bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vocational Outcomes After Traumatic Brain Injury; Prevalence and Risk Factors After 1 Year in a Multivariable Model
Authors: Singh Rajiv , Dawson Jeremy , Basu Subhashis , Humphries Thomas J. , Mason Suzanne , Lecky Fiona 
Published: May 2021

Objective:
To determine the prevalence of employment status (ES) or full-time study after traumatic brain injury (TBI) in a representative population and its predictive factors.

Design:
Prospective cohort study.

Setting:
Regional Major Trauma Centre. Participants: In total, 1734 consecutive individuals of working age, admitted with TBI to a Regional Trauma Centre, were recruited and followed up at 8 weeks and 1 year with face-to-face interview. Median age was 37.2 years (17.5-58.2); 51% had mild TBI, and 36.8% had a normal computed tomographic (CT) scan.

Main Outcome Measure:
Complete or partial/modified return to employment or study as an ordinal variable.

Results:
At 1 year, only 44.9% returned to full-time work/study status, 28.7% had a partial or modified return, and 26.4% had no return at all. In comparison with status at 6 weeks, 9.9% had lower or reduced work status. Lower ES was associated with greater injury severity, more CT scan abnormality, older age, mechanism of assault, and presence of depression, alcohol intoxication, or a psychiatric history. The multivariable model was highly significant (P < .001) and had a Nagelkerke R
2 of 0.353 (35.3%).

Conclusions:
Employment at 1 year is poor and changes in work status are frequent, occurring in both directions. While associations with certain features may allow targeting of vulnerable individuals in future, the majority of model variance remains unexplained and requires further investigation.
Path Analysis of the Mediating Roles of Personality, Distress, and Cognitive Flexibility in the Subjective Well-Being of Combat Veterans With Traumatic Brain Injury
Authors: Donnelly Kerry , Donnelly James P. 
Published: May 2021

Objective:
To determine the interrelationships among traumatic brain injury (TBI), maladaptive personality traits (MPT), psychological distress, and cognitive flexibility in the prediction of subjective well-being of post-9/11 veterans concurrently and over time.

Setting:
Five Veterans Affairs (VA) medical centers and 1 VA outpatient clinic in urban, suburban, and rural areas.

Participants:
Five hundred Operation Enduring Freedom/Operation Iraqi Freedom veterans at baseline (219 with TBI), 292 at 18-month follow-up (108 with TBI), drawn from a regional registry and clinic referrals.

Design:
Path analysis of data from a prospective cohort study.

Main Measures:
Satisfaction with Life Scale, 36-ltem Short-Form Health Survey (SF-36) Health Scale, Personality Assessment Screener, Beck Depression Inventory-II, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist-Military, Trail Making Test, Part B, Delis-Kaplan Executive Function System (D-KEFS) Category-Switching Verbal Fluency, and D-KEFS Color-Word Interference Test.

Results:
There was no direct effect of TBI on well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had significant direct effects on well-being at baseline and 18 months. Baseline model accounted for 66% of the variance in well-being; follow-up model accounted for 43% of well-being variance. Negative influence of distress significantly decreased from baseline to follow-up. Direct negative effect of MPT diminished slightly over 18 months; effect of cognitive flexibility increased. Significant relationships were estimated in prediction of distress by MPT, cognitive flexibility, and TBI. TBI predicted MPT. MPT, cognitive flexibility, and TBI had indirect effects on well-being. TBI had a positive indirect influence on distress. Total effects included 4 significant predictors of well-being at baseline and 18 months: distress, MPT, cognitive flexibility, and TBI.

Conclusion:
Experience of TBI alone did not predict subjective well-being at baseline or 18 months later. Psychological distress, MPT, and cognitive flexibility had direct effects on well-being at both time points. Interventions aimed at reducing distress and bolstering resilience and cognitive flexibility are recommended to increase subjective well-being in this population.
Performance Validity Testing in Patients Presenting to a Specialty Clinic With a Mild Traumatic Brain Injury
Authors: Sherry Natalie , Ernst Nathan , French Jonathan E. , Eagle Shawn , Collins Michael , Kontos Anthony 
Published: May 2021

Objective:
To evaluate predictors of performance validity testing (PVT) and clinical outcome in patients presenting to a specialty clinic with a mild traumatic brain injury (mTBI).

Setting:
An outpatient mTBI specialty clinic.

Participants:
Seventy-six (47% female) patients aged 16 to 66 (mean = 40.58, SD = 14.18) years within 3 to 433 days (mean = 30.63, SD = 54.88, median = 17.00) of a suspected mTBI between 2018 and 2019.

Design:
A cross-sectional, observational study comparing patients who passed PVT (n = 43) with those who failed (n = 33). A logistic regression (LR) was conducted to evaluate factors that predicted failed PVT. Independent-samples t tests and general linear model were used to evaluate PVT groups on clinical outcomes. The LR with a receiver operating characteristic (ROC) curve was conducted to evaluate embedded validity indicators.

Main Measures:
Performance validity testing, computerized neurocognitive testing, vestibular/oculomotor screening, symptom reports.

Results:
At their initial clinic visit 43% of patients failed PVT. PVT failure was predicted by presence of secondary gain (odds ratio [OR] = 8.11, P = .02), while a history of mental health predicted passing of PVT (OR = 0.29, P = .08). Those who failed PVT performed significantly worse on computerized neurocognitive testing (P < .05) and took an average of 33 days longer to return to work (P = .02). There was no significant difference (P = .20) in recovery time between failed/passed PVT groups when covarying for those who sustained a work injury. Word memory learning percentage less than 69% and design memory learning percentage less than 50% accurately classified patients who failed PVT (area under the ROC curve = 0.74; P < .001).

Conclusion:
Secondary gain was the best predictor of failed PVT. Patients presenting for mTBI evaluation and rehabilitation who fail PVT demonstrate worse performance on cognitive testing and take longer to return to work post-injury, but recover in a similar time frame compared with those who pass PVT. Clinicians should be cautious in discounting patients who yield invalid test results, as these patients appear to be able to achieve recovery in a treatment setting.
Next-Generation Sequencing Quickly Identifies Mycobacterium smegmatis in Spine Implant Infection
Authors: Clarkson Samuel J. , Goswami Karan , Paziuk Taylor , Belden Katherine A. , Hilibrand Alan S. , Parvizi Javad 
Published: May 2021

Abstract
We present the case of a 62-year-old woman who underwent revision surgery because of screw displacement after C1 to C3 laminectomy and occiput to C5 posterior fusion. Culture of tissue obtained intraoperatively grew nontuberculous mycobacteria (NTM) in 5 days; however, a specific species was not identified using culture until 5 weeks after sample collection. In contrast, next-generation sequencing analysis performed on samples obtained during a subsequent irrigation and debridement confirmed the presence of Mycobacterium smegmatis within 1 week. Although traditional culture identified a rapidly growing NTM in this case of spine implant infection, the species was not identified in a timely manner. Accurate and rapid species-level pathogen identification is imperative in the targeted treatment of NTM infections including spine implant infection. The use of molecular testing, such as next-generation sequencing, is helpful in identifying infecting organisms and guiding antimicrobial treatment.
Delayed Onset of COVID-19 in an Immunosuppressed Patient
Authors: Liroff Kaitlin , Fleury Christine , Dumitrescu Cristian , Kassaye Seble 
Published: May 2021

Abstract
We report on a case of delayed presentation of COVID-19 in a postpartum immunosuppressed patient with the confounding variable of cytomegalovirus viremia. This case highlights the importance of maintaining high suspicion for COVID-19 disease even with delayed onset of symptoms, as this diagnosis as important treatment and public health implications.
Multisystem Inflammatory Syndrome in an Adult With COVID-19—A Trial of Anakinra
Authors: Aggarwal Abhimanyu , Cohen Ezra , Figueira Marisol , Sabharwal Vishakha , Herlihy Julie M. , Bronwen Carroll , Barnett Elizabeth D. , Pelton Stephen I. , Camelo Ingrid Y. 
Published: May 2021

Abstract
COVID-19 disease has been a pandemic caused by a β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A life-threatening multisystem inflammatory syndrome (MIS), secondary to SARS-CoV-2 virus infection, sharing common features with Kawasaki disease shock syndrome, staphylococcal/streptococcal shock syndrome, and macrophage activation syndrome in pediatric patients has been described. A total of 27 cases in adults (MIS-A) with a similar presentation have been reported so far. Here we describe the case of a 21-year-old man admitted with abdominal pain, diarrhea, tachycardia, and low blood pressure. He had elevated troponin, ferritin, and interleukin-2 receptor levels and had evidence of myocarditis. He tested positive for SARS-CoV-2 IgG antibody, and a diagnosis of MIS-A was made. Our case adds to the scant literature on this topic, and to our knowledge, it is the first case where anakinra was administered. He recovered well. MIS-A should be considered when young adults present with multiorgan dysfunction.
Preprocedural Anxiety in the Transradial Cardiac Catheterization Era
Authors: Fernandez Ritin , Ellwood Laura , Lord Heidi , Curtis Elizabeth , Khoo John , Lee Astin , Weaver James 
Published: May 2021

Background
Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce.

Objective
The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures.

Methods
Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety.

Results
A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety.

Conclusion
Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.
Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care
Authors: Garrett Bowen , Carter Carol , Wissoker Doug 
Published: May 2021

Background:
A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish “good” from “poor” performance.

Objective:
The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold.

Data:
Medicare claims for 15 million PAC episodes from April 2013 to March 2015.

Research Design:
Given the overlap in patients treated in PAC settings, we developed a uniformly calculated MSPB measure for PAC providers that measures spending during the PAC stay and the following 30 days. We examine variation in the MSPB-PAC measure and characterize the measure’s reliability and its relationship to provider case counts.

Results:
Applied to our MSPB-PAC measure, a minimum threshold of 20 Medicare episodes as currently used by the Centers for Medicare & Medicaid Services (CMS) would not establish reasonably reliable measures and could result in drawing unduly erroneous conclusions about provider performance. The measures for home health agencies were considerably less stable and reliable than for institutional PAC providers.

Conclusions:
CMS should consider adopting a more stringent reliability standard for setting minimum case counts for MSPB-PAC and other measures. Its current threshold (R-statistic=0.4) reflects more random variation than differences in actual provider performance. To include as many providers as possible, CMS should consider pooling data over multiple years to avoid drawing incorrect conclusions about low-volume providers.
The Effects of Patient Demographics on Outpatient Endoscopy Utilization in Children With Eosinophilic Esophagitis
Authors: Bose Paroma , Hon Emily C. , Vitalpur Girish V. , Bennett William E. 
Published: May 2021

ABSTRACT

Objectives:
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus that requires esophagogastroduodenoscopy (EGD) for diagnosis and treatment monitoring. We aimed to identify the frequency of endoscopic monitoring in children with EoE and observe the effect of age, race, socioeconomic factors, and atopy on the rate of endoscopy.

Methods:
We queried the Pediatric Health Information System over a 15-year period for ambulatory EGDs in children with EoE. Subjects with at least 1 year of data were included. Age, sex, ethnicity, race, insurance type, median household income, and atopy were collected for each subject.

Results:
16,517 subjects were included (mean age 8.5 years). 3211 (19%) of subjects had ≥1 EGD per subject year (EGD/SY). Subjects >13 years old were more likely to have ≥1 EGD/SY compared to children 6–12 years (odds ratio [OR] 2.29, P < 0.001, 95% confidence interval [CI] = 2.06–2.54). Males were more likely to have ≥1 EGD/SY compared to females (OR 1.19, P < 0.001, 95% CI = 1.08–1.31). African-American subjects were 16% less likely than Caucasian subjects to have ≥1 EGD/SY (OR 0.84, P = 0.05, 95% CI = 0.71–1.00). Subjects with allergic rhinitis or anaphylaxis, food allergy, and/or oral allergy syndrome were more likely to have ≥1 EGD/SY (OR 1.67, P < 0.001, 95% CI = 1.47–1.90 and OR 3.65, P < 0.001, 95% CI = 3.25–4.11, respectively).

Conclusions:
Nineteen percent of subjects had ≥1 EGD/SY. Older age, male sex, allergic rhinitis, and food allergies were associated with more frequent endoscopic monitoring in children with EoE. Caucasian subjects had more frequent endoscopy than African-American subjects. This study raises awareness about underrecognized variation in the care of children with EoE.
Influencing Factors of Inflammatory Bowel Disease–Fatigue
Authors: Davis Suja P. , Chen Ding-Geng , Crane Patricia B. , Bolin Linda P. , Johnson Lee Ann , Long Millie D. 
Published: May 2021

Abstract

Background
Fatigue is a common symptom in adults with inflammatory bowel disease (IBD) and is influenced by many physiological, psychological, and situational factors. However, the influencing factors of fatigue associated with IBD have not been evaluated.

Objective
This study aims to examine factors associated with fatigue during IBD and develop a parsimonious model that describes the influencing factors of fatigue.

Methods
The study was a secondary analysis of cross-sectional data obtained from IBD Partners, an online cohort of adults with the disease, including 12,053 eligible participants. Data were collected using the Patient-Reported Outcomes Measurement Information System short-form scales measuring fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles. Physical activity was measured using a single question. Demographic and clinical variables were collected. Path analysis was computed to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD–fatigue based on the middle range theory of unpleasant symptoms’ conceptual framework.

Results
Most of the participants were White females. The data best fit a model with situational factors (physical activity and satisfaction with social roles as the mediators). The direct effect of IBD activity, age, sleep disturbances, pain interference, anxiety, and depression on IBD–fatigue was significant. Significant indirect effects were noted on IBD–fatigue from sleep disturbances, pain interference, and depression via physical activity and satisfaction with social roles.

Discussion
The study identified two important intervening variables from the tested model. In addition, other symptoms such as sleep, pain, anxiety, and depression are essential and also influence IBD–fatigue.
eSIMPLER: A Dynamic, Electronic Health Record–Integrated Checklist for Clinical Decision Support During PICU Daily Rounds
Authors: Geva Alon , Albert Ben D. , Hamilton Susan , Manning Mary-Jeanne , Barrett Megan K. , Mirchandani Dimple , Harty Matthew , Morgan Erin C. , Kleinman Monica E. , Mehta Nilesh M. 
Published: May 2021

OBJECTIVES:
Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration.

DESIGN:
Before-after quality-improvement study.

SETTING:
Quaternary PICU in an academic, free-standing children’s hospital.

PATIENTS:
All patients in the PICU during daily morning rounds.

INTERVENTIONS:
Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record.

MEASUREMENTS AND MAIN RESULTS:
The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88–98%] vs eSIMPLER: 98% [95% CI, 92–100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures—discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function—improved during the eSIMPLER phase.

CONCLUSIONS:
eSIMPLER, a dynamic, electronic health record–informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the “Five Rights” of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER’s effectiveness and its impact on patient outcomes need to be examined.
Virtual Reality Augments Movement During Physical Therapy
Authors: Hemphill Sydney , Rodriguez Samuel , Wang Ellen , Koeppen Kurt , Aitken-Young Bryn , Jackson Christian , Simons Laura , Caruso Thomas J. 
Published: May 2021

Objective
Virtual reality facilitates physical therapy via improved engagement. Although shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient physical therapy. The primary objective was to compare total physical therapy–guided movement supplemented with virtual reality with physical therapy–guided movement alone without virtual reality.

Design
This pragmatic, randomized, crossover study compared physical therapy–guided movement supplemented with virtual reality with physical therapy–guided movement alone without virtual reality in outpatients (ages 6–80 yrs). This community sample had variable physical therapy indications (injury, postoperative, chronic pain), and in pre-existing conditions, therefore, participants served as their own controls. Participants received 10 mins of both physical therapy–guided movement supplemented with virtual reality and physical therapy–guided movement alone without virtual reality separated by 5 mins. The primary outcome was differences in aggregate movement of physical therapy–guided exercises. Secondary outcomes explored OMNI rating of perceived exertion and participant and physical therapist satisfaction. Paired t tests, χ2 tests, and regression models were used to analyze differences.

Results
The 41 participants (17 pediatric and 24 adult) moved significantly more during physical therapy–guided movement supplemented with virtual reality compared with physical therapy–guided movement alone without virtual reality (1120.88 vs. 672.65 m, P < 0.001), regardless of which intervention was completed first. Physical therapy–guided movement supplemented with virtual reality treatment was associated with more movement of the target limbs, lower body (P < 0.001), and upper body (P < 0.05). The OMNI rating of perceived exertion scores did not differ between those who started with physical therapy–guided movement supplemented with virtual reality or physical therapy–guided movement alone without virtual reality, and physical therapist and patient surveys endorsed physical therapy–guided movement supplemented with virtual reality.

Conclusions
Patients completed more physical therapy–guided movement during physical therapy–guided movement supplemented with virtual reality than physical therapy–guided movement alone without virtual reality, and therapists and patients supported its use. Future studies will examine finer tracking of movements.