bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Instrumented Vertebrae Distal to T2 Leads to a Higher Incidence of Proximal Junctional Kyphosis During Growing-rod Treatment for Early Onset Scoliosis
Authors: Pan Aixing , Hai Yong , Yang Jincai , Zhang Yangpu , Zhang Yaoshen 
Published: May 2018

Study Design:
A retrospective case series.

Objective:
We sought to evaluate the prevalence and risk factors of proximal junctional kyphosis (PJK) after growing-rod surgery in patients with early onset scoliosis (EOS).

Summary of Background Data:
Growing-rod surgery is the primary treatment in patients with progressive EOS when conservative treatment fails. PJK is one of the most commonly reported postoperative complications.

Materials and Methods:
We retrospectively evaluated 50 patients (24 boys and 26 girls) diagnosed with EOS who underwent growing-rod surgery. Preoperative and follow-up demographic data, surgical strategies, and radiographic parameters were recorded and analyzed to identify PJK risk factors.

Results:
The mean age of patients at the time of the initial surgery was 8.6±2.5 years. Mean follow-up was 33.5±10.8 months, and mean number of lengthening surgeries were 2.14±1.52. Twenty-eight of the surgical procedures were single growing-rod surgeries, of which 22 were dual growing-rod surgeries. The upper instrumented vertebrae (UIV) ranged from C6–T6, and the lower instrumented vertebrae ranged from L1–S1. Ultimately, PJK developed in 14 (28%) of 50 patients. Taller patients, UIV distal to T2, and greater postoperative upper thoracic scoliosis (UTS) were suspected potential risk factors of PJK during the univariate analysis (P<0.1). Multifactorial regression analysis confirmed that UIV distal to T2 (hazard ratio=5.474; P=0.044) and postoperative UTS >50 degrees (hazard ratio=1.049; P=0.046) were the independent risk factors of PJK during growing-rod treatment in patients with EOS.

Conclusions:
The prevalence of PJK was 28% during growing-rod treatment in EOS. The independent risk factors for PJK were UIV distal to T2 and postoperative UTS >50 degrees. It is important for spine surgeons to recognize these risk factors when planning surgeries, and counseling patients and families about this possible complication.

Level of Evidence:
Level III.
Comparison of Freehand Sagittal Trajectories for Inserting Pedicle Screws Between C7 and T5
Authors: Oshina Masahito , Horii Chiaki , Hirai Shima , Matsubayashi Yoshitaka , Taniguchi Yuki , Hayashi Naoto , Tanaka Sakae , Oshima Yasushi 
Published: May 2018

Study Design:
Anatomic study using computed tomographic scans.

Objective:
The purpose of this paper was to determine the trajectory of pedicle screw insertions, in regard to posterior bony landmarks encountered during standard posterior exposure of the spine between the seventh cervical (C7) and the fifth thoracic (T5) vertebrae, when lateral fluoroscopic and radiographic guidance may be obstructed by the scapula and shoulders.

Summary of Background Data:
Only a few studies have evaluated the intraoperative sagittal trajectory of pedicle screw insertion.

Materials and Methods:
We assessed 64 participants of a health screening program using whole-spine computed tomographic scans. On the basis of 5 previously reported methods, we designed 3 freehand trajectories: lamina surface method (angle between the superior vertebral endplate and the surface of the lamina), spinous process method (angle between the superior vertebral endplate and a line connecting the tips of the index spinous process and the one cephalad to it), and facet tilt method (angle between the superior endplate and the superior facet tilt). We calculated each of the angles for the C7–T5 vertebrae and determined the most reliable method using coefficients of variation (CV) and intraobserver and interobserver reliability.

Results:
The lamina surface method had the smallest CVs for C7 and T1, and the mean angles were larger than 90 degrees (range, 94.7–102.4 degrees). The spinous process method had the smallest CVs between T2 and T5, and the mean angles were <90 degrees (range, 85.0–87.0 degrees). The intraobserver and interobserver reliabilities were good or excellent for both methods.

Conclusions:
The ideal sagittal trajectories for pedicle screw insertion are nearly orthogonal to the lamina surface or the line connecting the spinous processes, but were different for each of the vertebrae. The lamina surface method was the most reliable for C7 and T1, whereas the spinous process method was most reliable between T2 and T5.

Level of Evidence:
Level III.
Spinal Cord Swelling After Surgery in Cervical Spondylotic Myelopathy
Authors: Ozawa Hiroshi , Aizawa Toshimi , Tateda Satoshi , Hashimoto Ko , Kanno Haruo , Ishizuka Masato 
Published: May 2018

Study Design:
This is a prospective multicenter study.

Summary of Background Data:
Postoperative spinal cord swelling has been reported in patients with cervical spondylotic myelopathy. In the cases of the spinal cord swelling, the involvement in the intramedullary gadolinium­diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement on magnetic resonance imaging (MRI) was referred.

Objective:
The prevalence and clinical relevance of postoperative spinal cord swelling and its relationship with intramedullary Gd-DTPA enhancement in patients with cervical spondylotic myelopathy were investigated.

Subjects and Methods:
A total of 683 consecutive patients with cervical spondylotic myelopathy who underwent laminoplasty were examined. T1, T2, and Gd-DTPA-enhanced MRI were performed before surgery. Patients with intramedullary Gd-DTPA enhancement were allocated to the enhancement group. Fifty consecutive cases who did not exhibit intramedullary Gd-DTPA enhancement were allocated to the nonenhancement group. Both groups underwent MRI examinations at 1 month and 1 year after surgery.

Results:
The prevalence of spinal cord swelling in the enhancement group (26%) was significantly higher than that in the nonenhancement group (4%) (P=0.0038). At 1 year after surgery, spinal cord swelling had resolved in all patients in the nonenhancement group, while it persisted in 3 of 13 patients (23%) in the enhancement group. On multiple regression analysis, intramedullary Gd-DTPA enhancement rather than the spinal cord swelling showed a significant influence in terms of recovery of the Japanese Orthopedic Association score.

Conclusions:
Surgical outcomes of patients with postoperative swelling should be evaluated separately according to the presence or absence of intramedullary Gd-DTPA enhancement on MRI. Spinal cord swelling associated with intramedullary Gd-DTPA enhancement was indicative of poor prognosis.
Critical Analysis of Evidence About the Impacts of Faculty Development in Systematic Reviews: A Systematic Rapid Evidence Assessment
Authors: Newman Mark , Reeves Scott , Fletcher Simon 
Published: May 2018

Introduction:
Faculty Development (FD) encompasses a range of learning activities undertaken to prepare clinical teachers for their various roles as educators, leaders, and scholars. This article presents the findings of a systematic rapid evidence assessment that aimed to investigate the impact of FD on clinical teachers.

Methods:
We searched the published and gray literature for systematic reviews of FD to identify evidence to help inform judgments about which kinds of FD activities are effective for which groups of clinical teachers.

Results:
After screening the literature, we found seven systematic reviews met our inclusion criteria. Following a critical analysis of these reviews, we found that they contained a number of limitations in relation to their use of review methods and reporting of results.

Discussion:
On the basis of the analysis presented in this systematic rapid evidence assessment, we conclude that the included reviews do not provide high-quality evidence to effectively support decisions about choices of FD activities, even where the review authors made positive claims about impact. Suggestions are provided to improve the quality of systematic reviews in this area.
Family Presence During Resuscitation
Authors: Powers Kelly A. 
Published: May 2018

Background
Education on family presence during resuscitation (FPDR) has been shown to improve critical care nurses' support for FPDR; however, there have been limited studies in this area. Exploring nurses' perceived needs related to FPDR education is important to design educational interventions to promote FPDR in practice.

Objectives
The aim of this study was to explore the FPDR education needs of critical care nurses to provide recommendations for future educational interventions.

Methods
A cross-sectional survey design was used, and descriptive and qualitative data were collected online in 2016. A convenience sample of 395 critical care nurses was obtained. Participants completed online surveys, and descriptive statistics and thematic analysis were conducted.

Results
One-third of the participants had received FPDR education, and 83% desired to receive education on FPDR. Qualitative data revealed 4 themes: “nurses need education,” “team training is important,” “focus on implementation of FPDR,” and “a variety of preferences.”

Discussion
Critical care nurses' reported needs for FPDR education are currently not being met. It is important for nurse educators and researchers to design and test educational interventions to meet nurses' needs for guidance on implementing FPDR in clinical practice. In particular, online and simulation approaches should be investigated.
Adoption of an Electronic Template to Promote Evidence-Based Practice for Policies, Procedures, Guidelines, and Directives Documents
Authors: Corey Juliann , O'Donoghue Sharon C. , Kelly Veronica , Mackinson Lynn , Williams Donna , O'Reilly Kristin , DeSanto-Madeya Susan 
Published: May 2018

Background
Policies, procedures, and guidelines standardize care, meet regulatory requirements, and can promote safety in clinical practice. The existing protocols, policies, guidelines, and directives (PPGDs) at a level 1 trauma academic medical center were underused by the intensive care unit clinicians and did not always clearly represent the supporting evidence.

Aims
The goals of this project were to update the Critical Care Practice Manual (CCPM) and to ensure that clinical practice was aligned with best evidence. The aim was to design a new PPGD template that used technology to enhance the presentation and functionality of these documents.

Methods
Nurse project consultants reviewed every PPGD and solicited feedback from critical care nurses who consistently identified 2 barriers to utilization of CCPM: difficulty finding PPGDs and the cumbersomeness of lengthy policies. This improvement project used the principles of the Plan-Do-Study-Act cycle to test changes in real time. When 95% of the PPGDs were in the new format, a 22-question survey was created to elicit feedback from the direct care nurses who used the PPGD in the new electronic format.

Results
On the basis of the survey results, nurses at the medical center accessed a PPGD at least once a month. The overall results indicated that the respondents agreed or strongly agreed that the PPGDs provided guidance (85%), reflected current practice (76%), were clear and concise (75%), and were evidence based (73%). Only 24% of those surveyed were still having difficulty finding PPGDs.

Discussion/Conclusion
To facilitate timely modification and early adoption of the new PPGD format, the Plan-Do-Study-Act cycle was effectively used. The CCPM adopted a new electronic format that met the aims of the project. When making a commitment to develop evidence-based practice policies and guidelines, it is important to revisit the process, consider ongoing support, and educate frontline staff as applicable. The new template restored and enhanced the standardization of PPGDs. Technology can enhance usability and improve functionality, but it can also prove to be frustrating when implementing changes that use it, especially if users are not comfortable with it.
Trends in Black and White Opioid Mortality in the United States, 1979–2015
Authors: Alexander Monica J. , Kiang Mathew V. , Barbieri Magali 
Published: May 2018

Background:
Recent research on the US opioid epidemic has focused on the white or total population and has largely been limited to data after 1999. However, understanding racial differences in long-term trends by opioid type may contribute to improving interventions.

Methods:
Using multiple cause of death data, we calculated age-standardized opioid mortality rates, by race and opioid type, for the US resident population from 1979 to 2015. We analyzed trends in mortality rates using joinpoint regression.

Results:
From 1979 to 2015, the long-term trends in opioid-related mortality for Earlier data did not include ethnicity so this is incorrect. It is all black and all white residents in the US. blacks and whites went through three successive waves. In the first wave, from 1979 to the mid-1990s, the epidemic affected both populations and was driven by heroin. In the second wave, from the mid-1990s to 2010, the increase in opioid mortality was driven by natural/semi-synthetic opioids (e.g., codeine, morphine, hydrocodone, or oxycodone) among whites, while there was no increase in mortality for blacks. In the current wave, increases in opioid mortality for both populations have been driven by heroin and synthetic opioids (e.g., fentanyl and its analogues). Heroin rates are currently increasing at 31% (95% confidence interval [CI] = 27, 35) per year for whites and 34% (95% CI = 30, 40) for blacks. Concurrently, respective synthetic opioids are increasing at 79% (95% CI = 50, 112) and 107% (95% CI = −15, 404) annually.

Conclusion:
Since 1979, the nature of the opioid epidemic has shifted from heroin to prescription opioids for the white population to increasing of heroin/synthetic deaths for both black and white populations. See video abstract at, http://links.lww.com/EDE/B377.
Endometrioma, fertility, and assisted reproductive treatments: connecting the dots
Authors: Cecchino Gustavo N. , García-Velasco Juan A. 
Published: May 2018

Purpose of review
Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma.

Recent findings
The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms.

Summary
Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.
Diagnostic Ability of Corneal Shape and Biomechanical Parameters for Detecting Frank Keratoconus
Authors: Sedaghat Mohammad-Reza , Momeni-Moghaddam Hamed , Ambrósio Renato , Heidari Hamid-Reza , Maddah Nasim , Danesh Zeynab , Sabzi Fatemeh 
Published: May 2018

Purpose:
To assess the diagnostic capability of corneal shape and biomechanical parameters for distinguishing normal eyes from frank keratoconus (KCN).

Methods:
This is a retrospective analysis of eyes of 137 control subjects and 145 patients with KCN, with one of their eyes randomly selected as the study eye. Corneal biomechanical parameters were assessed using the Corvis ST (Oculus Optikgeräte GmbH) and Oculus Response Analyzer (Reichert Ophthalmic Instruments). Corneal tomography was performed using the Oculus Pentacam. The clinical diagnosis of KCN was based on slit-lamp findings (eg, Fleischer ring, Vogt striae) and abnormal topographic patterns on the sagittal (axial) front curvature map, disregarding tomographic and biomechanical findings. The discriminative ability for each parameter was tested using the Mann–Whitney U test. The accuracy of each parameter with statistically significant differences was determined using receiver operating characteristic curves, which were compared using the DeLong method.

Results:
Statistically significant differences were observed for all corneal shape and biomechanical parameters tested (P < 0.05) except peak distance at the highest concavity (P = 0.504). The area under the curve (AUC), sensitivity, and specificity for corneal hysteresis (CH) and corneal resistance factor (CRF) were 0.894, 80.7%, and 84.7% and 0.946, 85.5%, and 89.1%, respectively. The dynamic corneal response parameters from the Corvis ST, stiffness parameter at first applanation, integrated radius (IR), and deformation amplitude ratio at 2 mm (DA-2 mm) had AUC, sensitivity, and specificity of 0.965, 86.2%, and 94.9%; 0.961, 87.6%, and 93.4%; and 0.950, 80.7%, and 98.5%. The Corvis biomechanical index had an AUC of 0.998 (95% confidence interval, 0.983–1.000), with 96.6% sensitivity and 99.3% specificity. The Belin–Ambrósio enhanced ectasia deviation index (BAD-Dv3) and the tomographical/biomechanical index (TBI) had an AUC of 1.0 (95% confidence interval, 0.987–1.000), with sensitivity and specificity of 100%. The combined indices, Corvis biomechanical index, BAD-D, and TBI, had a statistically higher AUC than that of all corneal biomechanical parameters (DeLong, P < 0.001).

Conclusions:
The Scheimpflug-derived shape and biomechanical parameters are able to accurately distinguish normal corneas from frank (clinical) keratoconic corneas. However, the combined parameters were more effective. Further studies should test milder ectasia cases.
Bilateral Angle Closure Following the Infusion of a Monoclonal Antibody to Treat Relapsing Multiple Myeloma
Authors: Lee Andrew C. , Greaves Giovanni , Lee Ruby , Zdravkova Maria , Ahmad Samrah , McGovern Kerri , Ghiuzeli Cristina , Hymowitz Maggie 
Published: May 2018

Purpose:
We describe a case of bilateral angle closure glaucoma following the infusion of daratumumab, a monoclonal antibody used to treat relapsing multiple myeloma.

Methods:
This is an interventional case report.

Results:
A 59-year-old woman presented with bilateral angle closure glaucoma one day following her first infusion of daratumumab. B-scan echography showed ciliochoroidal effusions in both eyes. Cycloplegia was implemented given the suspicion for drug-induced angle closure, which resulted in prompt deepening of the anterior chambers and normalization of intraocular pressures. The ciliochoroidal effusions resolved 16 days following the cessation of daratumumab.

Conclusions:
Daratumumab may be associated with drug-induced secondary angle closure glaucoma.
Diversity in the American Society of Ophthalmic Plastic and Reconstructive Surgery
Authors: Charlson Emily S. , Tsai Lester , Yonkers Marc A. , Tao Jeremiah P. 
Published: May 2018

Purpose:
To assess the epidemiology of women and underrepresented minorities (URMs; Hispanic, African American, and Native American) in the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

Methods:
An observational retrospective study of living ASOPRS members was identified through the ASOPRS member directory, search engine-driven informatics, and direct communication. Members were profiled for gender, race, geographic location, and academic rank (or not). The percentage of women and URMs in the society over time was also assessed.

Results:
The authors identified 617 living ASOPRS members as of June 2017. Of these, 109 (17.7%) were female and 58 (9.4%) were URMs. Surgeons completed fellowships from 1961 (male) or 1973 (female) until 2015. Women members significantly increased from 7 (4.9% of the total) before 1986 to 24 (30.4%) between 2011 and 2015 (last 5 years). URMs significantly increased over time, with 0 female and 5 (3.4%) male minorities before 1985 to 5 (6.3%) females and 13 (16.5%) males within the last 5 years (p < 0.05). With only 1 female and 3 male members, African American representation was sparse. ASOPRS members were not found in 5 states and were most represented in California, New York, Florida, and Texas. Among ASOPRS members in full-time academic positions, women tended to have lower rank compared to men; however, after controlling for number of years post-fellowship, this finding was narrowly not statistically significant (p = 0.0624). There were no academic differences with URMs and nonminority groups.

Conclusions:
Women and URMs have increased steadily in ASOPRS, especially in recent years. Similar to the rest of ophthalmology and general medicine, there remain opportunities for ASOPRS to increase diversity.
Greater Proptosis Is Not Associated With Improved Compressive Optic Neuropathy in Thyroid Eye Disease
Authors: Nanda Tavish , Dunbar Kristen E. , Campbell Ashley A. , Bathras Ryan M. , Kazim Michael 
Published: May 2018

Purpose:
Despite the paucity of supporting data, it has generally been held that proptosis in thyroid eye disease (TED) may provide relative protection from compressive optic neuropathy (CON) by producing spontaneous decompression. The objective of this study was to investigate this phenomenon in patients with bilateral TED-CON.

Methods:
We retrospectively reviewed the charts of 67 patients (134 orbits) with bilateral TED-CON at Columbia-Presbyterian Medical Center. Significant asymmetric proptosis (Hertel) was defined as ≥ 2 mm.
1
Significant asymmetric CON was defined first, as the presence of an relative afferent pupillary defect. Those without an relative afferent pupillary defect were evaluated according to the TED-CON formula y = -0.69 – 0.31 × (motility) – 0.2 × (mean deviation) – 0.02 × (color vision) as previously established for the diagnosis of TED-CON.
2
A difference in the formula result ≥ 1.0 between eyes was considered significant. Patients were then divided into 4 groups.

Results:
Forty-one of 67 patients demonstrated asymmetric CON (29 by relative afferent pupillary defect, 12 by formula). Twenty-one of 67 patients demonstrated asymmetric proptosis. Only 5 of 12 (41.6%) of the patients who had both asymmetric proptosis and asymmetric CON (group 1) showed greater proptosis in the eye with less CON. Twenty-nine patients (group 2) showed that asymmetric CON occurred despite symmetrical proptosis. Seventeen patients (group 3), showed the inverse, that asymmetric differences in proptosis occurred with symmetrical CON.

Conclusion:
Despite commonly held assumptions, our results suggest that greater proptosis is not associated with improved TED-CON. Combining groups 1 to 3—all of which demonstrated asymmetry of either proptosis, CON, or both—91.4% of patients did not show a relationship between greater proptosis and improved CON.