bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Analysis of Utilization of Epidural Procedures in Managing Chronic Pain in the Medicare Population
Authors: Manchikanti Laxmaiah , Soin Amol , Mann Dharam P. , Bakshi Sanjay , Pampati Vidyasagar , Hirsch Joshua A. 
Published: July 2018

Study Design.
A retrospective cohort study of utilization patterns of epidural injections.

Objective.
The aim of this study was to assess patterns of utilization and variables of in chronic spinal pain in the fee-for-service (FFS) Medicare population, with a comparative analysis of pre- and post-Affordable Care Act (ACA) data from 2000 to 2009 and 2009 to 2016.

Summary of Background Data.
Over the years, utilization of interventional pain management techniques, specifically epidural injections have increased creating concern over costs and public health policy.

Methods.
The master data from the Centers for Medicare & Medicaid Services (CMS) physician/supplier procedure summary from 2000 to 2016 was utilized to assess utilization patterns. The descriptive analysis of the database analysis was performed using guidance from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Multiple variables were analyzed based on the procedures, specialties, and geography.

Results.
Caudal and lumbar interlaminar epidural injections decreased 25% from 2009 to 2016 with an annual decrease of 4% in contrast to lumbosacral transforaminal epidural injection episodes, increasing at an annual rate of 0.3%. In contrast, lumbar interlaminar epidural injections increased 2.4% annually, while transforaminal episodes increased 23% from 2000 to 2009. The ratio of interlaminar epidural injections to transforaminal epidural injection episodes has changed from 7 in 2000 to 1 in 2016, whereas ratio of services changed from 5 to 0.7. From 2009 to 2016, cervical/thoracic interlaminar epidural injections episodes increased at an annual rate of 0.5%, with a decrease of 2.3% for transforaminal epidural injections.

Conclusion.
Comparative analysis of the utilization of epidural injections from 2000 to 2009 and 2009 to 2016 showed vast differences with overall significant decreases in utilization, specifically for lumbar interlaminar and caudal epidural injections, with a continued, though greatly slowed increase of lumbosacral transforaminal epidural injections.

Level of Evidence: 3
Risk Factors for Positive Cultures in Presumed Aseptic Revision Spine Surgery
Authors: Steinhaus Michael E. , Salzmann Stephan N. , Lovecchio Francis , Shifflett Grant D. , Yang Jingyan , Kueper Janina , Sama Andrew A. , Girardi Federico P. , Cammisa Frank P. , Hughes Alexander P. 
Published: July 2018

Study Design.
Retrospective case-control study.

Objective.
To report culturing patterns and results in the setting of presumed aseptic revision spinal surgery.

Summary of Background Data.
The indications for obtaining cultures in revision spinal surgery remain unclear in the absence of a definitive diagnosis of infection. Culture results and risk factors for having positive cultures in this setting have not been previously studied.

Methods.
We retrospectively reviewed 595 consecutive revision spine surgeries performed by four senior spine surgeons between 2008 and 2013. Preoperative workup revealed the diagnosis of infection in 17 cases which were excluded from review. The remaining 578 presumed aseptic cases were included. Univariate and multivariate analyses were performed to identify variables associated with obtaining cultures and risk factors for positive cultures.

Results.
Cultures were obtained in 112 (19.4%) cases and were positive in 40.2%. Pseudarthrosis was the most common revision diagnosis when cultures were obtained (49.1%) and Propionibacterium acnes was the most common organism isolated from positive cultures (48.8%). Regarding culture results, multivariate analysis demonstrated that male sex (odds ratio [OR] = 3.4) and pseudarthrosis (OR = 4.1) were significantly associated with having positive cultures while fusion procedures (OR = 0.3) were negatively correlated, with area under the curve (AUC) 0.71.

Conclusion.
Unexpected positive cultures occurred commonly and P. acnes was the predominant isolated organism. Male sex, pseudarthrosis, and non-fusion cases predicted positive cultures. Considering these results, we recommend cultures be obtained in revision cases for pseudarthrosis, even in the setting of negative infectious work-up preoperatively.

Level of Evidence: 4
Comparison of Patient Reported Outcome Measurement Information System With Neck Disability Index and Visual Analog Scale in Patients With Neck Pain
Authors: Moses Michael J. , Tishelman Jared C. , Stekas Nicholas , Jevotovsky David S. , Vasquez-Montes Dennis , Karia Raj , Errico Thomas , Buckland Aaron , Protopsaltis Themistocles S. 
Published: July 2018

Study Design.
A retrospective analysis of a patient-reported outcomes database from a single institution from December 2016 to April 2017.

Objective.
To validate the association of Patient Reported Outcome Measurement Information System (PROMIS) with Neck Disability Index (NDI) in patients with neck pain and examine each instruments ability to capture concomitant arm pain and concomitant back pain.

Summary of Background Data.
PROMIS has been increasingly utilized and its computer adapted testing methodology improves assessment of pain and disability. However, literature is lacking regarding how these instruments perform in neck pain patients with concomitant arm pain or back pain.

Methods.
Inclusion criteria were age >18 years and a primary complaint of neck pain. The NDI; Visual Analog Scale (VAS) back, neck, arm, and leg; and PROMIS physical function, pain intensity, and pain interference questionnaires were administered. Propensity score matching was performed to compare patients with high and low back and arm pain by controlling for neck pain. Bivariate correlations and independent samples t tests were performed to assess linear relationships and compare back and arm pain groups with PROMIS.

Results.
Approximately, 130 patients were included. NDI correlated strongly to PROMIS physical function (r = −0.771, P < 0.001), pain intensity (r = 0.605, P < 0.001), and pain interference (r = 0.786, P < 0.001). VAS neck and arm pain also correlated to the PROMIS pain intensity instrument (VAS neck: r = 0.642, P < 0.001; VAS arm: r = 0.376, P < 0.001).
After matching for neck pain, the high and low back pain groups each included 32 patients. There were significant differences in PROMIS physical function when high and low back pain groups were compared (39.07 vs. 43.68, P = 0.031). No significant difference was found for any outcome metric for high and low arm pain groups.

Conclusion.
PROMIS instruments are capable of characterizing pain and disability in patients with neck pain and are sensitive to disability in regions adjacent to the neck.

Level of Evidence: 3
Real-World Effectiveness of Physical Therapy for Common Neck Pain Diagnoses
Authors: Divi Srikanth N. , Eleswarapu Ananth S. , Stout Christopher E. , Lee Michael J. 
Published: July 2018

Study Design:
Retrospective cohort study (Level of evidence—3).

Objective:
The objective of this study was to investigate the real-life effectiveness of physical therapy (PT) for patients initially presenting with common neck pain diagnoses.

Summary of Background Data:
Neck pain is a common cause of morbidity and a leading cause of disability in the United States. PT is prescribed as a first-line treatment for the vast majority of patients with neck pain; however, there is limited literature supporting the effectiveness of these treatments.

Methods:
A total of 1554 patients enrolled in PT for the nonoperative treatment of neck pain were included in the study. Three primary patient-reported outcome (PRO) measures [neck disability index (NDI), resting numeric pain rating scale (NPRS), and activity NPRS] were recorded before and at conclusion of therapy. Improvement was noted if patients met a threshold value for a minimal clinically important difference (MCID). Bivariate analysis using a χ2 test and multiple logistic regression analysis were performed to determine risk factors predictive of treatment failure.

Results:
About 40.5% of patients achieved MCID for NDI with an average change of −6.31 points. For resting NPRS and activity NPRS scores, 50.6% and 52.1% of patients achieved MCID with an average change of −1.93 and −2.36, respectively. After multiple logistic regression analysis, worker’s compensation status was found to be an independent predictor for treatment failure in all groups; whereas, Medicare status was found predictive of achieving MCID in the activity NPRS group.

Conclusions:
We observed that up to half of the patients analyzed met the minimum criteria for improvement in neck pain with respect to the PRO measures, suggesting that real-life effectiveness of PT for common neck pain diagnoses may approach 50%.
REVERSIBLE RETINAL TOXICITY IN A PATIENT TAKING AXITINIB
Authors: Jenkins Thomas L. , Aderman Christopher M. , Ho Allen C. 
Published: July 2018

Purpose:
Axitinib (Inlyta, New York, NY) is a kinase inhibitor indicated for the treatment of advanced renal cell carcinoma after failure of one previous systemic therapy. A case of bilateral retinal hemorrhages and cotton wool spots associated with axitinib is reported.

Methods:
A 62-year-old woman with a 4-year history of renal cell carcinoma with metastases was treated with axitinib at a maximum oral daily dose of 8 mg. Soon after beginning higher dose therapy, she developed blurred vision, floaters, and photopsias.

Results:
Funduscopic examination of both eyes revealed cotton wool spots and retinal hemorrhages that improved with cessation of therapy.

Conclusion:
Axitinib may be associated with microangiopathic retinal toxicity.
Macular Vessel Density and Ganglion Cell/Inner Plexiform Layer Thickness and Their Combinational Index Using Artificial Intelligence
Authors: Park Keunheung , Kim Jinmi , Lee Jiwoong 
Published: July 2018

Purpose:To evaluate the relationship between macular vessel density and ganglion cell to inner plexiform layer thickness (GCIPLT) and to compare their diagnostic performance. We attempted to develop a new combined parameter using an artificial neural network.Methods:A total of 173 subjects: 100 for the test and 73 for neural net training. The test group consisted of 32 healthy, 33 early, and 35 advanced glaucoma subjects. Macular GCIPLT and vessel density were measured using Spectralis optical coherence tomography and Topcon swept-source optical coherence tomography, respectively. Various regression models were used to investigate the relationships between macular vessel density and GCIPLT. A multilayer neural network with one hidden layer was used to determine a single combined parameter. To compare diagnostic performance, we used the area under the receiver operating characteristic curve (AUROC).Results:Correlation analyses in all subjects showed a significant correlation between macular vessel density and GCIPLT in all sectors (r=0.27 to 0.56; allPs≤0.006). The fitness of linear, quadratic, and exponential regression models showed clinically negligible differences (Akaike’s information criterion=714.6, 713.8, and 713.3, respectively) and were almost linear. In differentiating normal and early glaucoma, the diagnostic power of macular GCIPLT (AUROC=0.67 to 0.81) was much better than that of macular vessel density (AUROC=0.50 to 0.60). However, when vessel density information was incorporated into GCIPLT using the neural network, the combined parameter (AUROC=0.87) showed significantly enhanced diagnostic performance than all sectors of macular vessel density and GCIPLT (allPs≤0.043).Conclusions:Macular vessel density was significantly decreased in glaucoma patients and showed an almost linear correlation with macular GCIPLT. The diagnostic performance of macular vessel density was much lower than that of macular GCIPLT. However, when incorporated into macular GCIPLT using an artificial neural network, the combined parameter showed better performance than macular GCIPLT alone.
Contextual influences in decoding pain expressions: effects of patient age, informational priming, and observer characteristics
Authors: Hampton Amy J. D. , Hadjistavropoulos Thomas , Gagnon Michelle M. 
Published: July 2018

Abstract
We aimed to examine the effects of contextual factors (ie, observers' training background and priming texts) on decoding facial pain expressions of younger and older adults. A total of 165 participants (82 nursing students and 83 nonhealth professionals) were randomly assigned to one of 3 priming conditions: (1) information about the possibility of secondary gain (misuse); (2) information about the frequency and undertreatment of pain in the older adult (undertreatment); or (3) neutral information (control). Subsequently, participants viewed 8 videos of older adults and 8 videos of younger adults undergoing a discomforting physical therapy examination. Participants rated their perception of each patient's pain intensity, unpleasantness, and condition severity. They also rated their willingness to help, sympathy level, patient deservingness of financial compensation, and how negatively/positively they feel towards the patient (ie, valence). Results demonstrated that observers ascribed greater levels of pain and other indicators (eg, sympathy and help) to older compared with younger patients. An interaction between observer type and patient age demonstrated that nursing students endorsed higher ratings of younger adults' pain compared with other students. In addition, observers in the undertreatment priming condition reported more positive valence towards older patients. By contrast, priming observers with the misuse text attenuated their valence ratings towards younger patients. Finally, the undertreatment prime influenced observers' pain estimates indirectly through observers' valence towards patients. In summary, results add specificity to the theoretical formulations of pain by demonstrating the influence of patient and observer characteristics, as well as informational primes, on decoding pain expressions.
Genetic predisposition in pancreatitis
Authors: Gonska Tanja 
Published: July 2018

Purpose of review
Genetic mutations are the primary cause for acute recurrent (ARP) and chronic pancreatitis in children. Further, our medical approach for many diseases is changing from a one-drug therapy to more individualized therapeutic strategies. In respect to the therapeutic management of ARP/chronic pancreatitis, this entails an understanding of the individual, mainly genetic, risk factors that led to pancreatitis disease.

Recent findings
New pancreatitis-associated genes are continuously emerging from increasingly large genetic cohort studies. Furthermore, newer research findings demonstrate that multiple genetic and nongenetic factors are required to increase the individual risk for developing ARP/chronic pancreatitis. Last, there is new exciting development towards targeted pancreatitis therapy in the future.

Summary
This review introduces the current concept of ARP/chronic pancreatitis as a complex disease caused by multiple genetic and nongenetic factors. This warrants careful evaluation of these patients and ideally consultation of a pancreas expert to help understand individual genetic risk profiles and to provide more effective patient consultation.
Effectiveness of Video-Assisted Debriefing in Simulation-Based Health Professions Education
Authors: Zhang Hui , Mörelius Evalotte , Goh Sam Hong Li , Wang Wenru 
Published: July 2018

Background
Debriefing helps learners to gain knowledge through guided reflection and discussion. Video-assisted debriefing (VAD) refers to adding video review during the debriefing process.

Purpose
This review evaluated the effectiveness of VAD on learners' reactions, learning, and behavior compared with verbal debriefing (if possible) and identified its effective elements.

Methods
A structured search was conducted in PubMed, MEDLINE, CINAHL, ScienceDirect, Scopus, Web of Science, and PsycINFO. The quality of the included studies was evaluated using the Medical Education Research Study Quality Instrument.

Results
Twenty-three studies published between 2002 and 2017 were selected. Results showed that VAD improved learners' experience, attitude, and performance, but it did not show its advantage over verbal debriefing on knowledge acquisition. Effective elements included using experienced debriefers, curriculum-embedded simulation, a structured debriefing, and the time between 10 and 90 minutes.

Conclusions
VAD improved learning outcomes and offered comparable benefits as verbal debriefing.
The Accuracy of Left Ventricular and Left Atrial Volumetry Using 64-Slice Computed Tomography: In Vitro Validation Study With Human Cardiac Cadaveric Casts
Authors: Järvinen Vesa , Uusitalo Valtteri , Tolvanen Tuula , Saraste Antti , Kuusisto Jouni , Sinisalo Juha , Knuuti Juhani 
Published: July 2018

Objective
We aimed to validate the accuracy of imaging of left atrial and ventricular volumes using cardiac cadaveric silicone casts.

Methods
Left atrial (n = 14) and ventricular (n = 15) casts were imaged using 64-slice computed tomography (CT). Water displacement (WD) of cardiac casts was used as the gold standard for volume measurements.

Results
Compared with WD, CT resulted in slightly higher left atrial and ventricular volumes (54 ± 25 vs 56 ± 26 mL [P = 0.003] and 57 ± 47 vs 66 ± 47 mL [P = 0.0001]). Variability between left atrial and ventricular volumes by CT and WD was low (coefficients of variation [CVs], 4% [intraclass correlation coefficient {ICC}, 0.99] and 12% [ICC, 0.97]). Intraobserver variability of CT was low for both the left atrium and the left ventricle (CVs, 1% [ICC, 1.00] and 4% [ICC, 1.00]).

Conclusions
Cardiac CT is both accurate and reproducible in assessment of left ventricular and atrial chamber volumes.
Accelerated Internal Auditory Canal Screening Magnetic Resonance Imaging Protocol With Compressed Sensing 3-Dimensional T2-Weighted Sequence
Authors: Yuhasz Mikell , Hoch Michael J. , Hagiwara Mari , Bruno Mary T. , Babb James S. , Raithel Esther , Forman Christoph , Anwar Abbas , Thomas Roland J. , Shepherd Timothy M. 
Published: July 2018

Background and PurposeHigh-resolution T2-weighted sequences are frequently used in magnetic resonance imaging (MRI) studies to assess the cerebellopontine angle and internal auditory canal (IAC) in sensorineural hearing loss patients but have low yield and lengthened examinations. Because image content in the Wavelet domain is sparse, compressed sensing (CS) that uses incoherent undersampling ofk-space and iterative reconstruction can accelerate MRI acquisitions. We hypothesized that an accelerated CS T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) sequence would produce acceptable diagnostic quality for IAC screening protocols.Material and MethodsSeventy-six patients underwent 3 T MRI using conventional SPACE and a CS T2 SPACE prototype sequence for screening the IACs were identified retrospectively. Unilateral reconstructions for each sequence were separated, then placed into mixed folders for independent, blinded review by 3 neuroradiologists during 2 sessions 4+weeks apart. Radiologists reported if a lesion was present. Motion and visualization of specific structures were rated using ordinal scales. McNemar, Wilcoxon, Cohen κ, and Mann-WhitneyUtests were performed for accuracy, equivalence, and interrater and intrarater reliability.ResultsT2 SPACE using CS reconstruction reduced scan time by 80% to 50 seconds and provided 98.7% accuracy for IAC mass detection by 3 raters. Radiologists preferred conventional images (0.7–1.0 reduction on 5-point scale,P< 0.001), but rated CS SPACE acceptable. The 95% confidence for reduction in any cerebellopontine angle, IAC, or fluid-filled inner ear structure assessment with CS SPACE did not exceed 0.5.ConclusionsInternal auditory canal screening MRI protocols can be performed using a 5-fold accelerated T2 SPACE sequence with compressed sensing while preserving diagnostic image quality and acceptable lesion detection rate.
FDG PET-CT in Adrenal Multiple Myeloma
Authors: Choudhury Sayak , Purandare Nilendu , Agrawal Archi , Shah Sneha , Rangarajan Venkatesh 
Published: July 2018

Abstract
Extramedullary involvement in multiple myeloma is rare, but carries poor prognosis. We describe the FDG PET-CT findings of rare adrenal involvement in a case of multiple myeloma.
Frontal Sinus Osteoplastic Flap Surgery Using a Surgical Navigation System
Authors: Bang Yu Jin , Lim Byeong Woo , Ha Ryun , Woo Joo Hyun , Kim Seon Tae , Jung Joo Hyun , Cha Heung Eog , Chang Jin Soon , Han Ji Hye , Choi Ji Yun , Kang Il Gyu 
Published: July 2018

Objective:
To report the case of a 38-year-old woman who underwent osteoplastic flap surgery for recurrent frontal sinus mucocele. During surgery, the exact shape of the frontal sinus was duplicated using a surgical navigation system.

Methods:
In this case report, the authors suggest intraoperative surgical navigation systems are useful for accurately determining the dimensions of the frontal sinus for osteoplastic flap surgery.

Results:
The patient underwent successful and safe osteoplastic flap surgery using a surgical navigation system.

Conclusion:
Surgical navigation is useful and safe for frontal sinus osteoplastic flap surgery.
A Cost Analysis of Icon Reusable Underwear Versus Disposable Pads for Mild to Moderate Urinary Incontinence
Authors: Alam Pakeeza A. , Huang Jim C. , Clark Brett A. , Burkett Linda S. , Richter Lee A. 
Published: July 2018

Objective
The objective of this study was to perform a cost analysis assessing the economic feasibility of reusable underwear as alternative for disposable pads for women with mild to moderate urinary incontinence.

Methods
A consumer-perspective cost analysis was performed with the following assumptions: (1) consumers have mild to moderate urinary incontinence and use 2 pads per day (PPD); (2) consumers have a 2-week supply of underwear; (3) there is no difference in laundering cost between 2 incontinence options; (4) there is no difference in use of labor/other accessories of care; (5) there is no difference in skin complaints/associated cost; (6) cost of products are nonfluctuant with time; and (7) all incontinence products were purchased online. Sensitivity analyses were performed varying the longevity of underwear, price of regular underwear, price of pads, pads used per day, and shipping and handling.

Results
The total cost of disposable pads with regular underwear was US $392.40, whereas the cost of Icon underwear was US $380.80 over the course of 2 years. Icon costs less than using regular underwear with disposable pads as long as the cost of the regular underwear is at least US $2.17. Icon is economically inferior if the cost per pad is US $0.15 when using 3 PPD or if the cost per pad is US $0.24 when using less than 2 PPD.

Conclusions
Reusable incontinence underwear can be an economically feasible alternative to disposable pads for light to moderate urinary incontinence after 2 years of use assuming underwear has a 2-year longevity and the consumer is using 2 PPD with regular underwear.