bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infiltration Techniques for Local Infiltration Analgesia With Liposomal Bupivacaine in Extracapsular and Intracapsular Hip Fracture Surgery: Expert Panel Opinion
Authors: Amin Nirav H. , Hutchinson Hank L. , Sanzone Anthony G. 
Published: July 2018

Background:
Liposomal bupivacaine (LB) has demonstrated efficacy in improving pain scores and reducing opioid consumption across a variety of surgical settings, including orthopaedic surgery. However, meticulous infiltration techniques combined with a multimodal approach are important to optimizing outcomes.

Methods:
A panel of 4 orthopaedic surgeons and 3 anesthesiologists convened on April 1, 2017, to discuss current practices and develop a consensus statement regarding local infiltration analgesia with LB for extracapsular and intracapsular hip fracture surgery, including LB infiltration techniques.

Results:
Optimizing surgical outcomes with LB in hip fracture surgery requires an understanding of the neuroanatomy of the surgical site and the pharmacology of the drug. Meticulous infiltration technique is critical to achieve optimal results with LB given its viscosity and reduced diffusion compared with bupivacaine HCl. For extracapsular procedures, a total injection volume of 120 mL is recommended, whereas intracapsular procedures typically require a lower volume (∼80 mL). In both cases, infiltration is best achieved using a 22-gauge needle and applying a tracking and/or fanning technique. To ensure optimal placement, LB should be infiltrated using multiple, small-volume (1- to 5-mL) injections spaced at 1.0-cm intervals.

Conclusions:
These consensus recommendations regarding LB infiltration techniques can serve as a resource for designing clinical studies to evaluate outcomes using periarticular infiltration of LB in extracapsular and intracapsular hip fracture surgery as part of a multimodal pain management approach.

Level of Evidence:
Level V.
Multimodal Pain Strategies Including Liposomal Bupivacaine for Isolated Acetabular Fracture Surgery
Authors: Langworthy Michael J. , Sanzone Anthony G. 
Published: July 2018

Background:
The incidence of isolated acetabular fractures has been increasing, particularly in older adult patients. These fractures can be debilitating and may require prolonged immobilization and/or complex surgical reconstruction. Liposomal bupivacaine (LB) is a prolonged-release form of bupivacaine demonstrated to be effective in orthopaedic surgery. Defining a multimodal pain management plan, which incorporates optimized techniques for use of LB in acetabular surgery, may improve outcomes for patients.

Methods:
Two orthopaedic surgeons specializing in orthopaedic traumatology discussed best practices for infiltration of LB and recommendations for perioperative use of LB plus other anesthetics/analgesics for isolated acetabular fracture surgery.

Results:
Consensus techniques for isolated posterior and anterior acetabular fractures were developed. LB (266 mg/20 mL) should be expanded with 50 mL of bupivacaine HCl 0.25% and saline to a total volume of 120 or 300 mL for the posterior or anterior techniques, respectively. A 3.5-inch spinal needle is inserted tangentially, infiltrating 1 mL/cm into the fracture site, periosteum, muscle fascia, subcutaneous tissue, and skin. Patients receive acetaminophen, celecoxib, gabapentin, and opioids before surgery, adjusting appropriately for patient comorbidities and potential drug–drug interactions. At the end of the surgery, before closure, LB is infiltrated and patients receive a dose of intravenous acetaminophen. Presurgical medications are continued after surgery for approximately 10–14 days, after which opioids are only considered to treat breakthrough pain.

Conclusions:
These recommendations can be used to optimize and streamline care for patients with isolated acetabular fractures and act as a foundation for additional clinical research.

Level of Evidence:
Therapeutic Level V.
Comparison of the Pain Sensitivity Questionnaire and the Pain Catastrophizing Scale in Predicting Postoperative Pain and Pain Chronicization After Spine Surgery
Authors: Tuna Turgay , Boz Sibel , Van Obbergh Luc , Lubansu Alphonse , Engelman Edgard 
Published: July 2018

Study Design:
This was a prospective study evaluating the Pain Sensitivity Questionnaire (PSQ) in 110 patients undergoing spine surgery.

Objective:
The purpose of this study was to compare the ability of the PSQ-total and PSQ-minor scores with the Pain Catastrophizing Scale (PCS) in predicting the immediate postoperative pain of patients after spinal surgery and their risk of developing a chronically painful state.

Summary of Background Data:
Studies evaluating the PSQ as a preoperative determinant for the development of chronic pain are lacking. Therefore, we undertook the following study.

Materials and Methods:
Patients undergoing lumbar or cervical spine surgery were prospectively included in the study. The PSQ-total and PSQ-minor, the PCS and its subscores, the Oswestry Disability Index (ODI) and the Neck Disability Index were used preoperatively. Preoperative and postoperative Visual Analog Scale scores for pain at rest and movement and analgesics were recorded. At 12 months postoperatively, the Neck Disability Index and the ODI were once more assessed to evaluate pain chronicization.

Results:
A total of 110 patients scheduled to undergo surgery at our spine center participated in the study. Our results highlighted that Visual Analog Scale scores were increased for high catastrophizers at rest on the first postoperative day when compared with low catastrophizers. Preoperative use of opioids and a high score on the rumination subscale of the PCS were linked to greater postoperative morphine consumption. At 12 months, the PCS, the PSQ-total, and PSQ-minor showed correlations with the development of a chronically painful state for ODI scores >21, indicating a marked persistent disability.

Conclusions:
Both PSQ and PCS showed an ability to predict a chronically painful state as defined by the persistence of disability after lumbar surgery.
Why a P-Value is Not Enough
Authors: Solla Federico , Tran Antoine , Bertoncelli Domenico , Musoff Charles , Bertoncelli Carlo M. 
Published: July 2018

Background:
All doctors know that P-value<0.05 is “the Graal,” but publications require further parameters [odds ratios, confidence interval (CI), etc.] to better analyze scientific data.

Aim:
The aim of this study was to present P-values, CI, and common effect-sizes (Cohen d, odds ratio, and various coefficients) in a simple way.

Description:
The P-value is the probability, when the null hypothesis is true (eg, no difference or no association), of obtaining a result equal to or more extreme than what we actually observed. Simplistically, P-value quantifies the probability that the result is due to chance. It does not measure how big the association or the difference is. The CI on a value describes the probability that the true value is within a given range. A 95% CI means that the CI covers the true value in 95 of 100 performed studies. The test is significant if the CI does not include the null hypothesized difference or association (eg, 0 for difference). The effect-sizes are quantitative measures of the strength of a difference or association. If the P-value is <0.05 but the effect size is very low, the test is statistically significant but probably, clinically not so.

Conclusions:
Scientific publications require more parameters than a P-value. Statistical results should also include effect sizes and CIs to allow for a more complete, honest, and useful interpretation of scientific findings.
Acupuncture-Associated Mycobacterium goodii Infection of Prosthetic Knee Joint
Authors: Kruse Jason P. , Lewis Roshan J. , Smith Hayden L. , Taylor Matthew J. 
Published: July 2018

Abstract

Mycobacterium goodii is rarely associated with prosthetic joint infections. We report a case of M. goodii septic arthritis in an adult with a prosthetic knee–associated diagnosis subsequent to acupuncture. In patients with prosthetic joint replacements receiving acupuncture therapy, one should consider avoiding insertions near these joints.
Left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation reduces the development of long-term muscle pain
Authors: Seminowicz David A. , de Martino Enrico , Schabrun Siobhan M. , Graven-Nielsen Thomas 
Published: July 2018

Abstract
The left dorsolateral prefrontal cortex (DLPFC) is involved in the experience and modulation of pain, and may be an important node linking pain and cognition. Repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC can reduce chronic and experimental pain. However, whether left DLPFC rTMS can influence the development of chronic pain is unknown. Using repeated intramuscular injection of nerve growth factor to induce the development of sustained muscle pain (lasting weeks), 30 healthy individuals were randomized to receive 5 consecutive daily treatments of active or sham left DLPFC rTMS, starting before the first nerve growth factor injection on day 0. Muscle soreness and pain severity were collected daily for 14 days and disability on every alternate day. Before the first and 1 day after the last rTMS session, anxiety, depression, affect, pain catastrophizing, and cognitive performance on the attention network test were assessed. Left DLPFC rTMS treatment compared with sham was associated with reduced muscle soreness, pain intensity, and painful area (P < 0.05), and a similar trend was observed for disability. These effects were most evident during the days rTMS was applied lasting up to 3 days after intervention. Depression, anxiety, pain catastrophizing, and affect were unchanged. There was a trend toward improved cognitive function with rTMS compared with sham (P = 0.057). These data indicate that repeated left DLPFC rTMS reduces the pain severity in a model of prolonged muscle pain. The findings may have implications for the development of sustained pain in clinical populations.
The sliding set-point: how insulin and diet interact to explain the obesity epidemic (and how to fix it)
Authors: Gower Barbara A. , Goss Amy M. 
Published: July 2018

Purpose of review
The current approach to weight loss (intentional energy deficit) is difficult to implement and sustain, and rarely leads to successful long-term weight loss maintenance. The aim of this article is to review recent literature on the role of insulin in obesity propensity, and by extension, the effectiveness of carbohydrate restriction in facilitating weight loss, with particular attention to individual variability in patient response.

Recent findings
A genetic signature for insulin secretion predisposes to elevated BMI. A genetic signature for insulin resistance is a marker for impaired fat storage, is associated with relative leanness, and predisposes to cardiometabolic disease. The largest randomized weight-loss trial ever conducted to examine insulin/diet interactions revealed no interactive effect of insulin phenotype with diet composition on body weight in the context of energy restriction. However, smaller studies revealed unique effects of carbohydrate restriction on energy partitioning that are not reflected in body weight; that is, preferential loss of total and ectopic adipose tissue. Carbohydrate-restricted diets are associated with greater adherence, and with greater total and resting energy expenditure.

Summary
For patients with a predisposition to high insulin secretion, carbohydrate restriction may facilitate long-term reductions in body fat, perhaps by reducing hunger, maintaining energy expenditure, and promoting adherence.
The anteromedial thigh free flap: a primary reconstructive option or second best?
Authors: Hoshal Steven G. , Bewley Arnaud F. 
Published: July 2018

Purpose of reviewThis article reviews the recent literature on the anteromedial thigh free flap.Recent findingsThe anteromedial thigh (AMT) free flap is an excellent reconstructive option for head and neck defects. It is often overshadowed by the anterolateral thigh (ALT) free flap. Lack of familiarity with the anatomy of the AMT likely deters many surgeons from considering it as a reliable option. However, as many as one in 20 patients may not have anatomy suitable for ALT free-flap harvest, and in these cases the AMT provides an ideal alternative as it can be harvested through the same incision without added morbidity. Current areas of research include clinical, anatomic, cadaveric, and radiographic studies evaluating the AMT flap anatomy and utility.SummaryThe AMT flap has been successfully used to reconstruct the same types of soft tissue head and neck defects as the ALT. However, given that approximately 95% of patients appear to have anatomy favorable to harvest an ALT, the utility of the AMT should be reserved for patients with unfavorable lateral thigh anatomy or when when a chimeric flap is indicated and anatomy permits.
Medical management of aortic disease in children with Marfan syndrome
Authors: Lindsay Mark E. 
Published: July 2018

Purpose of review
Marfan syndrome (MFS) is the most common cause of aortic aneurysm in children and is associated with premature mortality. Whereas surgical therapy remains the primary treatment to prevent aortic complications, medical therapy may slow or prevent aortic growth. Pediatricians and pediatric cardiologists should become familiar with the diagnosis and management of MFS. This review focuses on the medical management for the most important life-threatening manifestation of MFS, thoracic aortic disease.

Recent findings
Several large-scale clinical trials and one meta-analysis have been reported comparing angiotensin receptors blockers with the standard therapy, beta blockers.

Summary
From the assembled evidence described in this review, beta blockers and angiotensin receptors blockers show clinical equivalence and either class of agent may be an appropriate choice for the medical management of aortic growth in children with MFS.
Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork
Authors: Grubaugh Martha L. , Flynn Linda 
Published: July 2018

OBJECTIVE
The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units.

BACKGROUND
Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup.

METHODS
Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables.

RESULTS
Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup.

CONCLUSION
Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.
Exploring the Relationship Between Nursing Specialty Certification and Surgical Site Infections
Authors: Bergquist-Beringer Sandra , Cramer Emily , Potter Catima , Stobinski James X. , Boyle Diane K. 
Published: July 2018

OBJECTIVE
The aim of this study is to explore the relationship between nursing specialty certification and surgical site infections (SSIs) for colon (COLO) and abdominal hysterectomy (HYST) surgical procedures.

BACKGROUND
SSI following COLO and HYST procedures is a preventable complication now included in the Centers for Medicare & Medicaid Services’ Hospital Inpatient Quality Reporting Program.

METHODS
Data from 69 hospitals, 346 units, and 6585 RNs participating in the National Database of Nursing Quality Indicators and SSI data on 22 188 patient COLO and HYST procedures from the National Healthcare Safety Network were examined in multivariate logistic regression analysis.

RESULTS
Magnet® status was associated with lower SSI occurrence after adjusting for other variables. Higher American Society of Anesthesiologists scores, longer surgical procedure time, and wound class were associated with higher SSI occurrence.

CONCLUSIONS
Future theory-based research should examine the association of nursing specialty certification with patient outcomes and investigate the effect of Magnet status on SSI.
Engagement in HIV Care Among Young Female Sex Workers in Zimbabwe
Authors: Napierala Sue , Chabata Sungai Tafadzwa , Fearon Elizabeth , Davey Calum , Hargreaves James , Busza Joanna , Mushati Phillis , Mtetwa Sibongile , Chiyaka Tarisai , Mugurungi Owen , Hanisch Dagmar , Hatzold Karin , Phillips Andrew , Cowan Frances M. 
Published: July 2018

Introduction:
Young female sex workers (FSWs) are at greater HIV risk than their older counterparts. Yet, the extent of their engagement with HIV services is largely unknown. We compared engagement among FSWs aged 18–24 years with those 25 years and older.

Methods:
We used respondent-driven sampling to recruit FSWs from 14 communities in Zimbabwe from November to December 2013. We collected data on demographics, behavior, service uptake, and HIV and viral load testing. Data were pooled and weighted using respondent-driven sampling-2 estimation. We analyzed HIV care cascade variables by age group. To identify potential drivers of younger FSW service use, we explored factors associated with knowing one's HIV status.

Results:
Among 2617 participants, mean age was 31 years and 26% were 18–24 years. Over half of FSWs initiated sex work before the age of 25 years. Overall HIV prevalence was 59% but was lower among younger FSWs (35% vs 67%, P < 0.01). Younger HIV-infected FSWs were significantly less engaged at each step of the care cascade. Among younger FSWs reporting antiretroviral therapy use, 62% had an undetectable viral load compared with 79% in older FSWs. In multivariable regression, young FSWs encouraged to have an HIV test by another FSW (adjusted odds ratio = 2.54; 95% confidence interval: 1.44 to 4.50), and those with no recent clients (adjusted odds ratio = 4.31; 95% confidence interval: 1.30 to 14.33) were more likely to report knowing their status.

Conclusions:
The high proportion of FSWs initiating sex work before the age of 25 years and their lower engagement in HIV services highlights the importance of considering this vulnerable population in HIV programming. Implementing targeted services tailored to the unique needs of young FSWs is a public health imperative.
Unusual Case of Metastatic Intracranial Hemangiopericytoma and Emphasis on Role of 68Ga-PSMA PET in Imaging
Authors: Patro Kanhu Charan , Palla Madhuri , Kashyap Raghava 
Published: July 2018

Abstract
We present a 53 year old woman initially diagnosed as hemangiopericytoma in the posterior fossa on the right side post excision with immunohistochemistry staining for CD34 being positive. Presently, the patient had difficulty in walking due to back pain and pain in left arm. Imaging with 18F-FDG PET showed low glucose avidity in disease sites but 68Ga-PSMA PET unequivocally demonstrated multiple skeletal and liver metastases with intense PSMA avidity. Patient received palliative radiotherapy to bone metastasis and was planned for chemotherapy. This report adds to the list of applications of 68Ga PSMA PET and a possible theranostic target.
Amiodarone-Induced Thyrotoxicosis
Authors: Censi Simona , Bodanza Valentina , Manso Jacopo , Gusella Sara , Watutantrige-Fernando Sara , Cavedon Elisabetta , Barollo Susi , Bertazza Loris , Cecchin Diego , Mian Caterina 
Published: July 2018

Purpose of the Report
Distinguishing between amiodarone-induced thyrotoxicosis (AIT) caused by excessive hormone synthesis (AIT-1) or by a destructive process (AIT-2) has important therapeutic implications, but is still difficult and debated. 99mTc-sestaMIBI thyroid scintigraphy (99m-STS) has been proposed as a tool for classifying the two forms.

Material and Methods
30 AIT patients (11 females and 19 males) who underwent 99m-STS were retrospectively assessed for the present study. For each patient, a target-to-background ratio (TBR) was obtained on planar images. The TBR was then correlated with the qualitative assessment of the scans and the final clinical diagnosis.

Results
Considering clinical response to treatment as the gold standard for differential diagnosis, 14 cases of AIT-1, 12 of AIT-2, and 4 mixed forms were identified. 99m-STS was able to qualitatively identify all the mixed forms, while 1/14 AIT-1 and 6/12 AIT-2 cases were misdiagnosed as mixed forms. When the quantitative index (the TBR) was compared with the final clinical diagnosis, ROC curve analysis enabled us to identify an IBR of 0.482 during 99m-STS as a cut-off capable of discriminating between AIT-1 and AIT-2, with 100% specificity and 91.7% sensitivity (P < 0.0001, area under the curve: 0.982).

Conclusions
Taking the TBR into consideration, 99m-STS proved a very useful tool for distinguishing AIT-1 from AIT-2, and thus offering patients appropriate treatment as of their diagnosis. This approach can avoid pointless and potentially dangerous combined overtreatments, and may speed up the return to normal thyroid function, which is crucial in AIT patients suffering from heart disease.
68Ga-NOTA-RM26 PET/CT in the Evaluation of Breast Cancer
Authors: Zang Jie , Mao Feng , Wang Hao , Zhang Jingjing , Liu Qingxing , Peng Li , Li Fang , Lang Lixin , Chen Xiaoyuan , Zhu Zhaohui 
Published: July 2018

Background
This prospective pilot study investigated the value of 68Ga-NOTA-RM26, an antagonist targeting gastrin-releasing peptide receptor, in evaluation of breast cancer.

Methods
Thirty-five women in suspicion of breast cancer based on mammography or ultrasonography were recruited with informed consent. They underwent PET/CT scans 30 minutes after intravenous injection of 68Ga-NOTA-RM26 in a dose of 1.85 MBq (0.05 mCi) per kilogram body weight within 1 week before surgery. The 68Ga-NOTA-RM26 uptake was correlated with the pathological and immunohistochemical findings.

Results

68Ga-NOTA-RM26 positivity was found correlated with estrogen receptor (ER) expression (P = 0.006) and menstrual status (P = 0.019). In 34 patients diagnosed with breast cancer, the SUVmax was found significantly higher in the ER-positive breast cancer (4.97 ± 1.89) than in the ER-negative breast cancer (2.78 ± 0.65, P < 0.001). 68Ga-NOTA-RM26 was also found accumulated in normal breast tissue, with the SUVmax significantly higher in patients at the secretory phase of menstrual cycle (2.27 ± 0.71) than in those at the nonsecretory phase (1.59 ± 0.49, P = 0.017) and postmenopause (1.43 ± 0.44, P = 0.002). If the secretory phase patients were excluded, the sensitivity, specificity, and accuracy for differentiation of breast cancer from breast tissue increased from 85.3%, 86.8%, and 86.1% to 100%, 90.9%, and 95.5%, respectively.

Conclusions
This pilot study indicates that the diagnostic accuracy of 68Ga-NOTA-RM26 PET/CT in breast cancer may correlate with ER expression and menstrual status of the patient. It may be better to avoid performing this examination during the menstrual secretory phase to reduce physiological uptake in normal breast tissue.