bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult Spinal Deformity Surgery in Patients With Movement Disorders
Authors: Varshneya Kunal , Azad Tej D. , Pendharkar Arjun V. , Desai Atman , Cheng Ivan , Karikari Isaac , Ratliff John K. , Veeravagu Anand 
Published: September 2019

Study Design.
This was a retrospective study using national administrative data from the MarketScan database.

Objective.
To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery.

Summary of Background Data.
Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown.

Methods.
The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls.

Results.
A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay.

Conclusion.
Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders.

Level of Evidence: 3
Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments
Authors: Oliveira Indiara Soares , Vanin Adriane Aver , Pena Costa Leonardo Oliveira , Medeiros Flávia Cordeiro , Ananias Oshima Renan Kendy , Inácio Angela Augusto , Matos da Cunha Thayane Araújo , Palomo Andressa Santos , Fukuda Thiago Yukio , de Freitas Diego Galace , Benvenuto Fernando , Menezes Costa Lucíola da Cunha 
Published: September 2019

Study Design.
A cross-sectional study.

Objective.
The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST).

Summary of Background Data.
LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries.

Methods.
This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire.

Results.
A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP.

Conclusion.
Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis.

Level of Evidence: 2
Selecting the Last Substantially Touching Vertebra as Lowest Instrumented Vertebra in Lenke type 2A-R and 2A-L Curves
Authors: Qin Xiaodong , He Zhong , Yin Rui , Qiu Yong , Zhu Zezhang 
Published: September 2019

Study Design.
A retrospective study.

Objective.
The aim of this study was to determine whether the last substantially touching vertebra (LSTV) can be selected as the optimal lowest instrumented vertebra (LIV) for Lenke 2A adolescent idiopathic scoliosis (AIS) with different lumbar modifiers (2A-R and 2A-L) and to investigate its relationship with the distal adding-on.

Summary of Background Data.
Previous studies have documented good outcomes in Lenke 1A curve when LSTV was selected as LIV.

Methods.
A total of 101 female patients were included with a minimum of 2-year follow-up after selective posterior surgery. Patients were classified on the basis of the direction of L4 tilt: 2A-L and 2A-R. Patients with LSTV-1, LSTV, or LSTV+1 selected as LIV were assigned to three groups. Factors associated with adding-on were analyzed through comparison among the three groups.

Results.
The level of LSTV was more distal in the 2A-R group than that in the 2A-L group (P = 0.011). Distal adding-on was observed in 24 patients (23.8%). In the 2A-R curves, 26.1% patients were found to have adding-on. The incidence of adding-on was significantly higher in LSTV-1 than LSTV or LSTV+1 group. Logistic regression analysis showed the distance between LIV and LSTV (LIV-LSTV <0) was the independent factor associated with adding-on (odds ratio [OR] = 8.7, 95% confidence interval [CI] = 3.1–45.5, P = 0.011). In the 2A-L curves, 21.8% patients were found to have adding-on. The incidence of adding-on was significantly lower in LSTV+1 than LSTV-1 or LSTV group. Similarly, logistic regression showed the distance between LIV and LSTV (LIV-LSTV ≤0) had significant association with adding-on (OR = 11.9, 95% CI = 2.5–53.2, P = 0.009).

Conclusion.
The distance between LIV and LSTV was a significant factor associated with adding-on for both 2A-R and 2A-L patients. The rule of selecting LIV should be different between 2A-R and 2A-L curves. We recommend to extend the fusion level to LSTV in 2A-R curve and to LSTV+1 in 2A-L curve to avoid distal adding-on.

Level of Evidence: 3
Periapical-dropout Screws Strategy For 3-Dimensional Correction of Lenke 1 Adolescent Idiopathic Scoliosis in Patients Treated by Posterior Spinal Fusion
Authors: Lertudomphonwanit Thamrong , Jain Viral V. , Sturm Peter F. , Patel Saral 
Published: September 2019

Study Design:
This was a single-center, retrospective study.

Objective:
The objective of this study was to compare periapical-dropout screws strategy (PDSS) with traditional-multilevel pedicle screws strategy (TMSS) for 3-plane correction of Lenke 1 adolescent idiopathic scoliosis deformity.

Summary of Background Data:
There are limited data in 3-plane correction and the optimal pedicle screw (PS) configuration for Lenke 1 adolescent idiopathic scoliosis surgery.

Materials and Methods:
Sixty-one consecutive patients with Lenke 1 curves (range: 50–80 degrees), undergoing single-stage posterior spinal fusion with PS fixation, were included. Patients with a minimum follow-up of 1 year were divided into 2 groups according to PS strategy. The PDSS group included 33 patients with PS placement bilaterally at both ends and apex of the construct. The TMSS group included 28 patients with conventional PS placement. Baseline, immediate, and last follow-up demographic, radiographic, and clinical outcomes were analyzed. Radiographic outcomes were assessed in axial (using rib index and apical vertebral rotation using Raimondi ruler and Upasani methods), coronal, and sagittal planes. The implant costs were also evaluated.

Results:
There were no differences in demographic, preoperative radiographic parameters and levels fused. The number of PSs per level fused was significantly lower in the PDSS group (1.3 vs. 1.4; P=0.0002). At last follow-up, major Cobb correction averaged 79% for the PDSS group and 69.5% for the TMSS group (P=0.001). T2–T12 kyphosis angle changes were 1 degree in the PDSS group and −2.5 degrees in the TMSS group (P=0.35). Rib index correction was 28.2% for the PDSS group and 17.7% for the TMSS group (P=0.02). Upasani grade apical vertebral rotation was significantly better in the PDSS group (0.7 vs. 1.4; P=0.0001). Clinical outcomes evaluated by Scoliosis Research Society-30 scores were similar in both groups. Total implant costs were significantly lower in the PDSS group ($16,852 vs. $18,926; P<0.001).

Conclusion:
The PDSS construct provides better deformity correction in all 3 planes and helps decrease implant costs compared with the TMSS construct. Thus, the PDSS construct can be considered as a rational strategy and cost-effective technique when treating moderate Lenke 1 curves with posterior spinal fusion.
Impact of K-Line (–) in the Neck-Flexion Position on Patient-reported Outcomes After Cervical Laminoplasty For Patients With Ossification of the Posterior Longitudinal Ligament
Authors: Kimura Atsushi , Shiraishi Yasuyuki , Sugawara Ryo , Inoue Hirokazu , Endo Teruaki , Takeshita Katsushi 
Published: September 2019

Study Design:
This study was a post hoc analysis of prospective data.

Objective:
The objective of this study was to investigate whether K-line (–) in the neck-flexion position [f-K-line (–)] affects patient-reported outcome measures after cervical laminoplasty for patients with ossification of the posterior longitudinal ligament (OPLL).

Summary of Background and Data:
The f-K-line was recently proposed as a predictor of poor outcomes after laminoplasty for patients with OPLL. However, its impact on patient-reported outcome measures remains to be elucidated.

Patients and Methods:
We analyzed prospectively collected data from 68 patients with cervical myelopathy due to OPLL who underwent double-door laminoplasty between 2008 and 2015. Patients were categorized into f-K-line (–) and f-K-line (+) groups on a baseline neck-flexion radiograph. Outcome measures included the Japanese Orthopaedic Association score, EuroQol 5-Dimensional Questionnaire, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and 11-point Numerical Rating Scale for pain. The degree of satisfaction with the outcome was assessed at the 2-year follow-up using a 7-point Numerical Rating Scale.

Results:
Of the 68 patients, 22 (32%) and 46 (68%) were grouped into the f-K-line (–) and f-K-line (+) groups, respectively. The 2 groups showed no significant difference in baseline functions. The f-K-line (–) group showed a significantly lower recovery rate of the Japanese Orthopaedic Association score and a significantly lower gain in EuroQol 5-Dimensional Questionnaire score than compared with the f-K-line (+) group at the 2-year follow-up. Among the 5 domains of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, cervical function, and upper extremity function were significantly lower in the f-K-line (–) group than in the f-K-line (+) group. Patients in the f-K-line (–) group also reported a significantly higher pain intensity in the upper and lower extremities and a significantly lower degree of satisfaction compared with those in the f-K-line (+) group.

Conclusion:
The f-K-line (–) was significantly associated with poorer functional recovery, higher pain intensity in the extremities, and lower patient satisfaction after cervical laminoplasty for patients with OPLL.
Relationship between arterial stiffness and unattended or attended blood pressure values
Authors: Paini Anna , Aggiusti Carlo , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , de Ciuceis Carolina , Sacca’ Giovanni , Verzeri Laura , Gatta Roberto , Rosei Enrico Agabiti , Muiesan Maria Lorenza , Salvetti Massimo 
Published: September 2019

Background and method:
Measurement of ‘unattended’ blood pressure (BP) may reduce or eliminate the ‘white-coat effect’. Despite the possible advantages of this approach for BP measurement, only few studies analysed the relationship between unattended BP and cardiovascular events or with hypertension-mediated organ damage (HMOD). The aim of our study was to evaluate the relationship between ‘attended’ or ‘unattended’ BP values and carotid-femoral pulse wave velocity (PWV) in 285 individuals undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre. Unattended BP (measured with the patient alone in the room, with an oscillometric device programmed to perform three BP measurements, at 1-min intervals, after 5 min) and attended BP were measured with the same device, on the same day of the measurement of PWV, in a random order.

Results:
Mean age was 63 ± 13 years, mean BMI 26 ± 4, 47% were women, 76% had hypertension (55% treated). Systolic unattended BP was lower than attended SBP (124.4 ± 14.3 vs. 130.9 ± 16.1 mmHg). PWV was similarly correlated with attended and unattended SBP values (r = 0.428 and r = 0.404, P < 0.0001, respectively). No difference for the prediction of increased arterial stiffness was observed at receiver operator curves (ROCs) analysis [attended SBP area under the curve (AUC) 0.665, 95% confidence interval (95% CI) 0.607–0.720 vs. unattended SBP: AUC 0.651, 95% CI 0.593–0.706, P for the comparison = ns].

Conclusion:
Attended and unattended BP values are similarly correlated with PWV, the gold standard measure of arterial stiffness. These findings may provide further information on the clinical value of unattended BP.
Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs
Authors: Katon Jodie G. , Bossick Andrew S. , Doll Kemi M. , Fortney John , Gray Kristen E. , Hebert Paul , Lynch Kristine E. , Ma Erica W. , Washington Donna L. , Zephyrin Laurie , Callegari Lisa S. 
Published: September 2019

Background:
Minimally invasive hysterectomy for fibroids decreases recovery time and risk of postoperative complications compared with abdominal hysterectomy. Within Veterans Affair (VA), black women with uterine fibroids are less likely to receive a minimally invasive hysterectomy than white women.

Objective:
To quantify the contributions of patient, facility, temporal and geographic factors to VA black-white disparity in minimally invasive hysterectomy.

Research Design:
A cross-sectional study.

Subjects:
Veterans with fibroids and hysterectomy performed in VA between October 1, 2012 and September 30, 2015.

Measures:
Hysterectomy mode was defined using ICD-9 codes as minimally invasive (laparoscopic, vaginal, or robotic-assisted) versus abdominal. The authors estimated a logistic regression model with minimally invasive hysterectomy modeled as a function of 4 sets of factors: sociodemographic characteristics other than race, health risk factors, facility, and temporal and geographic factors. Using decomposition techniques, systematically substituting each white woman’s characteristics for each black woman’s characteristics, then recalculating the predicted probability of minimally invasive hysterectomy for black women for each possible combination of factors, we quantified the contribution of each set of factors to observed disparities in minimally invasive hysterectomy.

Results:
Among 1255 veterans with fibroids who had a hysterectomy at a VA, 61% of black women and 39% of white women had an abdominal hysterectomy. Our models indicated there were 99 excess abdominal hysterectomies among black women. The majority (n=77) of excess abdominal hysterectomies were unexplained by measured sociodemographic factors beyond race, health risk factors, facility, and temporal or geographic trends.

Conclusion:
Closer examination of the equity of VA gynecology care and ways in which the VA can work to ensure equitable care for all women veterans is necessary.
The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
Authors: Park Sungchul , Stimpson Jim P. , Pintor Jessie K. , Roby Dylan H. , McKenna Ryan M. , Chen Jie , Ortega Alexander N. 
Published: September 2019

Objectives:
We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites).

Research Design:
Using 2003–2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach.

Results:
After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year).

Conclusions:
Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.
Who Will be the Costliest Patients? Using Recent Claims to Predict Expensive Surgical Episodes
Authors: Chhabra Karan R. , Nuliyalu Ushapoorna , Dimick Justin B. , Nathan Hari 
Published: September 2019

Introduction:
Surgery accounts for almost half of inpatient spending, much of which is concentrated in a subset of high-cost patients. To study the effects of surgeon and hospital characteristics on surgical expenditures, a way to adjust for patient characteristics is essential.

Design:
Using 100% Medicare claims data, we identified patients aged 66–99 undergoing elective inpatient surgery (coronary artery bypass grafting, colectomy, and total hip/knee replacement) in 2014. We calculated price-standardized Medicare payments for the surgical episode from admission through 30 days after discharge (episode payments). On the basis of predictor variables from 2013, that is, Elixhauser comorbidities, hierarchical condition categories, Medicare’s Chronic Conditions Warehouse (CCW), and total spending, we constructed models to predict the costs of surgical episodes in 2014.

Results:
All sources of comorbidity data performed well in predicting the costliest cases (Spearman correlation 0.86–0.98). Models on the basis of hierarchical condition categories had slightly superior performance. The costliest quintile of patients as predicted by the model captured 35%–45% of the patients in each procedure’s actual costliest quintile. For example, in hip replacement, 44% of the costliest quintile was predicted by the model’s costliest quintile.

Conclusions:
A significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data. By adjusting for patient factors, this will facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.
Is Perceived Stigma in Clinical Settings Associated With Poor Health Status Among New York City’s Residents of Color?
Authors: De Prabal , Pozen Alexis , Budhwani Henna 
Published: September 2019

Objectives:
Our objectives were to assess rates of perceived stigma in health care (clinical) settings reported by racially diverse New York City residents and to examine if this perceived stigma is associated with poorer physical and mental health outcomes.

Methods:
We analyzed data from the 2016 New York City Community Health Survey. We applied bivariable and multivariable methods to assess rates of perceived stigma, and perceived stigma’s statistical relationship with health care access, physical health status, and mental health status controlling for sociodemographics and health insurance status.

Results:
Perceived stigma was associated with poorer health care access [odds ratio (OR)=7.07, confidence interval (CI)=5.32–9.41), depression (OR=3.80, CI=2.66–5.43), diabetes (OR=1.86, CI=1.36–2.54), and poor overall general health (OR=0.43, CI=0.33–0.57). Hispanic respondents reported the highest rate of perceived stigma among racial and ethnic minority groups (mean=0.07, CI=0.05–0.08).

Conclusions:
We found that perceived stigma in health care settings was a potential barrier to good health. Prior studies have illustrated that negative health outcomes are common for patients who avoid or delay care; thus, the unfortunate conclusion is that even in a diverse, heterogeneous community, stigma persists and may negatively affect well-being. Therefore, eliminating stigma in clinical settings should be a top priority for health care providers and public health professionals seeking to improve health equity.
HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services
Authors: Pourat Nadereh , Chen Xiao , Lee Christopher , Zhou Weihao , Daniel Marlon , Hoang Hank , Sharma Ravi , Sim Hwa , Sripipatana Alek , Nair Suma 
Published: September 2019

Background:
Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration–funded health centers (HRSA HCs).

Objective:
We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians.

Research Design:
We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians.

Sample:
We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population.

Measures:
Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders.

Results:
We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs.

Conclusions:
HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.