bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of PROMIS CATs and PROMIS Global Health in an Interdisciplinary Pain Program for Patients With Chronic Low Back Pain
Authors: Lapin Brittany , Davin Sara , Stilphen Mary , Benzel Edward , Katzan Irene L. 
Published: September 2019

Study Design.
Retrospective cohort study.

Objective.
To (1) confirm validity of Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and pain interference computer-adaptive tests (CATs) and (2) assess the validity of PROMIS Global Health (GH) and five additional PROMIS CATs: social role satisfaction, fatigue, anxiety, depression, and sleep disturbance in a population of patients with chronic low back pain (cLBP) who completed a 3-month Interdisciplinary Pain Program (IPP).

Summary of Background Data.
Recent recommendations for assessing outcomes in patients with cLBP have included PROMIS scales; however, there is a need for further evaluation, and PROMIS GH has not been studied in this population.

Methods.
The study cohort included patients with cLBP who completed the entirety of a 3-month IPP between August 2016 and December 2018. Patient-reported outcome measures (PROMs) were analyzed before the start of the IPP and at graduation. Convergent and discriminant validity were evaluated using Pearson correlation coefficients. Known groups’ validity assessed the change in PROMIS scores stratified by improvement on the Modified LBP Disability Questionnaire. Responsiveness was evaluated with standardized response means based on global impression of change.

Results.
IPP was completed by 217 patients (67.7% women, age 53.8 ± 12.8). Convergent validity was supported (P < 0.01 for all pairwise PROMs comparisons). All PROMs improved significantly by graduation, with the largest improvement for PROMIS pain interference, physical function, social role satisfaction, and Modified LBP Disability Questionnaire. Known groups’ validity demonstrated the greatest change on PROMIS physical function, social role satisfaction, pain interference, and depression. Responsiveness was supported for all PROMs in 170 (78.3%) patients who indicated at least minimal improvement (standardized response means 0.43–1.06).

Conclusion.
Our study provides support of PROMIS CATs, highlights the importance of including other meaningful outcome measures, such as social role satisfaction, and provides the first validation of PROMIS GH, in patients with cLBP. PROMs collection can be streamlined through the use of PROMIS CATs which offer advantages over legacy measures.

Level of Evidence: 3
The Effect of Parity on Age-Related Degenerative Changes in Sagittal Balance
Authors: Bailey Jeannie F. , Sparrey Carolyn J. , Williams Frances M.K. , Curran Patrick F. , Lotz Jeffrey C. , Kramer Patricia A. 
Published: September 2019

Study Design.
Retrospective cohort study.

Objective.
Evaluate the effects of parity (number of births) on measures of sagittal posture in elderly women. The long-term objective of this study is to identify and mitigate factors contributing to age-related postural deformity in older adults.

Summary of Background Data.
Adult spinal deformity is a prevalent condition that often requires costly surgical management. Females are disproportionately represented in spinal deformity surgical cases with up to 90% of patients being women. The potential contributions of pregnancy on postural degeneration have only begun to be acknowledged and require further study.

Methods.
Two hundred eight women with standing lateral radiographs were selected from the TwinsUK register. Parity information was extracted from questionnaires. Sagittal balance measurements (thoracic kyphosis, lumbar lordosis [LL], pelvic incidence [PI]) were collected and PI-LL mismatch was calculated. One-way analysis of variance tests were done between three separate age categories for measures of sagittal balance and parity and stepwise multivariate regression was done for PI-LL.

Results.
Both age and PI-LL mismatch significantly differed between parity categories. PI-LL was on average 7.0° ± 2.5° greater in multiparous (3+ births) subjects than in nulliparous subjects (P < 0.01). Parity did not have an independent relationship with lumbar disc degeneration, lumbar bone mineral density, or any of the individual sagittal balance parameters (P > 0.05 for all), except for PI-LL. From a subanalysis of the effect of parity on sagittal alignment within twin pairs, we found that within pair differences in parity associate with within pair differences in thoracic kyphosis.

Conclusion.
This study established correlations between measures of spinal curvature in older women and parity for the first time. Longitudinal research is required to establish a causative relationship.

Level of Evidence: 4
Do Prophylactic Antibiotics Reach the Operative Site Adequately?
Authors: Naresh-Babu Jambuladinne , Arun-Kumar Viswanadha 
Published: September 2019

Study Design.
Prospective cohort study.

Objective.
To analyze the serum and drain concentrations of antibiotics administered by two different routes and compare the results.

Summary of Background Data.
Systemic antibiotics are expected to reach the surgical site and maintain adequate concentrations of the drug to prevent infection. However, it is unknown whether systemically administered antibiotics reach and maintain such adequate concentrations at the surgical wound or not.

Methods.
Forty patients undergoing elective spine surgery received intra-wound Vancomycin (1 GM) before the wound closure and single dose of intravenous Gentamycin (80MG) immediately after surgery. Blood and drain samples were collected postoperatively to estimate serum and drain concentrations of Gentamycin and Vancomycin. Drug Estimation Protocol: Drug concentrations were estimated by ADVIA Centaur CP immunoassay (direct chemiluminescence). Gentamycin and vancomycin in the test samples competes with their respective acridinium ester-labeled gentamicin and vancomycin derivatives for monoclonal mouse anti-gentamycin and anti-vancomycin antibodies which are covalently coupled to paramagnetic particles in the solid phase.

Results.
Gentamycin attained peak serum levels at 6 hours following administration with an average value of 9.90 ± 3.1 μg/mL which was decreased to 6.76 ± 2.6 μg/mL at 12 hours and steadily declining thereafter. Even though, the drug concentrations in the drain collection from the wound also attained peak levels at 6 hours, the drug concentrations were lower (3.75 ± 1.4 μg/mL) than that of serum concentrations and inadequately attained the recommended target peak of Gentamycin (4–12 μg/mL).
Wound levels of local vancomycin were significantly higher at 6 hours (413.4 ± 217.3 μg/mL) and well maintained even at 72 hours. Serum vancomycin levels were observed to be highest at 6 hours in negligible concentrations of 6.06 ± 2.2 μg/mL.

Conclusion.
After prophylactic systemic administration of the antibiotics, the antibiotic drug concentrations in the wound are much lower than the serum concentrations at any given time. After local intra-wound application of antibiotics, the drug concentrations in the wound are well maintained even after 72 hours.

Level of Evidence: 3
How Does Ossification of Posterior Longitudinal Ligament Progress in Conservatively Managed Patients?
Authors: Park Sehan , Lee Dong-Ho , Ahn Joosuk , Cho Jae Hwan , Lee Suk Kyu , Kim Kook-Jong , Park Jae Hong , Hwang Chang Ju , Park Jae Woo , Lee Choon Sung 
Published: September 2019

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to elucidate the progression of ossification of the posterior longitudinal ligament (OPLL) in conservatively managed patients and determine its risk factors

Summary of Background Data.
Although several studies have demonstrated how OPLL progresses after laminoplasty or fusion, its progression in conservatively managed patients remains unclear.

Methods.
The vertical length of the ossified mass and its thickness at each segment were evaluated on sagittal computed tomography images. Patients with vertical growth >2 mm were included in the vertical progression group. Segments with a thickness progression >1 mm were classified as thickness progressed segments, and patients who had at least one progressed segment were included in the thickness progression group. Based on the characteristics at each disc level, the ossified mass at each segment was classified into four types: type 1, no disc space involvement; type 2, involving the disc space, but not crossing; type 3, crossing the disc space, but not fused; and type 4, completely fused.

Results.
The progression of ossified mass was observed in younger patients (P < 0.01) and in C2-C3 involvement (P < 0.01) cases. Moreover, progression in both directions was observed more frequently in the mixed-type OPLL (P < 0.01). Progression occurred most often in type 3 segments (72.0%, P < 0.01). In type 3 segments, thickness progression was found more frequently in segments with segmental range of motion (ROM) ≥5° (55.6% vs. 27.8%, P = 0.04). The proportion of segments whose initial thickness was >5 mm was significantly higher among progressed segments (60.0% vs. 35.2%, P = 0.03).

Conclusion.
Young age, C2-C3 involvement, and mixed-type OPLL are risk factors for OPLL progression. Segments with morphology of crossing the segment, but without fusion (type 3), segmental ROM ≥5°, and initial thickness >5 mm need special attention.

Level of Evidence: 3
Religious Faith and Diabetes Health Beliefs in a Homeless Population
Authors: Lew Kelley Newlin , Arbuah Nancy , Nguyen Thuy 
Published: September 2019

ABSTRACT:
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
Theory of Nursing for the Whole Person
Authors: Swanson Cheryl , Thompson Audrey , Valentz Rachael , Doerner Laurie , Jezek Kenda 
Published: September 2019

ABSTRACT
Though unpublished in peer-reviewed literature for more than 40 years, the Theory of Nursing for the Whole Person has been, and remains, a highly useful framework for nursing practice, education, and research. Used by the College of Nursing at Oral Roberts University, the theory was developed by the founding dean, I. Tomine Tjelta. Founded on a Christian worldview, the theory is built on the basic nursing paradigm concepts, yet functions as a distinctly scriptural framework. The theory's five conceptual triads describe how nursing addresses the whole-person health-illness continuum for individuals, families, and communities.
Management of Freely Perforated Diverticulitis
Authors: Lumpkin Stephanie T. , Chaumont Nicole 
Published: September 2019

CASE SUMMARY:
A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A CT scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, free fluid in the pelvis, and free air noted near the diaphragm (Fig. 1). The surgeon completes the patient evaluation, recommends initiation of intravenous fluid resuscitation and antibiotics, and plans to go immediately to the operating room for surgical resection.
Distribution of Different Corneal Topography Patterns in Iranian Schoolchildren: The Shahroud Schoolchildren Eye Cohort Study
Authors: Hashemi Hassan , Pakzad Reza , Khabazkhoob Mehdi , Yekta Abbasali , Emamian Mohammad Hassan , Fotouhi Akbar 
Published: September 2019

Objectives:
To determine the distribution of corneal topography patterns (CTPs) in children aged 6 to 12 years and its association with the central corneal thickness (CCT), axial length (AL), mean corneal power (MCP), and corneal astigmatism (CA).

Methods:
In this population-based study, 5,620 children selected through random stratified cluster sampling were examined. After applying the inclusion criteria, 4,655 right eyes were analyzed. The Pentacam was used to determine the CTP and measure CA and MCP, and the BioGraph was used to measure the AL. Corneal topography patterns were classified based on the 10 patterns proposed by Rabinowitz et al.

Results:
The most common pattern in the right eye was the oval pattern [32.7%, 95% confidence interval (CI): 30.9–34.5] followed by asymmetric bowtie with superior steepening (AB-SS) (14.5%, 95% CI: 13.3–15.7), whereas the rarest patterns were AB with skewed radial axis (AB-SRAX) (0.1%, 95% CI: 0.0–0.2) and irregular pattern (0.2%, 95% CI: 0.1–0.4). The similarity between the two eyes was 23.2% (95% CI: 20.9–25.7). The mean CCT was significantly higher in AB-SS than inferior steepening (IS) (P=0.023), symmetric bowtie with SRAX (SB-SRAX) (P=0.030), and AB with IS (AB-IS) (P=0.015). Corneal astigmatism was higher in SB-SRAX compared with round and oval patterns (P value for both <0.001). The AL was greater, and the MCP was lower in the oval versus the SB-SRAX pattern (P value for both <0.001).

Conclusion:
The distribution of CTP was different in children and adults, and the oval and AB-SS patterns were the most common CTPs in the current study.
Pain, Dryness, and Itch Sensations in Eye Surface Disorders Are Defined By a Balance Between Inflammation and Sensory Nerve Injury
Authors: Belmonte Carlos 
Published: September 2019

Abstract:
Patients with corneal and conjunctival disorders report an array of ocular surface symptoms including stinging, foreign body sensation, and itching. The intensity and perceptual quality of these sensations and their duration, from brief intervals to long-term symptoms, also vary. We hypothesize that symptomatic differences across disorders reflect differences in the balance between ocular inflammation and nerve injury, with different conditions resulting from predominant effects of one of these, or a combined effect. This article provides an overview of corneal and conjunctival nerve cells, such as nociceptors and thermoreceptors, with descriptions of their morphological and molecular characteristics and their nerve-firing patterns and evoked sensations, as determined by earlier studies in animals and humans. Detailed descriptions of the changes in neuronal responses (such as abnormal responsiveness and spontaneous firing) due to local inflammation and nerve injury are provided, and assorted ocular surface disorders are discussed. Eye conditions in which inflammation is predominant include allergic conjunctivitis and photokeratitis, whereas nerve injury is the primary factor underlying complaints of dry eye after photorefractive keratectomy and in elderly patients. Both factors contribute substantially to dry eye disease and varicella-zoster infections. This model of the combined effects of inflammation and nerve injury serves to explain the different sensations reported in various eye surface disorders, including short-term versus chronic pain and dysesthesias, and may help to improve diagnoses and treatment methods.
Genomics and breast cancer screening
Authors: Tyler April L. 
Published: September 2019

ABSTRACT
Many women fear the risk of developing breast cancer, and some women have increased fear because of their family history. Thankfully, the study of genetics has brought forth tools to better identify women at risk. An understanding of genetics and cancer has led to genetic testing protocols which enable at-risk women to take preventative action through medication, surgery, and intensive screenings. These protocols not only have the potential to prevent cancer but also lead to early detection. Appropriate screening for women at risk for genetic breast cancer is essential for patient care. These screenings include specific risk assessment tests, genetic counseling, and genetic testing. To provide the best possible care for patients, providers must have a basic understanding of cancer, genetics, screening tests, genetic testing, and available prevention measures.
What happens in the shock room stays in the shock room? A time-based audio/video audit framework for trauma team performance analysis
Authors: Aukstakalnis Vytautas , Dambrauskas Zilvinas , Stasaitis Kestutis , Darginavicius Linas , Dobozinskas Paulius , Jasinskas Nedas , Vaitkaitis Dinas 
Published: September 2019

Introduction
A precise tool for analysis of trauma team performance is missing.

Objectives
To create a framework for trauma team performance analysis and feedback.

Methods
An observational study in a level I trauma centre in Lithuania was performed from January 1 2017 to August 31 2017. Audio/video review process was used to evaluate technical and nontechnical performance of the trauma team.

Results
In total, 143 trauma team activations were analysed. The mean rate of completion for the primary survey based on Advanced Trauma Life Support principles was 68.5%. Technical steps of patient resuscitation were measured in seconds during first hour of the treatment. The T-NOTECHS scale mean score was 11.99 (SD 2.9).

Conclusion
During the study period, we were able to measure the time needed for certain steps in trauma patient evaluation and management. Based on this analysis, a performance improvement program will be devised, including the HybridLab medical simulation, audio/video debriefing, and individualised feedback sessions.
Patient and Family Advisory Councils for Research
Authors: Harrison James D. , Anderson Wendy G. , Fagan Maureen , Robinson Edmondo , Schnipper Jeffrey , Symczak Gina , Carnie Martha B. , Hanson Catherine , Banta Jim , Chen Sherry , Duong Jonathan , Wong Celene , Auerbach Andrew D. 
Published: September 2019

OBJECTIVE
To describe strategies to recruit and support members from hard-to-reach groups on research-focused Patient and Family Advisory Councils (PFACs).

BACKGROUND
Ensuring diverse representation of members of research PFACs is challenging, and few studies have given attention to addressing this problem.

METHODS
A qualitative study was conducted using 8 focus groups and 19 interviews with 80 PFAC members and leaders, hospital leaders, and researchers.

RESULTS
Recruitment recommendations were: 1) utilizing existing networks; 2) going out to the community; 3) accessing outpatient clinics; and 4) using social media. Strategies to support inclusion were: 1) culturally appropriate communication methods; 2) building a sense of community between PFAC members; 3) equalizing roles between community members/leaders; 4) having a diverse PFAC leadership team; and 5) setting transparent expectations for PFAC membership.

CONCLUSION
Increasing the diversity of research PFACs is a priority, and it is important to determine how best to engage groups that have been traditionally underrepresented.
Optimizing Perioperative Pain Control After Ambulatory Urogynecologic Surgery
Authors: Winkelman William D. , Kim Youngwu , Erlinger Adrienne L. , Haviland Miriam J. , Hacker Michele R. , Elkadry Eman A. 
Published: September 2019

Objectives
The objective of this study was to determine the impact of a multimodal protocol on opiate use and postoperative pain after ambulatory urogynecologic surgery.

Methods
This was a retrospective cohort study comparing ambulatory urogynecologic surgery patients treated under a standard perioperative pain protocol with those treated under a multimodal perioperative pain protocol. The multimodal protocol consisted of preoperative gabapentin and acetaminophen and postoperative scheduled doses of acetaminophen and nonsteroidal anti-inflammatory drugs. Pain scores were obtained from nursing records and assessed on the Numeric Rating Scale 11 per hospital protocol. All opioid dosages were converted into morphine milligram equivalents using standardized conversion tables.

Results
We treated 109 patients under the standard protocol and 112 under the multimodal protocol. Patients had similar baseline characteristics. Overall, a minority of patients (39%) used postoperative opioids; this was similar in the 2 groups (P=0.45). The 2 groups also were similar with regard to the total postoperative morphine milligram equivalents (P=0.35). Postoperatively, patients treated under the standard protocol had higher mean pain scores (2.2 vs 1.4, P=0.002). Patients treated under the standard protocol were also significantly more likely to report postoperative pain (69%) than those treated under the multimodal protocol (52%; P=0.01), and the multimodal protocol was associated with a 25% lower risk of postoperative pain (risk ratio, 0.75; 95% confidence interval, 0.60–0.94) than the standard protocol.

Conclusions
Patients infrequently use opiates after ambulatory urogynecologic surgery. The use of a multimodal pain protocol was associated with lower pain scores, and patients in a multimodal pain protocol were more likely to report no pain.
A Clinical Risk Model to Predict Obstetric Anal Sphincter Injuries in Laboring Patients
Authors: Woo Victoria G. , Hung Yun-Yi , Ritterman-Weintraub Miranda L. , Painter Caitlyn E. , Ramm Olga 
Published: September 2019

Objective
Our objective was to develop a risk stratification tool for predicting obstetric anal sphincter injury risk in women during labor.

Methods
In this retrospective cohort study of singleton deliveries within Kaiser Permanente Northern California, a predictive model for anal sphincter injury was developed within the 2013 birth cohort and validated in the 2014 birth cohort of 22,741 births. Predictors of obstetric anal sphincter injury were identified using multiple regression analysis and used to create a risk calculator tool based on effect size and clinical judgment.

Results
Duration of second stage of labor, vacuum delivery, history of anal sphincter injury, maternal and gestational ages, and maternal race and ethnicity were associated with elevated risk of anal sphincter injury. Using these risk factors, we developed a validated parity-stratified scoring system. Among nulliparous women, 116 (1.3%) had a score of zero, corresponding to a 0.9% risk, and 1024 (11.7%) had a score higher than 6, corresponding to a 27.5% risk of anal sphincter injury. Among the multiparous women, 1181 (8.4%) had a score of zero, corresponding to a 0.1% risk, and the 260 (1.9%) with a score higher than 10 had a 7.7% risk. The predictive ability of the score derived based on the 2013 data was applied to the 2014 data, and results showed that the predictive abilities were statistically similar, except for one subgroup: multiparous women with a total score of ≥10.

Conclusions
Our anal sphincter injury risk stratification tool effectively predicts individual risk and can inform clinician and patient decision making to minimize maternal birth trauma.