bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Septic Arthritis of the Knee: Predictors of Septic Hip Do Not Apply
Authors: Obey Mitchell R. , Minaie Arya , Schipper Jaclyn A. , Hosseinzadeh Pooya 
Published: April 2019

Background:
The early diagnosis of pediatric septic arthritis is paramount to the prevention of long-term sequela. The purpose of this study is to investigate if the commonly used criteria developed by Kocher and colleagues for hip septic arthritis can be used for screening children with suspected septic knee.

Methods:
We retrospectively reviewed the charts of patients under the age of 19, between June 2002 to June 2017, who presented to a major tertiary-care children’s hospital with septic knee. Diagnostic criteria included either a positive synovial culture from the knee, synovial white blood cell (WBC)>50,000 cells/mm3, or synovial WBC count >25,000 cells/mm3 and clinical agreement of diagnosis from Infectious Disease and Orthopaedic colleagues. Collected data included the initial criteria described by Kocher and colleagues: history of fever, non–weight-bearing, erythrocyte sedimentation rate, and serum WBC as well as a recently modified criterion: C-reactive protein. Univariate analysis was used to determine the quality of these variables in ruling out septic knee.

Results:
One hundred four patient charts were found to meet our inclusion criteria demonstrating C-reactive protein>20 mg/L (75%), fever (65%), non–weight-bearing status (64%), erythrocyte sedimentation rate>40 mm/h (60%), and WBC>12,000 cells/mm3 (49%). With the 25 different combinations of these predictors adjusted for, in an escalating manner, 0 predictors suggested a sensitivity of 0.02, 1 predictor a sensitivity of 0.06, 2 predictors a sensitivity of 0.2, 3 predictors a sensitivity of 0.32, 4 predictors a sensitivity of 0.3, and 5 predictors a sensitivity of 0.11.

Conclusions:
According to the Kocher criteria of the hip, at 3 or more criteria the probability of septic arthritis becomes 93% with a sensitivity of 0.84 provoking many physicians to use this cutoff in their assessment of hip pain. This study suggests that if these criteria were applied to the knee, 52% of septic knee cases could be missed. There is a need for further investigation of specific criteria of the knee as the markers of the hip septic arthritis are not necessarily applicable in the knee.

Level of Evidence:
Level III.
Simulation Training of Orthopaedic Residents for Distal Radius Fracture Reductions Improves Radiographic Outcomes
Authors: Jackson Taylor J. , Shah Apurva S. , Buczek Matthew J. , Lawrence John Todd R. 
Published: April 2019

Background:
Most distal radius fractures can be treated with closed reduction and casting in pediatric patients. These skills are traditionally developed treating real patients, however, there is growing interest in the use of simulation training to supplement traditional learning strategies.

Methods:
Seventy-eight children with distal radius fractures that underwent closed reduction and casting by novice orthopaedic surgery residents were retrospectively reviewed. Radiographic measures of patients treated by simulation-trained residents were compared with patients treated by residents without simulation training.

Results:
Patients treated by simulation-trained residents had less residual angulation in the anteroposterior radiograph (3.7 vs. 6.3 degrees, P=0.006) and translation on the lateral (14% vs. 21%, P=0.040) and anteroposterior radiograph (10% vs. 16%, P=0.029). Patients treated by simulation-trained residents also had lower rates of redisplacement (50% vs. 79%, P=0.016).

Conclusions:
Loss of reduction is common, particularly when novice trainees perform their first independent reductions. Residents who underwent simulation training had lower rates of loss of reduction, thus simulation training has potential as a supplement to the traditional apprentice model of medical education.

Level of Evidence:
Level III.
Long-term Results of Spine Stapling for AIS to Skeletal Maturity and Beyond
Authors: Haber Lawrence L. , Adams Tyler M. , Briski David C. , Celestre Paul C. , Robbins Daniel J. , Waldron Sean R. 
Published: April 2019

Background:
We looked at long-term follow-up of spine stapling with Nitinol Staples. This was a cohort of all adolescent idiopathic scoliosis (AIS) patients with curves at high risk to progress based on curve magnitude, premenarchal status in all females, failure of brace treatment, and skeletal immaturity.

Methods:
This is a single surgeon retrospective review of consecutive AIS patients treated with Nitinol staples for progressive scoliosis. Fourteen patients, 16 curves from 2005 to 2008 were eligible. Minimum curve for stapling was 30 degrees. Standard preoperative, intraoperative, and postoperative data were collected. All patients were followed for a minimum of 36 months and to skeletal maturity. Three groups were: improved (group 1), correction of any amount; minimal progression (group 2), progression ≤10 degrees; and failure (group 3), ≥10 degrees of progression.

Results:
A total of 13 thoracic curves and 2 compensatory lumbar curves met the inclusion criteria (94%). Average follow-up was 61 months. The mean preoperative main thoracic curve was 35 degrees. All but 1 patients progressed at least 9 degrees in a brace prior to stapling. Females were all premenarchal, 10 patients were Risser 0 and 3 Risser 1. The average number of vertebrae stapled per curve was 6. Group 1 included 6 curves (40%). Group 2, 5 curves (33%). Group 3, 4 curves (27%). Three patients went on to uncomplicated fusion. Final curve measurement at the end of follow-up or before fusion (P=0.0037), curve progression (P≤0.001), and percentage of coronal correction on first postoperative standing radiograph (P=0.042) were the significant differences between groups 1+2 (successful) versus group 3 (failures). In total, 73% of this group either progressed ≤10 degrees or improved.

Conclusions:
This is the first study that follows AIS patients treated with spine stapling to skeletal maturity. Staples likely changed natural history in some of our patients. Initial percentage of correction on first standing postoperative PA x-rays was the only predictor of success. Stapling was safe without any long-term complications.

Level of Evidence:
Level III—retrospective study.
Hormone therapy is not associated with the risk of sudden sensorineural hearing loss in postmenopausal women: a 10-year nationwide population-based study
Authors: Chen Po-Jun , Chung Chi-Hsiang , Chien Wu-Chien , Chen Hsin-Chien 
Published: April 2019

Abstract

Objective:
The association between hormone therapy (HT) and the risk for sudden sensorineural hearing loss (SSNHL) in postmenopausal women has been described only in case reports. No large study has further evaluated the association between HT and the risk of SSNHL in postmenopausal women. The objective of our study was to investigate whether postmenopausal women with HT exhibit a risk of SSNHL.

Methods:
This matched cohort study enrolled 13,112 postmenopausal women 45 to 79 years of age who used HT between 2000 and 2010; they were selected from the National Health Insurance Research Database of Taiwan, and 39,336 participants without HT use were enrolled as controls matched by age and index year at a 1:3 ratio.

Results:
We used a Cox proportional hazards regression model to identify the risk of SSNHL during 10 years of follow-up, and the results indicated no significant increase in the proportion of postmenopausal women with HT use (P = 0.814) who developed SSNHL compared with those without HT use (1.14%, 150/13, 112 vs 1.12%, 439/39, 336). After adjustment for age and other variables, the adjusted hazard ratio was 0.78 (95% CI, 0.308-1.025, P = 0.762) and showed no association between HT use and SSNHL development in postmenopausal women.

Conclusions:
Our results showed that HT was not associated with the risk of SSNHL in postmenopausal women over a 10-year follow-up study.
Risk Factors for Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty
Authors: Inoda Satoru , Hayashi Takahiko , Takahashi Hidenori , Oyakawa Itaru , Yokogawa Hideaki , Kobayashi Akira , Kato Naoko , Kawashima Hidetoshi 
Published: April 2019

Purpose:
To investigate factors associated with cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) in Asian eyes.

Methods:
In this retrospective, interventional, consecutive case series, 77 eyes of 65 patients who underwent DMEK were evaluated; in 53 eyes, cataract surgery was performed 1 month before DMEK (staged DMEK), and 24 eyes underwent DMEK alone (simple DMEK). Central retinal thickness, incidence of CME, postoperative best-corrected visual acuity, central corneal thickness, and corneal endothelial cell density were assessed at 1, 3, and 6 months after surgery. Multiple regression analysis and stepwise variable selection were performed for parameters such as type of surgery, iris damage scores, age, sex, axial length, preoperative visual acuity, rebubbling, air volume in the anterior chamber on postoperative day 1, history of diabetes, and endothelial cell density loss rates at 6 months after surgery.

Results:
CME occurred in 12 (15.6%) of 77 eyes. There was no significant difference in best-corrected visual acuity between eyes with and without CME (P = 0.27). Multivariable analysis revealed that the difference in iris damage scores between before and after DMEK (P < 0.001), air volume in the anterior chamber (P = 0.012), simple DMEK (P = 0.020), and rebubbling (P = 0.036) were significantly associated with CME. Stepwise variable selection indicated that iris damage (P < 0.001) was the most important risk factor for CME.

Conclusions:
Iris damage due to DMEK might be a possible risk and aggravating factor for the development of CME after DMEK. Surgeons should attempt to minimize damage to the iris.
Association of rs613872 and Trinucleotide Repeat Expansion in the TCF4 Gene of German Patients With Fuchs Endothelial Corneal Dystrophy
Authors: Okumura Naoki , Hayashi Ryousuke , Nakano Masakazu , Tashiro Kei , Yoshii Kengo , Aleff Ross , Butz Malinda , Highsmith Edward W. , Wieben Eric D. , Fautsch Michael P. , Baratz Keith H. , Komori Yuya , Ueda Emi , Nakahara Makiko , Weller Julia , Tourtas Theofilos , Schlötzer-Schrehardt Ursula , Kruse Friedrich , Koizumi Noriko 
Published: April 2019

Purpose:
To investigate single nucleotide polymorphisms (SNPs) and trinucleotide repeat (TNR) expansion in the transcription factor 4 (TCF4) gene in a large cohort of German patients with Fuchs endothelial corneal dystrophy (FECD).

Methods:
Genomic DNA was obtained from 398 patients with FECD and from 58 non-FECD controls. Thirty-seven previously reported SNPs were evaluated by genotyping. The 398 FECD samples were analyzed for TNR expansions by short tandem repeat assays and Southern blotting. The possible associations between the TNR length and clinical parameters (age, sex, visual acuity, and central corneal thickness) were analyzed in 132 patients.

Results:
The SNPs in COL8A2, TCF8, LOXHD1, and AGBL1 showed no heterogeneity in 36 cases, although SLCA411 showed 3 nonsense mutations. SNPs were detected for TCF4 (rs613872, rs2123392, rs17089887, rs1452787, and rs1348047), but only rs613872 showed a significant association with FECD (P = 9.93 × 10−12). Overall, 315/398 (79%) patients harbored TNR lengths >50, whereas no non-FECD controls harbored TNR lengths >50. The TCF4 SNP rs613872 genotype was TT: 39 (67%), TG: 18 (31%), and GG: 1 (2%) in non-FECD controls; TT: 39 (47%), TG: 38 (46%), and GG: 6 (7%) in FECD cases harboring TNR <50; and TT: 23 (8%), TG: 224 (79%), and GG: 38 (13%) in FECD cases harboring TNR >50 (P = 2.93 × 10−25). No significant association was detected between the TNR length and clinical parameters.

Conclusions:
Our large German cohort demonstrated a significant association between the risk allele G in rs613872 and FECD, irrespective of TNR expansion, although this risk allele was more frequent in FECD cases with TNR expansion than without.
Occult hepatitis B and HIV infection
Authors: Soriano Vicente , Aguilera Antonio , Gonzalez Rocío , Gomez-Gallego Felix , Barea Luisa , Treviño Mercedes , Corral Octavio 
Published: April 2019

Introduction
Occult hepatitis B virus (HBV) infection, so-called occult B infection (OBI), is defined by the recognition of HBV-DNA in the absence of serum hepatitis B surface antigen (HBsAg). The HBV-DNA genome in OBI is fully replication competent and produced in the liver, characteristically with low-level HBV-DNA fluctuations in the bloodstream. The OBI status remains between chronic (HBsAg +) and resolved (anti-HBs +) phases in the natural history of HBV infection.

Methods
The clinical interest in OBI has increased because of its potential for overt HBV reactivation under immunosuppression as well as for HBV transmission, well established in recipients of blood transfusions and/or organ transplants.

Results
Given the shared transmission routes for HIV and HBV, earlier reports claimed that OBI was more frequent in AIDS patients. By contrast, the current scenario shows that OBI is negligible in the HIV population. One explanation is that HBV immunization and recall vaccination campaigns have been very active in this group. A second and most important reason points to the wide use of antiretroviral regimens that include anti-HBV active agents, that is, tenofovir, lamivudine, and/or emtricitabine. They are recommended either as treatment for all HIV carriers or as pre-exposure prophylaxis for uninfected individuals at risk. The consequences are that HBV reactivations associated with HIV-related immunodeficiency have become very rare. Furthermore, HBV suppression with these antivirals has markedly reduced the likelihood of transmission from OBI carriers and/or acquisition by uninfected exposed individuals.

Conclusion
Enthusiasm unabated, however, new tenofovir-sparing antiretroviral regimens are becoming popular and might account for a resurgence of OBI in the HIV setting.
Implementation of Legionella Prevention Policy in Health Care Facilities: The United States Veterans Health Administration Experience
Authors: Ambrose Meredith , Kralovic Stephen M. , Roselle Gary A. , Kowalskyj Oleh , Rizzo Vincent , Wainwright Don L. , Gamage Shantini D. 
Published: April 2019

Context:
The Veterans Health Administration requires implementation of Legionella prevention policy in potable water systems at Department of Veterans Affairs (VA) medical facilities across the United States and territories.

Program:
The Veterans Health Administration Central Office program offices with expertise in engineering and clinical aspects of Legionella prevention policy have provided joint, structured on-site assistance to VA medical facilities for consultation on policy implementation. Site visits included review of facility documentation and data, discussions with staff, touring of buildings, and development of recommendations.

Implementation:
Information obtained from on-site consultative assistance provided to VA medical facilities from December 2012 through January 2018 was reviewed to identify engineering and clinical challenges and lessons from implementation of Legionella prevention policy in VA health care buildings. Fifteen consultative site visits were conducted during this period regarding implementation of Legionella prevention and validation of effectiveness.

Evaluation:
It was found that implementation of Legionella prevention policy in potable water systems was complex and practices varied for each building. Common implementation challenges included capability of applying engineering controls, water stagnation, and assessment of health care association of Legionella cases. Process challenges included routine verification of actions, methods for assessing environmental validation data, and documentation of requirements. It was found that consistent and data-driven implementation of policy is crucial for an effective program.

Discussion:
Guidance and standards documents in the community for Legionella prevention in building water systems are often general in nature, but implementation requires specific decisions and routine assessments and modifications to optimize outcomes. This real-world review of challenges and lessons from a large health care system with a detailed primary Legionella prevention policy informs future development of guidance and policy, both within and external to VA, and can provide insight to other health care facilities planning to implement practices for water safety.
Quantifying the Value of Prevention: A Survey of Public Health Departments' Quantitative and Economic Modeling Capacity
Authors: McCullough J. Mac , Narain Kimberly , Rhoads Natalie , Fielding Jonathan E. , Teutsch Steven M. , Zimmerman Frederick J. 
Published: April 2019

Objective:
To improve the understanding of local health departments' (LHDs') capacity for and perceived barriers to using quantitative/economic modeling information to inform policy and program decisions.

Design:
We developed, tested, and deployed a novel survey to examine this topic.

Setting:
The study's sample frame included the 200 largest LHDs in terms of size of population served plus all other accredited LHDs (n = 67). The survey was e-mailed to 267 LHDs; respondents completed the survey online using SurveyMonkey.

Participants:
Survey instructions requested that the survey be completed from the perspective of the entire health department by LHD's top executive or designate. A total of 63 unique LHDs responded (response rate: 39%).

Main Outcome Measure(s):
Capacity for quantitative and economic modeling was measured in 5 categories (routinely use information from models we create ourselves; routinely use information from models created by others; sometimes use information from models we create ourselves; sometimes use information from models created by others; never use information from modeling). Experience with modeling was measured in 4 categories (very, somewhat, not so, not at all).

Results:
Few (9.5%) respondents reported routinely using information from models, and most who did used information from models created by others. By contrast, respondents reported high levels of interest in using models and in gaining training in their use and the communication of model results. The most commonly reported barriers to modeling were funding and technical skills. Nearly all types of training topics listed were of interest.

Conclusions:
Across a sample of large and/or accredited LHDs, we found modest levels of use of modeling coupled with strong interest in capacity for modeling and therefore highlight an opportunity for LHD growth and support. Both funding constraints and a lack of knowledge of how to develop and/or use modeling are barriers to desired progress around modeling. Educational or funding opportunities to promote capacity for and use of quantitative and economic modeling may catalyze use of modeling by public health practitioners.
Development and Review of the Chest Tube High-Feedback Educational Simulation Trainer (CHEST)
Authors: Crawford Scott B. , Huque Yasin I. , Austin Danielle E. , Monks Stormy M. 
Published: April 2019

IntroductionEmergency medicine physicians must receive training in chest tube placement. This life-saving skill must be completed quickly and competently to prevent morbidity and mortality. Training on live patients is no longer an appropriate or acceptable practice. Current training devices have been noted to be costly, may be difficult to store, or may require time-consuming cleanup or setup.MethodsFifteen Chest tube High-feedback Educational Simulation Trainers were created. Frames were made from wood and PVC, and soft tissue layers were designed using silicone and polyurethane foam. Nine training sites volunteered to test the model and provided feedback on the acceptability of the task trainer for skill training.ResultsSurvey findings demonstrated that the model was realistic for teaching, portable, and was easy to use and maintain. In our model, the outer skin was noted to tear easily, thus limiting its use for suture training. Overall programs reported that they would use this model if it was available for the same or lower cost than current models.ConclusionsAn inexpensive task trainer was created that was easy to store, quick to set up, durable, easy to clean, and rated as effective at training the skill of chest tube insertion.
A Porcine Model for Learning Ultrasound Anatomy of the Larynx and Ultrasound-Guided Cricothyrotomy
Authors: Mandell Daniel , Orebaugh Steven L. 
Published: April 2019

Background
Difficulty with tracheal intubation is the most common cause of serious adverse respiratory events during anesthesia. Cricothyrotomy is a life-saving procedure that is seldom performed by anesthesiologists. Anesthesiology residents are traditionally trained to perform cricothyrotomy with artificial mannequins and exposed larynx models from animals. These models lack the tissue feel of performing a cricothyrotomy on a patient with difficult neck anatomy. To improve the training experience, we developed a novel training model for cricothyrotomy using a porcine larynx, which incorporates ultrasonographic examination to identify the cricothyroid membrane, and permits varying degrees of difficulty.

Methods
Twenty-five residents were enrolled in a training curriculum consisting of (1) preprocedure training modules, (2) preprocedure hands-on demonstrations, and (3) three separate cricothyrotomy procedures using a porcine trachea. The first two procedures consisted of residents performing an open and a percutaneous cricothyrotomy on a model, which consisted of porcine trachea with chicken skin pinned over the larynx. The third procedure involved performing an open cricothyrotomy on a more challenging model, constructed by placing several layers of bacon fat between the larynx and chicken skin, making digital palpation of the laryngeal landmarks impossible. Before performing the procedure, residents located the cricothyroid interval with ultrasound. A postcurriculum survey was administered.

Results
Twenty-three of 25 residents were able to perform the open cricothyrotomy by digital palpation on the airway model on the first attempt. With the more challenging model, all 25 residents were able to locate the cricothyroid membrane by ultrasound and successfully perform open and percutaneous cricothyrotomy. Participants felt that they learned new information regarding ultrasound identification of laryngeal anatomy and gained valuable procedural experience in this training exercise.

Conclusions
Use of the porcine trachea with overlying animal skin and fat provides an effective partial-task trainer for open and percutaneous surgical airway education and lends itself to integration of ultrasound imaging for real-time identification of laryngeal and tracheal anatomy.