bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of the Existing Wellness Programs in Neurosurgery and Institution Champion's Perspectives
Authors: Wolfe Stacey Quintero , West James L , Hunt Matthew A , Murad Gregory J A , Fox W Christopher , Dow Jamie , Morone Peter J , Wellons John C , Podet Adam , Wilson Jason , Wu Julian K , Spiotta Alejandro M , Fargen Kyle M 
Published: August 2018

Abstract
Once the accepted norm during Harvey Cushing's time, the mantra of work to the exclusion of family and lifestyle is now recognized as deleterious to overall well-being. A number of neurosurgical residency training programs have implemented wellness programs to enhance the physical, mental, and emotional well-being of trainees and faculty. This manuscript highlights existing organized wellness education within neurosurgery residency programs in order to describe the motivations behind development, structure, and potential implementation strategies, cost of implementation, and identify successes and barriers in the integration process. This manuscript is designed to serve as a “how-to” guide for other programs who may identify a need in their own trainees and begins the discussion of how to develop wellness, leadership, grit, and resiliency within our future generation of neurosurgeons.
Lateral Transorbital Versus Endonasal Transpterygoid Approach to the Lateral Recess of the Sphenoid Sinus—A Comparative Anatomic Study
Authors: Alves-Belo Joao T , Mangussi-Gomes Joao , Truong Huy Q , Cohen Salomon , Gardner Paul A , Snyderman Carl H , Stefko S Tonya , Wang Eric W , Fernandez-Miranda Juan C 
Published: August 2018

Abstract

BACKGROUND
The treatment of cerebrospinal fluid leaks of the lateral recess of the sphenoid sinus (LRSS) faces difficulties due to the deep location of the osseous defect. When treated with craniotomies, brain retraction is a concern. The endoscopic endonasal transpterygoid approach (EETA) is a direct and less invasive procedure; however, it may require transection of the vidian nerve (VN).

OBJECTIVE
To investigate the feasibility of a lateral transorbital approach (LTOA) as an alternative pathway to the LRSS that avoids VN sacrifice.

METHODS
Six embalmed heads with well-pneumatized LRSS were preselected by inspecting their computed tomography scans. One LTOA and one EETA were performed on 1 side of each specimen. The approaches were compared regarding working distance and neurovascular structures being sacrificed. The working area of the LTOA was also measured.

RESULTS
The average working distances were 59.9 (±2.94) mm for the LTOA and 76.4 (±3.99) mm for the EETA (P < .001). The LTOA generated a working area with a diameter of 9 to 14 mm. The EETA demanded the sacrifice of VN and the sphenopalatine artery in all specimens to expose the LRSS. No neurovascular structures were found in the trajectory of the LTOA.

CONCLUSION
The LTOA to the LRSS is feasible, with minimal risk of injuring neurovascular structures. It offers a shorter pathway when compared to the EETA. Although the LTOA provides no options for vascularized flap reconstruction, it allows immediate access to muscle grafts. The LTOA may serve as an alternative to treating cerebrospinal fluid leaks of the LRSS.
Mitigating Barriers to Doctoral Education for Nurses
Authors: Taylor Laura A. , Terhaar Mary F. 
Published: August 2018

Abstract

AIM
This article reports preliminary outcomes of the Guiding Initiative for Doctoral EducationSM, which promotes success in doctoral study.

BACKGROUND
Nurses face challenges as they move intentionally, effectively, and expediently toward earning the doctorate. Selecting the doctoral education best suited to individual career goals is essential for success.

METHOD
An intensive, daylong program focused on setting goals, generating personal action plans, and mobilizing resources to promote success in application and return to the role of student.

RESULTS
Based on 70 nurses who participated in seven programs, 22 (31 percent) were admitted to their doctoral program of choice (6 PhD, 15 DNP, 1 EdD).

CONCLUSION
Nurses benefit from and value learning about the options for doctoral study, requirements for educational opportunities, the nature of the commitment required, challenges commonly encountered during the process, and the impact advanced education can be expected to have on immediate and long-term career opportunities.
Identifying Thoracic Compensation and Predicting Reciprocal Thoracic Kyphosis and Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery
Authors: Protopsaltis Themistocles S. , Diebo Bassel G. , Lafage Renaud , Henry Jensen K. , Smith Justin S. , Scheer Justin K. , Sciubba Daniel M. , Passias Peter G. , Kim Han Jo , Hamilton David K. , Soroceanu Alexandra , Klineberg Eric O. , Ames Christopher P. , Shaffrey Christopher I. , Bess Shay , Hart Robert A. , Schwab Frank J. , Lafage Virginie 
Published: August 2018

Study Design.
Retrospective analysis.

Objective.
To define thoracic compensation and investigate its association with postoperative reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK)

Summary of Background Data.
Adult spinal deformity (ASD) patients recruit compensatory mechanisms like pelvic retroversion and knee flexion. However, thoracic hypokyphosis is a less recognized compensatory mechanism.

Methods.
Patients enrolled in a multicenter ASD registry undergoing fusions to the pelvis with upper instrumented vertebra (UIV) between T9 and L1 were included. Patients were divided into those with postoperative reciprocal thoracic kyphosis (reciprocal kyphosis [RK]: change in unfused thoracic kyphosis [TK] ≥15°) with and without PJK and those who maintained thoracic alignment (MT). Thoracic compensation was defined as expected thoracic kyphosis (eTK) minus preoperative TK.

Results.
For RK (n = 117), the mean change in unfused TK was 21.7° versus 6.1° for MT (n = 102) and the mean PJK angle change was 17.6° versus 5.7° for MT (all P < 0.001). RK and MT were similar in age, body mass index (BMI), sex, and comorbidities. RK had larger preoperative PI–LL mismatch (30.7 vs. 23.6, P = 0.008) and less preoperative TK (22.3 vs. 30.6, P < 0.001), otherwise sagittal vertical axis (SVA), pelvic tilt (PT), and T1 pelvic angle (TPA) were similar. RK patients had more preoperative thoracic compensation (29.9 vs. 20.0, P < 0.001), more PI–LL correction (29.8 vs. 17.3, P < 0.001), and higher rates of PJK (66% vs. 19%, P < 0.001). There were no differences in preoperative health-related quality of life (HRQOL) except reciprocal kyphosis (RK) had worse Scoliosis Research Society questionnaire (SRS) appearance (2.2 vs. 2.5, P = 0.005). Using a logistic regression model, the only predictor for postoperative reciprocal thoracic kyphosis was more preoperative thoracic compensation. Postoperatively the RK and MT groups were well aligned. Both younger and older (>65 yr) RK patients had greater thoracic compensation than MT counterparts. The eTK was not significantly different from the postoperative TK for the RK group without PJK (P = 0.566).

Conclusion.
The presence of thoracic compensation in adult spinal deformity is the primary determinant of postoperative reciprocal thoracic kyphosis and these patients have higher rates of proximal junctional kyphosis.

Level of Evidence: 3
A Novel Method for the Prediction of the Pedicle Screw Stability
Authors: Ishikawa Koji , Toyone Tomoaki , Shirahata Toshiyuki , Kudo Yoshifumi , Matsuoka Akira , Maruyama Hiroshi , Hayakawa Chikara , Tani Soji , Sekimizu Masaya , Tsuchiya Koki , Eguro Takeshi , Oshita Yusuke , Ozawa Tomoyuki , Nakao Yusuke , Sano Shigeo , Nagai Takashi , Kanzaki Koji , Inagaki Katsunori 
Published: August 2018

Study Design:
Prospective feasibility study on consecutive patients.

Objective:
The aim of this study was to investigate the ability of regional BMD around the pedicle screw to predict the screw fixation.

Summary of Background Data:
Pedicle screw fixation is the gold standard technique for spinal fusion. Despite the advantage of biomechanical stability, screw loosening is a common complication. In previous studies, pullout strength and screw insertional torque were correlated, and most importantly, affected by bone mineral density (BMD). Although the density and structure of the vertebral body are not homogeneous, no study has yet evaluated the relationship between screw insertional torque and regional BMD around the pedicle screw in vivo.

Methods:
Consecutive 50 patients, scheduled for transpedicular fixation, were evaluated preoperatively for BMD measured by dual-energy absorptiometry (DXA) and quantitative computed tomography (QCT). Regional volumetric BMD around the pedicle screw (PS-vBMD) using the novel QCT technique was also evaluated. Among all patients, 190 screws (diameter, 7.5 to 8.5 mm; length, 40 to 45 mm, inserted from L1 to L5) were eligible for this study and were analyzed to identify factors contributing to insertional torque. The following factors were investigated: age, body mass index, laboratory data, pedicle diameter, screw diameter, screw length, and 5 types of bone mineral density measures [DXA: spine-areal BMD (aBMD), total hip-aBMD, femoral neck-aBMD, QCT: central-vBMD, PS-vBMD].

Results:
Insertional torque was significantly correlated with each BMD measurement and strongest with PS-vBMD (r=0.61, P<0.001). Multiple regression analysis showed PS-vBMD was most strongly correlated with screw insertional torque (stdβ=0.494; P<0.001). A model containing the following 5 predictors was significantly associated with screw insertional torque: age, pedicle diameter, screw diameter, screw length, and PS-vBMD.

Conclusions:
The preoperative measurement of PS-vBMD was technically feasible and reliably predictive of screw insertional torque during transpedicular fixation in a clinical setting.
Laryngeal Injury and Upper Airway Symptoms After Oral Endotracheal Intubation With Mechanical Ventilation During Critical Care: A Systematic Review*
Authors: Brodsky Martin B. , Levy Matthew J. , Jedlanek Erin , Pandian Vinciya , Blackford Brendan , Price Carrie , Cole Gai , Hillel Alexander T. , Best Simon R. , Akst Lee M. 
Published: August 2018

Objectives:
To systematically review the symptoms and types of laryngeal injuries resulting from endotracheal intubation in mechanically ventilated patients in the ICU.

Data Sources:
PubMed, Embase, CINAHL, and Cochrane Library from database inception to September 2017.

Study Selection:
Studies of adult patients who were endotracheally intubated with mechanical ventilation in the ICU and completed postextubation laryngeal examinations with either direct or indirect visualization.

Data Extraction:
Independent, double-data extraction and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias assessment followed the Cochrane Collaboration’s criteria.

Data Synthesis:
Nine studies (seven cohorts, two cross-sectional) representing 775 patients met eligibility criteria. The mean (sd; 95% CI) duration of intubation was 8.2 days (6.0 d; 7.7–8.7 d). A high prevalence (83%) of laryngeal injury was found. Many of these were mild injuries, although moderate to severe injuries occurred in 13–31% of patients across studies. The most frequently occurring clinical symptoms reported post extubation were dysphonia (76%), pain (76%), hoarseness (63%), and dysphagia (49%) across studies.

Conclusions:
Laryngeal injury from intubation is common in the ICU setting. Guidelines for laryngeal assessment and postextubation surveillance do not exist. A systematic approach to more robust investigations could increase knowledge of the association between particular injuries and corresponding functional impairments, improving understanding of both time course and prognosis for resolution of injury. Our findings identify targets for future research and highlight the long-known, but understudied, clinical outcomes from endotracheal intubation with mechanical ventilation in ICU.
Phase 3 Study of OnabotulinumtoxinA Distributed Between Frontalis, Glabellar Complex, and Lateral Canthal Areas for Treatment of Upper Facial Lines
Authors: De Boulle Koenraad , Werschler William Philip , Gold Michael H. , Bruce Suzanne , Sattler Gerhard , Ogilvie Patricia , Street James , Larsen Kristin E. , Yushmanova Irina , Lei Xiaofang , Lee Elisabeth , Vitarella Domenico , Mao Cheri 
Published: August 2018

BACKGROUND
Although commonly practiced, simultaneous onabotulinumtoxinA injections to multiple facial areas have not been investigated in prospective studies.

OBJECTIVE
Evaluate safety and efficacy of onabotulinumtoxinA for treatment of forehead lines (FHL) distributed between the frontalis (20 U) and glabellar complex (20 U), with or without simultaneous lateral canthal areas (crow's feet lines [CFL], 24 U) treatment.

METHODS
Subjects with moderate to severe FHL were randomized (2:2:1) to onabotulinumtoxinA 40 U, onabotulinumtoxinA 64 U, or placebo. After 180 days, subjects could receive up to 2 additional open-label onabotulinumtoxinA 64 U treatments.

RESULTS
The intent-to-treat (ITT) population comprised 787 subjects, and the modified ITT (mITT) population (subjects with psychological impact) comprised 568. After 30 days, onabotulinumtoxinA 40 U and 64 U significantly improved investigator- and subject-assessed FHL severity by at least 2 Facial Wrinkle Scale (FWS) grades in 45.6% and 53.0% of ITT subjects, respectively, versus 0.6% receiving placebo (both, p < .0001). Significantly more mITT subjects receiving onabotulinumtoxinA achieved investigator- and subject-assessed FWS ratings of none/mild versus placebo (p < .0001). OnabotulinumtoxinA was well tolerated.

CONCLUSION
OnabotulinumtoxinA distributed between the frontalis and glabellar complex, with or without additional CFL injections, was safe and effective for treatment of moderate to severe FHL.
Eye Tracking as a Biomarker for Concussion in Children
Authors: Bin Zahid Abdullah , Hubbard Molly E. , Lockyer Julia , Podolak Olivia , Dammavalam Vikalpa M. , Grady Matthew , Nance Michael , Scheiman Mitchell , Samadani Uzma , Master Christina L. 
Published: August 2018

Objective:
Concussion is the most common type of brain injury in both pediatric and adult populations and can potentially result in persistent postconcussion symptoms. Objective assessment of physiologic “mild” traumatic brain injury in concussion patients remains challenging. This study evaluates an automated eye-tracking algorithm as a biomarker for concussion as defined by its symptoms and the clinical signs of convergence insufficiency and accommodation dysfunction in a pediatric population.

Design:
Cross-sectional case–control study.

Setting:
Primary care.

Patients:
Concussed children (N = 56; mean age = 13 years), evaluated at a mean of 22-week post-injury, compared with 83 uninjured controls.

Independent Variables:
Metrics comparing velocity and conjugacy of eye movements over time were obtained and were compared with the correlation between Acute Concussion Evaluation (ACE) scores, convergence, and accommodation dysfunction.

Main Outcome Measures:
Subjects' eye movements recorded with an automated eye tracker while they watched a 220-second cartoon film clip played continuously while moving within an aperture.

Results:
Twelve eye-tracking metrics were significantly different between concussed and nonconcussed children. A model to classify concussion as diagnosed by its symptoms assessed using the ACE achieved an area under the curve (AUC) = 0.854 (71.9% sensitivity, 84.4% specificity, a cross-validated AUC = 0.789). An eye-tracking model built to identify near point of convergence (NPC) disability achieved 95.8% specificity and 57.1% sensitivity for an AUC = 0.810. Reduced binocular amplitude of accommodation had a Spearman correlation of 0.752(P value <0.001) with NPC.

Conclusion:
Eye tracking correlated with concussion symptoms and detected convergence and accommodative abnormalities associated with concussion in the pediatric population. It demonstrates utility as a rapid, objective, noninvasive aid in the diagnosis of concussion.
Irish Respiratory Clinical Nurse Specialists’ Experiences of Their Role
Authors: Fallon Noreen , Cassidy Irene , Doody Owen 
Published: August 2018

Aim and Objectives:The aim of this study was to explore respiratory clinical nurse specialists’ (CNSs’) experiences of their role.Background:Respiratory illnesses are currently 1 of the top 3 causes of mortality resulting in 1 in 5 deaths and are associated with significant human burden. Respiratory CNSs play a vital role in the management of respiratory disease through supporting improvements in quality of life, reduction of exacerbations, and subsequent hospital admission. While published literature exists regarding the CNS role, there is a dearth of published literature on the respiratory CNS role.Design:A qualitative descriptive design allowed the researcher to elicit respiratory CNSs’ experiences of their role.Methods:Ethical approval was obtained, CNSs were purposively sampled (n = 10), and data were collected by semistructured interviews, transcribed, and analyzed using content thematic analysis.Results:Three themes were identified within the findings: “multidimensional role,” “interacting and collaborating,” and “advancing the role.”Conclusions:Overall the study highlights that respiratory CNSs are active in the role as clinical experts, advocators, educators, collaborators, consultants, and health promoters. These findings recognize the importance of evaluating and building on the current CNS workforce in respiratory care and evaluating future development of the CNS role in specialized aspects of respiratory care in line with population and service needs.
Use of a Systematic Consultation Process to Facilitate Nursing Research Projects
Authors: Tehan Rebecca I. , Smith Carolyn R. , Draucker Claire B. , Martsolf Donna S. 
Published: August 2018

Purpose/Objectives:
The purpose of this article is to describe the use of a well-established, 5-stage consultation process, to advise a research team on planning strategies to engage domestic violence shelters (DVSs) as community partners in their study. The research team is testing a health promotion intervention for teens living in shelters with their parent and needed to enlist shelters as sites to recruit teens and conduct the intervention. Consultation aims were to (a) identify highly promising strategies described in peer-reviewed literature for identifying, recruiting, and collaborating with community organizations in research and (b) identify DVSs that would potentially serve as effective community partners for the study.

Methods:
A clinical nurse specialist and a public health master’s degree student led the consultation. The consultation process included (a) a systematic review of 29 peer-reviewed articles about research or program evaluation studies that engaged community partners and (b) a comprehensive online search of information about DVSs.

Outcomes:
Consultants identified 104 strategies used in studies to engage community partners and 10 specific DVSs most likely to effectively engage in the study.

Conclusion:
Clinical nurse specialists are well situated to provide consultation to research teams and should follow well-established consultation processes and systematic data collection procedures.
Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module
Authors: van de Grift Tim C. , Elfering Lian , Greijdanus Marijke , Smit Jan Maerten , Bouman Mark-Bram , Klassen Anne F. , Mullender Margriet G. 
Published: August 2018

Background:
The effectiveness of gender-confirming surgery is best evaluated on the basis of patient-reported outcomes. This is the first explorative study using the BODY-Q chest module, administered in trans men before and after mastectomy.

Methods:
Between October of 2016 and May of 2017, trans men were recruited to participate in a cross-sectional study. Data collection included standardized anamnesis and examination, screening questions on depression/anxiety, and seven BODY-Q scales, including new scales measuring satisfaction of the chest and nipples. Mean scores for preoperative and postoperative participants were compared, and regression analyses were conducted to identify factors associated with BODY-Q scores.

Results:
In total, 101 persons participated (89 percent; 50 preoperatively and 51 postoperatively). Postoperative participants reported significantly higher (better) scores on the chest (67), nipple (58), body (58) (t tests, all p < 0.001), and psychological (60) (t test, p = 0.05) scales compared with preoperative patients. Postoperative chest and nipple mean scores did not differ significantly from a gynecomastia comparison, whereas scores were less favorable on the psychosocial domains. Preoperatively, chest scores were not associated with objective breast size. Lower postoperative chest scores were associated with planned revision surgery (β = −0.52) and depressive symptoms (β = −0.59).

Conclusions:
The present findings indicate that chest and nipple satisfaction differences in trans men undergoing mastectomy can be detected using the BODY-Q chest module. Future prospective studies are needed to measure clinical change in satisfaction and how this relates to changes in other aspects of health-related quality of life.
Hybrid Prepectoral Breast Reconstruction: A Surgical Approach that Combines the Benefits of Autologous and Implant-Based Reconstruction
Authors: Momeni Arash , Kanchwala Suhail 
Published: August 2018

Background:
The advantages of hybrid breast reconstruction (i.e., the combination of free tissue transfer with simultaneous implant placement) are well known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a prepectoral approach is now routinely chosen.

Methods:
A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous prepectoral implant placement was performed. Clinical outcomes and postoperative complications were examined.

Results:
A total of 23 patients with a mean age of 46.6 years (range, 26 to 72 years) and mean body mass index of 25.8 kg/m2 (range, 21.4 to 32.1 kg/m2) underwent reconstruction with 46 free flaps with simultaneous prepectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 to 255 cc). Postoperative complications included hematoma [n = 1 (4.3 percent)], mastectomy skin flap necrosis [n = 5 (21.7 percent)], fat necrosis [n = 3 (13 percent)], and delayed wound healing at the flap donor site [n = 4 (17.4 percent)]. No case of implant malposition, implant infection, flap loss, or “red breast” syndrome was encountered during a mean follow-up of 8.4 months (range, 2 to 17 months).

Conclusions:
Prepectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. Although the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, but without being associated with complications such as rippling or animation deformity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.