bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting
Authors: Kim Elliott J. , Chotai Silky , Wick Joseph B. , Khan Inamullah , Sivaganesan Ahilan , Bydon Mohamad , Archer Kristin R. , Devin Clinton J. 
Published: January 2019

Study Design.
This study retrospectively analyzes prospectively collected data.

Objective.
Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status.

Summary of Background Data.
Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients.

Methods.
All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores.

Results.
Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2–90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time.

Conclusion.
Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery.

Level of Evidence: 3
PROMIS Pain Interference Is Superior to the Likert Pain Scale for Pain Assessment in Spine Patients
Authors: Bernstein David N. , St. John Matthew , Rubery Paul T. , Mesfin Addisu 
Published: January 2019

Study Design.
Cross-sectional cohort analysis.

Objective.
(1) To assess the correlation between Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) in patients seeking spine care; (2) to assess the correlation between PROMIS PF and the Likert Pain Scale (LPS) in patients seeking spine care; (3) to determine which pain scale best correlates to physical function overall and by number of clinic visits.

Summary of Background Data.
An accurate understanding of a patient's pain level is beneficial in setting clinical and pain management expectations. There is limited work analyzing which instrument best captures pain and its impact on function in patients seeking spine care.

Methods.
Spine center patients from February 2015 to November 2017 were asked to complete PROMIS PF and PI domains, as well as to report their pain level on a 0 (no pain) to 10 (worst pain) LPS at each visit. Pearson correlation coefficients were calculated between PROMIS PF and PROMIS PI; PROMIS PI and LPS; and PROMIS PF and LPS. Fisher r–z transformation method was utilized for confidence intervals (CIs) and to determine significant correlation differences. Analyses were performed for all data, as well as by office visit. Significance was set at P < 0.01.

Results.
A total of 21,774 first visit, 11,130 second visit, 6575 third visit, 4202 fourth visit, and 2819 fifth visit patients’ data were recorded. PROMIS PF demonstrated a moderate correlation with the LPS over all visits (r = 0.46–0.49, P < 0.01). PROMIS PF demonstrated a strong correlation with PROMIS PI over all visits (r = 0.73–0.77, P < 0.01). Overall, PROMIS PI demonstrated significantly better correlation to self-reported physical function than the LPS (P < 0.01).

Conclusion.
While PROMIS PI and the LPS both demonstrated significant correlation with self-reported physical function, PROMIS PI had a significantly stronger correlation.

Level of Evidence: 2
Effects of Athermal Shortwave Diathermy Treatment on Somatosensory Evoked Potentials and Motor Evoked Potentials in Rats With Spinal Cord Injury
Authors: Xie Caizhong , Li Xiangzhe , Fang Lu , Wang Tong 
Published: January 2019

Study Design.
A study on shortwave diathermy (SWD) versus no treatment following induced spinal cord injury (SCI) in rats.

Objective.
To investigate the effects of athermal SWD treatment on somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) and hindlimb movements in rats with SCI.

Summary of Background Data.
SWD has been proven to improve vascular circulation and reduce inflammation. However, there have been few studies on neuroprotective effect of SWD on SCI.

Methods.
Twenty-four female Sprague–Dawley (SD) rats were randomly divided into four groups: sham, SCI, SWD, and intact groups. The SCI model was established using the modified Allen weight-drop method. The SWD group received 15 sessions of athermal SWD treatment over a 3-week period of time at 24 hours after SCI. While the sham group and SCI group received no treatment after surgery. Hindlimb movements were evaluated by the Basso, Beattie, and Bresnahan (BBB) scale before surgery, and on days 1, 7, 14, and 21 after the surgery, respectively. The SEP and MEP measurements were simultaneously performed to detect the responses of neural conduction.

Results.
The week-by-week BBB scores showed a gradual improvement in the rats of both SCI and SWD groups from the first week to the end of the study; however, the BBB scores of the SWD group were higher than those of the SCI group over the course of 3 weeks. Data from the SEP and MEP measurements showed a significant improvement in the SWD group compared with the SCI group at each time point of observation, with a more prominent increase of amplitude and a more evident reduction of latency. There was a linear correlation between the BBB scores and the latency and amplitude of SEPs or MEPs.

Conclusion.
Athermal SWD treatment might facilitate the recovery of locomotor function and exert neuroprotective effect on the SCI.

Level of Evidence: N/A
The Relationship Between Lumbar Lateral Listhesis and Radiculopathy in Adult Scoliosis
Authors: Kleimeyer John P. , Liu Ning , Hu Serena S. , Cheng Ivan , Alamin Todd , Grottkau Brian E. , Kukreja Sunil , Wood Kirkham B. 
Published: January 2019

Study Design.
Retrospective review and prospective validation study.

Objective.
To develop a classification system of lumbar lateral listhesis that suggests different likelihoods of having radiculopathy in adult scoliosis.

Summary of Background Data.
The association of lumbar lateral listhesis with radiculopathy remains uncertain.

Methods.
A retrospective cohort of patients with adult scoliosis enrolled from 2011 to 2015 was studied to develop a classification system of lateral listhesis that can stratify the likelihood of having radiculopathy. Four radiological aspects of lateral listhesis, including Nash and Moe vertebral rotation, L4–L5 lateral listhesis, the number of consecutive listheses, and the presence of a contralateral lateral listhesis at the thoracolumbar junction above a caudal listhesis, were evaluated on radiographs. Their associations with the presence of radicular leg pain were evaluated using multivariable logistic regression. The classification system of lateral listhesis was thus developed using the most influential radiological factors and then validated in a prospective cohort from 2016 to 2017.

Results.
The retrospective cohort included 189 patients. Vertebral rotation is more than or equal to grade 2 (odds ratio [OR] = 9.45, 95% confidence interval [CI]: 4.07–25.14) and L4–5 listhesis (OR = 4.56, 95%CI: 1.85–12.35) were the two most influential listhesis factors associated with radiculopathy. The classification system of lateral listhesis was thus built based on the combinations of their respective presence: Type 0, 1, 2, 3 were defined as not having listhesis at all, none of the two factors present, one of the two presents, and both present, respectively. This classification significantly stratified the probability of radiculopathy, in both the retrospective cohort (0%, 6.4%, 33.8%, and 68.4% in Type 0, 1, 2, and 3, respectively; P < 0.001) and a prospective cohort of 105 patients (0%, 16.7%, 46.9%, and 72.7%; P < 0.001).

Conclusion.
Lumbar lateral listhesis is associated with the presence of radiculopathy in adult scoliosis. Types 2 and 3 lateral listhesis on radiographs may alert surgeons treating patients with spinal deformity.

Level of Evidence: 2
The Effect of Proton Pump Inhibitors on Bone Formation in a Rat Spinal Arthrodesis Model
Authors: Sonn Kevin A. , Wallace Stephen J. , Yuan Feng Ning F. , Schneider Andrew D. , Hsu Erin L. , Havey Robert M. , Patwardhan Avinash G. , Callaci John J. 
Published: January 2019

Study Design.
Rat posterolateral arthrodesis model.

Objective.
Quantify the impact of administration of a proton pump inhibitor on spine fusion.

Summary of Background Data.
Proton pump inhibitors (PPIs) are widely used for gastrointestinal disorders and for ulcer prophylaxis in patients taking non-steroidal anti-inflammatory drugs. PPIs cause chronic acid suppression which has been found to result in decreased bone mineral density, increased fracture risk, and impaired fracture healing. Despite advances in surgical techniques, pseudarthrosis still occurs in up to 24% of patients requiring revision surgery following spinal fusion procedures. Thus, there are likely many unidentified risk factors. While PPIs have been hypothesized to impact fracture healing, no study has evaluated their effect on spine arthrodesis rates.

Methods.
Thirty-eight female rats underwent posterolateral lumbar spinal fusion. Rats were divided into two groups: normal saline control and pantroprazole, which was administered by daily intraperitoneal injections. At 8 weeks postoperative spines were evaluated with manual palpation, microCT, histologic analysis, and biomechanical testing.

Results.
Fusion rates of the control group and PPI group were not significantly different (100% vs. 94%). Average fusion scores were significantly lower in the pantoprazole group. New bone formation identified on microCT imaging of bilaterally fused specimens demonstrated a lower average volume of newly generated bone in the PPI group, but this difference was not significant. Biomechanical testing demonstrated no significant difference in strength or stiffness of the fusion mass between the groups.

Conclusion.
This study demonstrates that administration of PPIs does not inhibit fusion rates, bone formation, or affect biomechanical integrity of fusion. However, lower fusion scores in the PPI group suggest that a negative impact may still exist. Future studies will explore growth factor and protein expression in the fusion masses as well as utilize higher doses of PPI to fully discern their effect on spine fusion.

Level of Evidence: N/A
Sliding the Medial Pin: A Safer Approach to Cross-pinning Humerus Supracondylar Fractures?
Authors: Wong Kenneth Pak Leung , Chew Ee Ming , Mahadev Arjandas 
Published: January 2019

Introduction:
Many methods have been described to minimize the risk of ulnar nerve injury during the insertion of a medial pin for the percutaneous pinning of pediatric supracondylar humerus fractures (SCHF). The most recent AAOS Clinical Practice Guidelines suggests that physicians might want to avoid the use of medial-entry pins due to considerations of potential injury to the ulnar nerve. However, there are circumstances whereby a cross pin configuration is required. These include cases where there is medial wall comminution or due to the obliquity of the fracture. In this study, we present a group of patients with SCHF in which the medial pin was inserted using a new technique.

Materials and Methods:
This is a retrospective case series approved by the local centralized institutional review board. The medical records of all patients who underwent closed reduction and percutaneous pinning for SCHF using a new technique—the sliding method—by a single pediatric orthopedic surgeon from August 2017 till January 2018 were reviewed. Patient demographics, fracture type, operative time, postoperative Baumann’s angle, postoperative lateral capitellohumeral angle, and the rate of ulnar nerve palsy were recorded.

Results:
This new technique was used in a total of 35 patients. Two patients were excluded as one had multiple same limb injuries, while another had a Gustilo 3A humerus supracondylar fracture. The average patient age at the time of surgery was 6.2 years (range: 2 to 12 y). There were 22 children with Gartland grade 3 fractures, 10 with grade 2b fractures, and 1 had a flexion type fracture. The average operative time was 21 minutes (range: 7 to 58 min). The average postoperative Baumann’s angle was 73.9 degrees (range: 63.8 to 79.6 degrees) and the average postoperative lateral capitellohumeral angle was 44.6 degrees (range: 31.1 to 56.8 degrees). There were no cases of ulnar nerve palsy.

Conclusions:
The sliding method is a novel technique of protecting the ulnar nerve during closed reduction percutaneous pinning of SCHF.

Level of Evidence:
Level IV.
Hip Resurfacing Utilizing the Direct Anterior Approach
Authors: Goltzer Oren , Guild George N. 
Published: January 2019

Background:
The direct anterior approach (DAA) has been used successfully in total hip arthroplasty with many benefits including improved radiographic positioning of components, earlier ambulation, as well as decreased narcotic consumption, length of stay, dislocation rate, discharge to rehabilitation facility (vs. home) and 30-day readmission. Hip resurfacing can be a successful surgical option for the properly selected patient as it can preserve bone stock and provide excellent function including improved activity levels as compared with total hip arthroplasty. Traditionally hip resurfacing has been performed via an extensile posterior approach, but the benefits of DAA can be applied to resurfacing though not without a learning curve.

Case Presentation:
Here we report the surgical technique of hip resurfacing performed supine on a Hana table via the DAA and include key steps to ensure adequate exposure and minimize complications.
Improved Guideline Adherence and Reduced Brain Dysfunction After a Multicenter Multifaceted Implementation of ICU Delirium Guidelines in 3,930 Patients
Authors: Trogrlić Zoran , van der Jagt Mathieu , Lingsma Hester , Gommers Diederik , Ponssen Huibert H. , Schoonderbeek Jeannette F. J. , Schreiner Frodo , Verbrugge Serge J. , Duran Servet , Bakker Jan , Ista Erwin 
Published: January 2019

Objectives:
Implementation of delirium guidelines at ICUs is suboptimal. The aim was to evaluate the impact of a tailored multifaceted implementation program of ICU delirium guidelines on processes of care and clinical outcomes and draw lessons regarding guideline implementation.

Design:
A prospective multicenter, pre-post, intervention study.

Setting:
ICUs in one university hospital and five community hospitals.

Patients:
Consecutive medical and surgical critically ill patients were enrolled between April 1, 2012, and February 1, 2015.

Interventions:
Multifaceted, three-phase (baseline, delirium screening, and guideline) implementation program of delirium guidelines in adult ICUs.

Measurements and Main Results:
The primary outcome was adherence changes to delirium guidelines recommendations, based on the Pain, Agitation and Delirium guidelines. Secondary outcomes were brain dysfunction (delirium or coma), length of ICU stay, and hospital mortality. A total of 3,930 patients were included. Improvements after the implementation pertained to delirium screening (from 35% to 96%; p < 0.001), use of benzodiazepines for continuous sedation (from 36% to 17%; p < 0.001), light sedation of ventilated patients (from 55% to 61%; p < 0.001), physiotherapy (from 21% to 48%; p < 0.001), and early mobilization (from 10% to 19%; p < 0.001). Brain dysfunction improved: the mean delirium duration decreased from 5.6 to 3.3 days (–2.2 d; 95% CI, –3.2 to –1.3; p < 0.001), and coma days decreased from 14% to 9% (risk ratio, 0.5; 95% CI, 0.4–0.6; p < 0.001). Other clinical outcome measures, such as length of mechanical ventilation, length of ICU stay, and hospital mortality, did not change.

Conclusions:
This large pre-post implementation study of delirium-oriented measures based on the 2013 Pain, Agitation, and Delirium guidelines showed improved health professionals’ adherence to delirium guidelines and reduced brain dysfunction. Our findings provide empirical support for the differential efficacy of the guideline bundle elements in a real-life setting and provide lessons for optimization of guideline implementation programs.
The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
Authors: Baston Cameron M. , Coe Norma B. , Guerin Claude , Mancebo Jordi , Halpern Scott 
Published: January 2019

Objectives:
Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome.

Design:
We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI.

Setting:
ICUs that care for patients with acute respiratory distress syndrome.

Subjects:
Patients with moderate to severe acute respiratory distress syndrome.

Interventions:
The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning.

Measurements and Main Results:
In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088–1.714) quality-adjusted life years at an additional long-term cost of $31,156 (95% CI, –$158 to $92,179) (incremental cost-effectiveness ratio = $38,648 per quality-adjusted life year [95% CI, $1,695–$98,522]). If society was willing to pay $100,000 per quality-adjusted life year, any intervention costing less than $51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008–0.147) more survivals-to-discharge at a cost of $5,242 (95% CI, –$19,035 to $41,019) (incremental cost-effectiveness ratio = $44,615 per extra survival [95% CI, –$250,912 to $558,222]). If hospitals were willing to pay $100,000 per survival-to-discharge, any intervention costing less than $5,140 per patient would represent good value.

Conclusions:
Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.
Toward Gender Equity in Critical Care Medicine: A Qualitative Study of Perceived Drivers, Implications, and Strategies*
Authors: Leigh Jeanna Parsons , Grood Chloe de , Ahmed Sofia B. , Ulrich Ania C. , Fiest Kirsten M. , Straus Sharon E. , Stelfox Henry T. 
Published: January 2019

Objectives:
Critical care medicine is a medical specialty where women remain underrepresented relative to men. The purpose of this study was to explore perceived drivers (i.e., influencing factors) and implications (i.e., associated consequences) of gender inequity in critical care medicine and determine strategies to attract and retain women.

Design:
Qualitative interview-based study.

Setting:
We recruited participants from the 13 Canadian Universities with adult critical care medicine training programs.

Participants:
We invited all faculty members (clinical and academic) and trainees to participate in a semistructured telephone interview and purposely aimed to recruit two faculty members (one woman and one man) and one trainee from each site. Interviews were transcribed verbatim, and two investigators conducted thematic analysis.

Interventions:
Not applicable.

Measurements and Main Results:
Three-hundred seventy-one faculty members (20% women, 80% men) and 105 trainees (28% women, 72% men) were invited to participate, 48 participants were required to achieve saturation. Participants unanimously described critical care medicine as a specialty practiced predominantly by men. Most women described experiences of being personally or professionally impacted by gender inequity in their group. Postulated drivers of the gender gap included institutional and interpersonal factors. Mentorship programs that span institutions, targeted policies to support family planning, and opportunities for modified role descriptions were common strategies suggested to attract and retain women.

Conclusions:
Participants identified a gender gap in critical care medicine and provided important insight into the impact for personal, professional, and group dynamics. Recommended improvement strategies are feasible, map broadly onto reported drivers and implications, and are applicable to critical care medicine and more broadly throughout medical specialties.
Critical Care Ultrasound: A Systematic Review of International Training Competencies and Program
Authors: Wong Adrian , Galarza Laura , Duska Frantisek 
Published: January 2019

Objectives:
Critical care ultrasonography has become established within ICUs as a diagnostic tool and to guide management strategies and practical procedures. Following an international consensus statement in 2011, various national professional societies and organizations have sought to develop and deliver training program. The aim of this review was to assess the similarities and differences among these postgraduate intensive care/critical care training program.

Data Sources:
A systematic review was performed in two steps. First, we searched medical databases and national societies’ websites for documents meeting predefined inclusion criteria. If not found, professionals related to critical care ultrasonography were contacted.

Data Extraction:
Data were extracted independently by two authors. Analyses were conducted on general training requirements as well as specific competencies defined in the documents.

Data Synthesis:
Eight national program from seven countries were identified from a total of 25 countries; all identified program have defined competencies for core critical care ultrasonography. Although there were common themes across these program, significant variations in training requirements and assessments existed, for example, number of scans required for echocardiography training ranged from 10 to 100. Furthermore, the specifics of each ultrasound module varied between program.

Conclusions:
Despite widespread and increasing use of ultrasound in ICUs, the majority of countries lacked a formal training program and clearly defined competencies. Even among the countries where these are available, there remains variability. There is a need to better define the competencies required in core critical care ultrasonography and standardize the assessment process.