bluuebunny/crossref_metadata_2025_split huggingface dataset:
Birth Plans—Impact on Mode of Delivery, Obstetrical Interventions, and Birth Experience Satisfaction: A Prospective Cohort Study
Authors: Afshar Y. , Mei J.Y. , Gregory K.D. , Kilpatrick S.J. , Esakoff T.F. 
Published: November 2018

(Birth. 2018;45:43–49)
Birth plans are intended to serve as a communication tool between women and their providers. Patient involvement in decision-making during childbirth has been positively associated with patient satisfaction with birth. However, one study found more than half of medical personnel believed the presence of a birth plan predicted worse outcomes, while only 2% of pregnant women believed birth plans were associated with worse outcomes. There is a lack of research on birth outcomes in the presence of birth plans. The authors of this study hypothesized women with birth plans would have fewer obstetrical interventions, fewer cesarean deliveries, and greater satisfaction with their birth experience.
Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement: A Descriptive Study Using Magnetic Resonance Imaging and Ultrasound
Authors: Barrett N.M. , Arzola C. , Krings T. , Downey K. , Carvalho J.C.A. 
Published: November 2018

(Reg Anesth Pain Med. 2018;43:92–96)
Unintentional puncture of the dura mater is one of the most common complications of epidural catheter placement and can result in a postdural puncture headache. The incidence of this complication has remained unchanged and efforts to identify patient risk factors have been unsuccessful. There has not been success in identifying risk factors for this complication. A retrospective study showed there was a higher risk of atypical sonoanatomy of the ligamentum flavum/dura mater unit among women who experienced unintentional dural puncture during epidural placement compared with a control group. It was not clear whether this was a limitation of ultrasound imaging or a representation of abnormal anatomy. The objectives of this study were to assess for abnormal lumbar anatomy in women sustaining unintentional dural punctures during labor epidural placement utilizing magnetic resonance imaging (MRI) and ultrasound.
A Randomized Trial of Phenylephrine Infusion Versus Bolus Dosing for Nausea and Vomiting During Cesarean Delivery in Obese Women
Authors: George R.B. , McKeen D.M. , Dominguez J.E. , Allen T.K. , Doyle P.A. , Habib A.S. 
Published: November 2018

(Can J Anesth. 2018;65(3):254–262)
Hypotension is a common complication of cesarean delivery with spinal anesthesia and can cause intraoperative nausea and/or vomiting (IONV). Bolus dosing of phenylephrine has been shown to be an effective treatment for hypotension, but it does not treat or prevent IONV. Prophylactic phenylephrine infusion, however, has been shown to reduce the incidence of hypotension as well as maternal nausea and vomiting. However, previous studies excluded obese women. This multicenter, randomized, double-blinded study compared phenylephrine infusion to phenylephrine boluses, hypothesizing that IONV incidence would be lower with prophylactic phenylephrine infusion.
IV. POSTOPERATIVE ANALGESIA Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review
Authors: Gamez B.H. , Habib A.S. 
Published: November 2018

(Anesth Analg. 2018;126(5):1606–1614)
Severe acute pain after cesarean delivery (CD) triples a women’s risk of developing postpartum depression. Consequently, preoperative identification of women at greater risk for severe postoperative pain may be helpful in identifying more effective and intensive analgesic interventions for this population. In this narrative review, the authors evaluated the utility of various existing tools to predict severe pain and/or opioid consumption in the first 48 hours after CD.
Prophylactic Use of an Intra-Aortic Balloon Pump in a High-risk Patient With Peripartum Cardiomyopathy Requiring Cesarean Delivery
Authors: Samalavicius R.S. , Puodziukaite L. , Radaviciute I. , Norkiene I. , Urbonas K. , Misiuriene I. , Janusauskas V. , Zorinas A. , Rucinskas K. , Serpytis P. 
Published: November 2018

(Int J Obstet Anesth. 2018;33:67–71)
The most commonly used mechanical-assist device for the management of heart failure is the intra-aortic balloon pump (IABP). The balance between myocardial oxygen supply and demand is improved via the device’s counter-pulsation. Although some case reports have mentioned the use of IABP counter-pulsation for circulatory support in pregnant women with cardiac failure, few publications have discussed its use during delivery. This case report described the successful management of a patient with peripartum cardiomyopathy who underwent cesarean delivery using preemptive IABP counter-pulsation.
The Multimodal Assessment Model of Pain
Authors: Wideman Timothy H. , Edwards Robert R. , Walton David M. , Martel Marc O. , Hudon Anne , Seminowicz David A. 
Published: November 2018

Objectives:
Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges.

Methods:
This is a narrative review.

Results:
MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non–self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures.

Discussion:
MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain.
Subfibular impingement: current concepts, imaging findings and management strategies
Authors: Kaplan Jonathan R.M. , Aiyer Amiethab , Nguyen Duc M. , Vulcano Ettore , Buller Leonard T. , Sheth Pooja , Jose Jean 
Published: November 2018

Subfibular impingement is one cause of extraarticular ankle impingement characterized by pain in the lateral aspect of the hindfoot. Associated with severe hindfoot deformity, subfibular impingement can be secondary to posterior tibial tendon dysfunction, calcaneal fracture malunion, or neuropathic or inflammatory arthritidies. MRI often is necessary to rule out other causes of ankle pain. Advanced imaging findings are related to abutment between the fibula and calcaneus and include subcortical marrow edema, cystic changes, sclerosis, and the presence of soft-tissue entrapment or extensive soft-tissue thickening between the fibula and the calcaneus. A trial of nonoperative management should be exhausted prior to open or arthroscopic procedures being considered. However, in recalcitrant cases unresponsive to conservative treatment, there are several surgical procedures described for the management of these deforming forces.Level of Evidence: Level V.
Patient attitudes towards electronics usage in a hospital-based orthopaedic clinic: a survey study
Authors: McDaniel Claire , Davis Meghan , Kessler Michael 
Published: November 2018

Background:
Patients and physicians are increasingly using technology to deliver healthcare for both preserving information and communication methods. However, little research has been done into patient attitudes towards technology use in the outpatient orthopaedic clinic.

Methods:
A paper survey was conducted of 1000 patients in a mixed-specialty hospital-based orthopaedic surgery clinic to determine patient attitudes towards common technologies. Data analysis was performed using chi-squared and Fisher exact tests. Continuous variables were examined using Kruskal-Wallis tests.

Results:
Most patients reported approving of desktops (98.0%, 95% CI 96.9%-98.8%) or tablets (97.4%, 95% CI 96.2-98.3%) to access medical files, as well as communication methods such as cellular phones set to silent (92.1%, 95% CI 90.3%-93.7%) and pagers set to silent (94.3%, 95% CI 92.7%-95.6%). However, most patients disapproved of cellular phones set to ring (32.3%, 95% CI 29.4%-35.3%), and approved less of pagers that are set to beep mode (70.2%, 95% CI 67.3%-73.0%), indicating that patients dislike intrusions into the clinical encounter.

Conclusions:
The majority of patients approve of certain technology use in the outpatient orthopaedic clinic, specifically means to access medical records and nonintrusive communication methods. As patients rank the orthopaedic surgeons’ bedside manner as a highly important aspect of outpatient clinical care, technology integration must be carefully done to preserve bedside manner.
Recovery of Bone Mineral Mass After Upper Limb Fractures in Children and Teenagers
Authors: Maggio Albane B.R. , Martin Xavier , Tabard-Fougère Anne , Steiger Christina , Dayer Romain , Delhumeau Cécile , Ceroni Dimitri 
Published: November 2018

Background:
Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures. This study aimed to prospectively determine whether previously reported lower bone mineral mass following immobilization for wrist and forearm fractures in children and teenagers had recovered at 6- and 18-month follow-up.

Methods:
We recruited 50 children and teenagers who underwent a cast-mediated immobilization for a forearm or wrist fracture. Dual-energy x-ray absorptiometry scans of different skeletal sites were performed at the time of fracture, at cast removal, at 6 and at 18-month follow-up. Injured patients were paired with healthy controls according to sex and age. Dual-energy x-ray absorptiometry values were compared between groups and the injured and uninjured forearms of the patients.

Results:
At the time of fracture, injured and healthy subjects showed no differences between their bone mineral density (BMD) and bone mineral content (BMC) z-scores at the lumbar spine, or between their BMDs at the peripheral wrist. At cast removal, upper limb bone mineral variables were significantly lower in the injured group (except for the ultradistal radius) than in the uninjured group, with differences ranging from 3.8% to 10.2%. No residual decrease in bone mineral variables was observed at any upper limb site at 6- and 18-month follow-up (28 injured patients). Significant residual increases in the BMDs and BMCs were observed for the injured group’s ultradistal radius and whole wrists (+4.8% to +5.2%).

Conclusions:
A rapid bone mass reversal occurs by resumption of mobilization, with full bone recovery 6 months after a forearm or wrist fracture. Finally, healing bone callus could introduce a bias into the interpretation of BMD and BMC data at the fracture site, not only at cast removal but also 18 months after the fracture.
Radiological Evaluation Does Not Reflect the Clinical Outcome After Surgery in Unstable Thoracolumbar and Lumbar Type A Fractures Without Neurological Symptoms
Authors: Lorente Rafael , Lorente Alejandro , Palacios Pablo , Barrios Carlos , Rosa Bárbara , Vaccaro Alexander 
Published: November 2018

Study design:
This is a prospective study of 2 cohorts.

Objective:
Compare the clinical and radiologic outcome of 2 cohorts of unstable thoracolumbar and lumbar fractures treated by open posterior fixation (OPF) with bone graft or by percutaneous fixation (PCF) without grafting.

Summary of Background Data:
In recent years, PCF is the most common treatment of thoracolumbar fractures. To date, no studies have analyzed clinical outcomes in terms of return to work.

Material and Methods:
Two cohorts of patients with unstable thoracolumbar and lumbar fractures fractures (type A2, A3, and A4) without neurological symptoms underwent OPF (n=91) or PCF (n=54) between 2010 and 2015. A conventional radiologic study was performed in the preoperative, immediate postoperative period, 1-year, and 2-year follow-up. Clinical outcomes were evaluated by Visual Analog Scale and Oswestry Disability Index scores at 1-year and 2-year follow-up. The period to return to work and the type of work were also recorded.

Results:
The percentages of correction were significantly higher in cases operated by OPF: fracture angle (P<0.001), kyphotic deformity (P<0.001), vertebral compression (P<0.001), and displacement (P<0.001). Cases operated by PCF experienced greater loss of correction at 2-year follow-up, especially in fracture displacement (P<0.001), deformity angle (P<0.001), kyphotic deformity (P<0.001), and in the sagittal index (P<0.001). Besides this greater loss of correction, PCF cases showed better Visual Analog Scale (P<0.001) and Oswestry Disability Index scores (P<0.001) at final follow-up. The percentage of patients returning to the same heavy work position was higher in the PCF group (P<0.001) and in a shorter period of time (P<0.001).

Conclusions:
The greater loss of correction of patients undergoing PCF does not reflect the clinical outcomes that were significantly better as compared to patients undergoing open fixation with grafting. It would be useful to further evaluate if the radiological changes could have a long-term clinical significance.
Epidermal growth factor receptor tyrosine kinase inhibitors in advanced nonsmall cell lung cancer: what is the preferred first-line therapy?
Authors: Roeper Julia , Griesinger Frank 
Published: November 2018

Purpose of review
Epidermal growth factor receptor (EGFR) mt+ nonsmall cell lung cancer (NSCLC) were the first molecularly described NSCLC with an established ‘targeted’ therapy inhibiting mutated EGFR [EGFR tyrosine kinase inhibitor (TKI)]. EGFR TKI of first and second generation have led to an unprecedented improvement in objective response rate, progression-free survival (PFS) and overall survival (OS) compared with chemotherapy with a significantly reduced toxicity and improved quality of life. Fast elucidation of the most frequent resistance mechanism against first and second-generation TKI, T790M, led to the approval of the third-generation TKI osimertinib in second line.

Recent findings
Recently, the FLAURA study showed an impressive PFS benefit and immature OS data for osimertinib against solely first-generation TKI's. Also, the ARCHER study comparing dacomitinib against first-generation TKI showed a PFS and also OS benefit. Two studies combining EGFR TKI and antiangiogenesis showed PFS but no OS benefit. Lately, the combination of TKI and chemotherapy has seen a revival with the NEJ009 study, resulting in an impressive median OS of 55 months.

Summary
Therefore, potentially four different therapeutic options are available in first-line therapy of EGFR mt+ NSCLC, first, second, third generation, TKI + antiangiogenic agent and TKI + chemotherapy. The purpose of the review is to help to guide physicians to decide in their treatment choice and discuss potential directions of research.
C-Reactive Protein Values After Colorectal Resection: Can We Discharge a Patient With a C-Reactive Protein Value >100? A Retrospective Cohort Study
Authors: Benoit Olivier , Faron Mathieu , Margot Nicolas , Creavin Ben , Debove Clotilde , Tiret Emmanuel , Parc Yann , Lefevre Jérémie H. 
Published: November 2018

BACKGROUND:C-reactive protein is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery. Evolution of procedures (laparoscopy, enhanced recovery program, early discharge, complex redo surgery) may influence C-reactive protein values; however, this is poorly studied to date.OBJECTIVE:The aim of this study is to evaluate C-reactive protein as an indicator of postoperative complication and as a predictor for discharge.DESIGN:This is retrospective study of a consecutive monocentric cohort.SETTINGS:All patients undergoing a colorectal resection with anastomosis (2014–2015) were included.MAIN OUTCOMES MEASURES:C-reactive protein, leukocytosis, type of resection, and postoperative course were the primary outcomes measured.RESULTS:A total of 522 patients were included. The majority had either a colorectal (n = 159, 31%) or coloanal anastomosis (n = 150, 29%). Overall morbidity was 29.3%. C-reactive protein was significantly higher among patient having intra-abdominal complications at an early stage (day 1–2) (164.6 vs 136.2;p= 0.0028) and late stage (day 3–4) (209.4 vs 132.1;p< 0.0001). In multivariate analysis, early C-reactive protein was associated with BMI (coefficient, 4.9; 95% CI, 3.2–6.5;p< 0.0001) and open surgical procedures (coefficient, 43.1; 95% CI, 27–59.1;p< 0.0001), while late C-reactive protein value was influenced by BMI (coefficient, 4.8; 95% CI, 2.5–7.0;p= 0.0024) and associated extracolonic procedures (coefficient, 34.2; 95% CI, 2.7–65.6;p= 0.033). Sensitivity, specificity, negative predictive values, and positive predictive values for intra-abdominal complication were 85.9%, 33.6%, 89.3%, and 27.1% for an early C-reactive protein <100 mg/L and 72.7%, 75.4%, 89.4%, and 49.2% for a late C-reactive protein <100 mg/L. Four hundred seven patients with an uneventful postoperative course were discharged at day 8 ± 6.4 with a mean discharge C-reactive protein of 83.5 ± 67.4. Thirty-eight patients (9.3%) were readmitted and had a significantly higher discharge C-reactive protein (138.6 ± 94.1 vs 77.8 ± 61.2,p= 0.0004). Readmission rate was 16.5% for patients with a discharge C-reactive protein >100 mg/L vs 6% with C-reactive protein <100 mg/L (p= 0.0008). For patients included in an enhanced recovery program (discharge at day 4 ± 2.4), the threshold should be higher because discharge is around day 3 or 4. With a C-reactive protein <140, readmission rate was 2% vs 19%, (p= 0.056).LIMITATIONS:This study includes retrospective data.CONCLUSION:C-reactive protein <100 mg/L is associated with a lower risk of intra-abdominal complication and readmission rates. SeeVideo Abstractat http://links.lww.com/DCR/A749.
Robotic Transanal Minimally Invasive Surgery for the Excision of Rectal Neoplasia: Clinical Experience With 58 Consecutive Patients
Authors: Tomassi Marco J. , Taller Janos , Yuhan Robert , Ruan Joseph H. , Klaristenfeld Daniel D. 
Published: November 2018

BACKGROUND:
Given the significant perioperative risks and costs of total mesorectal excision, minimally invasive transanal surgical approaches have grown in popularity for early rectal cancer and rectal polyps. This article discusses a transanal robotic surgery technique to perform full-thickness resections of benign and malignant rectal neoplasms.

OBJECTIVE:
The purpose of this study was to describe an initial experience with robotic transanal minimally invasive surgery.

DESIGN:
This was a retrospective cohort study of consecutive patients who underwent robotic transanal minimally invasive surgery.

SETTINGS:
The study was conducted at a high-volume colorectal surgery practice with a large health maintenance organization.

PATIENTS:
Patients at Southern California Kaiser Permanente with early rectal cancer and rectal polyps amenable to transanal excision were included.

INTERVENTIONS:
Transanal resection of rectal tumors were removed using robotic transanal minimally invasive surgery.

MAIN OUTCOME MEASURES:
Local recurrence of rectal pathology was measured.

RESULTS:
A total of 58 patients underwent robotic transanal minimally invasive surgery with full-thickness rectal resection by 4 surgeons for the following indications: rectal cancer (n = 28), rectal polyp (n = 18), rectal carcinoid (n = 11), and rectal GI stromal tumor (n = 1). Mean operative time was 66.2 minutes (range, 17–180 min). The mean tumor height from the anal verge was 8.8 cm (range, 4–14 cm), and the mean specimen size was 3.3 cm (range, 1.3–8.2 cm). A total of 57 (98.3%) of 58 specimens were intact, and 55 (94.8%) of 58 specimens had negative surgical margins. At a mean follow-up of 11.5 months (range, 0.3–33.3 mo), 3 patients (5.5%) developed local recurrences, and all underwent successful salvage surgery.

LIMITATIONS:
The study was limited by being a retrospective, nonrandomized trial with short follow-up.

CONCLUSIONS:
Robotic transanal minimally invasive surgery is a safe, oncologically effective surgical approach for rectal polyps and early rectal cancers. It offers the oncologic benefits and perioperative complication profile of other transanal minimally invasive surgical approaches but also enhances surgeon ergonomics and provides an efficient transanal rectal platform. See Video Abstract at http://links.lww.com/DCR/A759.
Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New Tools to Evaluate Symptoms and Health-Related Quality of Life in Hemorrhoidal Disease
Authors: Rørvik Håvard D. , Styr Karl , Ilum Lars , McKinstry Grant L. , Dragesund Tove , Campos André H. , Brandstrup Birgitte , Olaison Gunnar 
Published: November 2018

BACKGROUND:
There are no adequately validated tools to evaluate symptoms or disease-specific health-related quality of life in hemorrhoidal disease.

OBJECTIVE:
The purpose of this study was to assess validity, reliability, and responsiveness of a symptom score of patient-reported pain, itching, bleeding, soiling, and prolapse (Hemorrhoidal Disease Symptom Score). In addition, the study set out to assess reliability and responsiveness of an instrument to measure health-related quality of life in patients with hemorrhoids (Short Health ScaleHD), with 1 item in its 4 dimensions: symptom load, functional status, disease-specific worries, and general well-being.

DESIGN:
This was a cross-sectional (validity and reliability) and longitudinal (responsiveness) study.

SETTINGS:
The study was conducted at a single center.

PATIENTS:
Cohort 1 included 295 patients with hemorrhoids to study validity and 60 patients with test–retest scores to study reliability. Cohort 2 included 128 and 121 patients operated for hemorrhoids to study responsiveness of the Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD.

MAIN OUTCOME MEASURES:
The study evaluated validity, reliability, and responsiveness. Patient-reported symptom load on a 7-point Likert scale was used as comparator, and receiver operating characteristics curve assessed discriminative validity. Interclass correlation assessed reliability. Receiver operating characteristics curve assessed responsiveness, meaning the ability to discriminate between patients with and without improvement after surgery.

RESULTS:
The Hemorrhoidal Disease Symptom Score demonstrated the ability to discriminate between patients reporting high or low symptom load (area under the curve = 0.786 (95% CI, 0.725–0.848)). The Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD demonstrated adequate reliability and responsiveness, with interclass correlation of 0.822 (95% CI, 0.715–0.891) and 0.763 (95% CI, 0.634–0.851) and area under the curve of 0.843 (95% CI, 0.756–0.929) and 0.840 (95% CI, 0.752–0.929).

LIMITATIONS:
We had no gold standard comparator to assess validity and responsiveness.

CONCLUSIONS:
The findings suggest that the Hemorrhoidal Disease Symptom Score is valid, reliable, and responsive and that the Short Health ScaleHD is reliable and responsive. Used together, these tools provide a good overview of symptoms and their impact on patient well-being. See Video Abstract at http://links.lww.com/DCR/A770.