bluuebunny/crossref_metadata_2025_split huggingface dataset:
76. ELDERLY AS THE MOST PATIENTS WHO ROUTINELY CONTROL HYPERTENSION IN THE CARDIOLOGY OUTPATIENT CLINIC OF WEST NUSA TENGGARA PROVINCE GENERAL HOSPITAL
Authors: Tsuraya Lina , Pintaningrum Yusra 
Published: May 2021

Background:
Hypertension is the number one cause of high mortality rates in Indonesia. Basic Health Research 2018 data shows that the prevalence of hypertension has increased from 25.8% in 2013 to 34.1% in 2018. Chronic hypertension can cause various changes in the structure and function of the heart which is known as hypertensive heart disease.

Objective:
To describe the characteristics of hypertensive patients in the cardiology outpatient clinic of West Nusa Tenggara Province General Hospital period July 2019–December 2020.

Method:
This research is a descriptive-analytical study with a retrospective research design. The sample of this study was all new patients diagnosed with hypertension and registered in the medical records. The data was processed using Microsoft excel.

Result:
A total of 1038 hypertension patients was found with the percentage of male is 56.5% and female is 43.5%. It was found that the elderly group dominated (92.87%). Hypertension with coronary artery disease was 456 patients (43.93%) and hypertension with diabetes mellitus and coronary artery disease were 60 patients (5.78%). Most of the patients with hypertension in this research were located in Mataram (46.91%) and the new case of hypertension decreased from July 2019 to December 2020 probably due to the issue of COVID-19.

Conclusion:
Most patients diagnosed with hypertension are elderly, where percentage of male is almost same with female patients. It was found that both of hypertension and diabetes mellitus are risk factors that play a major role in the development of coronary artery disease.
77. ASSOCIATION OF D-DIMER AND FIBRINOGEN LEVEL WITH MORTALITY OF HYPERTENSIVE COVID-19 PATIENTS
Authors: Damay V. , Sugeng C. , Umboh O. , Moeis E. 
Published: May 2021

Background:
Hypertension is the most evident comorbid in Covid-19. Thromboembolism, arguably the most thrilling pathomechanism in Covid-19. D-dimer and fibrinogen are parameters to describe thromboembolism but still need a real-world data about its association with mortality in hypertension.

Objective:
To explore association of D-dimer and fibrinogen level with mortality in hypertensive and non hypertensive Covid-19 patients

Methods:
This is a cross sectional retrospective study. Subjects were confirmed Covid-19 patients above 18 years old in RSUP Prof. Dr. R.D. Kandou Manado within last 5 months with D-dimer and fibrinogen examination. Data were analyzed using Mann-Whitney and Chi-square method.

Results:
There were 178 patients, male 93 (52%), female 85 (47.8%), average 52.71 ± 15.30 years old, 100 (56.2%) hypertensive and 78 (43.8%) non hypertensive patients. Among hypertensive patients, 18 (35.3%) with elevated D-dimer and 14 (28%) with elevated fibrinogen did not survive, compared to 4 (10.3%) and 3 (7.7%) in non-hypertensive patients.
There was significant association between D-dimer and mortality in hypertensive patients (PR = 3.46, 95% CI 1.39–8.59; p = 0.003, Median 1.65) and significant differences of D-dimer and fibrinogen level in hypertensive and non-hypertensive (1.65 IQR 3.13 vs. 0.44 IQR 0.79; p = 0.0001, 560 IQR 302.5 vs. 430 IQR 200; p = 0.0001). There was no significant difference of outcome regarding anti-coagulant injection.

Conclusion:
Mortality was about 3 times higher in hypertensive patients with high D-dimer. This study revealed to us that D-dimer potentially a mortality predictor in hypertensive Covid-19 patients.
Early debridement improves outcome in managing ankle tuberculosis: a systematic review
Authors: Rusdianto Ignatius Angga , Tania Fidia , Siswanto Belinda Azhari , Pitarini Astuti 
Published: May 2021

Background:
Extra pulmonary tuberculosis (TB) accounts for 10% of all TB patients. Involvement of the musculoskeletal system accounts for only 3%, with ankle TB less than 1% of all musculoskeletal TB. In Indonesia the prevalence of TB is 660 within 100,000 persons, and data for extrapulmonary TB and musculoskeletal TB are unknown. Diagnosis of TB infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction, functional disability, and poorer prognosis.

Methods:
EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopic*”, “debridement” and “open.” English language studies with surgical management of ankle TB by arthroscopy or open debridement that were published between 2004 and 2019 were included. Studies of arthrodesis and multi-drug resistant TB were excluded.

Results:
After an initial search of 60 studies, 28 were excluded, and 20 were duplicates. Twelve studies (six case-control studies, four case series, and two cohort) were included. In total, 103 patients with a mean age of 43.8 (7 to 90) years were treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean time to surgery was 10.9 (1 to 80) months, and a mean postoperative treatment of 35.5 (1.5 to 260) months. All patients had a mean treatment time of 10 (4 to 21) months with rifampicin, isoniazid, pyrazinamide, and ethambutol. No patients were lost to follow-up.

Conclusions:
Early debridement is recommended to improve outcome in managing ankle TB. This review is limited by the lack of high evidence level studies from high-quality randomized controlled trials, lack of control groups, heterogenous outcomes reporting, small sample sizes, and no objective scoring were used to report the outcomes. However, larger sample sizes with long-term follow-up data were not found.

Level of Evidence:
Level IV.
Injury incidence is higher on artificial turf compared with natural grass in high school athletes: a retrospective cohort study
Authors: Paliobeis Andrew , Sivasundaram Lakshmanan , Knapik Derrick M. , Labelle Mark W. , Olson Matthew , Karns Michael R. , Salata Michael J. , Voos James E. 
Published: May 2021

Background:
Prior investigations have demonstrated increased injury risk on artificial turf at the collegiate and professional levels. However, no prior study has examined this risk among high school athletics beyond football. The purpose of this study was to compare injury incidences on artificial versus natural playing surfaces among high school athletes.

Methods:
Data collected from 26 high schools was analyzed to compare injury incidences on artificial turf versus natural grass based on sport. Analyses were also performed to compare injury incidence by injury location (upper extremity, lower extremity, torso), sport, level of competitive play (freshman, junior varsity, varsity), and practice versus competition.

Results:
We identified 953 injuries, with 61% (n=585) occurring on turf and 39% (n=368) on grass. Athletes were 58% more likely to sustain injuries on artificial turf than natural grass relative risk ratio [RR] 1.5897, confidence interval [CI]: 1.4062 to 1.7971, P<0.0001). Lower extremity (RR 1.9597, CI: 1.6169 to 2.3752, P<0.0001), torso (RR 1.8636, CI: 1.1123 to 3.1225, P=0.0181), and upper extremity (RR 1.4494, CI: 1.1104 to 1.8919, P=0.0063) injuries were significantly more likely to occur on artificial turf. Football (RR 1.4572, CI: 1.2726 to 1.6687, P<0.0001), girls soccer (RR 1.7073, CI: 1.1857 to 2.4583, P=0.0040), boys soccer (RR 1.8286, CI: 1.2296 to 2.7194, P=0.0029), and rugby (RR 23.0000, CI: 3.1998 to 165.3244, P=0.0018) had higher injury incidences on artificial turf.

Conclusions:
Athletes were 58% more likely to sustain an injury on artificial turf. Football, soccer, and rugby athletes were at a significantly greater injury risk on artificial turf. Upper and lower extremity and torso injuries also occurred with higher incidence on artificial turf.

Level of Evidence:
Level IV.
Identifying patterns of utilization of single-use video laryngoscopy and supraglottic airway devices to reduce waste
Authors: Baerg Tim , Klapman Seth , Cloyd Benjamin , Hovord David , Edelman Tony , Healy David , Schechtman Samuel 
Published: May 2021

Introduction:
Lean management, a systematic method of reducing waste in manufacturing, is an approach that has led to quality improvement and cost reduction in health systems. Utilization of single-use airway equipment, such as videolaryngoscope (VL) blades and supraglottic airways (SGAs) has helped reduce the risk of cross-contamination and the time and cost associated with reprocessing and sterilization.

Methods:
We examined the efficiency of single-use VL blades and SGAs within our tertiary care health system. Purchasing data were reviewed and compared with device utilization within the electronic medical record to determine the amount of waste of disposable airway equipment. Direct observations (Gemba walks) were made in the operating rooms to assess device utilization. For SGAs, a diagnostic questionnaire was sent to providers regarding approaches to use.

Results:
We found the total cost of opened but unused VL blades equaled $29,267. For SGAs, we found that devices were often opened before use and that there is a 16.67% first-time failure rate for placement of SGAs.

Conclusions:
Through education and organizing device setup, and streamlining communication, there is a possibility to reduce future waste.
Bone health in diabetes: Indian perspective
Authors: Pal Rimesh , Bhadada Sanjay Kumar 
Published: May 2021

Purpose of review
Despite estimated 77 million people having diabetes, bone health in Asian Indians with diabetes is largely unknown. This review summarizes the published literature on fracture risk and factors affecting it in Asian Indians with diabetes.

Recent findings
Data on fracture prevalence in diabetes is limited; one study showed that diabetes was associated with a significantly higher number of fractures compared with subjects without diabetes (4% vs. 2.4%, P < 0.05). The prevalence of osteoporosis in Asian Indians with type 2 diabetes mellitus (T2D) varies from 35.5 to 49.5%. Studies have shown an increased, similar or lower areal bone mineral density (BMD) at the lumbar spine and/or hip in patients with T2D compared to controls without diabetes. On the contrary, the BMD in patients with type 1 diabetes mellitus (T1D) is modestly low compared to age- and sex-matched healthy controls without diabetes. Recent studies have shown compromised mechanical, material and compositional properties of trabecular bone in Asian Indians with T2D suggesting deteriorated bone quality as one of the contributors of high fracture risk.

Summary
Further research is needed to generate evidence-based guidelines to prevent and manage bone fragility in Asian Indians with diabetes.
Veterans’ Use of Veterans Health Administration Primary Care in an Era of Expanding Choice
Authors: Hynes Denise M. , Edwards Samuel , Hickok Alex , Niederhausen Meike , Weaver Frances M. , Tarlov Elizabeth , Gordon Howard , Jacob Reside L. , Bartle Brian , O’Neill Allison , Young Rebecca , Laliberte Avery 
Published: May 2021

Background:
The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers.

Objectives:
The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider.

Research Design:
This was a retrospective, observational over fiscal years (FY) 2015–2018.

Subjects:
Veterans receiving primary care services paid for by the VA.

Measures:
Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year.

Results:
There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care.

Conclusion:
As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans’ use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans’ health care needs are met.
County-level Predictors of Growth in Community-based Primary Care Use Among Veterans
Authors: Gordon Sarah H. , Beilstein-Wedel Erin , Rosen Amy K. , Zheng Tianyu , Kelley Alan Taylor , Cook James , Zahakos Sarah S. , Wagner Todd H. , Vanneman Megan E. 
Published: May 2021

Background:
The 2014 Choice Act expanded the Veterans Health Administration’s (VA) capacity to purchase services for VA enrollees from community providers, yet little is known regarding the growth of Veterans’ primary care use in community settings.

Objectives:
The aim was to measure county-level growth in VA community-based primary care (CBPC) penetration following the Choice Act and to assess whether CBPC penetration increased in rural counties with limited access to VA facilities.

Data and Sample:
A total of 3132 counties from VA administrative data from 2015 to 2018, Area Health Resources Files, and County Health Rankings.

Analysis:
We defined the county-level CBPC penetration rate as the proportion of VA-purchased primary care out of all VA-purchased primary care (ie, within and outside VA). We estimated county-level multivariate linear regression models to assess whether rurality and supply of primary care providers and health care facilities were significantly associated with CBPC growth.

Results:
Nationally, CBPC penetration rates increased from 2.7% in 2015 to 7.3% in 2018. The rurality of the county was associated with a 2–3 percentage point (pp) increase in CBPC penetration growth (P<0.001). The presence of a VA facility was associated with a 1.7 pp decrease in CBPC penetration growth (P<0.001), while lower primary care provider supply was associated with a 0.6 pp increase in CBPC growth (P<0.001).

Conclusion:
CBPC as a proportion of all VA-purchased primary care was small but increased nearly 3-fold between 2015 and 2018. Greater increases in CBPC penetration were concentrated in rural counties and counties without a VA facility, suggesting that community care may enhance primary care access in rural areas with less VA presence.
Comparing Outcomes of Flap-Based Salvage Reconstructions in the Radiated Breast
Authors: Patel Ashraf A. , Arquette Connor P. , Rowley Mallory A. , Borrelli Mimi R. , Lee Gordon K. , Nazerali Rahim S. 
Published: May 2021

Introduction
Chest wall irradiation significantly decreases the strength and quality of breast tissue supporting prostheses, increasing the risk of skin breakdown and implant or tissue expander extrusion. Autologous tissue, including the latissimus dorsi (LD) or abdominal-based flaps, including the muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps, may be used to salvage reconstructions. However, data comparing outcomes of the two flap options remains limited. We compare postoperative outcomes from both flap types after autologous salvage reconstruction in irradiated breasts.

Methods
Charts were retrospectively reviewed from patients who underwent either chest wall radiation or postmastectomy radiation therapy followed by salvage autologous reconstruction with either a LD and an implant or an abdominal-based flap (muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps). Patients with a history of tissue expander or implant failure requiring autologous salvage as part of 2-staged or delayed-immediate breast reconstruction that were operated on between January 2005 and November 2015 were included. Basic demographics, comorbidities, and recipient site complications (infection, wound dehiscence, seroma, hematoma, fat necrosis, and flap failure) were collected.

Results
A total of 72 patients met the inclusion criteria which included 72 flaps; 35 LD and 37 abdominally based flaps. Demographics and comorbidities did not vary significantly between patient groups. Mean follow-up was 767.6 weeks, and all reconstructions were unilateral. Nineteen (26.4%) patients had at least one complication, most commonly minor infections (9.7%). Overall complication rates were not significantly different between flap groups (P = 0.083). Wound dehiscence was significantly higher in the abdominal group (P = 0.045), and fat necrosis also trended higher in this group (P = 0.085). Major infection trended higher in the latissimus group (P = 0.069).

Conclusions
When comparing outcomes of salvage flap-based reconstruction in radiated breast tissue, overall complication rates were similar when comparing postoperative outcomes between the LD- and abdominal-based flaps. Wound dehiscence was significantly higher when salvage reconstruction used an abdominal flap. Understanding the complications after salvage procedures can help inform decision making and optimize patient care to improve outcomes after breast reconstruction in the radiated breast.
Preoperative Music Listening in Pelvic Reconstructive Surgery: A Randomized Trial
Authors: Chen Yufan Brandon , Barnes Hayley , Westbay Lauren , Wolff Birte , Shannon Megan , Adams William , Acevedo-Alvarez Marian , Mueller Elizabeth R. , Pham Thythy T. 
Published: May 2021

Objectives
We aimed to investigate the effect of music listening on preoperative anxiety compared with usual care in patients undergoing pelvic reconstructive surgery.

Methods
Patients scheduled for pelvic reconstructive surgery were enrolled on the day of surgery. Participants were randomized to either the usual care (control group) or to music listening on headphones (music group) before their surgery. Participants completed the Spielberg State-Trait Anxiety Inventory form Y1 to measure baseline state anxiety levels before surgery and again after 30 minutes of usual care or music listening. The primary outcome was the change in state anxiety score as measured by the State-Trait Anxiety Inventory form Y1.

Results
Sixty-nine women completed the study (35 assigned to the control group and 34 assigned to the music group). Analysis of the primary outcome included 66 participants (34 in the control group and 32 in the music group). Improvement in state anxiety was significantly better for patients assigned to music listening (−6.69; SD, 6.98) than for patients assigned to the control group (−1.32; SD, 8.03; P = 0.01). Six weeks postoperatively, patients in the music group (n = 29) reported higher overall satisfaction when compared with those in the control group (n = 31, P = 0.03).

Conclusion
Patients undergoing pelvic reconstructive surgery present with moderate anxiety on the day of surgery. Allowing patients to listen to their preferred music is a simple intervention that may lower preoperative anxiety and improve satisfaction in this patient population.
Evolution of COVID-19 symptoms during the first 9 months after illness onset
Authors: Wynberg Elke , van Willigen Hugo , Dijkstra Maartje , Boyd Anders , Kootstra Neeltje A. , van den Aardweg Joost G. , van Gils Marit J. , Matser Amy , de Wit Marije R. , Leenstra Tjalling , de Bree Godelieve , de Jong Menno D. , Prins Maria ,   the RECoVERED Study Group
Published: May 2021

AbstractBackgroundFew longitudinal data on COVID-19 symptoms across the full spectrum of disease severity are available. We evaluated symptom onset, severity and recovery up to nine months after illness onset.MethodsThe RECoVERED Study is a prospective cohort study based in Amsterdam, the Netherlands. Participants aged>18 years were recruited following SARS-CoV-2 diagnosis via the local Public Health Service and from hospitals. Standardised symptom questionnaires were completed at recruitment, at one week and month after recruitment, and monthly thereafter. Clinical severity was defined according to WHO criteria. Kaplan-Meier methods were used to compare time from illness onset to symptom recovery, by clinical severity. We examined determinants of time to recovery using multivariable Cox proportional hazards models.ResultsBetween 11 May 2020 and 31 January 2021, 301 COVID-19 patients (167[55%] male) were recruited, of whom 99/301(32.9%) had mild, 140/301(46.5%) moderate, 30/301(10.0%) severe and 32/301(10.6%) critical disease. The proportion of symptomatic participants who reported at least one persistent symptom at 12 weeks after illness onset was greater in those with severe/critical disease (81.7%[95%CI=68.7-89.7%]) compared to those with mild or moderate disease (33.0%[95%CI=23.0-43.3%] and 63.8%[95%CI=54.8-71.5%]). Even at nine months after illness onset, almost half of all participants (42.1%[95%CI=35.6-48.5]) overall continued to report ≥1 symptom. Recovery was slower in participants with BMI≥30kg/m2 (HR 0.51[95%CI=0.30-0.87]) compared to those with BMI<25kg/m2, after adjusting for age, sex and number of comorbidities.ConclusionsCOVID-19 symptoms persisted for nine months after illness onset, even in those with mild disease. Obesity was the most important determinant of speed of recovery from symptoms.
SIR-based model with multiple imperfect vaccines
Authors: Aguilar-Canto Fernando Javier , de León Ugo Avila Ponce , Avila-Vales Eric 
Published: May 2021

AbstractSince the introduction of vaccination in the current COVID-19 outbreak, many countries have approved and implemented vaccination campaigns to mitigate and ultimately curtail the pandemic. Several types of vaccines have been proposed and many of them have finally been approved and used in different countries. The different types of vaccines have different vaccine parameters, and therefore, this situation induces the necessity of modeling mathematically the scenario of multiple imperfect vaccines. In this paper, we introduce a SIR-based model considering different vaccines, and study the basic properties of the model, including the stability of the Disease-Free Equilibrium (DFE), which is locally asymptotically stable if the reproduction number is less than 1. A sequence of further results aims to enumerate the conditions where the reproduction number can be decreased (or increased). Two important mathematical propositions indicate that in general vaccination might not be enough to contain an outbreak and that the addition of new vaccines could be counterproductive if the leakiness parameter is greater than a threshold η. This model, despite its simplicity, was validated with data of the COVID-19 pandemic in five countries: Israel, Chile, Germany, Lithuania, and Czech Republic, observing that improvements for the vaccine campaigns can be suggested by the developed theory.