bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Course of Orofacial Pain and Jaw Disability After Whiplash Trauma
Authors: Lampa Ewa , Wänman Anders , PhD Erik Nordh , Stålnacke Britt-Marie , Häggman-Henrikson Birgitta 
Published: September 2019

Study Design.
Prospective cohort study.

Objective.
The aim of this study was to evaluate the course of orofacial pain and jaw disability in relation to neck pain, neck disability, and psychosocial factors at the acute stage and the chronic stage after whiplash trauma.

Summary of Background Data.
Many individuals report chronic pain in the orofacial region after whiplash trauma. The possible association between whiplash trauma and orofacial pain is debated. Prospective studies are therefore needed to evaluate the development of orofacial pain after whiplash trauma.

Methods.
Within 1 month following a whiplash trauma, 176 cases were examined and compared to 116 controls with questionnaires concerning neck and jaw pain and related disability, nonspecific physical symptoms and depression. At the 2-year follow-up, 119 cases (68%) and 104 controls (90%) were re-examined.

Results.
Compared to controls, cases reported more jaw and neck pain, both at baseline and follow-up. A majority (68%) of cases with pain in the jaw region in the acute stage also reported jaw pain at the follow-up. The intensity of jaw and neck pain was correlated both at baseline and follow-up. Both neck pain and jaw pain were correlated to nonspecific physical symptoms and to depression.

Conclusion.
Orofacial pain and jaw disability related to neck pain are often present already at the acute stage after whiplash trauma and persist into the chronic stage for most individuals. Assessment following whiplash trauma should therefore include both the neck and the orofacial regions. More studies are needed to further evaluate risk factors for development of orofacial pain after whiplash trauma.

Level of Evidence: 3
The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes
Authors: Protopsaltis Themistocles S. , Ramchandran Subaraman , Tishelman Jared C. , Smith Justin S. , Neuman Brian J. , Jr Gregory M. Mundis , Lafage Renaud , Klineberg Eric O. , Hamilton D. Kojo , LaFage Virginie , Gupta Munish C. , Hart Robert A. , Schwab Frank J. , Burton Douglas C. , Bess Shay , Shaffrey Christopher I. , Ames Christopher P. 
Published: September 2019

Study Design.
Retrospective review of a prospectively collected database.

Objective.
To define a simplified singular measure of cervical deformity (CD), C2 slope (C2S), which correlates with postoperative outcomes.

Summary of Background Data.
Sagittal malalignment of the cervical spine, defined by the cervical sagittal vertical axis (cSVA) has been associated with poor outcomes following surgical correction of the deformity. There has been a proliferation of parameters to describe CD. This added complexity can lead to confusion in classifying, treating, and assessing outcomes of CD surgery.

Methods.
A prospective database of CD patients was analyzed. Inclusion criteria were cervical kyphosis>10°, cervical scoliosis>10°, cSVA>4 cm, or chin-brow vertical angle >25°. Patients were categorized into two groups and compared based on whether the apex of the deformity was in the cervical (C) or the cervicothoracic (CT) region. Radiographic parameters were correlated to C2S, T1 slope (T1S) and 1-year health-related quality-of-life outcomes as measured by the EuroQol 5 Dimension questionnaire (EQ5D), modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and the Neck Disability Index (NDI).

Results.
One hundred four CD patients (C = 74, CT = 30; mean age 61 yr, 56% women, 42% revisions) were included. CT patients had higher baseline cSVA and T1S (P < 0.05). C2S correlated with T1 slope minus cervical lordosis (TS-CL) (r = 0.98, P < 0.001) and C0-C2 angle, cSVA, CL, T1S (r = 0.37–0.65, P < 0.001). Correlation of cSVA with C0-C2 was weaker (r = 0.48, P < 0.001). At 1-year postoperatively, higher C2S correlated with worse EQ-5D (r = 0.28, P = 0.02); in CT patients, higher C2S correlated with worse NDI, modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and EQ5D (all r > 0.5, P≤0.05). Using linear regression, moderate disability by EQ5D corresponded to C2S of 20°(r2 = 0.08). For CT patients, C2S = 17° corresponded to moderate disability by NDI (r2 = 0.4), and C2S = 20° by EQ5D (r2 = 0.25).

Conclusion.
C2S correlated with upper-cervical and subaxial alignment. C2S correlated strongly with TS-CL (R = 0.98, P < 0.001) because C2S is a mathematical approximation of TS-CL. C2S is a useful marker of CD, linking the occipitocervical and cervico-thoracic spine. C2S defines the presence of a mismatch between cervical lordosis and thoracolumbar alignment. Worse 1-year postoperative C2 slope correlated with worse health outcomes.

Level of Evidence: 3
Understanding Thoracic Spine Morphology, Shape, and Proportionality
Authors: Lafage Renaud , Steinberger Jeremy , Pesenti Sebastien , Assi Ayman , Elysee Jonathan C. , Iyer Sravisht , Lenke Lawrence G. , Schwab Frank J. , Kim Han Jo , Lafage Virginie 
Published: September 2019

Study Design.
Retrospective review.

Objective.
The aim of this study was to describe thoracic kyphosis (TK) in a normal asymptomatic population and to evaluate the association between TK magnitude and its shape.

Summary of Background Data.
Understanding spinal anatomy requires a three-dimensional appreciation of the spine's shape, morphology, and proportions. The customary definition of TK is the angle between T4 and T12. However, little is known on the actual shape of TK in adults.

Methods.
Asymptomatic volunteers were recruited; demographic data along with full-body standing radiographs were recorded. Radiographic data such as T1–12 and T4–12 angles were collected. Maximum TK and vertebral orientation/tilt were also collected, in addition to cumulative TK and Centered Kyphosis at T7. The cohort was stratified by T1–12 value (<40°, 40°–60°, and>60°) and comparisons and regressions were performed afterward.

Results.
One hundred nineteen subjects were included (average age 50.8 yrs, 81 female). Mean T1–12 kyphosis was 49.5°, mean T4–12 kyphosis 41.5°, and mean maximum TK was 52.6°. T1 was the most anteriorly tilted vertebra, L1 the most posteriorly tilted; T7 was horizontal, independently of T1–12 value or age. Cumulative kyphosis analysis revealed that the apex of kyphosis was located at T6-T7. Regression analysis predicting the value and the percentage of T1–7 both yielded T1–12 as a predictor (Adj. r2 = 0.32, Adj. r2 = 0.13).

Conclusion.
Changes in kyphosis distribution in an asymptomatic population suggest that TK is not a simple circle arc: with low TK, 2/3 of the kyphosis is located in the upper part and when TK increases, the distribution of kyphosis will be symmetric around T7. It is possible to predict the amount of kyphosis in the upper part using total kyphosis value. This could help estimate preoperative compensation and predict reciprocal change.

Level of Evidence: 3
Pelvic Compensation in Sagittal Malalignment
Authors: Beyer George , Khalifé Marc , Lafage Renaud , Yang Jingyan , Elysee Jonathan , Frangella Nicholas , Steinmetz Leah , Ge David , Varlotta Christopher , Stekas Nicholas , Manning Jordan , Protopsaltis Themistocles , Passias Peter , Buckland Aaron , Schwab Frank , Lafage Virginie 
Published: September 2019

Study Design.
Single-center retrospective study.

Objective.
Investigate how differing degrees of pelvic incidence (PI) modulate the recruitment of pelvic tilt (PT) in response to similar amounts of sagittal malalignment as measured by T1-Pelvic Angle (TPA).

Summary of Background Data.
Past research has shown that some patients do not recruit PT in response to sagittal malalignment. Given the anatomic relationship between PI and PT, we sought to determine whether differing PI is associated with variable recruitment of PT.

Methods.
Single-center retrospective study of 2077 patients undergoing full body radiographs and TPA>10°. Five groups of patients (Very Low, Low, Average, High, and Very High PI) were defined utilizing PI ranges on a Gaussian distribution. Linear regression (LR) evaluated correlation of TPA to PT within each PI group. Multivariate LR evaluated whether correlation between TPA and PT differed between each PI group.

Results.
Mean PT increased with increasing levels of PI (P < 0.05). Within the full cohort, PT correlated with TPA (r = 0.80, P < 0.001). Multivariate LR revealed significant differences between slopes and intercepts of the linear relationship between PT and TPA within the PI groups. Compared with patients with an average PI, patients with Very Low PI had 3.4° lower PT while holding TPA constant (P < 0.001). Further, patients with Very High PI displayed a PT of 1.9° higher than patients with an Average PI while holding TPA constant (P = 0.01). A similar difference of −1.8°, and 1.2° with respect to the Average PI group was observed in the Low and High PI groups, respectively (P < 0.001). Means and standard deviations of PT at varying levels of TPA were defined for PI groups.

Conclusion.
This is the first study which demonstrated that PI is associated with varied recruitment of PT while maintaining constant sagittal malalignment. The results reported herein are intended to allow surgeons to assess a patient's magnitude of compensatory PT for an individual patient's PI.

Level of Evidence: 3
Utilization of Predictive Modeling to Determine Episode of Care Costs and to Accurately Identify Catastrophic Cost Nonwarranty Outlier Patients in Adult Spinal Deformity Surgery
Authors: Ames Christopher P. , Smith Justin S. , Gum Jeffrey L. , Kelly Michael , Vila-Casademunt Alba , Burton Douglas C. , Hostin Richard , Yeramaneni Samrat , Lafage Virginie , Schwab Frank J. , Shaffrey Christopher I. , Bess Shay , Pellisé Ferran , Serra-Burriel Miquel 
Published: September 2019

Study Design.
Retrospective review of prospectively-collected, multicenter adult spinal deformity (ASD) database.

Objective.
The aim of this study was to evaluate the rate of patients who accrue catastrophic cost (CC) with ASD surgery utilizing direct, actual costs, and determine the feasibility of predicting these outliers.

Summary of Background Data.
Cost outliers or surgeries resulting in CC are a major concern for ASD surgery as some question the sustainability of these surgical treatments.

Methods.
Generalized linear regression models were used to explain the determinants of direct costs. Regression tree and random forest models were used to predict which patients would have CC (>$100,000).

Results.
A total of 210 ASD patients were included (mean age of 59.3 years, 83% women). The mean index episode of care direct cost was $70,766 (SD = $24,422). By 90 days and 2 years following surgery, mean direct costs increased to $74,073 and $77,765, respectively. Within 90 days of the index surgery, 11 (5.2%) patients underwent 13 revisions procedures, and by 2 years, 26 (12.4%) patients had undergone 36 revision procedures. The CC threshold at the index surgery and 90-day and 2-year follow-up time points was exceeded by 11.9%, 14.8%, and 19.1% of patients, respectively. Top predictors of cost included number of levels fused, surgeon, surgical approach, interbody fusion (IBF), and length of hospital stay (LOS). At 90 days and 2 years, a total of 80.6% and 64.0% of variance in direct cost, respectively, was explained in the generalized linear regression models. Predictors of CC were number of fused levels, surgical approach, surgeon, IBF, and LOS.

Conclusion.
The present study demonstrates that direct cost in ASD surgery can be accurately predicted. Collectively, these findings may not only prove useful for bundled care initiatives, but also may provide insight into means to reduce and better predict cost of ASD surgery outside of bundled payment plans.

Level of Evidence: 3
Engaging Faith for Spiritual Fitness
Authors: Busby Steven 
Published: September 2019

ABSTRACT:
The experience of going from a student nurse to a working registered nurse can be quite an adjustment. Once the newness of the first job wears off, graduate nurses may be prone to unexpected burnout and compassion fatigue. The purpose of this article is to help student nurses recognize ways to engage their faith to lay the foundation for spiritual fitness and to plan for the spiritual care they will need to have a long, impactful, and satisfying career.
Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms
Authors: Goldhammer Hilary , Crall Cary , Keuroghlian Alex S. 
Published: September 2019

Abstract
As transgender and gender-diverse people are gaining increased visibility in clinical settings, clinicians are requesting better guidance on providing affirming care to improve the mental health and well-being of these patients. In particular, more direction is needed on whether, when, and how to diagnose and treat borderline personality disorder among gender minorities, partially in response to beliefs among some mental health clinicians that a gender minority identity may be a manifestation of identity diffusion. In this Perspectives article, we argue that gender minority identity, even when fluid, is rarely a sign of identity diffusion. By taking a careful history of a patient’s gender identity development, the clinician can clarify and gain more conviction regarding the presence of a patient’s gender minority identity. Moreover, multiple stigma-related stressors experienced by gender minorities may produce symptoms and behaviors that can mimic or be consistent with certain diagnostic criteria for borderline personality disorder. We therefore conclude with recommendations for adopting a gender-affirming framework to treat borderline personality symptoms when present among gender minority patients, with implications for future research and practice.
Endocarditis and bacterial brain abscess in a young woman with a single atrium, patent ductus arteriosus, and Eisenmenger syndrome
Authors: Wang Wuwan , Feng Panpan , Wang Lu , Dong Qian , Huang Wei 
Published: September 2019

Abstract

Rationale:
A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection.

Patient concern and diagnoses:
We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment.

Intervention:
Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her.

Outcomes:
The patient presented a relatively good outcome during follow-up for >6 months.

Lessons:
This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.
Only one-third of hepatocellular carcinoma cases are diagnosed via screening or surveillance: a systematic review and meta-analysis
Authors: Zhao Changqing , Xing Feng , Yeo Yee Hui , Jin Michelle , Le Richard , Le Michael , Jin Mingjuan , Henry Linda , Cheung Ramsey , Nguyen Mindie H. 
Published: September 2019

Background/objects
Early hepatocellular carcinoma diagnosis is associated with better long-term survival. Studies of at-risk patients who are monitored in routine practice have reported an overall adherence rate to hepatocellular carcinoma screening/surveillance of approximately 60% and suboptimal diagnostic efficacy of the current screening/surveillance tools. However, it is unclear how many hepatocellular carcinoma patients were actually diagnosed via screening/surveillance given these obstacles. Therefore, via a systematic review of PubMed and Scopus databases from 2000 to 2019, we aimed to identify the proportion of patients with hepatocellular carcinoma diagnosed via screening/surveillance in routine practice.

Methods
We included original research articles of studies of patients already diagnosed with hepatocellular carcinoma that reported the proportion of hepatocellular carcinoma diagnosed via screening/surveillance.

Results
The study included 60 studies and 50 554 hepatocellular carcinoma cases. The pooled proportion of hepatocellular carcinoma diagnosed by screening/surveillance was 37% (95% confidence interval: 31%–44%) and differed by geographic region (North America/Asia/Europe/Oceania/Africa/South America, 31%/42%/41%/30%/29%/47%, P = 0.017, respectively) and by surveillance interval (<12 months 39% vs. 12 months 19%, P < 0.01) but not by disease etiology, cirrhosis status, clinical setting, practice setting, hepatocellular carcinoma diagnosis period, or surveillance method.

Conclusion
Globally, hepatocellular carcinoma was diagnosed via screening/surveillance in less than half of the patients (37%) regardless of healthcare setting or liver disease etiology and without improvement over time despite several recent guideline updates. Research is needed to understand the barriers to screening/surveillance to include medical as well as social and cultural influences.
Exploring the Lived Experiences of Staff Nurses Transitioning to the Nurse Manager Role
Authors: Pilat Melissa , Merriam Deborah H. 
Published: September 2019

OBJECTIVE
The objective of this study was to discover the experience of nurse managers (NMs) who had transitioned from a staff nurse position

BACKGROUND
Nurses who become NMs may receive little or no training or support during the transition process. This study sought to gain the perspective of NMs who transitioned into the role.

METHODS
A phenomenology method was used to interview 10 NMs regarding their experience of transitioning into the NM role. Meleis Role Transition theory provided the theoretical framework.

RESULTS
Five themes were identified that related to the research questions: expectations, essential knowledge and skills, graduate education prepared, sought support and mentoring from colleagues, and role mastery not possible. Participants experienced role insufficiency due to lack of support and resources.

CONCLUSIONS
Further research is needed to understand nurses' experience after completing an NM developmental program, contributing to role mastery.
Vaccination Capability Inventory of Community, Migrant, and Homeless Health Centers: A Survey Report
Authors: Lewis Joy H. , Whelihan Kate , Roy Debosree , White Earla J. , Morgan Christine , Vora Rupal S. , Boyle Kimberly R. , Luebbering Corey , Bay R. Curtis , Lindley Megan C. 
Published: September 2019

Context:
Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults.

Program:
We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations.

Implementation:
A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018.

Evaluation:
A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided.

Discussion:
Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.
Antipruritic Placebo Effects by Conditioning H1-antihistamine
Authors: Meeuwis Stefanie H. , van Middendorp Henriët , Pacheco-Lopez Gustavo , Ninaber Maarten K. , Lavrijsen Adriana P.M. , van der Wee Nic , Veldhuijzen Dieuwke S. , Evers Andrea W.M. 
Published: September 2019

ABSTRACTObjectiveAllergic rhinitis symptoms can be reduced by behaviorally conditioning antihistamine. It is unclear whether these findings extend to histamine-induced itch or work when participants are informed about the conditioning procedure (open-label conditioning). The current study aims to investigate the efficacy of (open-label) antipruritic behavioral conditioning for histamine-induced itch.MethodsHealthy participants (n= 92; 84% female) were randomized to I) an open-label conditioned, II) closed-label conditioned, III) conditioned-not-evoked control, or IV) nonconditioned control group. A two-phase conditioning paradigm was used. During acquisition, a conditioned stimulus (CS; distinctively tasting beverage) was repeatedly paired with the H1-antihistamine levocetirizine (groups I–III). During evocation, the CS was paired with placebo (I, II), or instead of the CS, water was paired with placebo (III). The nonconditioned control group (IV) received CS with placebo in both phases. Itch after histamine iontophoresis and physiological data (i.e., spirometry, heart rate, skin conductance) were assessed. Combined conditioned and combined control groups were first compared, and analyses were repeated for separate groups.ResultsMarginally lower itch was reported in the combined conditioned compared with the control groups (F(1,88) = 2.10,p= .076, η2partial= 0.02); no differences between separate groups were found. No effects on physiological data were found, except for heart rate, which reduced significantly and consistently for control groups, and less consistently for conditioned groups (group by time interaction:F(7,80) = 2.35,p= .031, η2partial= 0.17).ConclusionLimited support was found for the efficacy of antipruritic behavioral conditioning, regardless of whether participants were informed about the conditioning procedure. The application of open-label conditioning in patient populations should be further researched.Trial Registration:www.trialregister.nl; ID NTR5544.