bluuebunny/crossref_metadata_2025_split huggingface dataset:
Externally Validated Score to Predict Cesarean Delivery After Labor Induction With Cervical Ripening
Authors: Jochum Floriane , Le Ray Camille , Blanc-Petitjean Pauline , Langer Bruno , Meyer Nicolas , Severac François , Sananes Nicolas 
Published: August 2019

OBJECTIVE:
To build a score to predict the risk of cesarean delivery after labor induction with cervical ripening, and to compare its predictive capacities with other already existing scores.

METHODS:
This study is a secondary analysis of data collected in the prospective multicenter observational French population-based cohort study Methods of Induction of Labor and Perinatal Outcomes, the primary objective of which was to obtain national data regarding labor induction practices in 94 maternity units. A total of 1,692 patients were randomly split into a derivation data set of 1,024 patients (60%) and an internal validation set of 668 patients (40%). Statistical analyses were performed using a Bayesian approach, allowing the use of priors (ie, previous results published in the literature). The final score is a simplified 50-point score. The score was validated using the internal validation set and an external data set of 4,242 patients from the National Institutes of Health's Consortium for Safe Labor database. We compared the area under the curve (AUC) of our score with two other scores: the modified Bishop score and the Levine score, which is a recently published risk calculator for cesarean delivery after labor induction with unfavorable cervix.

RESULTS:
In the multivariate analysis, height, body mass index, gestational age, parity, dilation, effacement, fetal head station, medical indication, suspicion of macrosomia, premature rupture of membranes and concerning fetal status were found to be strongly associated with cesarean delivery. The AUC in the derivation set and internal validation set were 0.76 (0.73–0.79) and 0.74 (0.70–0.78), respectively. On the external validation set, the AUC for the present score, the Levine score, and the modified Bishop score were 0.81 (0.79–0.82), 0.76 (0.75–0.78), and 0.74 (0.73–0.76), respectively.

CONCLUSION:
Our easy-to-use, externally validated score is efficient in predicting cesarean delivery after labor induction with cervical ripening.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02477085.
Human Papillomavirus Genotyping Compared With a Qualitative High-Risk Human Papillomavirus Test After Treatment of High-Grade Cervical Intraepithelial Neoplasia
Authors: Bottari Fabio , Iacobone Anna D. , Passerini Rita , Preti Eleonora P. , Sandri Maria T. , Cocuzza Clementina E. , Gary Devin S. , Andrews Jeffrey C. 
Published: August 2019

OBJECTIVE:
To systematically examine human papillomavirus (HPV) genotyping compared with qualitative high-risk HPV result during follow-up after treatment of high-grade cervical intraepithelial neoplasia (CIN), for risk estimation of posttreatment high-grade CIN.

DATA SOURCES:
MEDLINE, Cochrane, and ClinicalTrials.gov were searched from January 2000 to April 2019 for prospective studies of women and retrospective studies of residual specimens from women, tested using HPV assays with genotype reporting.

METHODS OF STUDY SELECTION:
The primary outcome was posttreatment high-grade CIN after treatment of high-grade CIN. Risk of bias (individual study quality) was evaluated with a modified Newcastle-Ottawa Scale. Overall quality of evidence for the risk estimate outcomes was evaluated using modified GRADE methodology for observational diagnostic studies.

TABULATION, INTEGRATION, AND RESULTS:
Of the 233 identified abstracts, 33 full-text articles were retrieved, and seven studies were included in the synthesis. The risk of bias was deemed to be low. Either a positive qualitative HPV test result or a positive test result for the same genotype that was present pretreatment have a sensitivity for predicting posttreatment high-grade CIN that approaches 100%. However, the positive predictive value (PPV) for the same genotype result pretreatment and posttreatment (median 44.4%) is about double the PPV (median 22.2%) for qualitative HPV results. The PPV of a new HPV infection posttreatment approximates zero. Human papillomavirus genotyping discriminated risk of posttreatment high-grade CIN to a clinically significant degree for women after treatment procedures for high-grade CIN lesions, when same-genotype persistence was compared with new genotype infection.

CONCLUSION:
There is moderately high-quality evidence to support the improved clinical utility of HPV genotyping compared with qualitative HPV positivity to follow-up after treatment of high-grade CIN.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO: CRD42018091095.

FUNDING SOURCE:
Becton, Dickinson and Company, BD Life Sciences—Diagnostic Systems.
Vaginal Hysterectomy Suturing Skills Training Model and Curriculum
Authors: Balgobin Sunil , Owens David M. , Florian-Rodriguez Maria E. , Wai Clifford Y. , McCord Eddie H. , Hamid Cherine A. 
Published: August 2019

BACKGROUND:
Declining vaginal hysterectomy numbers in obstetrics and gynecology training programs highlights the need for innovative methods to teach vaginal surgical skills. We describe our experience with a vaginal hysterectomy skills simulation curriculum.

INSTRUMENT:
A low-fidelity bench model was constructed to simulate four vaginal hysterectomy suturing tasks. A polyvinyl chloride downspout adapter and low-cost materials simulate the Heaney pedicle stitch, simple pedicle stitch, double ligature, and continuous running stitch.

EXPERIENCE:
Faculty expert vaginal surgeons established proficiency levels for each task. Resident (N=30) pass rates for tasks 1, 2, and 3 were 1 of 30 (3.3%), 7 of 30 (23.3%), and 4 of 30 (13.3%), respectively, for the left side, and 3 of 30 (10%), 9 of 30 (30%), and 10 of 30 (33.3%), respectively, for the right side. For task 4, the pass rate was 14 of 30 (46.7%). The majority of residents felt that the model simulates the technical skills required for vaginal hysterectomy and agreed that vaginal skills laboratory training would improve their ability to perform procedures in the operating room. Ninety-two percent of residents felt that a vaginal surgery skills curriculum would be a useful addition to their simulation education.

CONCLUSION:
A proficiency-based vaginal hysterectomy skills simulation curriculum using a low-fidelity model may be an important training and evaluation tool for vaginal surgical skills training.
Does Operative Intervention Provide Early Pain Relief for Patients With Unilateral Sacral Fractures and Minimal or No Displacement?
Authors: Tornetta Paul , Lowe Jason A. , Agel Julie , Mullis Brian H. , Jones Clifford B. , Teague David , Kempton Laurence , Brown Krista , Friess Darin , Miller Anna N. , Spitler Clay A. , Kubiak Erik , Gary Joshua L. , Leighton Ross , Morshed Saam , Vallier Heather A. 
Published: August 2019

Objectives:
To compare pain after operative versus nonoperative pelvic ring injuries with unilateral sacral fractures.

Design:
Prospective, multicenter, observational.

Setting:
Sixteen trauma centers.

Patients/Participants:
Skeletally mature patients with pelvic ring injury and minimally displaced unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries.

Main Outcome Measurements:
Pelvic displacement was documented on injury plain radiographs and computed tomography scans; a 10 point Visual Analog Scale (VAS) was used to evaluate pain was obtained in the anterior and posterior pelvic ring during the time of union (12 weeks).

Results:
One hundred ninety-four patients with unilateral sacral fractures displaced less than 5 mm, mean age of 38.7, and mean Injury Severity Score of 14.5 were included. Ninety-nine percent had lateral compression injuries, and 62% were in zone 1. Seventy-four percent were treated nonoperatively. Nonoperative patients had more zone 1 fractures (71%, P = 0.004). Nonoperative patients reported mean VAS 2.7 points higher in the posterior pelvis (P = 0.01) and 1.9 points higher anteriorly (P = 0.11) 24 hours after injury compared with patients treated operatively. After 3 months, nonoperative patients reported higher VAS scores than operative patients: 4.0 versus 2.9 posteriorly (P = 0.019) and 3.2 versus 2.3 anteriorly (P = 0.035).

Conclusions:
For sacrum fractures with minimal or no displacement, slight differences in the VAS were noted within 24 hours after injury or surgery, but limited differences were seen at 3 months for either operatively treated minimally or undisplaced sacrum fractures. It is unknown whether this represents clinical relevance. These differences were below the minimally important clinical difference for VAS scores for other orthopaedic conditions.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Intramedullary Nails Yield Superior Results Compared With Plate Fixation When Using the Masquelet Technique in the Femur and Tibia
Authors: Morwood Michael P. , Streufert Benjamin D. , Bauer Amy , Olinger Catherine , Tobey Devon , Beebe Michael , Avilucea Frank , Buitrago Andres R. , Collinge Cory , Sanders Roy , Mir Hassan 
Published: August 2019

Objectives:
To determine the optimal fixation method [intramedullary nail (IMN) vs. plate fixation (PF)] for treating critical bone defects with the induced membrane technique, also known as the Masquelet technique.

Design:
Retrospective cohort study.

Setting:
Four Level 1 Academic Trauma Centers.

Patients/Participants:
All patients with critical bone defects treated with the induced membrane technique, or Masquelet technique, between January 1, 2005, and January 31, 2018.

Intervention:
Operative treatment with a temporary cement spacer to induce membrane formation, followed by spacer removal and bone grafting at 6–8 weeks.

Main Outcome Measurements:
Time to union, number/reason for reoperations, time to full weight-bearing, and any complications.

Results:
One hundred twenty-one patients (56 tibias and 65 femurs) were treated with a mean follow-up of 22 months (range 12–148 months). IMN was used in 57 patients and plates in 64 patients. Multiple grafting procedures were required in 10.5% (6/57) of those with IMN and 28.1% (18/64) of those with PF (P = 0.015). Reoperation for all causes occurred in 17.5% (10/57) with IMN and 46.9% (30/64) with PF (P = 0.001). Average time to weight-bearing occurred at 2.44 versus 4.63 months for those treated with IMN and plates, respectively (P = 0.002). The multivariable adjusted analysis showed that PF is 6.4 times more likely to require multiple grafting procedures (P = 0.017) and 7.7 times more likely to require reoperation (P = 0.003) for all causes compared with IMN.”

Conclusions:
This is the largest study to date evaluating the Masquelet technique for critical size defects in the femur and tibia. Our results indicate that patients treated with IMN had faster union, fewer grafting procedures, and fewer reoperations for all causes than those treated with plates, with differences more evident in the femur. The authors believe this is a result of both the development of an intramedullary canal and circumferential stress on the graft with early weight-bearing when using an IMN, as opposed to a certain degree of stress shielding and delayed weight-bearing when using PF. We, therefore, recommend the use of an IMN whenever possible as the preferred method of fixation for tibial and femoral defects when using the Masquelet technique.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center
Authors: Bakhru Rita N. , Davidson James F. , Bookstaver Rebeca E. , Kenes Michael T. , Peters Stephen P. , Welborn Kristin G. , Creech Oksana R. , Morris Peter E. , Files D. Clark 
Published: August 2019

Objectives:
Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance.

Design:
Adults admitted to the medical ICU of a large tertiary care academic hospital with shock and/or respiratory failure requiring mechanical ventilation were screened for participation in a newly formed ICU recovery clinic. Participant selection and attendance rates were tracked. Reasons for nonattendance were assessed by phone call in a subset of patients.

Setting:
A newly formed ICU recovery clinic of a large tertiary care academic hospital.

Patients:
All patients admitted to the medical ICU were screened.

Interventions:
ICU recovery clinic appointments were scheduled for all eligible patients. A subset of nonattenders were called to assess reasons for nonattendance.

Measurements and Main Results:
Over 2 years, we admitted 5,510 patients to our medical ICU. Three hundred sixty-two were screened into the recovery clinic. One-hundred sixty-six were not scheduled for clinic; major reasons included discharge to hospice/death in the hospital (n = 55) and discharge to a facility (n = 50). One-hundred ninety-six patients were scheduled for a visit and of those, 101 (52%) arrived to clinic. Reasons for nonattendance in a surveyed subset of nonattenders included patient’s lack of awareness of the appointment (50%, n = 9/18), financial concerns (17%, n = 3/18), and transportation difficulty (17%, n = 3/18).

Conclusions:
ICU recovery clinics may address the needs of survivors of critical illness. Barriers to clinic attendance include high mortality rates, high rates of clinic appointment cancelations and nonattendance, and discharge to locations such as skilled nursing facilities or long-term acute care hospitals. Improved communication to patients about the role of the clinic may facilitate attendance and minimize canceled appointments.
Incidence of Dexmedetomidine Withdrawal in Adult Critically Ill Patients: A Pilot Study
Authors: Bouajram Rima H. , Bhatt Krupa , Croci Rhiannon , Baumgartner Laura , Puntillo Kathleen , Ramsay James , Thompson Ashley 
Published: August 2019

Objectives:
To determine the incidence of dexmedetomidine withdrawal in adult critically ill patients.

Design:
This was a prospective, observational study of patients from November 2017 to December 2018.

Setting:
Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.

Patients:
Adult critically ill patients on dexmedetomidine infusions for at least 3 days.

Interventions:
Indicators of withdrawal were assessed at baseline and at least daily during the dexmedetomidine wean period. Delirium was assessed using the Confusion Assessment Method for the ICU. Sedation was assessed using the Richmond Agitation-Sedation Scale. The Withdrawal Assessment Tool-1 was performed and vital signs were recorded during each assessment. Patients were considered positive for dexmedetomidine withdrawal if they had two or more of the following symptoms: positive Confusion Assessment Method for the ICU, Richmond Agitation-Sedation Scale greater than +1, positive Withdrawal Assessment Tool-1 assessment, tachycardia (heart rate > 90 beats/min), and hypertension (systolic blood pressure > 140 mm Hg or mean arterial pressure > 90).

Measurements and Main Results:
Forty-two patients were included in the study, with 64% of patients experiencing signs of dexmedetomidine withdrawal. The median time on dexmedetomidine for all patients was 9.6 days (5.8–12.7 d), and the median dose of dexmedetomidine received was 0.8 µg/kg/hr (0.5–1 µg/kg/hr). Of the patients who were positive for withdrawal, the most prevalent withdrawal symptoms observed included delirium, hypertension, and agitation (93%, 48%, and 33%, respectively). We found no correlation between chronic opioid tolerance and incidence of withdrawal symptoms. Peak dexmedetomidine doses greater than 0.8 µg/kg/hr and cumulative daily doses of dexmedetomidine greater than 12.9 µg/kg/d were associated with a higher incidence of withdrawal.

Conclusions:
The majority of patients in our study demonstrated signs that may be indicative of dexmedetomidine withdrawal. Peak and cumulative daily dexmedetomidine dose, rather than duration of therapy, may be associated with a higher incidence of withdrawal signs. Regular screening of patients on prolonged dexmedetomidine infusions is recommended to ensure safe and effective use in critically ill patients.
Triple-Plane Augmentation Mastopexy
Authors: Ismail Karima T. , Ismail Mariam T. , Ismail Taher A. , Ismail Ahmed T. , Toth Bryant A. 
Published: August 2019

Background:
Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. The aim was to achieve harmonious, natural fullness, better projection, and appropriate size with limited scarring. We named this technique triple-plane augmentation mastopexy as three planes are used: the first plane is the subfascial plane, the second is the subglandular plane, and the third is the subpectoral plane.

Methods:
A retrospective review was performed of 75 consecutive cases of grade 3 or glandular ptosis treated in a single clinic by three separate surgeons adopting the same technique from January 2010 to January 2017. Triple-plane augmentation mastopexy begins by undermining the breast tissue through a tunnel until the second rib is in the prepectoral plane. Then, the subpectoral pocket for the implant is dissected with release of the lower border of the pectoralis major and avoiding release of the sternal border. Subsequently, the breast tissue is suspended at the lower border of the second rib, followed by subpectoral insertion of the implant and skin envelope excision.

Results:
Surgical follow-up varied from a minimum of 6 months to a maximum of 6 years, with an average of 3 years. Among a total of 75 patients, 64 patients (85.3%) complied with follow-up and 49 (76.5%) of these patients were satisfied. Complications varied from early complications (14.6%) to late complications (21.5%).

Conclusions:
Grade 3 and glandular ptosis represent a challenge to plastic surgeons. Traditional techniques may fail to achieve optimized results. Triple-plane augmentation mastopexy is a safe, reliable procedure that ensures long-term desired aesthetic outcomes with limited scarring.
Direct Comparison of Patient-completed and Physician-completed Caprini Scores for Plastic Surgery Patients
Authors: Veith Jacob , Collier Willem , Rockwell W. Bradford , Pannucci Christopher 
Published: August 2019

Background:
We examined the ability of plastic surgery patients to perform their own venous thromboembolism (VTE) risk stratification using a previously validated patient-completed Caprini risk scoring sheet.

Methods:
Patients’ Caprini scores were obtained by an attending physician at an office visit through interview and chart review. Subsequently, patients independently completed a previously validated patient reported scoring sheet. We compared patient and physician reported Caprini scores by each Caprini subquestion and by the overall score. We described discordance of scores using frequencies and proportions, quantified the level of agreement using Cohen’s Kappa coefficient, Spearman’s correlation coefficient, and the Wilcoxon rank-sum test, and visualize scoring differences using Bland–Altman plots, where appropriate.

Results:
We prospectively enrolled 50 patients. Only 24% (n = 12) of patients had exact matches in physician-completed and patient-completed Caprini scores. Among the 76% (n = 38) with discrepancies, 26 received a higher patient-reported score (median = 2 points, range 1–8 points) and 12 received a lower patient-reported score (median = −1.5 points, range −1 to −6 points). Existing venous thromboembolism prophylaxis guidelines support chemical prophylaxis for inpatients with Caprini scores ≥7. Among 38 patients with score discrepancies, 8 (21.1%) would have been incorrectly prescribed chemical prophylaxis and 4 (10.5%) would have been incorrectly denied chemical prophylaxis.

Conclusions:
Plastic surgery patients cannot reliably calculate their own 2005 Caprini scores. Reliance on patient completed scores alone would promote ~25% of patients receiving inappropriate prophylaxis strategies.
A Modified Technique of Transposition of Temporalis Muscle in Selected Cases of Longstanding Facial Paralysis
Authors: Askar Sherif M. , Mohammed Nasser N. , Elibiary Hassan A. 
Published: August 2019

Abstract
The authors present a modified technique of temporalis muscle transposition technique in cases of longstanding facial paralysis. Slips of the temporalis fascia were passed through the tunnels to reach the contralateral para-median plane. The procedure provides 2 point of fixation to the transferred muscle. Local flaps were used for temporal hollow obliteration and for temporalis muscle elongation.
This case series included 11 patients. The modified technique was performed for all patients to reanimate the lower face while gold weight impanation in the upper eye lid was used for re-animation of the eye in 9 patients. By the end of follow up, the procedure was considered successful in 9 patients. Eight patients expressed their satisfaction and 7 patients were happy with the regained facial movement.
The modified temporalis muscle transfer technique might be a valuable option in cases of longstanding facial paralysis. The lips would be camouflaged, non-stretched and would move with the whole mid-face.
Radiographic Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography
Authors: Al-Ghurabi Zainab H. , Al-Bahrani Zainab M. 
Published: August 2019

Purpose:To assess the morphology of nasopalatine canal and to determine the variation of this canal in correlations to age and gender in Iraqi sample using cone beam computed tomography (CBCT).Materials and methods:A total of 200 requested CBCT images for nasopalatine canal evaluation before dental implantology at the anterior maxillary region. The morphology of canals was classified into 3 groups in coronal cross-sections. The effects of age and gender were also measured.Results:The study comprised 100 males and 100 females with mean age of 30.64 ± 9.46 years. Most of the cases showed Y-shape configuration type III 43.5% followed by type I single canal 35.5%, and type II with 2 parallel canals 21%,Conclusion:Due to the wide variation in the morphology of nasopalatine canals, it is highly recommended to perform CBCT evaluation to the anterior maxilla before dental implantology in order to prevent any damage to the neurovascular bundle.