bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Transcutaneous Electrical Nerve Stimulation Energy in Older Adults: A Pilot Clinical Trial
Authors: García-Pérez Sara , García-Ríos Ma Carmen , Pérez-Mármol José Manuel , Tapia-Haro Rosa María , Albornoz-Cabello Manuel , Valenza Marie Carmen , Aguilar-Ferrándiz María Encarnación 
Published: September 2018

ABSTRACT

OBJECTIVE:
To evaluate the effectiveness of a transcutaneous electric nerve stimulation (TENS) device typically used for pain suppression (analgesia) during pressure injury (PI) healing, peripheral vascularization, and secondary pain in older adults with chronic PIs and cognitive impairment.

DESIGN AND SETTING:
This pilot clinical trial followed patients from 6 nursing homes.

PATIENTS AND INTERVENTION:
Twenty-two patients with PIs in the distal third of their lower limbs (7 men, 15 women) were included in this study. The control group completed standard wound care (SWC), whereas the experimental group received SWC and TENS. A total of 20 sessions were conducted for each group over 2 months, 3 times a week.

MAIN OUTCOME MEASURE:
PI area, PI healing rate, blood flow, skin temperature, oxygen saturation, and level of pain at baseline and posttreatment.

MAIN RESULTS:
Significant improvements were achieved in PI area (mean difference, 0.92; 95% confidence interval [CI], 0.15–1.67; P =.024), healing rate (3; 95% CI, 1–4.99; P =.009), skin temperature (1.82; 95% CI, 0.35–3.28; P =.021), and pain (1.44; 95% CI, 0.49–2.39; P =.008) in the experimental group, whereas none of the variables revealed a significant change in the control group.

CONCLUSIONS:
The effect of local and spinal TENS combined with the SWC for PI produced a significant improvement in size, healing, skin temperature, and pain levels.
Improvement in Work Ability, Psychological Distress and Pain Sites in Relation to Low Back Pain Prognosis
Authors: Nordstoga Anne L. , Vasseljen Ottar , Meisingset Ingebrigt , Nilsen Tom I. L. , Unsgaard-Tøndel Monica 
Published: September 2018

Study Design.
Prospective observational study pooled from two clinical cohorts.

Objective.
To investigate the longitudinal relation between multisite pain, psychological distress, and work ability with disability, pain, and quality of life.

Summary of Background Data.
Knowledge of prognostic factors is essential for better management of patients with low back pain (LBP). All domains of the biopsychosocial model have shown prognostic value; however, clinical studies rarely incorporate all domains when studying treatment outcome for patients with LBP.

Methods.
A total of 165 patients with nonspecific LBP seeking primary care physiotherapy were included. Mixed-effects models were used to estimate longitudinal relations between the exposure variables and concurrent measures of outcomes at baseline and 3 months. Logistic regression was used to estimate odds ratios for minimal important difference in outcome.

Results.
Higher work ability was associated with less disability −2.6 (95% confidence interval [CI]: −3.3, −2.0), less pain: −0.4 (95% CI: −0.5, −0.3), and higher quality of life 0.03 (95% CI: 0.02, 0.04). Higher psychological distress and number of pain sites were associated with higher disability: 10.9 (95% CI: 7.7, 14.1) and 2.3 (95% CI: 1.4, 3.2) higher pain: 1.9 (95% CI: 1.3, 2.5) and 0.4 (95% CI: 0.2, 0.5), and lower quality of life: −0.1 (95% CI: −0.2, −0.1) and −0.02 (95% CI: −0.03, −0.01), respectively. Improvement in work ability showed consistent associations with successful outcome for disability (odds ratio [OR]: 4.8, 95% CI: 1.3, 18.1), pain (OR: 3.6, 95% CI: 1.1, 12.1), and quality of life (OR: 4.5, 95% CI: 1.4, 15.1) at 3 months. Reduced psychological distress was associated with improvement in pain only (OR 4.0, 95% CI: 1.3, 12.3).

Conclusion.
More pain sites, higher psychological distress, or lower work ability showed higher disability, more pain, and lower quality of life in patients with LBP. Only improvement in work ability was consistently related to successful outcomes.

Level of Evidence: 2
Changes in the Use of Lumbar Arthrodesis Procedures Within Accountable Care Organizations
Authors: Schoenfeld Andrew J. , Sturgeon Daniel J. , Harris Mitchel B. , Blucher Justin A. , Kang James D. , Haider Adil H. , Bono Christopher M. 
Published: September 2018

Study Design.
A retrospective review of Medicare claims data (2009–2014).

Objective.
The aim of this study was to evaluate changes in the use of lumbar fusion procedures following the formation of Accountable Care Organizations (ACOs).

Summary of Background Data.
Within surgical care afforded by ACOs, savings are thought to be realized by improved care coordination as well as reductions in the use of preference-sensitive procedures such as lumbar fusion.

Methods.
We queried fee-for-service claims for patients enrolled in Medicare Part A and B, identifying patients who received lumbar spine fusion, discectomy, or decompression procedures. We performed a difference-in-differences analysis comparing the use of lumbar fusion in ACOs and non-ACOs in the period before (2009–2011) and after (2012–2014) ACO formation. Propensity score adjustment was used to address differences in case-mix. Multivariable logistic regression was used to compare the likelihood of receiving a lumbar fusion in ACOs and non-ACOs in the period before and after ACO formation.

Results.
Within organizations that would form ACOs, the raw rate of lumbar fusion increased from 50% (n = 2183) in 2009 to 2011 to 54% (n = 2283) in 2012 to 2014. Among non-ACOs, the use of fusion increased from 52% (n = 110,160) to 59% (n = 109,917). Adjusted difference in differences in the use of lumbar fusion between ACOs and non-ACOs was -2.6 percentage points (P = 0.13). When limited to patients with spinal stenosis, ACOs significantly reduced the use of fusion (-5.8 percentage points; P = 0.03).

Conclusion.
Our results indicate that ACOs may effectively curtail the use of lumbar fusion procedures, particularly among patients with spinal stenosis. As these interventions are often associated with higher complications and need for reoperation, such practices might accrue additional health care savings for Medicare beyond those realized during the index surgical period.

Level of Evidence: 3
Risk of Surgical Site Infection and Mortality Following Lumbar Fusion Surgery in Patients With Chronic Steroid Usage and Chronic Methicillin-Resistant Staphylococcus aureus Infection
Authors: Singla Anuj , Qureshi Rabia , Chen Dennis Q. , Nourbakhsh Ali , Hassanzadeh Hamid , Shimer Adam L. , Shen Francis H. 
Published: September 2018

Study Design.
A retrospective database analysis among Medicare beneficiaries

Objective.
The aim of this study was to determine the effect of chronic steroid use and chronic methicillin-resistant Staphylococcus aureus (MRSA) infection on rates of surgical site infection (SSI) and mortality in patients 65 years of age and older who were treated with lumbar spine fusion.

Summary of Background Data.
Systemic immunosuppression and infection focus elsewhere in the body are considered risk factors for SSI. Chronic steroid use and previous MRSA infection have been associated with an increased risk of SSI in some surgical procedures, but their impact on the risk of infection and mortality after lumbar fusion surgery has not been studied in detail.

Methods.
The PearlDiver insurance-based database (2005–2012) was queried to identify 360,005 patients over 65 years of age who had undergone lumbar spine fusion. Of these patients, those who had been taking oral glucocorticoids chronically and those with a history of chronic MRSA infection were identified. The rates of SSI and mortality in these two cohorts were compared with an age- and risk-factor matched control cohort and odds ratio (OR) was calculated.

Results.
Chronic oral steroid use was associated with a significantly increased risk of 1-year mortality [OR = 2.06, 95% confidence interval (95% CI) 1.13–3.78, P = 0.018] and significantly increased risk of SSI at 90 days (OR = 1.74, 95% CI 1.33–1.92, P < 0.001) and 1 year (OR = 1.88, 95% CI 1.41–2.01, P < 0.001). Chronic MRSA infection was associated with a significantly increased risk of SSI at 90 days (OR = 6.99, 95% CI 5.61–9.91, P < 0.001) and 1 year (OR = 24.0, 95%CI 22.20–28.46, P < 0.001) but did not significantly impact mortality.

Conclusion.
Patients over 65 years of age who are on chronic oral steroids or have a history of chronic MRSA infection are at a significantly increased risk of SSI following lumbar spine fusion.

Level of Evidence: 3
Epidemiological State, Predictors of Early Mortality, and Predictive Models for Traumatic Spinal Cord Injury
Authors: Shibahashi Keita , Nishida Masahiro , Okura Yoshihiro , Hamabe Yuichi 
Published: September 2018

Study Design.
Multi-center, retrospective cohort study.

Objective.
To determine the epidemiology, identify predictors of early mortality, and develop predictive models for traumatic spinal cord injury (SCI).

Summary of Background Data.
Despite improved initial care and management strategies, traumatic SCI remains a devastating event. Knowledge of the epidemiological state and predictive factors for mortality is important for developing strategies and counseling; however, they have not been adequately investigated, and predictive modeling regarding outcomes remains an underused modality for patients with traumatic SCI.

Methods.
Using a nationwide trauma registry—the Japan Trauma Data Bank—we identified adult (≥18 yrs) patients with SCI between 2004 and 2015. The endpoint was in-hospital mortality. Characteristics of each patient were described. Multivariate logistic regression analyses were performed to identify factors significantly associated with in-hospital mortality and develop a predictive model.

Results.
In total, 236,698 patients were registered in the database. Of the 215,835 adult patients, 8069 (3.7%) had SCI. The majority had SCI at the cervical level with falls at ground level being the primary etiology. Over the study period, median age, the proportion of cervical SCI, and the etiology of falls at ground level increased. The mortality rate was 5.6%. The following eight factors, age, sex, Glasgow Coma Scale on arrival (GCS), hypotension on arrival, bradycardia on arrival, severe head injury, Injury Severity Score (ISS), and neurological severity of SCI, were independently associated with mortality. A predictive model consisting of these variables predicted mortality with area under the receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.86–0.90).

Conclusion.
Over the 12-year period, patient characteristics, etiology, and post-SCI outcomes significantly changed. We identified eight prognostic factors of early mortality. A predictive model including these factors showed excellent performance and may improve treatment strategies, healthcare resource allocation, and counseling.

Level of Evidence: 3
Comparison of Postoperative Outcomes According to Compensatory Changes of the Thoracic Spine Among Patients With a T1 Slope More Than 40°
Authors: Oe Shin , Togawa Daisuke , Yamato Yu , Yoshida Go , Hasegawa Tomohiko , Kobayashi Sho , Yasuda Tatsuya , Banno Tomohiro , Arima Hideyuki , Mihara Yuki , Ushirozako Hiroki , Matsuyama Yukihiro 
Published: September 2018

Study Design.
Retrospective study of postoperative outcomes of adult spinal deformity (ASD) surgery.

Objective.
To clarify the differences in postoperative outcomes depending on the presence or absence of thoracic compensatory changes among patients with a T1 slope (TS) more than 40°.

Summary of Background Data.
Loss correction after ASD surgery is more likely to occur when preoperative TS is more than 40°. When preoperative TS is more than 40°, some cases involve compensatory changes in the thoracic spine and decreased thoracic kyphosis (TK); others involve increased TK without compensatory changes.

Methods.
Seventy-nine patients with TS more than 40° who underwent ASD surgery were enrolled and separated into compensated and noncompensated groups (group C: TK <40°; group NC: TK ≥40°). Radiographic parameters obtained by whole-spine standing x-ray, the Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) questionnaire were assessed.

Results.
There were 41 patients in group C and 38 patients in group NC. Preoperative significant differences in TS did not disappear after surgery (preoperative TS: group C and group NC = 46° and 55°, P < 0.001; just after surgery: group C and group NC = 27° and 40°, P < 0.001; 2 years later: group C and group NC = 34° and 47°, P < 0.001). There were no significant differences in ODI and all domains of the SRS-22 before surgery. However, 2 years after the surgery, ODI (38%), pain (3.5), self-image (3.0), and total (3.2) values of the SRS-22 for group NC were significantly worse than those (28%, 4.0, 3.4, and 3.5, respectively) for group C (P < 0.05).

Conclusion.
Changes in the thoracic spine (TS and TK >40°) result in poor postoperative outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine must be considered. Even when TS is more than 40°, TK less than 40°, and upper instrumented vertebra set to the lower thoracic level result in good postoperative outcomes.

Level of Evidence: 3
Safety and Efficacy of Revision Minimally Invasive Lumbar Decompression in the Ambulatory Setting
Authors: Hirsch Brandon P. , Khechen Benjamin , Patel Dil V. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern 
Published: September 2018

Study Design.
A retrospective analysis.

Objective.
The aim of this study was to investigate differences in perioperative outcomes between patients undergoing revision minimally invasive lumbar spine decompression (MIS LD) in the ambulatory and hospital-based surgical settings.

Summary of Background Data.
Revision LD has been associated with an increased risk of complications compared with primary LD. Furthermore, ambulatory primary LD has been demonstrated to be a safe and viable option in appropriately selected patients. However, there is a paucity of information comparing hospital-based versus ambulatory outcomes in revision LD.

Methods.
A prospectively maintained surgical registry of patients undergoing revision MIS lumbar laminectomy and/or discectomy for degenerative pathology from 2013 to 2017 was retrospectively reviewed. Propensity score matching was performed to adjust for measured confounding variables, including patient age, comorbidity burden as measured by Charlson Comorbidity Index, and preoperative diagnosis. Differences in operative variables, complication rates, pain scores, narcotics consumption, and reoperation rates were assessed using Pearson Chi-squared analysis (categorical) and Student t test (continuous).

Results.
Seventy patients were included, of whom 35 underwent revision MIS LD at a hospital-based center (HBC), and 35 underwent surgery at an ambulatory surgical center (ASC). HBC and ASC patients demonstrated similar postoperative visual analog scale pain scores and hourly narcotics consumption during surgical stay (P < 0.001). ASC patients exhibited a significantly shorter length of stay than hospital-based patients (2.7 vs. 11.6 hours, P < 0.001).

Conclusion.
Patients undergoing revision MIS LD in an ASC demonstrated similar perioperative outcomes as compared to patients undergoing revision MIS LD in a HBC. These results suggest that revision MIS LD can be performed safe and effectively in the ambulatory setting in an appropriately selected surgical population. Further study of patient outcomes following spine surgery performed outside of the traditional hospital setting is crucial, as the delivery of care in the ambulatory setting continues to grow in popularity.

Level of Evidence: 3
Safety of Outpatient Single-level Cervical Total Disc Replacement
Authors: Bovonratwet Patawut , Fu Michael C. , Tyagi Vineet , Ondeck Nathaniel T. , Albert Todd J. , Grauer Jonathan N. 
Published: September 2018

Study Design.
A retrospective cohort comparison study.

Objective.
The aim of this study was to investigate the perioperative adverse event profile of cervical total disc replacement (CTDR) performed as an outpatient relative to inpatient procedure.

Summary of Background Data.
Recent reimbursement changes and a push for safe reductions in hospital stay have resulted in increased interest in performing CTDRs in the outpatient setting. However, there has been a paucity of studies investigating the safety of outpatient CTDR procedures, despite increasing frequency.

Methods.
Patients who underwent single-level CTDR were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Outpatient versus inpatient procedure status was defined by length of stay, with outpatient being less than 1 day. Patient baseline characteristics and comorbidities were compared between the two groups. Propensity score matched comparisons were then performed for 30-day perioperative complications and readmissions between the two cohorts. In addition, perioperative outcomes of outpatient single-level CTDR versus matched outpatient single-level anterior cervical discectomy and fusion (ACDF) cases were compared.

Results.
In total, 373 outpatient and 1612 inpatient single-level CTDR procedures were identified. After propensity score matching was performed to control for potential confounders, statistical analysis revealed no significant difference in perioperative complications between outpatient versus matched inpatient CTDR. Notably, the rate of readmissions was not different between the two groups. In addition, there was no difference in rates of perioperative adverse events between outpatient single-level CTDR versus matched outpatient single-level ACDF.

Conclusion.
The perioperative outcomes evaluated in the current study support the conclusion that, for appropriately selected patients, single-level CTDR can be safely performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient CTDR or outpatient single-level ACDF.

Level of Evidence: 3
Incidence, Risk Factors, and Clinical Implications of Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion
Authors: Bovonratwet Patawut , Fu Michael C. , Tyagi Vineet , Bohl Daniel D. , Ondeck Nathaniel T. , Albert Todd J. , Grauer Jonathan N. 
Published: September 2018

Study Design.
Retrospective study of prospectively collected data.

Objective.
To determine the incidence, timing, risk factors, and clinical implications of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Postoperative hematomas requiring reoperation are rare but potentially catastrophic complications after ACDF. However, there has been a lack of large cohort studies investigating these complications in the ACDF population despite increasing outpatient procedure volume.

Methods.
Patients who underwent ACDF in the 2012 to 2016 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of hematoma requiring reoperation within 30 days postoperatively. Risk factors for this outcome were identified using multivariate regression. Postoperative length of stay, subsequent complications, and mortality were compared between patients who did and did not develop a hematoma requiring reoperation.

Results.
A total of 37,261 ACDF patients were identified, of which 148 (0.40%) developed a hematoma requiring reoperation (95% confidence interval [CI], 0.33%–0.46%). Of the cases that developed this complication, 37% occurred after discharge. Risk factors for the development of hematoma requiring reoperation were multilevel procedures (most notably ≥3 levels, relative risk [RR] = 3.14, 95% CI = 1.86–5.32, P < 0.001), preoperative international normalized ratio >1.2 (RR = 2.85, 95% CI = 1.42–5.71, P = 0.006), lower BMI (notably body mass index ≤24, RR = 2.11, 95% CI = 1.21–3.67, P = 0.008), American Society of Anesthesiologists classification ≥3 (RR = 2.07, 95% CI = 1.47–2.91, P < 0.001), preoperative anemia (RR = 1.71, 95% CI = 1.12–2.63, P = 0.027), and male sex (RR = 1.67, 95% CI = 1.18–2.37, P = 0.004). In addition, patients who developed a hematoma requiring reoperation before discharge had a longer length of stay. Further, those who developed a hematoma requiring reoperation were at higher risk for subsequent ventilator requirement, deep wound infection, pneumonia, and reintubation.

Conclusion.
Postoperative hematoma requiring reoperation occurred in approximately 1 in 250 patients after ACDF. High-risk patients should be closely monitored through the perioperative period.

Level of Evidence: 3
Measurement of the Background Gamma Dose Rates in Houston, Texas: A Descriptive Summary of an Undergraduate Research Mentored Project Performed by Students Underrepresented in the Health Physics Profession
Authors: Ozain-Porterie Anastasia M. , Quach Tommy , Harvey Mark C. 
Published: September 2018

Abstract
Natural background radiations include cosmic, terrestrial, and medical sources. Cosmic radiation is mostly shielded by the magnetic field of the Earth; however, those that penetrate can produce nuclear interactions within the Earth’s atmosphere yielding cosmic ray showers. Terrestrial and medical sources of radioactivity are typically identified through radionuclide-specific decay signatures. Medical sources of radiation mainly result from diagnostic x rays, which attenuate into the environment. These x rays also contribute slightly to background radiation. The purpose of this study was to have students involved with the Texas Southern University (TSU) health physics program measure and report background gamma dose rates in Houston, Texas, using the Canberra InSpectorTM 1000 Digital Hand-Held Multichannel Analyzer. The results were compared with the average gamma dose rate on Earth. Of note, TSU is one of the largest historically black colleges and universities (HBCUs) in the nation and currently boasts the only undergraduate health physics program in Houston. Targeted locations were selected within the I‐610 loop of Houston covering an area of approximately 100 km2. Measurements were performed at nine locations and verified by GPS latitude and longitude coordinates. The dose rate was measured over a 100 m2 area at each location, while spectral analysis was simultaneously performed for natural gamma-emitters. Our results suggest the dose rate averaged over all geographical locations in this study was 0.114 ± 0.001 μSv h−1 and thus, consistent with most literature. The only radionuclide identified in the spectra in all measurements was 40K due to the limited energy resolution of the InSpectorTM 1000.