bluuebunny/crossref_metadata_2025_split huggingface dataset:
Independent Associations With 30- and 90-Day Unplanned Readmissions After Elective Lumbar Spine Surgery: A National Trend Analysis of 144 123 Patients
Authors: Elsamadicy Aladine A , Ren Xinru , Kemeny Hanna , Charalambous Lefko , Sergesketter Amanda R , Rahimpour Shervin , Williamson Theresa , Goodwin C Rory , Abd-El-Barr Muhammad M , Gottfried Oren N , Xie Jichun , Lad Shivanand P 
Published: June 2018

Abstract

BACKGROUND
Unplanned hospital readmissions contribute significantly to soaring national healthcare expenditures. To alleviate this burden, Centers for Medicare and Medicaid Services implemented initiatives to penalize hospitals for unplanned 30-d hospital readmissions. There is a paucity of data identifying patient risk factors independently associated with 30- and 90-d readmissions.

OBJECTIVE
To investigate similarities in patient risk factors associated with 30- and 90-d unplanned readmissions following elective lumbar spine surgery.

METHODS
The National Readmission Database (NRD) was queried to identify patients undergoing elective lumbar spine surgery between 2013 and 2014. Patients were grouped by no readmission (Non-R), unplanned readmission within 30 days (30-R), and unplanned readmission within 31 to 90 days (90-R). Multivariate analysis determined factors associated with 30- and 90-d readmissions.

RESULTS
We identified 144 123 patients with 10 592 (7.3%) patients experiencing an unplanned readmission (30-R: n = 7228 [5.0%]; 90-R: n = 3364 [2.3%]; Non-R: n = 133 531). The most common inpatient complication observed in those patients readmitted was dural tear (30-R: 7.7%, 90-R: 4.6%, Non-R: 4.3%). The most prevalent 30- and 90-d complication seen among the readmitted cohort was infection (30-R: 18.5%, 90-R: 7.4%). In multivariate regression analysis, age, insurance status, chronic obstructive pulmonary disorder (COPD), depression, hypertension, diabetes, deficiency anemia, and obesity were independently associated with 30-d readmission; however, age and obesity were not independently associated with 90-d readmission.

CONCLUSION
Our study demonstrated national unplanned readmission rates after elective spinal surgery to be 7.3%. With age, insurance status, COPD, depression, hypertension, diabetes, deficiency anemia, obesity, and depression all independently associated with unplanned hospital readmission. Future solutions that focus on reducing preventable readmissions may improve patient outcomes and reduce healthcare costs.
Brain Tectal Tumors: A Flexible Approach
Authors: Perin Alessandro , Galbiati Tommaso Francesco , Casali Cecilia , Legnani Federico Giuseppe , Mattei Luca , Prada Francesco Ugo , Saini Marco , Saladino Andrea , Riker Nicole , DiMeco Francesco 
Published: June 2018

Abstract

BACKGROUND AND IMPORTANCE
Mesencephalic tectal gliomas represent a subset of midbrain tumors, which are more frequent in children than in adults. They usually become symptomatic when causing hydrocephalus by occluding the aqueduct. Because of their slow progression, due to their benign histology, they are characterized by a relatively good prognosis, although hydrocephalus might jeopardize patients’ prognosis. Treatment is usually represented by cerebrospinal fluid diversion associated or not with biopsy.

CLINICAL PRESENTATION
We report 2 illustrative cases of tectal gliomas in adults where endoscopic third ventriculostomy (ETV) and simultaneous endoscopic biopsy were obtained during the same operation by means of a single burr hole with a flexible endoscope.

CONCLUSION
We recommend using this overlooked neurosurgical tool for such cases, since it allows the surgeon to safely perform an ETV, then judge whether biopsy can be done or not, without harming the patient, and possibly achieving an important piece of information (histopathological diagnosis) to manage this subset of oncological patients.
Development and Implementation of an Inexpensive, Easily Producible, Time Efficient External Ventricular Drain Simulator Using 3-Dimensional Printing and Image Registration
Authors: Bow Hansen , He Le , Raees Muhammad Aanish , Pruthi Sumit , Chitale Rohan 
Published: June 2018

Abstract

BACKGROUND
External ventricular drain (EVD) placement is one of the most commonly performed procedures in neurosurgery, frequently by the junior neurosurgery resident. Simulators for EVD placement are often costly, time-intensive to create, and complicated to set up.

OBJECTIVE
To describe creation of a simulator that is inexpensive, time-efficient, and simple to set up.

METHODS
This simulator involves printing a hollow head using a desktop 3-dimensional (3D) printer. This head is registered to a commercially available image-guidance system. A total of 11 participants volunteered for this simulation module. EVD placement was assessed at baseline, after verbal teaching, and after live 3D view instruction.

RESULTS
Accurate placement of an EVD on the right side at the foramen of Monro or the frontal horn of the lateral ventricle increased from 44% to 98% with training. Similarly, accurate placement on the left increased from 42% to 85% with training.

CONCLUSION
During participation in the simulation, accurate placement of EVDs increased significantly. All participants believed that they had a better understanding of ventricular anatomy and that this module would be useful as a teaching tool for neurosurgery interns.
Resection of 2 Intradural Extramedullary Cervical Spine Tumors in a Patient With Neurofibromatosis Type 2: 3-Dimensional Operative Video
Authors: Dekker Simone E , Glenn Chad A , Ostergard Thomas A , Wu Osmond C , Alonso Fernando , Pace Jonathan A , Rothstein Brian D , Ray Abhishek , Bambakidis Nicholas C 
Published: June 2018

Abstract
This 3-dimensional operative video illustrates resection of 2 cervical spine schwannomas in a 19-yr-old female with neurofibromatosis type 2. The patient presented with lower extremity hyperreflexity and hypertonicity. Magnetic resonance imaging (MRI) demonstrated 2 contrast-enhancing intradural extramedullary cervical spine lesions causing spinal cord compression at C4 and C5. The patient underwent a posterior cervical laminoplasty with a midline dural opening for tumor resection. Curvilinear spine cord compression is demonstrated in the operative video. After meticulous dissection, the tumors were resected without complication. The dural closure was performed in watertight fashion followed by laminoplasty using osteoplastic titanium miniplates and screws. Postoperative MRI demonstrated gross total resection with excellent decompression of the spinal cord. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.
Characterization of Balance Control After Moderate to Severe Traumatic Brain Injury: A Longitudinal Recovery Study
Authors: Perez Olinda Habib , Green Robin E , Mochizuki George 
Published: June 2018

Abstract

Background
Balance impairments after traumatic brain injury (TBI) are common and persist after injury. Postural asymmetries in balance have been reported, but not quantified, across recovery.

Objective
The objective of this study was to characterize balance recovery after moderate to severe TBI, with a focus on postural asymmetry.

Design
A secondary analysis of prospectively collected data was used in this study.

Methods
Data were from 45 participants with moderate to severe TBI. Participants’ balance in 2 bipedal stances and 2 unipedal stances was assessed with force plates at approximately 2, 5, and 12 months after injury. Single-visit data from participants who were matched for age and served as healthy controls were collected for visual comparison using 95% confidence intervals. Spatial and temporal center-of-pressure (COP) measures were calculated from force plates in the anteroposterior (AP) and mediolateral (ML) directions.

Results
Despite improvements in net ML COP postural sway from 2 to 5 months after injury, there were no changes in AP postural sway across recovery. Postural sway in individuals with TBI was higher than normative values at all time points in both directions. Interlimb synchrony did not change across recovery in either direction. TBI weight-bearing asymmetry was lower than normative values at all time points and did not change across recovery. The characteristics of unipedal stance differed between limbs.

Limitations
Sample size was reduced as a result of the inclusion and exclusion criteria; future studies will benefit from a larger sample size.

Conclusions
The absence of recovery in ML COP postural sway, interlimb synchrony, and weight-bearing symmetry indicated that reduced ML control may contribute to balance impairments after TBI. These impairments may extend to dynamic balance tasks and may also place individuals with TBI at a higher risk for falls.
Does evidence support the use of cat allergen immunotherapy?
Authors: Dhami Sangeeta , Agarwal Arnav 
Published: June 2018

Purpose of review
Cat allergy can manifest as allergic rhinitis, conjunctivitis and/or asthma. With widespread cat ownership and exposure, cat allergy has emerged as a major cause of morbidity. Cat allergen immunotherapy is a potential disease modifying treatment for patients with cat allergy. We examine evidence on the effectiveness, cost-effectiveness and safety of cat allergen immunotherapy and consider the clinical contexts in which it should be prescribed.

Recent findings
The European Association of Allergy and Clinical Immunology systematic reviews on allergic rhinitis and asthma along with the accompanying guidelines on allergic rhinitis were used as primary sources of evidence. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are most common routes of administration for allergen immunotherapy (AIT). A limited number of high-quality studies related to cat dander have shown mixed results in improvements in ocular and nasal symptoms, asthma symptoms, peak expiratory flow rate and medication use scores with subcutaneous immunotherapy. Two studies examining cat dander and cat-related allergy response with sublingual immunotherapy have shown mixed results in terms of symptomatic response. One randomized trial examining intralymphatic immunotherapy has shown a positive symptom response and a favourable safety profile. Although studies have reported mixed results regarding safety of SCIT, adverse events have been reported more commonly with SCIT than SLIT.

Summary
There is a limited body of high-quality evidence on the effectiveness and safety of cat AIT and no high-quality data on its cost-effectiveness. The available evidence on effectiveness is mixed based on studying a limited array of immunological, physiological and patient-reported outcome measures. Based on this evidence and extrapolating on the wider evidence base in AIT, it is likely that some patients may benefit from this modality of treatment, particularly those with moderate-to-severe disease who are inadequately controlled on allergen avoidance measures and pharmacotherapy and those who are monosensitized to Felix Domesticus 1. Further evidence is, however, required from larger trials before more definitive advice can be offered.
The Matrix: Moving From Principles to Pragmatics in Medical School Curriculum Renewal
Authors: Jarvis-Selinger Sandra , Hubinette Maria 
Published: June 2018

Many medical programs embarking on curriculum renewal begin with overarching goals and principles, but struggle with how to translate these into an implementable curriculum and assessment practices. This article describes the Matrix, a tool developed as a means of transforming high-level pedagogic principles into a concrete curriculum while addressing the complexities of curriculum content, context, people, and places. Using a known framework as an analytic lens, the authors explore the Matrix’s intended and unintended impacts on the University of British Columbia Medical Doctor Undergraduate Program (MDUP).
The Matrix is a graphical representation of the 130 weeks of the renewed MDUP curriculum. Its focus is on week-level objectives, which are mapped to year-level milestones and deconstructed into individual session objectives via virtual course books.
The Matrix had several predictable outcomes. It served as a tool for translating principles into a pragmatic curriculum. It created a curriculum map that reflected the original vision for renewal, enabled curriculum drift monitoring, and provided a high-level yet detailed visual representation. However, this innovation had unexpected system impacts with respect to multiple levels of governance, and it enabled realignment of the MDUP’s governance structure with the functionality required to administer the renewed curriculum.
The Matrix created a foundation for curriculum mapping at the MDUP. It has transitioned from the curriculum development and renewal phase into a useful implementation framework. The authors propose that it could be adapted by others for local use.
The ALiEM Faculty Incubator: A Novel Online Approach to Faculty Development in Education Scholarship
Authors: Chan Teresa M. , Gottlieb Michael , Sherbino Jonathan , Cooney Robert , Boysen-Osborn Megan , Swaminathan Anand , Ankel Felix , Yarris Lalena M. 
Published: June 2018

Problem
Early- and midcareer clinician educators often lack a local discipline-specific community of practice (CoP) that encourages scholarly activity. As a result, these faculty members may feel disconnected from other scholars.

Approach
Academic Life in Emergency Medicine (ALiEM) piloted the Faculty Incubator. This longitudinal, asynchronous, online curriculum focused on developing a virtual CoP among 30 early- to midcareer medical educators (the “incubatees”), 8 core faculty mentors, and 10 guest mentors. The yearlong curriculum included 12 monthly modules focusing on core concepts in medical education scholarship. The initiative connected the incubatees with a virtual community of peers and mentors, with whom they completed multiple scholarly projects, sought mentorship, and engaged professionally. The authors used an online, closed, social media platform (Slack) to facilitate the exchange of ideas.

Outcomes
In the inaugural year (March 2016–February 2017), the mentorship team facilitated exceptional levels of online engagement among incubatees. All participants (incubatees, core mentors, and guest mentors) shared 1,081 files and exchanged a total of 22,665 messages (approximately 62 per day). Of these, 3,036 (13.4%) were via open channels, 5,483 (24.2%) via small groups, and 14,146 (62.4%) via direct messages.

Next Steps
The ALiEM Faculty Incubator represents a proof of concept, and initial outcomes show that it is possible to engage an international group of early- to midcareer medical educators to create a vibrant online CoP. The Faculty Incubator leaders plan to determine whether this engaged group of health professions educators will increase their scholarly output as a result of this initiative.
Glucocorticoids and antimalarials in systemic lupus erythematosus: an update and future directions
Authors: Ugarte Amaia , Danza Alvaro , Ruiz-Irastorza Guillermo 
Published: June 2018

Purpose of review
The purpose of this review is highlighting the most recent evidence on the clinical efficacy and toxicity of glucocorticoids and antimalarials in systemic lupus erythematosus (SLE) and provide recommendations on their current use.

Recent findings
Glucocorticoid toxicity is well known. Recent data confirm the increased risk of infection and damage accrual. An observational study form Hong Kong has seen increased mortality among users of high-dose prednisone regimes. Several studies support the efficacy of medium-low doses and methyl-prednisolone pulses in lupus patients, both with and without nephritis.
New data confirm the effects of antimalarials in preventing SLE activity, damage and infections, and in decreasing mortality. New screening recommendations for hydroxychloroquine maculopathy have been recently published. Combining mepacrine and hydroxychloroquine in patients with refractory cutaneous and/or articular lupus activity has proved highly effective.

Summary
Universal therapy with hydroxychloroquine should be aimed to patients with SLE without contraindications. Doses greater than 4 mg/kg/day should be avoided and regular eye screening warranted to minimize the risk of macular toxicity. Every effort should be made to reduce the dose of oral glucocorticoids. In moderate-severe flares, pulse methyl-prednisolone are more effective and much less toxic than increasing the oral doses of prednisone.
Vulvar Tuberculosis Cutis Orificialis Concomitant to Pulmonary Tuberculosis: A Case Report
Authors: Oliveira Mayara , Vita-Campos Clarissa , Jeunon Thiago 
Published: June 2018

Abstract:
Tuberculosis (TB) is a common condition with increasing incidence worldwide. Cutaneous TB represents a small portion of extrapulmonary TB. Health care professionals must be aware of cutaneous forms of TB to avoid delay in diagnosis and treatment. We present a case of a 59-year-old woman with vulvar TB cutis orificialis in association with pulmonary TB without any other involvement of genitourinary system. We discuss epidemiological aspects, classification, treatment, range of histopathological patterns, and use of ancillary techniques for diagnosis.
Indeterminate Dendritic Cell Tumor: A Report of Two New Cases Lacking the ETV3-NCOA2 Translocation and a Literature Review
Authors: Davick Jonathan J. , Kim Jinah , Wick Mark R. , Gru Alejandro A. 
Published: June 2018

Abstract:
Indeterminate dendritic cell tumor (IDCT) is a cutaneous proliferation of histiocytes that share morphologic and immunophenotypic properties with Langerhans cells. IDCT was recently included in the updated WHO classification of tumors of hematopoietic and lymphoid tissues. Recent studies have shown that some cases of IDCT demonstrate an ETV3-NCOA2 translocation, supporting the idea that IDCT is a clonal neoplasm. We report 2 new cases of IDCT at our institution lacking the ETV3-NCOA2 translocation. We also present a comprehensive review of reported cases of IDCT in the medical literature. Eighty-five cases of IDCT were reported in the literature between 1985 and 2016. The median age at diagnosis was 45 years. In contrast to Langerhans cell histiocytosis, IDCT is limited to the skin in the majority of cases (88%) and generally follows an indolent clinical course. Most reported lesions are cured with complete excision. However, the histologic features of IDCT and langerhans cell histiocytosis are similar. Conjoint immunostaining for CD1a and langerin is necessary for optimal classification.
Self-healing Cutaneous Mucinosis in Adulthood: The Adult Counterpart of the Juvenile Variant of the Disease?
Authors: Deza Gustavo , García-Martínez Pablo , Gallardo Fernando , Barranco Carlos , Pujol Ramon M. 
Published: June 2018

Abstract:Self-healing cutaneous mucinosis (SHCM) is an idiopathic localized cutaneous mucinosis mainly described in children and characterized clinically by an acute onset of papules and nodules that exhibit a spontaneous resolution in a period ranging from weeks to few months. Histologically, a diffuse mucin deposition in the dermis and/or hypodermis associated with a proliferation of spindle-shaped cells and some large epithelioid gangliocyte-like mononuclear cells is usually observed. An uncommon adult variant of SHCM has also been reported; however, the clinicopathological features described in these patients are extremely heterogeneous and differ significantly from the juvenile variant of the disease, often showing exclusively dermal involvement. We report a case of a 37-year-old female patient with multiple asymptomatic nodules located on the legs and arms that resolved spontaneously in a period of 2 years, showing the typical subcutaneous features of the juvenile variant of SHCM at the histological examination (ie, mucinous areas associated with dense bands of fibrosis containing arborizing thin-walled vessels, spindle-shaped fibroblasts, and some gangliocyte-like cells). To the best of our knowledge, this is the first report of SHCM showing the classic pattern of deep-seated subcutaneous involvement of the disease in an adult patient. We also review the cases of adult-onset SHCM reported in the literature.
Drivers of Seasonal Variation in Tuberculosis Incidence
Authors: Tedijanto Christine , Hermans Sabine , Cobelens Frank , Wood Robin , Andrews Jason R. 
Published: June 2018

Background:
Seasonality in tuberculosis incidence has been widely observed across countries and populations; however, its drivers are poorly understood. We conducted a systematic review of studies reporting seasonal patterns in tuberculosis to identify demographic and ecologic factors associated with timing and magnitude of seasonal variation.

Methods:
We identified studies reporting seasonal variation in tuberculosis incidence through PubMed and EMBASE and extracted incidence data and population metadata. We described key factors relating to seasonality and, when data permitted, quantified seasonal variation and its association with metadata. We developed a dynamic tuberculosis natural history and transmission model incorporating seasonal differences in disease progression and/or transmission rates to examine magnitude of variation required to produce observed seasonality in incidence.

Results:
Fifty-seven studies met inclusion criteria. In the majority of studies (n=49), tuberculosis incidence peaked in spring or summer and reached a trough in late fall or winter. A standardized seasonal amplitude was calculated for 34 of the studies, resulting in a mean of 17.1% (range: 2.7–85.5%) after weighting by sample size. Across multiple studies, stronger seasonality was associated with younger patients, extrapulmonary disease, and latitudes farther from the Equator. The mathematical model was generally able to reproduce observed levels of seasonal case variation; however, substantial variation in transmission or disease progression risk was required to replicate several extreme values.

Conclusions:
We observed seasonal variation in tuberculosis, with consistent peaks occurring in spring, across countries with varying tuberculosis burden. Future research is needed to explore and quantify potential gains from strategically conducting mass screening interventions in the spring.
Twenty years of adverse drug reactions: a look back – part 2
Authors: Ferner Robin E. , Anton Christopher 
Published: June 2018

Summary
After 20 years, Robin Ferner and Christopher Anton, who took on responsibility for the Adverse Drug Reaction Bulletin from its founder Professor Dai Davies, are handing over responsibility to Professor Kim Dalhoff and his colleague Dr Jon Andersen in Copenhagen. They take the opportunity to review some interesting, important, or unusual clinical aspects of adverse drug reactions encountered over the last twenty years.