bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Can We Define Clinically Important Improvement in Pain Scores After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? Minimum 2-Year Follow-up Study
Authors: Beck Edward C. , Nwachukwu Benedict U. , Kunze Kyle N. , Chahla Jorge , Nho Shane J. 
Published: October 2019

Background: Patient postoperative pain is being increasingly reported in the field of hip preservation surgery. The visual analog scale (VAS) for pain is one of the most commonly utilized measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain. Purpose: (1) To define the substantial clinical benefit (SCB), patient acceptable symptomatic state (PASS), and minimal clinically important difference (MCID) for the VAS pain score in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome after 2 years from surgery and (2) to identify preoperative predictors of achieving each outcome endpoint. Study Design: Case series; Level of evidence, 4. Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and March 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome scores were recorded at 2 years postoperatively. To quantify clinical significance of outcome achievement for the VAS pain score, the MCID, PASS, and SCB were calculated. Results: A total of 976 patients were included in the final analysis. The VAS pain score threshold for achieving the MCID was defined as a decrease of 14.8; the PASS was defined as achieving a 2-year postoperative score of 21.6 points; and the SCB was defined as a decrease of 25.5 or a score of 15.4 points at 2 years. The rates of achieving the MCID, PASS, and SCB were 97.6%, 66.4%, and 71.2%, respectively. Regression analysis demonstrated that sports involvement, low body mass index, smaller preoperative alpha angle, and absence of articular damage and chondromalacia were predictive of achieving the PASS (all P < .05). Preoperative predictors for achieving the SCB included being male, no smoking history, smaller alpha angle, higher modified Harris Hip Score, and lower VAS pain score (all P < .05). Conclusion: This study identified scores for VAS pain that can be used to define clinically significant outcome after arthroscopic treatment of femoroacetabular impingement syndrome. Specifically, a decrease in pain score of 14.8 was a clinically important improvement in VAS pain, while an absolute score <15.4 or a change of 25.5 represented the upper threshold of VAS pain improvement. Additionally, there were both modifiable and nonmodifiable factors that predicted achieving clinically significant levels of postoperative pain improvement.
The Perinatal Mental Health of Indigenous Women: A Systematic Review and Meta-Analysis
Authors: Owais Sawayra , Faltyn Mateusz , Johnson Ashley V. D. , Gabel Chelsea , Downey Bernice , Kates Nick , Van Lieshout Ryan J. 
Published: October 2019

Objective: Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women. Methods: We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum. Results: Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [ OR] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity ( OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women ( OR 1.86; 95% CI, 1.51 to 2.28). Conclusion: Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations. Trial Registration: PROSPERO-CRD42018108638.
Characteristics of Effective School-Based, Teacher-Delivered Mental Health Services for Children
Authors: Park Sunyoung , Guz Samantha , Zhang Anao , Beretvas S. Natasha , Franklin Cynthia , Kim Johnny S. 
Published: October 2019

Purpose: The increasing need for school-based mental health services has altered teachers’ involvement in mental health services. Methods: This study presents a meta-analysis from a previous systematic review to identify which study characteristics result in effective treatment outcomes. Specific treatment characteristics analyzed in this study include type of intervention, treatment modality, length of treatment, and type of measurement. Effect sizes were coded by internalizing and externalizing disorders, depending on the symptoms the corresponding treatments were intended to address. A final sample size included 9 independent effect sizes of internalizing behaviors and 21 effect sizes of externalizing behaviors. Results: Internalizing disorders, social skill interventions, classroom modalities, and medium treatment length were moderating treatment characteristics. No significant effects were found for externalizing disorders. Conclusions: These results further add to the research on teacher’s role in school-based mental health services and provide important information for social workers who work in schools.
Comparison of two eyelid speculums and their effect on intraocular pressure in clinically normal cats
Authors: Selk Ghaffari Masoud , Mohitmafi Soroush , Hajizadeh Sara 
Published: October 2019

Objectives The present study was undertaken to determine the possible effects of the placement two different types of eyelid speculum on intraocular pressure (IOP) measurement in clinically normal cats. Methods Thirty healthy cats were divided randomly into two groups of 15, group B (Barraquer wire speculum) and group W (Williams eye speculum). All cats were sedated with intramuscular medetomidine (Dorbene vet; 100 μg/kg) then placed in right lateral recumbency, and IOP was recorded in the left eye using a Tono-Pen Vet tonometer without and with an eyelid speculum in place in both groups. Results The without-speculum IOPs for cats in group B and group W were 13.8 ± 3.0 mmHg and 13.2 ± 3.6 mmHg, respectively, and did not differ significantly. A significant increase in IOP (19.8 ± 3.7 mmHg) was observed in group W in with-speculum measurements in comparison to the without-speculum values ( P <0.001).There was no significant difference between with- and without-speculum IOP values (13.8 ± 2.7 mmHg) in group B ( P = 1.0). Conclusions and relevance The Barraquer wire speculum has no effect on IOP compared with the Williams eye speculum in normal cats, and may be an appropriate choice in cats for intraocular surgeries that cannot tolerate acute increases in IOP.
A nomogram for predicting the response to exclusive enteral nutrition in adult patients with isolated colonic Crohn’s disease
Authors: Xu Yihan , Guo Zhen , Huang Liangyu , Gong Jianfeng , Li Yi , Gu Lili , Shen Weisong , Zhu Weiming 
Published: October 2019

Background: Isolated colonic Crohn’s disease (cCD) responds less well to induction therapy with exclusive enteral nutrition (EEN) compared with ileal or ileocolonic disease in adult patients; therefore, we aimed to identify the factors that influence the response to EEN and develop a predictive nomogram model to optimize the use of EEN in cCD patients. Materials and methods: Eighty-five cCD patients treated with EEN as first-line therapy at our center between 1 June 2012 and 30 June 2018 were retrospectively analyzed as the primary cohort. The primary endpoint was clinical remission after EEN therapy. Potential predictive factors for the efficacy of EEN were assessed by univariate and multivariate analyses, and a nomogram to predict the response to EEN therapy in cCD patients was designed. Another 19 cCD patients were retrospectively included in the validation cohort to verify the accuracy of the nomogram model. Results: The clinical remission rates for the primary cohort and validation cohort were 52.9% and 47.4%, respectively. Pancolitis was the greatest contributor to the risk of failure to respond to EEN [odds ratio (OR) = 4.896; 95% confidence interval (CI) = 1.223–19.607; p = 0.025], lean body mass index (LBMI), colonic lesion features, simple endoscopic scores for Crohn’s disease, C-reactive protein before treatment and ∆prealbumin were also related to the efficacy of EEN in cCD. The nomogram model showed robust discrimination, with an area under the receiving operating characteristic curve of 0.906. Conclusion: Several predictive factors for response to EEN therapy in cCD adult patients were identified, and a promising nomogram that can predict the effect of EEN in cCD was developed.
Management of Athletes With G6PD Deficiency: Does Missing an Enzyme Mean Missing More Games?
Authors: Stone Shane N. , Reisig Karl V. , Saffel Heather L. , Miles Christopher M. 
Published: October 2019

Context: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is likely the most prevalent enzyme deficiency on the planet, with an estimated 4.9% of people, or approximately 330 million individuals, across the globe affected by the disease. In the United States, 4% to 7% of the population is likely affected, but each year our nation’s major sport leagues become more international. It is important for medical professionals who treat athletes to understand how this genetic condition can affect the athletes we are working with, especially because exercise in itself results in oxidative stress. Evidence Acquisition: PubMed was searched for relevant articles published from 1980 to 2018. The search terms G6PD, athletes, military, and sports were used. Study Design: Clinical review. Level of Evidence: Level 4. Results: Though some case reports suggest a potential impact on athlete safety and performance, controlled studies demonstrate limited impact of exercise on oxidative stress in G6PD-deficient individuals. The care of athletes with G6PD deficiency does not drastically differ from the care of athletes without this condition. Most of the medications and supplements that are regularly given to athletes should not negatively affect their health. Conclusion: Although the care of athletes with G6PD deficiency is for the most part no different from the care of other athletes, there are certain situations (visiting areas where malaria is endemic) and medications for which it is important to recognize how your management should change. G6PD deficiency is not regularly screened for but could be considered if an athlete has known sickle cell disease or when traveling to areas where malaria is prevalent. Expanding our knowledge of G6PD deficiency will allow for better care of athletes.
Concha Bullosa Affects Baseline and Postoperative Quality-of-Life Measures in Surgically Managed Chronic Rhinosinusitis
Authors: Qualliotine Jesse R. , Jafari Aria , Shen Sarek , Bernstein Jeffrey D. , DeConde Adam S. 
Published: October 2019

BackgroundConcha bullosa (CB) is a prevalent anatomic variant and frequent surgical target in endoscopic sinus surgery (ESS). However, whether CB impacts quality-of-life (QOL) in chronic rhinosinusitis (CRS) is not well established. The purpose of this study was to investigate baseline and post-ESS QOL differences in patients with medically recalcitrant CRS with and without CB.MethodsDemographic and surgical characteristics, baseline and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores for 137 patients with CRS who underwent primary ESS at our institution were recorded. Computed tomography (CT) scans were reviewed for Lund–Mackay score and presence of CB. Multiplanar CT was used to measure CB dimensions and estimate volume. Multivariable analysis was performed to identify differences in SNOT-22 overall and symptom-domain scores between patients with upper quartile (≥0.8 mL) CB and without CB.ResultsCB was found in 37% of patients with mean volume of 0.67 mL. There were no significant differences in distribution of clinicodemographic variables by large CB status. At baseline, large CB was associated with higher SNOT-22 extranasal-rhinologic domain score (9.8 vs 6.0, P < .01). Following ESS, patients with large CB reported greater improvement in SNOT-22 extranasal-rhinologic domain score (multivariable mean absolute improvement 3.8, P = .01; relative 56% vs 30%).ConclusionPatients with medically recalcitrant CRS and concomitant large CB have higher SNOT-22 extranasal-rhinologic domain scores at baseline, but also report greater intradomain improvement exceeding the subdomain’s mean clinically important difference. To our knowledge, this is the first demonstration that CB has a clinically significant impact on QOL in CRS, and surgical intervention may be helpful to address these symptoms.
Symptom and cost evaluation of ureteric stent extraction using strings versus flexible cystoscopy at a single high-volume centre
Authors: Bates Anthony Simon , Jameson Molly , Nkwam Nkwam Michael , Khan Masood Ahmed 
Published: October 2019

Background: This study evaluated ureteric stent symptoms using a modified ureteric stent symptom questionnaire (USSQ) for patients undergoing stent removal by either flexible cystoscopy, or manual, healthcare worker lead string extraction. Methods: Patients completed a stent symptom questionnaire derived from the USSQ. Mean data were compared between groups using paired Student’s t-tests. Data are presented as mean ± SD with associated p-values. A departmental cost analysis was undertaken. Results: Ninety patients completed questionnaires, 30 undergoing flexible cystoscopy and 60 string extraction. Six stents with strings were removed early (days 1–5, 6.67%, four female and two male). There were no adverse events recorded for this group. Men undergoing string extraction had significantly less pain (2.47 ± 1.88) compared to men undergoing flexible cystoscopic removal (5.67 ± 2.27, p < 0.001). There was no significant difference in pain scores for women undergoing string and flexible cystoscopic stent removal (3.56 ± 2.56 versus 3.66 ± 3.14, p > 0.90). The mean duration of stents left in situ was significantly less in the string group (10.1 ± 5.3 versus 26.5 ± 14.1 days, p < 0.001). Urinary tract infection rates did not differ between the string and the cystoscopy groups (3.7% ± 0.19 versus 2.78% ± 0.46, p > 0.90). The haematuria rates were 32.14% ± 0.47 and 66.67% ± 0.5, respectively ( p < 0.001). In our study, 60 flexible cystoscopies were avoided, saving over £67,000 at the institution within our study period. Conclusions: In our small study, stents removed with strings reduced pain scores in men, the duration of an indwelling ureteric stent, and cost to the health service. Level of evidence: 2b
Use of mobile health applications for health-promoting behavior among individuals with chronic medical conditions
Authors: Mahmood Asos , Kedia Satish , Wyant David K , Ahn SangNam , Bhuyan Soumitra S 
Published: October 2019

Background Chronic medical conditions (CCs) are leading causes of morbidity and mortality in the United States. Strategies to control CCs include targeting unhealthy behaviors, often through the use of patient empowerment tools, such as mobile health (mHealth) technology. However, no conclusive evidence exists that mHealth applications (apps) are effective among individuals with CCs for chronic disease self-management. Methods We used data from the Health Information National Trends Survey (HINTS 5, Cycle 1, 2017). A sample of 1864 non-institutionalized US adults (≥18 years) who had a smartphone and/or a tablet computer and at least one CC was analyzed. Using multivariable logistic regressions, we assessed predisposing, enabling, and need predictors of three health-promoting behaviors (HPBs): tracking progress on a health-related goal, making a health-related decision, and health-related discussions with a care provider among smart device and mHealth apps owners. Results Compared to those without mHealth apps, individuals with mHealth apps had significantly higher odds of using their smart devices to track progress on a health-related goal (adjusted odds ratio (aOR) 8.74, 95% confidence interval (CI): 5.66–13.50, P <  .001), to make a health-related decision (aOR 1.77, 95% CI: 1.16–2.71, P <  .01) and in health-related discussions with care providers (aOR 2.0, 95% CI: 1.26–3.19, P <  .01). Other significant factors of at least one type of HPB among smart device and mHealth apps users were age, gender, education, occupational status, having a regular provider, and self-rated general health. Conclusion mHealth apps are associated with increased rates of HPB among individuals with CCs. However, certain groups, like older adults, are most affected by a digital divide where they have lower access to mHealth apps and thus are not able to take advantage of these tools. Rigorous randomized clinical trials among various segments of the population and different health conditions are needed to establish the effectiveness of these mHealth apps. Healthcare providers should encourage validated mHealth apps for patients with CCs.
Does a modifiable risk factor score predict disability worsening in people with multiple sclerosis?
Authors: Marck Claudia H , Aitken Zoe , Simpson Steve , Weiland Tracey J , Jelinek George A 
Published: October 2019

Background Risk factors for chronic disease include smoking, hazardous alcohol consumption, physical inactivity, unhealthy body mass index and poor diet (SNAP factors). In multiple sclerosis (MS) SNAP factors are associated with health outcomes such as disability in cross-sectional studies, but longitudinal data are lacking. Objective The objective of this study was to assess whether a combined SNAP risk score predicts disability worsening. Methods Longitudinal self-reported data from two time-points 2.5 years apart from an international survey of 1225 people with MS were used in linear regression models adjusted for potential confounding. Disability worsening was measured using the patient-derived Multiple Sclerosis Severity Score. Results The majority (62%) had two or more risk factors, with insufficient fruit and vegetable intake (83%), unhealthy body mass index (42%) and physical inactivity (33%) most common. Some SNAP factors at follow-up were associated with disability at follow-up (cross-sectionally), and in addition there was some evidence that increasing risk factors was associated with disability worsening over the 2.5 year study period. Baseline SNAP score was not predictive of disability worsening at follow-up, however. Conclusion Known risk factors for morbidity and mortality were common and associated with disability cross-sectionally, but not prospectively. Further studies using longer time frames, objective measures and interventions may elucidate potential benefits from changes in risk factors on MS outcomes.
Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion
Authors: Lu Young , Lin Charles C. , Stepanyan Hayk , Alvarez Andrew P. , Bhatia Nitin N. , Kiester P. Douglas , Rosen Charles D. , Lee Yu-Po 
Published: October 2019

Study Design: Retrospective large database study. Objective: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. Methods: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. Results: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). Conclusions: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement.