bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar and transforaminal approaches in the treatment of L5-S1 disc herniation
Authors: Hua Wenbin , Zhang Yukun , Wu Xinghuo , Gao Yong , Li Shuai , Wang Kun , Zeng Xianlin , Yang Shuhua , Yang Cao 
Published: November 2018

Abstract
The purpose of this retrospective study was to assess the clinical outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar approach versus the transforaminal approach under general anesthesia in the treatment of L5-S1 disc herniation.
Sixty patients with L5-S1 disc herniation were non-randomly recruited and assigned into two groups. One group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the interlaminar approach under general anesthesia, while the other group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the transforaminal approach under general anesthesia. The operative time, fluoroscopy time, and perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 18 months postoperatively.
The mean operative time and fluoroscopy time in the interlaminar group were significantly shorter compared with those in the transforaminal group. The mean VAS and ODI postoperative scores were significantly improved over the preoperative scores in both groups. According to the MacNab classification system, more than 90.0% of the patients achieved an excellence/good rating in both groups. An intraoperative epineurium injury occurred in both groups. The total recurrence rate during 18 months follow-up was 3.3% in the interlaminar group and 0% in the transforaminal group.
It is efficient and safe to perform discectomy by using full-endoscopic visualization technique via both interlaminar and transforaminal approaches under general anesthesia in patients with L5-S1 disc herniation. Discectomy performed by using full-endoscopic visualization technique via the interlaminar approach requires a shorter operative time and suffers less radiation exposure than the transforaminal approach.
Importance of prognostic value of neutrophil to lymphocyte ratio in patients with ST-elevation myocardial infarction
Authors: Park Jin-Sun , Seo Kyoung-Woo , Choi Byoung-Joo , Choi So-Yeon , Yoon Myeong-Ho , Hwang Gyo-Seung , Tahk Seung-Jea , Shin Joon-Han 
Published: November 2018

Abstract
The ratio between the absolute number of neutrophils and the number of lymphocytes (NLR) has recently emerged as a potential new biomarker predicting worse clinical conditions ranging from infectious disease to cardiovascular disease. Prognostic significance of NLR in patients with ST-elevation myocardial infarction (STEMI) is not established. This study aimed to investigate prognostic impact of NLR in patients with STEMI.
We analyzed the data and clinical outcomes of 30-day survivors with STEMI who received successful coronary intervention from 2006 to 2010. NLR was computed from the absolute values of neutrophils and lymphocytes from the complete blood count at admission. Occurrence of major adverse cardiovascular events (MACEs; death, recurrent MI, target vessel revascularization (TVR)) at 5 years was evaluated.
We enrolled 326 patients and mean follow-up duration was 68 ± 36 months. The mean NLR was 4.7 ± 5.2. Among all patients, all-cause mortality occurred in 46 patients (14%). Initial NLR was higher in patients who experienced all-cause mortality (6.39 ± 8.9 vs 4.2 ± 3.1, P = .004). In a multivariate regression model, the higher NLR was independently associated with increased risk for all-cause mortality (Hazard ratio, 1.085; 95% confidence interval, 1.002–1.174, P = .044).
Increased NLR was associated increased rate of all-cause mortality in 30-day survivors after index STEMI, who received successful coronary intervention.
Constructing a Sensitizing Definition of Certification in Nursing for Research Purposes
Authors: Chappell Kathy , Jeong Dahn , ElChamaa Rima , Lundmark Vicki , Kendall-Gallagher Deborah , Salt Elizabeth , Newhouse Robin , Johantgen Meg , Reeves Scott , Moore Donald , Olson Curtis , Van Hoof Thomas , Price David , Campbell Craig , Danilovich Natalia , Kitto Simon 
Published: November 2018

OBJECTIVE
The aim of this study was to construct a sensitizing definition of certification in nursing for research purposes that can provide a foundation from which to further develop a coherent research program building evidence about the impact of certification on healthcare outcomes.

BACKGROUND
The lack of a single definition of certification in nursing makes it difficult to draw conclusions about the relationship between specialty certification and patient outcomes.

METHODS
This study was guided by the Delphi-Chaffee hybrid methodology proposed by Grant et al.

DISCUSSION
Constructing a single, sensitizing definition of certification: 1) provides coherency for direction of certification research; 2) serves as a guide for researchers; and 3) facilitates multimethodological approaches to exploring the relationship among the different components of the definition of certification.

CONCLUSION
A sensitizing definition of certification provides an opportunity for researchers to study the relationship between nursing certification and patient outcomes.
Assessing Compassion Fatigue Risk Among Nurses in a Large Urban Trauma Center
Authors: Wijdenes Kati L. , Badger Terry A. , Sheppard Kate G. 
Published: November 2018

OBJECTIVE
This study evaluated the prevalence and severity of compassion fatigue (CF) risk among nurses employed in a large southwestern hospital system.

BACKGROUND
Compassion fatigue is defined as multifaceted exhaustion stemming from untreated distress that leads to physical and emotional problems. Low morale, increased medication errors, and higher turnover can result.

METHODS
A descriptive design was used to identify: 1) the prevalence and severity of CF risk among a sample of registered nurses; and 2) the differences in demographic characteristics correlated with CF risk.

RESULTS
Forty-six percent of nurses reported moderate to high CF risk. Compassion fatigue risk was significantly associated with years of employment, unit worked, job changes, and use of sick days.

CONCLUSION
This study reports new knowledge about compassion fatigue, established risk profiles across clinical units, and clarified optimal timing for interventions for those at the highest risk for CF.
Pilot Evaluation of a Functional Pain Assessment Scale
Authors: Halm Margo , Bailey Christie , St. Pierre Jeanne , Boutin Nancy , Rojo Susan , Shortt Melissa , Theobald Lisa , Pettycrew Elena 
Published: November 2018

Purpose/Aims:Common pain assessment tools measure intensity, ignoring other dimensions of pain like function. The aim of this study was to test the psychometric properties of a newly developed functional pain assessment scale (FPAS) for use in clinical practice.Design/Methods:In this descriptive correlational study, an FPAS was developed and then evaluated against 2 validated pain tools in 68 hospitalized adult patients experiencing acute and/or chronic pain. These tools included the numeric pain rating scale and a 100-mm visual analog scale.Results:The FPAS was significantly correlated (ρ= 0.72–0.87;P< .001) with the numeric pain rating scale and visual analog scale in cognitively intact patients but not the cognitively impaired (ρ= 0.22–0.34;P> .05). Test-retest reliability coefficients for the 3 scales were high (ρ= 0.82–0.94;P< .001), demonstrating stability of the measures. Overall, patients preferred the FPAS; this preference was significantly greater in patients older than 40 years.Conclusions:This pilot study provided support for the reliability and validity of the FPAS in cognitively intact patients experiencing pain. Although more research is needed, clinicians may consider using the FPAS with cognitively intact adults to assess the functional impact of pain on pain intensity. Clinical nurse specialists play a pivotal role in role modeling and guiding the introduction and testing of new assessment approaches into clinical practice settings across the continuum of care.
Percutaneous Aponeurotomy and Lipofilling versus Limited Fasciectomy for Dupuytren’s Contracture: 5-Year Results from a Randomized Clinical Trial
Authors: Selles Ruud W. , Zhou Chao , Kan Hester J. , Wouters Robbert M. , van Nieuwenhoven Christianne A. , Hovius Steven E. R. 
Published: November 2018

Background:
In the Dupuytren Rotterdam randomized controlled trial, percutaneous aponeurotomy with lipofilling (PALF) was as effective as limited fasciectomy in correcting primary Dupuytren’s contracture after 1 year. The authors report the 5-year results of this trial, with a special focus on recurrence of contractures.

Methods:
The authors invited all patients who had undergone PALF or limited fasciectomy to participate in a posttrial follow-up assessment. Thirty-one PALF patients and 21 limited fasciectomy patients were assessed by an independent examiner for the degree of contracture and whether patients had undergone a secondary procedure. The primary composite endpoint was recurrence rate, defined as either 20 degrees or greater worsening in contracture (relative to week 3) or as having undergone a secondary procedure for a new or worsening contracture.

Results:
At 5 years, more joints in the PALF group than in the limited fasciectomy group had a recurrence (74 percent versus 39 percent; p = 0.002). When redefining recurrence as a worsening in total extension deficit of at least 30 degrees for treated digits as often reported, this was 77 percent versus 32 percent (p = 0.001). Total extension deficit was also worse for PALF-reated digits (53 degrees versus 31 degrees; p < 0.010).

Conclusions:
Although the authors previously reported that PALF offers a shorter convalescence and fewer long-term complications but a similar degree of contracture correction at 1-year follow-up, at 5 years, the corrections were less durable than those for limited fasciectomy. This again highlights that limited fasciectomy and different types of needle aponeurotomy have specific advantages and disadvantages to weigh by patients and clinicians.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, II.
Caregiver-Reported Outcomes and Barriers to Care among Patients with Cleft Lip and Palate
Authors: Bennett Katelyn G. , Ranganathan Kavitha , Patterson Anne K. , Baker Michaella K. , Vercler Christian J. , Kasten Steven J. , Buchman Steven R. , Waljee Jennifer F. 
Published: November 2018

Background:
For children with cleft lip and/or palate, access to care is vital for optimizing speech, appearance, and psychosocial outcomes. The authors posited that inadequate access to care negatively impacts outcomes in this population.

Methods:
Sixty caregivers of children with cleft lip and palate were surveyed to assess perceived barriers using the validated Barriers to Care questionnaire. The questionnaire includes 39 items divided into five subscales, with higher scores indicating fewer barriers. Caregiver-reported outcomes were assessed using the Cleft Evaluation Profile, which captures cleft-specific appearance- and speech-related outcomes. Higher scores correspond to less satisfactory outcomes. Desire for revision surgery was assessed as a binary outcome among caregivers. Multivariable regression was used to evaluate the relationship of barriers to care, caregiver-reported outcomes, and desire for revision, adjusting for clinical and demographic covariates.

Results:
Sixty percent of caregivers perceived barriers to care, and caregivers who reported poorer access to care described poorer cleft-related outcomes (r
2 = 0.19, p = 0.024). Caregivers with poorer skills (r
2 = 0.17, p = 0.037), expectations (r
2 = 0.17, p = 0.045), and pragmatics (r
2 = 0.18, p = 0.026) subscale scores were associated with worse Cleft Evaluation Profile scores. Barriers were also negatively associated with aesthetic item scores (r
2 = 0.11, p = 0.025). Finally, caregivers reporting fewer barriers were 21.2 percent less likely to express interest in revision surgery.

Conclusions:
Barriers to care were associated with poorer appearance-related outcomes and increased interest in revision among caregivers of cleft patients. Enhancing access to care is critical in order to effectively meet goals of care for these families.
Can Functional Nasal Surgery Treat Chronic Headaches? A Systematic Review
Authors: Farmer Rebecca L. , Garg Ravi K. , Afifi Ahmed M. 
Published: November 2018

Background:
Nasal surgery is one of the most common operations performed by plastic surgeons. The link between functional nasal surgery and improvement in nasal breathing is well established, but there are other metrics that have been shown to improve as a result of anatomical correction of the nose. Current literature suggests that surgery to remove nasal mucosal contact points can reduce symptoms in chronic headache patients. The authors conducted a systematic literature review to determine the validity of this hypothesis.

Methods:
A systematic search of the literature was performed using the terms “headache,” “rhinogenic headache,” “contact point,” “migraine,” and “surgery/endoscopy.”

Results:
The authors identified 39 articles encompassing a total of 1577 patients who underwent surgery to treat mucosal contact point headaches. Septoplasty and turbinate reduction were the most commonly performed procedures, often in combination with endoscopic sinus surgery. Analysis of the combined data demonstrated improvement in the reported severity of patient symptoms, with 1289 patients (85 percent) reporting partial or complete resolution of headaches postoperatively. Average visual analogue scale scores and number of headache days in patients undergoing nasal surgery were reduced from 7.4 ± 0.9 to 2.6 ± 1.2 (p < 0.001) and 22 ± 4.3 days to 6.4 ± 4.2 days (p = 0.016), respectively. Improvement in headache symptoms was significantly associated with a positive response to preoperative anesthetic testing, and with inclusion of endoscopic sinus surgery as part of the surgery.

Conclusion:
Functional nasal surgery is a viable option to improve headache symptoms in appropriately selected patients.
Googling Aesthetic Plastic Surgery for Patient Insights into the Latest Trends
Authors: Motosko Catherine C. , Zakhem George A. , Saadeh Pierre B. , Hazen Alexes 
Published: November 2018

Background:
Analysis of Internet search patterns is rapidly transforming the study of human behavior. Google’s data, accessed through Google Trends, have proven extremely insightful in several fields of medical research. Despite its adoption in other fields of medicine, Google Trends has not yet been explored in the field of plastic surgery.

Methods:
The number of cosmetic surgery procedures from 2005 through 2016 was obtained from the American Society of Plastic Surgeons annual reports. Using Google Trends, the most commonly used keywords describing each procedure were determined, and data regarding search interest over time, interest across geographic area, and Related Queries were obtained. The number of procedures performed annually was compared to relative search volume from the corresponding year and the year prior to determine correlation.

Results:
Of the 22 procedures evaluated, the annual number of eight procedures correlated with Internet search volume in the corresponding year, and six procedures correlated with the Internet searches performed in the year prior. Florida and New York were the states with the most searches for these procedures. Related Queries suggested that several factors, such as operative techniques, notable individuals undergoing procedures, and cost, variably drove correlations for different procedures.

Conclusions:
Google Trends is a powerful tool that can be used to better understand patient interest in, questions about, and decisions regarding cosmetic surgery procedures. These findings warrant action by aesthetic surgeons to increase interest, address misinformation, and help patients fill the gaps of information missed by Internet searches.
Free Ulnar Forearm Flap: Design, Elevation, and Utility in Microvascular Nasal Lining Reconstruction
Authors: Kantar Rami S. , Rifkin William J. , Cammarata Michael J. , Diaz-Siso J. Rodrigo , Farber Scott J. , Rodriguez Eduardo D. 
Published: November 2018

Summary:
Reconstruction of the nasal lining has traditionally been performed using the folded radial forearm free flap, given its reliable blood supply, pliability, and familiarity to surgeons with respect to its harvest. More recently, the free ulnar forearm flap has been proposed as an alternative reconstructive option for the nasal lining, with safe and reliable outcomes, and improved donor-site morbidity compared with its radial counterpart. In this article, the authors provide educational video footage with accompanying text description of the senior author’s (E.D.R) approach to design and elevation of the free ulnar forearm flap for the purpose of reconstructing a composite nasal defect.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Proliferative Lesions Found at Reduction Mammaplasty: Incidence and Implications in 995 Breast Reductions
Authors: Mastroianni Melissa , Lin Alex , Hughes Kevin , Colwell Amy S. 
Published: November 2018

Background:
Reduction mammaplasty relieves symptomatic macromastia. Pathologic specimens occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies examine the incidence, risk factors, and outcomes in this population.

Methods:
A retrospective review was performed between 2000 and 2012. The pathologic condition was categorized as benign, proliferative, or cancer.

Results:
Five hundred seventy-two patients underwent 995 reduction mammaplasties. Cancer was detected in 23 specimens (2.3 percent) and proliferative lesions were detected in 137 (13.8 percent). Compared with patients with benign pathologic findings, patients with proliferative lesions or cancer were older (p < 0.001), had greater body mass index (p = 0.003), had increased unilateral procedures (p < 0.001), and more had history of cancer (p < 0.001). On multivariable regression analysis, age (OR, 1.058; 95 percent CI, 1.040 to 1.077; p < 0.001) and prior breast cancer (OR, 2.070; 95 percent CI, 1.328 to 3.227, p = 0.001) were independent risk factors for proliferative lesions, and age significantly predicted cancer (OR, 1.054; 95 percent CI, 1.012 to 1.097; p = 0.010). Forty-one percent of patients with proliferative lesions and no history of cancer had a change in management. If there was a history of cancer, 54 percent had a change in management.

Conclusions:
Proliferative lesions of the breast may be more common than previously reported. Age and a history of breast cancer increase the risk for proliferative lesions. All should be referred to oncology, as nearly half of these patients will have a change in management.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
3-Dimensional Quantification of Composite Pleural Plaque Volume in Patients Exposed to Asbestos Using High-resolution Computed Tomography
Authors: Dournes Gael , Dubois Adrian , Benlala Ilyes , Lacourt Aude , Paris Christophe , Gislard Antoine , Clin Benedicte , Pairon Jean-Claude , Baldacci Fabien , Laurent François 
Published: November 2018

Rationale:
As pleural plaque has been reported as a risk factor in the occurrence of lung cancer and mesothelioma, a reproducible and precise method of measurement of pleural plaque volume (PPV) is needed to further describe these relationships. The aim of the study was to assess the reproducibility of a 3-dimensional computed tomography (3D-CT) volumetric analysis of PPV in patients with occupational exposure to asbestos.

Material and Methods:
A total of 28 patients were retrospectively randomly selected from the multicenter APEXS (Asbestos Post Exposure Survey) study, which was held between 2003 and 2005. All patients underwent a 3D-CT scan. Two readers specialized in chest radiology completed the 3D semiautomated quantification of lung volume using dedicated software. They also had to categorize the visual extent of pleural plaque in terms of thickness and circumference. Reproducibility of the continuous PPV variable was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Reproducibility of categorical variables was assessed using the κ test.

Results:
Intraobserver reproducibility of PPV was almost perfect (ICC=0.98 [95% interval: 0.97-0.99]), and interobserver reproducibility was very good (ICC=0.93 [0.88-0.97]). At Bland-Altman analysis, the mean differences were 0.1 (limit of agreement: −11.0 to 11.2) and 3.7 cc3 (−17.8 to 25.2), respectively. Visual analysis of both plaque in terms of thickness and circumference were fair to moderate, with κ values ranging from 0.30 to 0.60.

Conclusions:
3D semiautomatic quantification of PPV is feasible and reproducible using CT in patients with occupational exposure to asbestos. PPV measurement may be useful to correlate with other asbestos-related disease outcomes and prognosis.
Hospital Volume Matters
Authors: O’Donnell Thomas F. X. , Boitano Laura T. , Deery Sarah E. , Lancaster Robert T. , Siracuse Jeffrey J. , Schermerhorn Marc L. , Scali Salvatore T. , Patel Virendra I. 
Published: November 2018

Objective:
We studied whether the volume–outcome relationship would persist in more complex aortic operations.

Background:
Despite the added complexity of the involvement of the renal arteries in open juxtarenal abdominal aortic aneurysm (AAA) repair, the volume effect in these difficult operations has yet to be defined.

Methods:
We identified all patients in the Vascular Quality Initiative (VQI) who underwent open AAA repair from 2003 to 2016. We calculated each hospital's average annual volume for total open AAA repairs, and total open juxtarenal AAA repairs. We compared adjusted perioperative and long-term survival across quintiles of hospital volume, and constructed models including both volume metrics to evaluate the cross-volume effects.

Results:
Of 8880 total open AAA repairs, there were 3470 open juxtarenal cases. Centers with low (<4), medium (4–14), and high (>14) volumes of open juxtarenal repair demonstrated adjusted perioperative mortality of 9.0%, 4.9%, and 3.9%, respectively (P < 0.01). When both volume metrics were considered, open juxtarenal volume, but not total open AAA volume was associated with perioperative mortality (lowest quintile of juxtarenal volume: OR 2.36 [1.29–4.30], P < 0.01). Hospital volume was not associated with adjusted long-term mortality. High volume centers were more likely to use renal protective strategies such as mannitol and cold renal perfusion (both P < 0.01). Low volume centers performed a similar proportion of cases each year, but 22 centers (13%) did stop performing repairs during the study period.

Conclusion:
Hospitals with low annualized volumes of open juxtarenal repair have higher perioperative mortality, irrespective of their total open aortic volume. Complex open AAA repairs should be performed at experienced centers, and future efforts should focus on centralization of complex aortic care.