatments. Accurate AD diagnosis is critical but often involves invasive and expensive tests that include brain scans and spinal taps. Recommending these tests for only patients who are likely to develop the disease will save families of cognitively normal individuals and hospitals from unnecessary expenditures. Moreover, many of the subjects chosen for clinical trials for AD therapies never develop any cognitive impairment and prove not to be ideal candidates for those trials. It is thereby critical to find inexpensive ways to first identify individuals who are likely to develop cognitive impairment and focus attention on them for in-depth testing, diagnosing, and clinical trial participation. Research shows that AD is a slowly progressing disease. This slow progression allows for early detection and treatment, but more importantly, gives the opportunity to predict the likelihood of disease development from early indications of memory lapses. Neuropsychological tests have been shown to be effective in identifying cognitive impairment. Relying exclusively on a set of longitudinal neuropsychological test data available from the ADNI database, this paper has developed Recurrent Neural Networks (RNN) to diagnose the current and predict the future cognitive states of individuals. The RNNs use sequence prediction techniques to predict test scores for two to four years in the future. The predicted scores and predictions of cognitive states based on them showed a high level of accuracy for a group of test subjects, when compared with their known future cognitive assessments conducted by ADNI. This shows that a battery of neuropsychological tests can be used to track the cognitive states of people above a certain age and identify those who are likely to develop cognitive impairment in the future. This ability to triage individuals into those who are likely to remain normal and those who will develop cognitive impairment in the future, advances the quest to find appropriate candidates for invasive tests like spinal taps for disease identification, and the ability to identify suitable candidates for clinical trials.
Improving executive, behavioural and socio-emotional competences in very preterm young adolescents through a mindfulness-based intervention: study protocol and feasibility
Authors: Siffredi Vanessa , Liverani Maria Chiara , Smith Mariana Magnus , Meskaldji Djalel Eddine , Stuckelberger-Grobéty Françoise , Freitas Lorena G. A. , Albuquerque Jiske De , Savigny Emilie , Gimbert Fanny , Hüppi Petra Susan , Merglen Arnaud , Tolsa Cristina Borradori , Hà-Vinh Leuchter Russia 
Published: January 2021

ABSTRACTBackground(VPT) children and adolescents exhibit executive, behavioural and socio-emotional difficulties that persists into adulthood. Previous research suggests that mindfulness-based intervention (MBI) may specifically target the development of theses competences. The objective of the current study is to describe the study protocol and to evaluate the feasibility of a clinical trial on a MBI program to enhance executive, behavioural and socio-emotional competences in a cohort of VPT young adolescents.Methods164 VPT young adolescents from 10 to 14 years old, born before 32 gestational weeks, were invited to participate in an MBI program of 8 weekly sessions in groups of up to 8 participants, lasting 1h30. Participant were enrolled in a randomised controlled trial (RCT) or in a pre-post intervention designs depending of their availability. Satisfaction and attendance measures of the MBI were collected using self-reported questionnaires and registration of attendance.ResultsOf the 63 participants who were enrolled in the study (38.2% of families invited to participate), 52 (82.5%) completed all assessments. Once enrolled, acceptability was high as shown by the high attendance rate in the sessions and the feedback evaluation questionnaire.DiscussionTo our knowledge, this is the first study to investigate the feasibility of an MBI study in VPT born young adolescents. Our findings suggest that an MBI study is feasible and show a high acceptability among participants. The use of an RCT design in our study constitutes the gold standard for testing the efficacy of such intervention in VPT young adolescents. If effective, the MBI program could potentially be a valuable tool for improving executive, behaviour and socio-emotional competences in the vulnerable VPT population.Trial registrationClinicalTrials,NCT04638101. Registered 19 November 2020 - Retrospectively registered,https://clinicaltrials.gov/show/NCT04638101.