bluuebunny/crossref_metadata_2025_split huggingface dataset:
Considering Spine Surgery
Authors: Moulton Haley , Tosteson Tor D. , Zhao Wenyan , Pearson Loretta , Mycek Kristina , Scherer Emily , Weinstein James N. , Pearson Adam , Abdu William , Schwarz Susan , Kelly Michael , McGuire Kevin , Milam Alden , Lurie Jonathan D. 
Published: June 2018

Study Design.
Prospective evaluation of an informational web-based calculator for communicating estimates of personalized treatment outcomes.

Objective.
To evaluate the usability, effectiveness in communicating benefits and risks, and impact on decision quality of a calculator tool for patients with intervertebral disc herniations, spinal stenosis, and degenerative spondylolisthesis who are deciding between surgical and nonsurgical treatments.

Summary of Background Data.
The decision to have back surgery is preference-sensitive and warrants shared decision making. However, more patient-specific, individualized tools for presenting clinical evidence on treatment outcomes are needed.

Methods.
Using Spine Patient Outcomes Research Trial data, prediction models were designed and integrated into a web-based calculator tool: http://spinesurgerycalc.dartmouth.edu/calc/. Consumer Reports subscribers with back-related pain were invited to use the calculator via email, and patient participants were recruited to use the calculator in a prospective manner following an initial appointment at participating spine centers. Participants completed questionnaires before and after using the calculator. We randomly assigned previously validated questions that tested knowledge about the treatment options to be asked either before or after viewing the calculator.

Results.
A total of 1256 consumer reports subscribers and 68 patient participants completed the calculator and questionnaires. Knowledge scores were higher in the postcalculator group compared to the precalculator group, indicating that calculator usage successfully informed users. Decisional conflict was lower when measured following calculator use, suggesting the calculator was beneficial in the decision-making process. Participants generally found the tool helpful and easy to use.

Conclusion.
Although the calculator is not a comprehensive decision aid, it does focus on communicating individualized risks and benefits for treatment options. Moreover, it appears to be helpful in achieving the goals of more traditional shared decision-making tools. It not only improved knowledge scores but also improved other aspects of decision quality.

Level of Evidence: 2
Negative beliefs about back pain are associated with persistent, high levels of low back disability in community-based women
Authors: Alyousef Bothaina , Cicuttini Flavia M. , Davis Susan R. , Bell Robin , Botlero Roslin , Urquhart Donna M. 
Published: June 2018

Abstract

Objectives:
Although pessimistic beliefs about back pain are associated with low back pain and disability, our understanding of their role in the natural history of the condition is limited. This study examined the association between beliefs about back pain and the development and progression of low back pain and disability over a 2-year period in community-dwelling women.

Methods:
A total of 506 women were recruited at baseline to participate in a 2-year cohort study. Beliefs about back pain were measured at baseline using the Back Beliefs Questionnaire, and low back pain and disability were assessed at baseline and 2 years using the Chronic Pain Grade Questionnaire (CPG). Participants were categorized into the following groups based on their CPG scores: no, developing, resolving, and persistent high-intensity pain and disability.

Results:
Of the 442 (87.4%) women who participated in the 2-year follow up study, 108 (24.4%) and 69 (15.6%) reported high levels of low back pain and disability, respectively. Negative beliefs about low back pain were associated with persistent, high levels of low back disability (M(SE) = 26.1(1.4) vs 31.3(0.31), P = 0.002), but not persistent, high-intensity pain (M(SE) = 28.9(1.02) vs 31.2(0.33), P = 0.2), after adjusting for confounders. Women with persistent high-intensity pain and disability had more negative responses to belief statements about the future consequences of the condition compared with those with no, resolving, or developing pain and disability (P < 0.001-0.03).

Conclusions:
This study found that pessimistic beliefs about back pain were associated with persistent high levels of low back disability, suggesting that strategies aimed at improving negative beliefs may reduce the chronicity associated with this condition.
Chronic Intraocular Inflammation as a Risk Factor for XEN Gel Stent Occlusion: A Case of Microscopic Examination of a Fibrin-obstructed XEN Stent
Authors: Gillmann Kevin , Mansouri Kaweh , Bravetti Giorgio E. , Mermoud André 
Published: June 2018

Introduction:
In recent years microinvasive glaucoma surgery has risen in popularity. Among microinvasive glaucoma surgery options is the XEN gel stent (Allergan Plc, Dublin, Ireland), a 45 μm wide ab-interno microstent. It has proven effective in lowering intraocular pressure (IOP) with low complication rates. However, XEN gel stents can become obstructed and cause postoperative rise in IOP. The causes and predicting factors for such obstructions still requires further research.

Case Report:
We describe the case of a 69-year-old male patient, with traumatic glaucoma and chronic intraocular inflammation showed by laser flare photometry, following childhood trauma and anterior segment surgery. Uncontrollable IOP despite maximal antiglaucomatous therapy was managed with XEN-augmented Baerveldt surgery. Despite good initial filtration and IOP control, the XEN stent became obstructed and was surgically replaced. After a month, the new stent became obstructed and was replaced by a thicker-lumened Baerveldt tube. This restored good filtration, and adequate IOP was maintained postoperatively. Microscopic examination of the obstructed XEN stent showed a dense fibrin plug.

Discussion and Conclusions:
This case report shows that fibrin formation could be an important factor in XEN gel stent obstruction, even in initially successfully filtering stents. The association of fibrinogenesis and intraocular inflammation could add a note of caution to the use of XEN gel stents in complicated cataract surgery, or advocate for aggressive anti-inflammatory treatments postoperatively. This could lead to a refinement in success predictors and better patient selection for XEN surgery. Finally, this could open the way to new management options for persistent obstructions, including pharmaceutical fibrinolysis.
Trends in Avoidable Hospitalizations for Diabetes: Experience of a Large Clinically Integrated Health Care System
Authors: Yaqoob Maidah , Wang Jihan , Sweeney Ann T. , Wells Cynthia , Rego Virginia , Jaber Bertrand L. 
Published: June 2018

ABSTRACT
Prevention quality indicators (PQIs) are used in hospital discharge data sets to identify quality of care for ambulatory care–sensitive conditions, such as diabetes. We examined the impact of clinical integration efforts on diabetes-related PQIs in a large community-based health care organization. Inpatient and observation hospitalizations from nine acute care hospitals were trended over 5 years (2012–2016). Using established technical specifications, annual hospitalizations rates were calculated for four diabetes-related PQIs: uncontrolled diabetes, short-term complications, long-term complications, and lower extremity amputations. The mean (±standard error of the mean) annual hospitalization rate for uncontrolled diabetes and short-term complications gradually increased from 1.3 ± 1.1 and 3.2 ± 2.5 per 1,000 discharges to 2.4 ± 1.7 (p < .001) and 7.1 ± 3.2 (p < .001) per 1,000 discharges, respectively. Conversely, the annual hospitalization rate for long-term complications and lower extremity amputations gradually decreased from 12.6 ± 1.1 and 88.6 ± 1.0 per 1,000 discharges to 6.5 ± 1.0 (p = .004) and 82.2 ± 1.0 per 1,000 discharges (p < .001). Trends generally persisted across payers, age, sex, and race. There was an inverse correlation between county income-per-capita and hospitalization rate for short-term complications (p = .04), long-term complications (p = .03), and lower extremity amputations (p < .001). Study limitations included use of administrative data, evolving coding practices, and ecological fallacy. Ambulatory-based efforts to optimize diabetes care can prevent long-term complications and reduce avoidable hospitalizations.
Terrorist attacks in Paris: managing mass casualties in a remote trauma center
Authors: Femy Florent , Follin Arnaud , Juvin Philippe , Feral-Pierssens Anne-Laure 
Published: June 2018

Objective
On 13 November 2015, Paris was the target of multiple terrorist attacks responsible for a massive influx of casualties in emergency departments (EDs). Because of the activation of a local crisis plan and the arrival of extra staff, our capacities increased markedly. Our aim was to analyze whether our center, in this challenging context, efficiently managed this massive influx of patients.

Patients and methods
We carried out a monocentric retrospective study. All patients received in the first 24 h were included (isolated psychological trauma with no physical injury excluded). Our main endpoint was to assess patient diversion through early secondary transfers ( ≤ 24 h) because of an overrun of our capacities.

Results
A total of 53 victims were sent to our center in a 4 h timeframe; 12 patients were excluded (no physical injury). We analyzed 41 victims. Their median injury severity score was 4 (1;9). Three (7%) patients were transferred after ED management to a nearby hospital within the first 24 h for minor orthopedic surgery. There was a significant increase in medical/surgical staff (eight ED physicians instead of two; six intensivists vs. two; three orthopedic surgeons vs. one). Among the victims, 71% had firearms wounds and 30% had open fractures. Twenty surgeries were performed in the first 24 h. There were no in-hospital deaths.

Conclusion
Faced with an unusual event and thanks to the increase in staff, our operating capacities increased. Our center took charge of almost all victims. Patient diversion concerned only three patients transferred to a nearby hospital for minor orthopedic surgery.
Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians
Authors: Halm Brunhild M. , Leone Tina A. , Chaudoin Lindsey T. , McKinley Kenneth W. , Ruzal-Shapiro Carrie , Franke Adrian A. , Tsze Daniel S. 
Published: June 2018

Objectives
The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist.

Methods
Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard.

Results
A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%–90.1%) and 94.4% (95% CI, 72.7%–99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%–98.2%) and 81.0% (95% CI, 65.5%–90.5%), respectively. The interrater reliability between the PEM physician's and radiologist’s measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days.

Conclusions
While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.
Procurement of Extended Vascularized Skin Flaps from the Donor Enables Hand Transplantation in Severe Upper Extremity Burns: An Anatomical Study
Authors: Dalla Pozza Edoardo , Bassiri Gharb Bahar , Papay Francis A. , Drake Richard L. , Steckler Andrew , Rampazzo Antonio 
Published: June 2018

Background:
Hand transplantation in patients with severe upper extremity burns can be associated with an increased risk of exposure of vessels, tendons, and nerves because of extensive skin and soft-tissue deficit. This study evaluated how to reliably transfer additional extended skin flaps with a standard hand allograft.

Methods:
Twenty-five upper extremities were used. Sixteen were injected with latex to map the perforating branches of the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries. Nine hand allografts were procured, injected with blue ink through the brachial artery to assess the perfusion of the skin flaps, and then mock transplanted.

Results:
Sizable perforators from the brachial, superior ulnar collateral, radial, ulnar, and posterior interosseous arteries were used to augment the vascularization of the skin flaps. The average stained area of the medial arm flap was between 85.7 and 93.9 percent. The stained area of the volar forearm flap was the smallest when based on perforators within 6 cm from the wrist crease (51.22 percent). The dorsal forearm flap showed the least amount of staining (34.7 to 46.1 percent). The average time to repair tendons, nerves, and vessels was longer when a single volar forearm-arm flap was harvested (171.6 minutes). Harvest of the allograft associated with a distally based forearm flap and islanded arm flap was the fastest (181.6 ± 17.55 minutes).

Conclusion:
Extended skin flaps, based on perforators of the main axial vessels, can be reliably transplanted with a standard hand allograft based on the brachial or axillary vascular pedicle.
68Ga DOTA-Exendin PET/CT for Detection of Insulinoma in a Patient With Persistent Hyperinsulinemic Hypoglycemia
Authors: Parihar Ashwin Singh , Vadi Shelvin Kumar , Kumar Rajender , Mittal Bhagwant Rai , Singh Harmandeep , Bal Amanjit , Walia Rama , Shukla Jaya , Sinha Saroj Kumar 
Published: June 2018

Abstract
Insulinomas are the most common functioning pancreatic neuroendocrine tumors and the leading cause of persistent hypoglycemia with hyperinsulinemia in adults. Glucagon-like-peptide-1 (GLP) receptor analogs are the latest agents being used in the detection of insulinomas, with initial reports suggesting high sensitivity due to universal GLP1 receptor expression on these tumors. PET/CT imaging in this patient using 68Ga DOTA-Exendin, a GLP receptor analog, proved useful for accurate localization of the culprit lesion, aiding in the definitive management of the patient.
Dog Attack Causing Lip Wound
Authors: Maia Gabriela Vasconcelos , de Albuquerque Amanda Lobão , Ximenes Talyne Albuquerque , Magalhães Tibério Gomes , de Souza Carvalho Abrahão Cavalcante Gomes 
Published: June 2018

Abstract
Animal bites are relatively common occurrences reaching about 4.5 millions of people every year. The main aggressor is the domesticated dog, responsible for around 90% of the patients, with children being the most affected, with 70% of the registered patients, while with adults that number is a lot lower (15%). Bites around the head and neck require special attention. Due to the presence of noble structures and the rich local vascularization, any wounds have been immediately addressed to stop bleeding and further complications. The present study shows a woman patient, victim of a dog bite in her face, where the dog is her own, a domesticated Weimaraner. The patient was attended to in the Unidade de Pronto Atendimento, the procedure was to first apply anesthesia, then clean up the wound, debris of borders, and the plane suturation. Two months after the surgery, the patient showed satisfactory healing, with no complaints about pain or esthetics. As final considerations, it has to be remembered that facial trauma has to be assessed and taken care of immediately, in a way that closing the wound in the first hours after the trauma increase the chances of obtaining a better esthetic as physiologic result for the patient, also preventing infections from the wound and external environment. Also, in the case of animal bites, it is important that the professional possess the knowledge to deal with each individual situation, employing the correct prophylactic vaccine and perform the correct notification.
Evaluating the National Surgical Quality Improvement Program-Pediatric Surgical Risk Calculator for Pediatric Craniosynostosis Surgery
Authors: Gadgil Nisha , Pan I-Wen , Babalola Solomon , Lam Sandi 
Published: June 2018

Background:
The American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric (NSQIP-P) risk calculator was developed based on national data. There have been no studies assessing the risk calculator's performance in pediatric neurosurgery. The authors aimed to evaluate the predictions from the risk calculator compared to our single institution experience in craniosynostosis surgery.

Methods:
Outcomes from craniosynostosis surgeries performed between 2012 and 2016 at our academic pediatric hospital were evaluated using the NSQIP-P risk calculator. Descriptive statistics were performed comparing predicted 30-day postoperative events and clinically observed outcomes. The performance of the calculator was evaluated using the Brier score and receiver operating characteristic curve (ROC).

Results:
A total of 202 craniosynostosis surgeries were included. Median age was 0.74 years (range 0.15–6.32); 66% were males. Blood transfusion occurred in 162/202 patients (80%). The following clinical characteristics were statistically correlated with surgical complications: American Society of Anesthesiologists physical status classification >1 (P < 0.001), central nervous system abnormality (P < 0.001), syndromic craniosynostosis (P = 0.001), and redo operations (P = 0.002). Postoperative events occurred in <3%, including hardware breakage, tracheal-cartilaginous sleeve associated with critical airway, and surgical site infection. The calculator performed well in predicting any complication (Brier = 0.067, ROC = 73.9%), and for pneumonia (Brier = 0.0049, ROC 99%). The calculator predicted a low rate of cardiac complications, venous thromboembolism, renal failure, reintubation, and death; the observed rate of these complications was 0.

Conclusions:
The risk calculator demonstrated reasonable ability to predict the low number of perioperative complications in patients undergoing craniosynostosis surgery with a composite complications outcome. Efforts to improve the calculator may include further stratification based on procedure-specific risk factors.
The Second Society for Simulation in Healthcare Research Summit
Authors: Scerbo Mark W. , Calhoun Aaron W. , Paige John T. , Sanko Jill , Sokolowski John 
Published: June 2018

Summary Statement
In this article, we report on the Second Society for Simulation in Healthcare Research Summit held in 2017. This meeting succeeded the First Research Summit from 2011 with the goal of advancing the scope of healthcare simulation research. During the one and a half day summit, some of the world's leading experts in simulation, healthcare, and simulation in healthcare convened to discuss ideas about what research goals would be most beneficial to the healthcare simulation community, and what could be done to achieve them. We describe the rationale for the meeting, the organization, the program, and the articles that emerged from the Summit, which are found in this supplemental issue of Simulation in Healthcare.
Novel Approaches to Block Complement
Authors: Böhmig Georg A. , Wahrmann Markus , Eskandary Farsad , Rostaing Lionel 
Published: June 2018

Abstract
The complement system may contribute in many ways to transplant injury, being a promising target for specific therapeutic interventions. There is evidence that the monoclonal anti-C5 antibody eculizumab is effective in the prevention and treatment of early antibody-mediated rejection, but terminal complement blockade might be of limited efficiency in chronic rejection. Given the diversity of immunological events triggered by activation steps upstream to C5, in particular, opsonin and anaphylatoxin formation through C3 cleavage, one may argue that, in the specific context of antibody-mediated rejection, inhibition of antibody-triggered classical pathway (CP) activation might be beneficial. Strategies to interfere with key CP component C1 are currently under clinical evaluation and include the therapeutic use of purified C1-inhibitor, which, besides targeting the integrity and function of the C1 complex, also affects components of the LP, the contact system, the coagulation cascade or surface molecules mediating leukocyte-endothelial interactions. In addition, a monoclonal anti-C1s antibody (BIVV009) has now entered clinical evaluation and was shown to effectively block antibody-triggered CP activation in rejecting kidney allografts. Moreover, modified apheresis techniques for preferential removal of macromolecules, including C1q, may allow for efficient complement depletion, in addition to antibody removal. The availability of effective strategies to interfere with the CP, as well as innovative approaches targeting other pathways, some of them already being tested in clinical trials, will help us figure out how complement contributes to acute and chronic graft injury, and hopefully provide us with new ways to more efficiently counteract rejection.