bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge, Attitudes and Practices of Obstetricians for Postpartum Pain Control in the United States [33L]
Authors: Khan Muhammad Shoaib , Jackson Theresa N. , Mushtaq Nasir , Royall Nelson A. , Miller Barbara H. , Gold Karen P. 
Published: May 2019

INTRODUCTION:
Postpartum pain is one of the most common morbidities in the postpartum period. Absence of clinical practice guidelines to treat postpartum pain combined with the ongoing opioid prescriptions epidemic has impacted the physicians' practices. The objective was to study the knowledge, attitudes and practices of obstetricians in regards to postpartum pain control across the United States.

METHODS:
This nation-wide cross-sectional study was conducted electronically from 3/2018 to 5/2018. Participants included obstetrics-gynecology or family medicine-trained obstetricians practicing in academic institutions. Survey included 34 questions and response rate was 35% (648/1878). Institutional review board approval was obtained for this study.

RESULTS:
Respondents' characteristics included mean age 46.2 (±11.0) years, females 422 (66%) and Caucasians 483 (75%). Regarding knowledge about guidelines, 153 (24%) were familiar with postpartum pain management and 351 (54%) were familiar with chronic pain management guidelines. Regarding the most common source of pain post-vaginal delivery, 87 (13%) correctly cited perineal pain, while post-cesarean delivery, 333 (51%) correctly cited incisional pain. Regarding pain level, 474 (72%) felt there is mild pain post-vaginal delivery, while 506 (78%) felt there is moderate pain post-cesarean delivery. Regarding opioids for treating postpartum pain, 367 (57%) felt that it should be considered only if the pain is unresolved, while 195 (30%) felt it is unnecessary most of the times. The national attention to opioids prescription epidemic has moderately to severely impacted practices of 230 (36%) respondents.

CONCLUSION:
This study provides unique obstetricians' perspectives around postpartum pain management that can help develop clinical practice guidelines for treating this common morbidity.
Labor Progression Slower Than the Zhang Standards Is Associated With Worse Maternal and Fetal Outcomes [35L]
Authors: Zdroik Anna , Altman Alan , Marcotte Michael Paul , Mincarelli Delores , Holbert Michael 
Published: May 2019

INTRODUCTION:
In 2010, Zhang et al published data on over 62000 laboring patients that challenged the work of Friedman, which had been in place for over 50 years. This data included the 95th percentile of labor progression for each centimeter of cervical change in active labor. The purpose of this study was to investigate maternal and fetal outcomes in labors that progressed slower than these standards during the first stage of labor.

METHODS:
This was an IRB approved retrospective review of 9415 patients that had reached 6cm of dilation. The duration of each cervical change, up until complete dilation, was compared to the 95th percentile Zhang data. Maternal and neonatal outcomes were compared between labors that remained within these standards and those and those that progressed slower.

RESULTS:
Of the 9415 labors, 1467 (15.6%) had cervical dilation slower than the Zhang 95th percentile data. These labors were associated with greater risk of maternal ICU admission (RR 5.4, 1.4-21.6, p=0.02), maternal fever (RR 2.6, 2.2-3.0, p<0.0001), maternal blood transfusion (RR 3.0, 1.7-5.4, p=.0003), maternal readmission (RR 2.0, 1.3-2.9, p=0.0009). Neonatal macrosomia (RR 2.3, 1.5-3.5, p=0.0002), shoulder dystocia (RR 1.4, 1.1-1.8, p=0.0148), 5 minutes Apgar <7 (RR 3.0, 1.7-5.3, P=0.0002), and NICU admission (RR 1.7, 1.2-2.3, p=0.0017) were also increased. Overall combined maternal and neonatal morbidity was increased (RR 1.9, 1.7-2.1, p<0.0001).

CONCLUSION:
Labors characterized by cervical dilation slower than the 95th percentile Zhang standards are associated with worse maternal and fetal outcomes. Clinicians should be aware of this increased risk as they manage labors.
Eosinophilic esophagitis during sublingual and oral allergen immunotherapy
Authors: Cafone Joseph , Capucilli Peter , Hill David A. , Spergel Jonathan M. 
Published: May 2019

Purpose of review
The aim of this review is to discuss the current evidence regarding the development of eosinophilic esophagitis (EoE) in individuals undergoing oral and sublingual immunotherapy (SLIT) for both food and environmental allergens. Cumulative incidence of EoE in patients on allergen immunotherapy for peanut, milk, and egg is estimated.

Recent findings
De novo development of EoE in patients undergoing oral and SLIT has been demonstrated on the scale of case reports and prospective randomized trials. However, few individuals with EoE-like symptoms during immunotherapy undergo endoscopy, and the long-term outcomes of immunotherapy-associated EoE are unknown.

Summary
Evidence exists to suggest that allergen immunotherapy could place individuals at risk for the development of EoE, the true incidence of which may vary depending on antigen exposure and methods used to define the condition.
Human epidermal growth factor receptor 2-positive digestive tumors
Authors: Wagner Anna D. , Özdemir Berna C. , Rüschoff Josef 
Published: May 2019

Purpose of review
This manuscript aims at providing an update and overview on the role of Human epidermal growth factor receptor 2 (HER2) testing and HER2-directed therapies in digestive tumors.

Recent findings
Phase 3 trial data demonstrating a survival benefit of HER2-targeting treatments are limited to gastric cancer. However, HER2 positivity is also found in 5–6% of colorectal, 7% of pancreatic, and 16% of extrahepatic biliary cancers. Although phase 2 trial data support the use of the combination of trastuzumab and lapatinib with chemotherapy in HER2-positive colorectal cancer, the patient's benefit from targeted treatment of HER2-positive biliary or pancreatic neoplasms is currently unclear, and further clinical trials are necessary.

Summary
With the exception of gastric cancer, there are currently no defined guidelines for HER2 testing in other digestive tumors. Various HER2-targeting therapies, which are standard of care in HER2-positive breast cancer, failed in HER2-positive gastric cancers. Thus, the predictive value of HER2 overexpression depends on the tumor type, and results of breast cancer trials cannot a priori be extrapolated to digestive cancers. Next-generation sequencing panel diagnostics may furthermore identify targetable activating mutations in gastric, extrahepatic biliary, and colorectal cancer, particularly if traditional testing (immunohistochemistry/in-situ hybridization) is negative. However, their clinical relevance needs to be determined.
The Reason Matters: Deep Wrist Injury Patterns Differ with Intentionality (Accident versus Suicide Attempt)
Authors: Kisch Tobias , Matzkeit Nico , Waldmann Annika , Stang Felix , Krämer Robert , Schweiger Ulrich , Mailänder Peter , Westermair Anna Lisa 
Published: May 2019

Background:
Despite the clinical importance of suicidal deep wrist injuries (DWIs), we currently do not know whether their injury patterns differ from accidental injuries.

Methods:
This retrospective study included all patients admitted to the Clinic of Plastic Surgery for acute treatment of a DWI from 2008 to 2016, except for isolated injuries to the palmaris longus (PL) and amputations. Intentionality of the injury was determined using documentation of psychiatric evaluations; cases that could not be categorized regarding intentionality were excluded.

Results:
About 20% of DWIs stemmed from suicide attempts, which involved the nondominant hand in 94.5%. Suicidal DWIs were more likely to involve the median nerve, radial artery, PL, and flexor carpi radialis (FCR), especially on the nondominant hand, but were less likely to involve the ulnar artery and nerve on the dominant hand. The effect of the protective structures PL/flexor carpi ulnaris on the median nerve/ulnar artery could be confirmed for suicidal DWIs, but intactness of the FCR was associated with increased radial artery injuries. Longitudinal cut orientation in suicidal DWIs was associated with more radial artery injuries, but fewer injuries to tendons and nerves. Frequencies of various other injury constellations are tabulated to aid in clinical assessment.

Conclusions:
Suicidal and accidental DWIs differed in various aspects of injury pattern. Suicidal injuries were mostly localized to the nondominant radial side, and accidental injuries to the ulnar side. Also, the so-called protective structure FCR had the opposite effect in suicidal injuries. Thus, findings regarding injury patterns in accidental DWIs cannot be generalized to suicidal injuries.
Combined Method with Free Omentum Flap and Split-thickness Skin Flap for Hand Reconstruction Following Radical Excision of an Arteriovenous Malformation
Authors: Hatano Takaharu , Motomura Hisashi , Deguchi Ayaka , Fujikawa Heishiro , Maeda Shusaku 
Published: May 2019

Summary:
The treatment for arterial venous malformation (AVM) of functionally and aesthetically important parts such as the hand is considered to be challenging. AVM existed in the right forearm and the thenar region of 55-year-old man. Combined method with free omentum flap and split-thickness skin flap was performed for hand reconstruction after radical excision of an AVM. The postoperative course was good. Seven years have passed postoperatively, and functional but aesthetical results are satisfying with no recurrence. Our operative procedure with complete resection of AVM with placement of the free omental flap to the resected area and placing back the original skin as a skin graft is considered to be an ideal curative surgical treatment of the AVM.
Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in a Patient with a History of Toxic Epidermal Necrosis
Authors: Sinelnikov Mikhail Y. , Starceva Olesya I. , Melnikov Dmitriy V. , Ivanov Semen I. , Makarenko Dmitriy A. 
Published: May 2019

Summary:
Breast reconstruction is a procedure that is in increased demand due to high incidence of breast cancer. To provide high-quality esthetic and functional results, each patient should be properly managed. Patients with comorbid conditions have become more common and account for higher difficulty in perioperative patient management. Despite the ongoing diversification of comorbidities in patients undergoing breast reconstruction, it is the patient’s right to receive this final stage in rehabilitation after a mastectomy. We present a clinical vignette of a patient with a severe comorbid hypersensitivity disorder undergoing breast reconstruction with the deep inferior epigastric artery perforator flap. Despite early postoperative complications, our brigade managed to maintain flap viability without the use of surgical or pharmacological assistance in a patient with a history of toxic epidermal necrosis syndrome.
Long-term Prognosis of Mandibular Distraction in 3 Cases of Hypoglossia-Hypodactyly Syndrome without Extremity Anomalies
Authors: Imai Yoshimichi , Kochi Shoko , Nakajo Tetsu , Yamada Atsushi 
Published: May 2019

Summary:
Hypoglossia-hypodactyly, or aglossia-adactylia syndrome with or without limb anomalies, is an extremely rare congenital condition. It is characterized by a narrow, V-shaped mandibular dental arch with micrognathia, and is typically challenging to treat. We have previously reported 3 patients with hypoglossia-hypodactyly syndrome without limb anomalies who were treated with transverse distraction osteogenesis at the mandibular symphysis during childhood. In this report, we present the long-term prognoses of these 3 cases, until 18 years of age. Of the 3 total cases, sufficient and stable results in occlusion, speech, mastication, and facial appearance were obtained in 2 cases with subsequent orthodontic treatments. Similar results were not observed in the remaining case when continuous orthodontic treatments were not performed. Based on these results, we propose that the transverse distraction osteogenesis procedure at the mandibular symphysis during childhood could be a reliable method to correct the V-shaped mandibular arch of hypoglossia-hypodactyly syndrome, when subsequent orthodontic treatments are provided during the patient’s growing period.
Patient-reported Outcome Instruments in Lower Extremity Trauma: A Systematic Review of the Literature
Authors: Mundy Lily R. , Grier A. Jordan , Weissler E. Hope , Carty Matthew J. , Pusic Andrea L. , Hollenbeck Scott T. , Gage Mark J. 
Published: May 2019

Background:
Advances in fracture fixation and soft tissue coverage continue to improve the care of patients after limb-threatening lower extremity (LE) trauma. However, debate continues regarding which treatment option—reconstruction or amputation—is most appropriate. Many authors have attempted to quantify the patient experience in this treatment paradigm; however, they have not used patient-reported outcome (PRO) instruments specific to this population. Our aim was to identify and evaluate PRO instruments developed specifically for LE trauma, applicable to reconstruction and amputation, using established PRO instrument development and validation guidelines.

Methods:
A multidisciplinary team used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to query PubMed, Medline Ovid, EMBASE, Cochrane, Medline Web of Science, and Psych Info databases from inception to November 2016. Publications were included that described the development and/or validation of a PRO instrument assessing satisfaction and/or quality of life in LE trauma, applicable to both amputation and reconstruction. Two authors independently reviewed each full-text citation.

Results:
After removing duplicates, 6,290 abstracts were identified via the database query. Following a preliminary title and abstract screen, 657 full-text citations were reviewed. Of these references, none satisfied the previously established inclusion criteria.

Conclusions:
No studies were identified that described a PRO instrument developed to assess outcomes in LE trauma patients applicable to both reconstruction and amputation. There is thus a need for a PRO instrument designed specifically for patients who have sustained limb-threatening LE trauma to guide treatment decisions.
Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method
Authors: Magnusson Mark R. , Connell Tony , Miroshnik Michael , Layt Craig , Ashton Mark , Deva Anand K. , Farrow Hamish , Januszkiewicz Janek 
Published: May 2019

Background:
Geographical differences in breast implant selection approaches exist, and clinical data to guide the process are limited. Developing knowledge of implant-related risk factors further complicates the process. This analysis aimed to establish expert consensus on considerations for breast implant selection in Australia and New Zealand based on practice patterns in those countries.

Methods:
A modified Delphi method was used to gain consensus from experts in breast augmentation surgery in Australia and New Zealand. Panelists anonymously completed an initial questionnaire on current considerations in implant selection, discussed a summary of their responses in a live meeting, and completed a final consensus survey based on their live recommendations.

Results:
Seven panelists completed the final consensus survey. Consensus recommendations included ensuring consideration of proper surgical technique (pocket formation, positioning of implant) and patient tissue and anatomical characteristics, weighing relative expected results of various surface textures, sizes, and degrees of cohesivity, and careful contemplation of the migration risk.

Conclusions:
This modified Delphi exercise provided consensus recommendations on the key factors involved in implant selection from the perspective of plastic surgeons with practices in Australia and New Zealand. A primary recommendation was that the choice of implant for each patient should be individualized to patient tissue and anatomical characteristics.
Preliminary Dose Assessment for Emergency Response Exercise Using Unsealed Radioactive Contamination
Authors: Cochran Lainy D. , Marianno Craig M. 
Published: May 2019

Abstract
A preliminary dose assessment for an emergency response exercise using unsealed radioactive sources was performed based on conservative calculation methods. The assessment was broken into four parts: activation, distribution, exercise participation, and post-exercise monitoring. The computer code MicroShield was used to determine external exposure from the source during and after distribution. Internal exposure via inhalation and ingestion was estimated by assuming fractional intakes of activity and converting to dose using annual limits on intake and dose coefficients. It was determined from the dose assessment that a radionuclide-dependent range of 37 MBq to 1.5 GBq can be used to achieve detectable dose rates during the exercise without exceeding assumed administrative dose limits. Of the identified radionuclides, 99mTc results in the lowest dose and is recommended from a radiological safety standpoint. However, the choice of which radionuclide and what activity to use for an exercise should be made based on budget and the logistics of the actual exercise.
Providing Care for Comorbid Mental Health Conditions in the Polytrauma System of Care
Authors: Pastorek Nicholas J. , Petska Kelly S. , Duchnick Jennifer J. , Chard Kathleen M. , Belanger Heather G. 
Published: May 2019

Objective:
To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes.

Design:
To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting.

Conclusion:
To further develop mental health treatment within the PSC, the following recommendations were made: (1) continued support for family members as critical members of the rehabilitation team; (2) adding measures and mechanisms to monitor mental health within the PSC; and (3) exploration of modern technologies to enhance care of existing polytrauma clients and to better prepare to serve clients with all types of acquired brain injury.
Developing the Disorders of Consciousness Guideline and Challenges of Integrating Shared Decision-Making Into Clinical Practice
Authors: Armstrong Melissa J. 
Published: May 2019

Objective:
To review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and highlight challenges to SDM in disorders of consciousness.

Methods:
We describe guideline development strategies and implications for use, approaches to SDM generally and with surrogate decision makers, and considerations when implementing the prolonged disorders of consciousness guideline into clinical care.

Results:
Clinical practice guidelines aim to improve high-quality patient care and outcomes by assessing the best medical evidence and incorporating this into care recommendations. This is accomplished through transparent methodology and compliance with published standards. Guidelines support SDM with patients and surrogate decision makers. Effective SDM can be challenging in conditions such as prolonged disorders of consciousness where surrogates are required, but assessment of patient values and incorporation of these values into SDM is ethically critical.

Conclusions:
Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for individuals with prolonged disorders of consciousness. They also provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is needed into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.
Use of Topical Steroids in Conjunctivitis: A Review of the Evidence
Authors: Holland Edward J. , Fingeret Murray , Mah Francis S. 
Published: May 2019

Purpose:
Conjunctivitis, or inflammation of the conjunctiva, is a common condition that can be caused by infectious (eg, bacterial or viral infections) and noninfectious (eg, allergy) etiologies. Treatment involves diagnosis of the underlying cause and use of appropriate therapies. A broad-spectrum therapy that can address multiple etiologies, and also the accompanying inflammation, would be very useful. In this review, we discuss the usefulness of topical ophthalmic corticosteroids and ophthalmic formulations that combine corticosteroids with anti-infectives/antibiotics for treating acute infectious conjunctivitis.

Methods:
A review of the published literature and relevant treatment guidelines.

Results:
Topical corticosteroids are useful in treating ocular inflammation, but most treatment guidelines recommend steroid use generally in severe cases of conjunctivitis. This is partly due to risks associated with steroid use. These risks include potential for prolonging adenoviral infections and potentiating/worsening herpes simplex virus infections, increased intraocular pressure, glaucoma, and cataracts. Most of these perceived risks are not, however, supported by high-quality clinical data. They are also associated with long-term steroid uses that are dissimilar to applications for infectious conjunctivitis. Clinical data show that ophthalmic formulations that combine corticosteroids with broad-spectrum anti-infectives could be effective and well tolerated when used for short-term treatment (≤2 weeks).

Conclusions:
Corticosteroids, in combination with anti-infectives, could be a promising treatment option for acute conjunctivitis subject to development of further evidence on their effectiveness and safety in conjunctivitis treatment.