bluuebunny/crossref_metadata_2025_split huggingface dataset:
LisFranc Fusion
Authors: Jonard Brandon , Wroblewski Andrew , Junko Jeffrey 
Published: July 2019

Summary:
Lisfranc injuries remain a frequently missed pathology and may present as an isolated injury or as a component of a polytrauma case. Weight-bearing films or advanced imaging such as CT may be imperative in identifying or further classifying the injury. Common indications for fusion after lisfranc injury include primarily ligamentous injuries, delayed/chronic presentations, or post-traumatic arthritis, although primary fusion in the setting of acute fracture may be considered as an alternative to open reduction internal fixation techniques. The primary goals of surgery are to provide stability to the midfoot and restoration of the anatomical arch/cascade. The purpose of this video is to demonstrate a technique for tarsometatarsal joint fusion in the setting of acute lisfranc injury. This technique may be used for both ligamentous as well as bony varieties.

Video available at:
http://links.lww.com/JOT/A804
Mediational E-values
Authors: Smith Louisa H. , VanderWeele Tyler J. 
Published: July 2019

Background:
Mediation analysis is a powerful tool for understanding mechanisms, but conclusions about direct and indirect effects will be invalid if there is unmeasured confounding of the mediator–outcome relationship. Sensitivity analysis methods allow researchers to assess the extent of this bias but are not always used. One particularly straightforward technique that requires minimal assumptions is nonetheless difficult to interpret, and so would benefit from a more intuitive parameterization.

Methods:
We conducted an exhaustive numerical search over simulated mediation effects, calculating the proportion of scenarios in which a bound for unmeasured mediator–outcome confounding held under an alternative parameterization.

Results:
In over 99% of cases, the bound for the bias held when we described the strength of confounding directly via the confounder–mediator relationship instead of via the conditional exposure–confounder relationship.

Conclusions:
Researchers can conduct sensitivity analysis using a method that describes the strength of the confounder–outcome relationship and the approximate strength of the confounder–mediator relationship that, together, would be required to explain away a direct or indirect effect.
Renin–Angiotensin–Aldosterone System-based Antihypertensive Agents and the Risk of Colorectal Cancer Among Medicare Beneficiaries
Authors: Htoo Phyo T. , Stürmer Til , Jonsson-Funk Michele , Pate Virginia , Simpson Ross J. , Lund Jennifer L. 
Published: July 2019

Background:
Biologic evidence suggests that angiotensin II may play a role in tumor progression or growth. We compared the short-term colorectal cancer (CRC) risk among initiators of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) versus guideline-recommended clinical alternatives (beta blockers, calcium channel blockers [CCB], and thiazides).

Methods:
We conducted a new-user cohort study on U.S. Medicare beneficiaries aged over 65 years, who initiated antihypertensive monotherapy during 2007–2013 and were free of cancer diagnosis before drug initiation. Follow-up began 6 months postinitiation to allow time for the diagnostic delay. We estimated hazard ratios (HR) with 95% confidence intervals (CI) using propensity score weighted Cox regression, overall and stratified by time since drug initiation, and 5-year cumulative risk differences (RD) using Kaplan–Meier estimator. We assessed the potential for unmeasured confounding using supplemental data from Medicare Current Beneficiary Survey.

Results:
For analyses without censoring for treatment changes, we observed 532 CRC events among 111,533 ACEI/ARB initiators. After a median follow-up of 2.2 years (interquartile range: 1.0–3.7), CRC risk was similar between ACEI/ARB and active comparators, with adjusted HRs of 1.0 (95% CI = 0.85, 1.1) for ACEI/ARB versus beta blockers, 1.2 (95% CI = 0.97, 1.4) for ACEI/ARB versus CCB and 1.0 (95% CI = 0.80, 1.3) for ACEI/ARB versus thiazide. Five-year RDs and as-treated analyses, which censored follow-up at medication changes, produced similar findings.

Conclusions:
Based on real-world antihypertensive utilization patterns in Medicare beneficiaries, our study suggests no association between ACEI/ARB initiation and the short-term CRC risk.
Simple and Rapid Quantification of the Multi-Enzyme Targeting Antifolate Pemetrexed in Human Plasma
Authors: van den Hombergh Erik , de Rouw Nikki , van den Heuvel Michel , Croes Sander , Burger David M. , Derijks Jeroen , van Erp Nielka P. , ter Heine Rob 
Published: July 2019

Background:
Pemetrexed is an antifolate cytostatic drug that targets multiple enzymes involved in folate biosynthesis and is indicated for treatment of non–small-cell lung cancer and malignant pleural mesothelioma. As evidence for an exposure–response/toxicity relationship is accumulating, dose individualization using therapeutic drug monitoring may be a feasible strategy to optimize treatment. The purpose of this study was to develop a simple, sensitive, high-performance liquid chromatography method with UV detection for quantification of pemetrexed levels in human plasma.

Method:
The method involves a simple protein precipitation, followed by ultra-performance liquid chromatography with ultraviolet detection at a wavelength of 254 nm. Pemetrexed was separated using a mobile phase with a linear gradient and a run time of only 7 minutes.

Results:
The assay has been validated over the concentration range 0.25–500 mg/L of pemetrexed. Accuracy for this assay ranged from −4.50% to 1.78%, and the within- and between-run coefficients of variation were <3.57%. Pemetrexed in plasma was proven to be stable for 8 months at −40°C.

Conclusions:
The bioanalytical method we developed proved to be simple, accurate, precise, and fast. This analytical method is successfully in use for therapeutic drug monitoring and will be used for pharmacokinetic studies.
A Unifying Algorithm in Microvascular Reconstruction of Oral Cavity Defects Using the Trilaminar Concept
Authors: Butler Daniel P. , Dunne Jonathan A. , Wood Simon H. , Jallali Navid 
Published: July 2019

Background:
Although many algorithms exist to classify oral cavity defects, they are limited by either considering a single subsite or failing to provide a concise reconstructive algorithm for the breadth of defects. Based upon our experience as a tertiary referral center, a unifying algorithm is presented that guides free flap selection in this heterogenous population.

Methods:
All intraoral defects requiring microvascular reconstruction from February 2012 to August 2018 were reviewed. Defects were classified according to their depth as unilaminar (type U = mucosa only), bilaminar (type B = mucosa and bone), or trilaminar (type T = mucosa, bone, and skin) and the number and side of mucosal zones involved (from 1 to 5). Hard palate defects were considered separately and excluded if part of a wider maxillectomy defect.

Results:
A total of 118 patients were eligible for inclusion in the study. Of type U defects involving 1 mucosal zone, 98% were reconstructed with a radial forearm free flap. Ninety-two percentage of type U defects involving ≥2 mucosal zones were reconstructed with an anterolateral thigh flap. Among type B defects, 86% were reconstructed with a fibula osseocutaneous free flap if less than 4 mucosal zones were involved and 100% reconstructed with an ALT if ≥4 mucosal zones were involved. The algorithm presented was accurate for 93% of the cases. Ninety-eight percentage of patients achieved intelligible speech and 72% returned to a normal diet. Flap success rate was 100%.

Conclusions:
The algorithm presented provides a simple system to guide the reconstruction of oral cavity defects.
High-efficiency Combination Treatment of Submental Neck Fullness
Authors: Cheng Carl K.L. 
Published: July 2019

Background:
Fat accumulation, skin laxity, and muscle contraction cause aging cervical fullness. Combining botulinum toxin to treat muscle contraction, and technique-oriented microfocused ultrasound for skin laxity, can improve cervical fullness without requiring lipolysis. Gel-assisted depth adjustment (GADA) is a depth-targeting, image-guided approach using an appropriate gel volume to precisely heat tissue layers during real-time visualization.

Methods:
A 41-year-old woman presented with moderate submental neck fullness and saggy cheeks. An appropriate gel volume was applied as determined by the targeted tissue layer’s distance from the skin. The submental and submandibular areas received 112 lines of 0.9 J/cm2 microfocused ultrasound with visualization (MFU-V) from a 4.5-mm transducer and 0.3 J/cm2 from a 3-mm transducer to treat the SMAS and dermosubcutis, respectively. For concomitant jowling, these transducers delivered 111 MFU-V lines to the lower cheek. Six units of incobotulinumtoxinA was injected in 1 point at the mandible to modulate hyperactive mentalis muscles. The platysma received 10U of incobotulinumtoxinA per cheek, whereas downturned mouth corners received 4U of incobotulinumtoxinA.

Results:
One-month posttreatment, submentum improvements included changes of the vertical pogonion position, more mandible angularity, and a straighter mandibular line. Anterior chin projection was more pronounced and the pogonion had more inferior displacement, creating a younger appearance in the chin-neck complex. Patients followed-up for 3 months also demonstrated these changes.

Conclusions:
Delivering MFU-V using the GADA technique effectively tightens submental and submandibular soft tissues. When combined with incobotulinumtoxinA, muscles in the chin and perioral area are relaxed. Thus, GADA yields significant clinical improvement and patient satisfaction.
Varicose Vein Treatment by Suction-assisted Shaving Phlebectomy without the Use of Transillumination/Irrigation: A Simple, Quick and Effective Method
Authors: Hsu Honda , Lee Jiunn-Tat 
Published: July 2019

Background:
Traditional management of saphenous vein incompetency is using high ligation and stripping with multiple stab incision phlebectomies for the varicose tributaries. A number of minimally invasive options have been described, each with their own advantages and disadvantages. We describe a new technique using suction-assisted shaving phlebectomy without transillumination and irrigation in the management of varicose veins.

Methods:
All patients that underwent combined conventional high ligation and stripping for saphenous vein insufficiency and suction-assisted shaving phlebectomy for varicose tributaries between 2011 and 2016 was included. They were evaluated with respect to surgical time, number of incisions, complications, and outcomes.

Results:
A total of 232 patients with mean age of 49 years old were included. The mean operation time for combined saphenous stripping and suction-assisted shaving phlebectomy was 29.5 minutes and for suction-assisted shaving phlebectomy was 7.4 minutes. The number of incisions excluding the groin incision was 3 incisions in 38 limbs, 2 incisions in 186 limbs, and 1 incision in 33 limbs. Postoperative complications included 2 (0.8%) skin perforation, 1 cellulitis (0.4%), 2 hematoma (0.8%), 3 saphenous neuropathy (1.2%), 4 skin pigmentation (1.6%), 4 skin depression or irregularities (1.6%), and 3 hypertrophic scarring (1.2%).

Conclusions:
Suction-assisted shaving phlebectomy has the advantage of decreased operating time, fewer surgical incisions, ad decreased scar formation. There is no need to purchase expensive medical equipment. It is a simple and effective procedure with comparable complication rates. This technique aims to replace traditional ambulatory phlebectomy and transilluminated powered phlebectomy.
To Post or Not to Post: Plastic Surgery Practice Marketing, Websites, and Social Media?
Authors: Mess Sarah A. , Bharti Gaurav , Newcott Ben , Chaffin Abigail E. , Van Natta Bruce W. , Momeni Reza , Swanson Scott 
Published: July 2019

Summary:
Social media is beginning to eclipse practice websites and other traditional electronic marketing utilized by plastic surgeons. First, highlights are presented from the relevant electronic marketing literature. Next, this article presents a new case study of how, why, when, and what social media is being used by ASPS members (n = 100). Results suggest a significant disconnect between plastic surgeons and the highest impact platforms reported in the literature such as Instagram, YouTube, Snapchat, and Facebook. Plastic surgeons currently prefer to focus electronic marketing efforts on practice websites over social media platforms. This study suggests that instead of relying on their practice websites to disseminate information, surgeons should be utilizing social media, posting promotions, before-and-after photos, and videos to develop their client base.
The electronic nose technology in clinical diagnosis: A systematic review
Authors: Farraia Mariana Valente , Cavaleiro Rufo João , Paciência Inês , Mendes Francisca , Delgado Luís , Moreira André 
Published: July 2019

Abstract

Background:
Volatile organic compounds (VOC) are end products of human metabolism (normal and disease-associated) that can be mainly excreted in breath, urine, and feces. Therefore, VOC can be very useful as markers of diseases and helpful for clinicians since its sampling is noninvasive, inexpensive, and painless. Electronic noses, or eNoses, provide an easy and inexpensive way to analyze gas samples. Thus, this device may be used for diagnosis, monitoring or phenotyping diseases according to specific breathprints (breath profile).

Objective:
In this review, we summarize data showing the ability of eNose to be used as a noninvasive tool to improve diagnosis in clinical settings.

Methods:
A PRISMA-oriented search was performed in PubMed and Cochrane Library. Only studies performed in humans and published since 2000 were included.

Results:
A total of 48 original articles, 21 reviews, and 7 other documents were eligible and fully analyzed. The quality assessment of the selected studies was conducted according to the Standards for Reporting of Diagnostic Accuracy. Airway obstructive diseases were the most studied and Cyranose 320 was the most used eNose.

Conclusions:
Several case–control studies were performed to test this technology in diverse fields. More than a half of the selected studies showed good accuracy. However, there are some limitations regarding sampling methodology, analysis, reproducibility, and external validation that need to be standardized. Additionally, it is urgent to test this technology in intend-to-treat populations. Thus, it is possible to think in the contribution of VOC analysis by eNoses in a clinical setting.
Pharmacogenomics in clinical care
Authors: Wysocki Kenneth , Seibert Diane 
Published: July 2019

ABSTRACT
Health care designed specifically for a person based on their genetic makeup (“personalized” or “precision” medicine) is expanding rapidly, especially in the area of drug selection. Pharmacogenomic (PGx) testing, when drugs and doses are selected based on an individual's genetic profile, is increasingly being used to guide the selection of drugs or therapies to optimize outcomes and minimize side effects. Based on an individual's genetic blueprint, health care providers now have important information about how a drug is likely to behave in that individual's body. Pharmacogenomic information on drug labels is now available for nearly 250 drugs. Health care organizations are also increasingly making this information available to customers to reduce emergency department visits, improve outcomes (selecting the right chemotherapy doses), and reduce cost. This study reviews some of the challenges and benefits on using PGx testing to improve clinical outcomes.
Tax incentives for preceptors of nurse practitioner students in Massachusetts: A potential solution
Authors: Carelli Katherine Valorie , Gatiba Peris N. , Thompson Linda S. 
Published: July 2019

ABSTRACT
With a growing population, there is an increasing need for nurse practitioners to improve access to health care. There is currently a shortage of nurse practitioner (NP) preceptors across Massachusetts, making clinical placements difficult and at times unachievable. The lack of NP preceptors has a direct impact on student outcomes, educational programs, and ultimately access to care. The authors explored lessons learned about the national scale of this problem and whether Massachusetts should entertain legislative initiatives similar to other states as a solution. Data were collected from the boards of nursing and the national and state chapters of the American Association of Nurse Practitioners regarding current and pending legislation. State and federal sources and the Massachusetts Association of Colleges of Nursing provided statistical and qualitative data on current and future needs for NP preceptors. States that have successfully passed legislation have awarded tax incentives to NP preceptors, although none of the existing regulations have assessed for their effectiveness in improving preceptor availability. Massachusetts may benefit from legislation to improve NP student access to preceptors; however, incentives related to geographical location may best serve both students and the greater population.
Research translation and the evolving PhD and DNP practice roles: A collaborative call for nurse practitioners
Authors: Falkenberg-Olson Ann C. 
Published: July 2019

ABSTRACT
Doctoral prepared nurse practitioners (NPs) are uniquely positioned for responsible leadership as essential members of the health care system and have a professional responsibility to contribute to research and clinical inquiry initiatives that advance health care delivery and improve outcomes. Academic preparation of the Doctor of Philosophy (PhD) and Doctor of Nursing Practice (DNP), although different in focus, offers opportunities for effective collaborations that transcend and integrate the scientific and practice roles of generating data and translating evidence. As health care organizations evolve in managing complexities of providing high-quality care, roles for the PhD as research scientist and DNP as research translation specialist will also evolve to keep pace. Despite this professional calling and global opportunity for research and evidence-based practice (EBP), future NPs and nurses will be challenged with an imminent lack of experts who have the skills needed for data and research generation and evidence translation. This commentary introduces and discusses emerging roles and organizational models for doctoral prepared NPs in research, EBP, quality assurance, and quality improvement projects, offers suggestions for NPs interested in research and clinical inquiry, and seeks to ignite excitement for scientific discovery in NP-driven initiatives. Nurse practitioners are encouraged to take advantage of the many opportunities to shape and expand their careers by engaging in knowledge generation for improving health care outcomes.
Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome—Should We Provide Cochlear Implants Earlier?
Authors: Hall Andrew C. , Kenway Bruno , Sanli Halit , Birman Catherine S. 
Published: July 2019

Objective:
Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center.

Study Design:
Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed.

Setting:
Tertiary referral center.

Patients:
Patients with a diagnosis of LVAS who received a cochlear implant (CI). Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis.

Intervention(s):
Therapeutic.

Main Outcome Measure(s):
: Postoperative speech perception scores.

Results:
Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford-Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98%. Smaller numbers were available for post-CI City University of New York (CUNY) and Consonant-Nucleus-Consonant (CNC) word scores yet similar excellent results were seen.

Conclusions:
Our study results suggest the CI should be considered when BKB scores have dropped to 85%. We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.
Rationale and methods of a randomized clinical trial to compare specific exercise programs versus home exercises in patients with subacromial impingement syndrome
Authors: Gutiérrez-Espinoza Héctor , Araya-Quintanilla Felipe , Zavala-González Jonathan , Gana-Hervias Gonzalo , Martínez-Vizcaino Vicente , Álvarez-Bueno Celia , Cavero-Redondo Iván 
Published: July 2019

Abstract

Background
Subacromial impingement syndrome (SIS) is a common clinical condition with a multifactorial etiology. Currently, there is a great variety of therapeutic exercise modalities aimed at treating SIS. Based on alterations of the glenohumeral and/or dysfunctional scapular kinematics associated with SIS, we hypothesize that the implementation of a specific exercise program with special focus on the correction of muscle deficits should be more effective than nonspecific exercises performed at home. This article describes the rationale and methods of study aimed at testing the effectiveness of specific exercise programs versus home exercises in patients with SIS.

Method/Design
Ninety-four patients between the ages of 18 and 50 years referred to the Physical Therapy department of the Clinical Hospital San Borja Arriaran in Chile will be randomized to 2 treatment arms. The intervention group will receive a program of specific exercises with a duration of 12 weeks, taking as a reference the algorithm of clinical decision proposed by a panel of experts. The control group will receive a program of nonspecific exercises to perform at home. Three evaluations will be performed: before the initiation of treatment, and at the 12-week and 1-year follow-up. The primary outcome measure will be the shoulder function by the Constant-Murley questionnaire, and the secondary outcome measures will be the upper extremity function by the Disabilities of the Arm, Shoulder and Hand questionnaire, and pain by the visual analog scale.

Discussion
This article reports the design of a randomized clinical trial aimed at assessing the effectiveness of a specific exercise program versus home exercises in patients with SIS.

Trial registration
Brazilian registry of clinical trials UTN number U1111-1204-0268. Registered 27 September 2017.