bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Disability After Long Corrective Fusion to the Pelvis in Elderly Patients With Spinal Deformity
Authors: Togawa Daisuke , Hasegawa Tomohiko , Yamato Yu , Yoshida Go , Kobayashi Sho , Yasuda Tatsuya , Oe Shin , Banno Tomohiro , Arima Hideyuki , Mihara Yuki , Ushirozako Hiroki , Matsuyama Yukihiro 
Published: January 2018

Study Design.
A prospective case series analysis.

Objective.
The purpose of this study was to investigate the degree of difficulty in daily activities of adult spinal deformity (ASD) patients after corrective long fusion to the pelvis, with an emphasis on bend forward activities.

Summary of Background Data.
No prospective studies have been reported regarding the postoperative impairments and their time course after long fusion in ASD patients.

Methods.
One-hundred three patients [26 men, 77 women; mean age 68 (50–82) years] who underwent corrective long fusion from the thoracic spine to the pelvis were included. As a control group, 578 volunteers [213 men, 365 women; mean age 72 (50–84)] who underwent musculoskeletal examination were included. Seven daily activities were assessed using Disability Scores (DS10), which ask patients to rate the difficulty of actions from 1 (very easy) to 10 (very difficult). The activities selected were a) gait, b) ability to trim toe nails, c) lie supine, d) perform personal hygiene, e) put on pants, f) pick up an item from the floor, and g) get down on all fours. Each of these activities were rated by all volunteers and patients at five assessment points in 2 years. Questionnaires (ODI, SRS-22, and DS10) were administered preoperatively, at discharge, 6 months, 1 year, and 2 years postoperatively. Radiographic parameters and clinical results of the control group were compared with those of the ASD patients and the patients with different upper instrumented vertebrae.

Results.
Although successful clinical results and deformity corrections were achieved, the ASD patients reported significant difficulty in b), d), e), f), and g) after the surgery (all P < 0.0001), regardless of the fusion length. The difficulty gradually improved toward 2 years but did not reach preoperative status.

Conclusion.
Activities requiring patients to bend forward were more difficult for elderly ASD patients postoperatively.

Level of Evidence: 3
Do Preoperative Corticosteroid Injections Increase the Risk for Infections or Wound Healing Problems After Spine Surgery?
Authors: Farshad Mazda , Burgstaller Jakob M. , Held Ulrike , Steurer Johann , Dennler Cyrill 
Published: January 2018

Study Design.
A prospective multicenter cohort study.

Objectives.
This study evaluates the risk for surgical site infections (SSIs) or wound healing problems (WHPs) in patients who underwent corticosteroid injection before lumbar decompression surgery.

Summary of Background Data.
Corticosteroid injections are often used for the treatment of the degenerated spine. However, their well-known immunosuppressive effects could increase the risk for local infections, particularly if a surgical intervention follows the injection rapidly.

Methods.
The Swiss Lumbar Stenosis Outcome Study (LSOS), which is a prospective multicenter cohort study of patients with symptomatic lumbar spinal stenosis, was used as database. Of 743 patients, 422 patients underwent surgery and were eligible for the study. Ten patients (2.4%) were revised for either SSIs (n = 6) or WHPs (n = 4). A control group (n = 19) was constructed matched according to age, sex, diabetes, and body mass index (BMI). Odds ratios (ORs) were calculated by using a conditional logistic regression model to quantify the risk of SSI or WHP after preoperative corticosteroid injection. Subgroup analysis was performed for patients with injection within 0 to 3 months before surgery, 0 to 6 months before surgery, or any injection at all before surgery.

Results.
Within this cohort, no significant association could be found between preoperative corticosteroid injection and postoperative SSI or WHP in patients with corticosteroid injections within 0 to 3 months before surgery [OR = 0.36, 95% confidence interval (95% CI) 0.04–3.22], 0 to 6 months before surgery (OR = 0.69 95% CI 0.14–3.49), or any time before surgery (OR = 0.43, 95% CI 0.04–3.22).

Conclusion.
Within the here investigated cohort, the risk of SSIs or WHPs following lumbar spinal decompression surgery seems not highly associated with preoperative corticosteroid injections. However, the safe time interval between corticosteroid infiltrations and surgery remains unknown, should not be decreased incautiously, and is the subject of further research.

Level of Evidence: 2
Dedicated Afternoon Rounds for ICU Patients’ Families and Family Satisfaction With Care
Authors: Weber Urs , Johnson Jennifer , Anderson Nathanial , Knies Andrea K. , Nhundu Belinda , Bautista Cynthia , Huang Kevin B. , Hamza Muhammad , White Jessica , Coppola Anna , Akgün Kathleen M. , Greer David M. , Marcolini Evie G. , Gilmore Emily J. , Petersen Nils H. , Timario Nona , Poskus Kelly , Sheth Kevin N. , Hwang David Y. 
Published: January 2018

Objective:
It was hypothesized that adding dedicated afternoon rounds for patients’ families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU.

Design:
Pre- and postimplementation (pre-I and post-I) design.

Setting:
Single academic neuroscience ICU.

Patients:
Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission.

Intervention:
The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week.

Measurements and Main Results:
One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03).

Conclusions:
Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU’s overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
Tripolymeric Corneal Coating Gel Versus Balanced Salt Solution Irrigation During Cataract Surgery: A Retrospective Analysis
Authors: Giardini Pietro , Hauranieh Nicola , Gatto Claudio , D'Amato Tóthová Jana 
Published: January 2018

Purpose:
To compare the protective properties and ease of manipulation during cataract surgery of corneal coating with a gel (eyeDRO; AL.CHI.MI.A. S.R.L, Italy) and corneal irrigation with balanced salt solution (BSS).

Methods:
We analyzed the data of 51 patients receiving either eyeDRO or BSS during routine cataract surgery performed within a 20-day period in 2016. The selected parameters were intraoperative clarity and ease of manipulation; postoperative epithelial integrity; and patient discomfort.

Results:
Compared with BSS irrigation, eyeDRO coating significantly increased intraoperative clarity and ease of manipulation (P < 0.01). Single application was required in eyeDRO-treated eyes, whereas BSS was applied 5.3 ± 0.4 times on average (P < 0.01). Two hours postoperatively, a normal epithelium was observed in 90.0% and 60.0% of eyeDRO-coated and BSS-irrigated eyes, respectively; punctate epithelial damage was observed in 9.7% and 40.0% (P < 0.05) of eyeDRO-coated and BSS-irrigated eyes, respectively; eye irritation and foreign body sensation were experienced by 13.0% and 37.0% of eyeDRO-treated patients and by 65.0% and 100% of BSS-treated patients, respectively (P < 0.01). Twenty-four hours postoperatively, 80.0% of BSS-treated patients versus 19.0% of eyeDRO-treated patients still experienced foreign body sensation (P < 0.01).

Conclusions:
EyeDRO coating was shown to be a safer and more effective option than BSS irrigation in cataract surgery because single application provided optimal hydration and intraoperative clarity during the entire surgery, better preserved the corneal epithelium, and offered postoperative comfort to the patient.
Knowledge, Practices, and Barriers to HIV Preexposure Prophylaxis Prescribing Among Washington State Medical Providers
Authors: Wood Brian R. , McMahan Vanessa M. , Naismith Kelly , Stockton Jonathan B. , Delaney Lori A. , Stekler Joanne D. 
Published: January 2018

Background
We aimed to assess HIV preexposure prophylaxis (PrEP) awareness and prescribing practices among Washington State medical providers from diverse professional disciplines and practice types.

Methods
In May 2016, we administered an anonymous online survey to licensed medical practitioners who provide primary, longitudinal, walk-in, emergency, obstetric, gynecologic, sexually transmitted infection, or family planning care.

Results
Of 735 eligible providers, 64.8% had heard of PrEP. Younger providers and providers with a doctor of medicine degree were more likely to be aware of PrEP compared with older providers (P = 0.0001) and providers of other training backgrounds (advanced registered nurse practitioner, doctor of osteopathic medicine, or physician assistant; P = 0.04). Among providers aware of PrEP, most frequent reported concerns about prescribing were adherence (46.0%) and costs (42.9%). Providers felt very (20.1%) or somewhat (33.8%) comfortable discussing PrEP overall, but very (26.8%) or somewhat (44.7%) uncomfortable discussing cost and insurance issues. The 124 PrEP prescribers reported a median of 2 (range, 1–175; total, 1142) patients prescribed PrEP. Prior authorizations and insurance denials had prevented prescriptions for 28.7% and 12.1% of prescribers, respectively.

Conclusions
Interventions to improve PrEP access should include education to inform medical providers about PrEP, with particular attention to provider types less likely to be aware. Continued efforts to eliminate cost and insurance barriers and educate providers regarding financial resources would help improve PrEP access.
Characteristics Associated With Delivery of an Infant With Congenital Syphilis and Missed Opportunities for Prevention—California, 2012 to 2014
Authors: Biswas Hope H. , Chew Ng Rilene A. , Murray Erin L. , Chow Joan M. , Stoltey Juliet E. , Watt James P. , Bauer Heidi M. 
Published: January 2018

Background
Congenital syphilis (CS), the transmission of Treponema pallidum from mother to fetus during pregnancy, can cause adverse birth outcomes. In 2012 to 2014, the CS rate in California increased more than 200% from 6.6 to 20.3 cases per 100,000 live births. Our objectives were to identify characteristics associated with delivering an infant with CS and missed opportunities for prevention among syphilis-infected pregnant women in California.

Methods
We linked California Department of Public Health syphilis surveillance records from women aged 15 to 45 years—diagnosed from March 13, 2012, to December 31, 2014—to birth records. We compared characteristics among mothers who delivered an infant with CS (CS mothers) with mothers who delivered an infant without CS (non-CS mothers) by using χ2 or Fisher exact tests. To visualize gaps in prevention among syphilis-infected pregnant women, we constructed a CS prevention cascade, a figure that shows steps to prevent CS.

Results
During the selected period, 2498 women were diagnosed as having syphilis, and 427 (17%) linked to birth records; 164 (38%) were defined as CS mothers and 263 (62%) as non-CS mothers. Mothers with CS were more likely than non-CS mothers to have their first prenatal care visit in the third trimester. High proportions of mothers in both groups reported high-risk sexual behaviors, methamphetamine use, or incarceration (13%–29%). The CS prevention cascade showed decrements of 5% to 11% in prenatal care receipt, testing, and treatment steps; only 62% of potential CS births were prevented.

Conclusions
Multifaceted efforts are needed to address gaps in the CS prevention cascade and reduce CS cases in California.
Inability to Perform the Repeated Chair Stand Task Predicts Fall-Related Injury in Older Primary Care Patients
Authors: Shea Cristina A. , Ward Rachel E. , Welch Sarah A. , Kiely Dan K. , Goldstein Richard , Bean Jonathan F. 
Published: January 2018

Objective
The aim of the study was to examine whether the chair stand component of the Short Physical Performance Battery predicts fall-related injury among older adult primary care patients.

Design
A 2-yr longitudinal cohort study of 430 Boston-area primary care patients aged ≥65 yrs screened to be at risk for mobility decline was conducted. The three components of the Short Physical Performance Battery (balance time, gait speed, and chair stand time) were measured at baseline. Participants reported incidence of fall-related injuries quarterly for 2 yrs. Complementary log-log discrete time hazard models were constructed to examine the hazard of fall-related injury across Short Physical Performance Battery scores, adjusting for age, sex, race, Digit Symbol Substitution Test score, and fall history.

Results
Participants were 68% female and 83% white, with a mean (SD) age of 76.6 (7.0). A total of 137 (32%) reported a fall-related injury during the follow-up period. Overall, inability to perform the chair stand task was a significant predictor of fall-related injury (hazard ratio = 2.11, 95% confidence interval = 1.23–3.62, P = 0.01). Total Short Physical Performance Battery score, gait component score, and balance component score were not predictive of fall-related injury.

Conclusions
Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.
Pediatric Brain
Authors: Ryu Young Jin , Choi Young Hun , Cheon Jung-Eun , Lee Woo-Jin , Park Subin , Park Ji Eun , Kim Woo Sun , Kim In-One 
Published: January 2018

Purpose
The aim of this study was to identify the signal intensity (SI) changes in the dentate nucleus (DN) and the globus pallidus (GP) on unenhanced T1-weighted magnetic resonance (MR) images after multiple administration of gadolinium-based contrast agents (GBCAs) in children and compare those changes between linear and macrocyclic GBCAs.

Materials and Methods
This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. We identified 92 children who underwent at least 4 consecutive MR examinations exclusively using either linear GBCA (gadodiamide or gadopentetate dimeglumine, n = 41) or macrocyclic GBCA (gadoterate meglumine, n = 51). Signal intensity ratio changes in the DN to pons and GP to thalamus between the first and last MR examinations were calculated.

Results
The SI ratios in the linear group increased significantly between the first and last MR examinations (mean difference: DN to pons, 0.0461 ± 0.0480, P < 0.001; GP to thalamus, 0.0332 ± 0.0385, P < 0.001), but not in the macrocyclic group (mean difference: DN to pons, −0.0010 ± 0.0371, P = 0.855; GP to thalamus, 0.0007 ± 0.0294, P = 0.867). In the linear regression analysis, the numbers of administrations of gadodiamide and gadopentetate dimeglumine were highly associated with the differences in SI ratios (DN to pons, P < 0.001 and P = 0.003; GP to thalamus, P < 0.001 and P = 0.002, respectively).

Conclusion
The SIs of the DN and GP on unenhanced T1-weighted images increased after serial administrations of linear GBCA, but not macrocyclic GBCA, in children. The number of linear GBCA administration had a linear association with the SI changes in the DN and GP.
Ultrasound Indicators of Rectal Support Defect in Women With Obstructive Defecatory Symptoms
Authors: Rostaminia Ghazaleh , Javadian Pouya , Awad Charbel , Shobeiri S. Abbas 
Published: January 2018

Objective
The anatomic and physiologic pathophysiology of obstructive defecatory symptoms is complex and poorly understood. As a consequence, there is no one surgical method that can achieve overall superiority. We aimed to investigate rectal architectural change in women with obstructive defecatory symptoms using three-dimensional pelvic floor ultrasound.

Methods
This retrospective cohort study included 65 women who were referred to our urogynecology clinic because of varied pelvic floor disorders between January 2013 and January 2014. Patients completed a standardized interview including PFDI-20 questionnaire and received a standard examination and assessment of pelvic floor by three-dimensional endovaginal ultrasound. Women were categorized to case and control based on their answers to questions 7, 8, and 14 on PFDI-20 (Colorectal and Anal Distress Index) questionnaire. In ultrasound images, levator plate descent angle, levator plate-probe distance, and rectal area have been measured and values have been compared among symptomatic and asymptomatic patients.

Results
Forty-five women with obstructive defecatory symptoms and 20 asymptomatic women entered the study. There was no significant difference in mean (SD) age (56.55 [SD] 13.29 vs 51.8 [15], P = 0.2), mean (SD) body mass index (27.39 [6.7] vs 24.2 [4.08], P = 0.11), and median (range) parity (3 [1–7] vs 2 [1–6], P = 0.15) among categories. There was significant difference in ultrasound measurements, levator plate descent angle, levator plate-probe distance, and rectal area, between women with obstructive defecatory symptoms and asymptomatic women.

Conclusions
Women with obstructive defecatory symptoms have wider rectum and descendent levator plate regardless of the stage of prolapse as measured by POPQ or the severity of rectocele.
Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence
Authors: Winkelman William D. , Warsi Ann , Huang Alison J. , Schembri Michael , Rogers Rebecca G. , Richter Holly E. , Myers Deborah L. , Kraus Stephen R. , Johnson Karen C. , Hess Rachel , Gregory Thomas , Bradley Catherine S. , Arya Lily A. , Brown Jeanette S. , Stone Katie L. , Subak Leslee L. 
Published: January 2018

Objective
The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence.

Methods
A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale.

Results
Of the 640 participants, mean (SD) age was 56 (±14) years and 68% were white. Participants reported an average of 3.9 (±3.0) urgency incontinence episodes per day and 1.3 (±1.3) episodes of nocturia per night. At baseline, 57% had poor sleep quality (PSQI score, >5) and 17% reported daytime sleepiness (Epworth Sleepiness Scale score, >10). Most women (69%) did not use sleeping medication during the prior month, whereas 13% reported use of sleeping medication 3 or more times per week. An increase in total daily incontinence episodes, total daily urgency incontinence episodes, total daily micturitions, and moderate to severe urge sensations were all associated with higher self-report of poor sleep quality according to the PSQI (all P ≤ 0.01). Higher scores on the Bother Scale and the Health-Related Quality of Life for overactive bladder on the Overactive Bladder Questionnaire were similarly associated with higher rates of poor sleep quality (both P ≤ 0.01). In subgroup analysis of those who took sleeping medications less than twice a week, there was still a significant relationship between incontinence measures and quality of sleep as measured by the PSQI. In multivariable analyses, greater frequency of nighttime urgency incontinence was associated with poor sleep quality (P = 0.03).

Conclusions
Among ambulatory women with urgency urinary incontinence, poor sleep quality is common and greater frequency of incontinence is associated with a greater degree of sleep dysfunction. Women seeking urgency urinary incontinence treatment should be queried about their sleeping habits so that they can be offered appropriate interventions.
Is observation for traumatic hemothorax safe?
Authors: Demetri Leah , Martinez Aguilar Myriam M. , Bohnen Jordan D. , Whitesell Ryan , Yeh D. Dante , King David , de Moya Marc 
Published: January 2018

BACKGROUND
Eastern Association for the Surgery of Trauma guidelines suggest tube thoracostomy (TT) be considered for all traumatic hemothoraces. However, previous research has suggested that some traumatic hemothoraces may be observed safely. We sought to (1) determine the safety of selective observation for traumatic hemothorax and (2) identify predictors of failed observation.

METHODS
All patients with traumatic hemothorax from 2000 to 2014 at a Level I trauma center were identified and categorized by size as small (<300 cc) or large (≥300 cc) based on chest computed tomography (CT) scan measurements. Patients with no CT or with TT placement before CT were excluded. Patients were categorized into four intervention groups: (i) early TT (<24 hours after CT), (ii) failed observation (TT ≥24 hours after CT), (iii) successful observation (no TT), and (iv) inevaluable due to early mortality (no TT but died within 7 days). Univariate analyses compared outcomes between groups. Multivariate analyses identified independent predictors of failed observation.

RESULTS
Three hundred forty patients met the inclusion criteria. 156 (46%) patients received early TT. Of the 184 patients that were initially observed, 121 (66%) were successfully observed, 53 (29%) failed observation, and 10 (5%) were inevaluable due to early mortality. Most of the successfully observed hemothoraces were small (119/121, 98%). Four independent predictors of failed observation were identified: older age, fewer ventilation-free days, large hemothorax, concurrent pneumothorax. Patients, who received TT were more likely than non-TT patients to receive tissue plasminogen activator, develop an empyema, have fewer hospital-free days, and are discharged to rehabilitation rather than home. When compared to early TT, failed observation was associated with a higher likelihood of discharge to rehabilitation but no difference in mortality, hospital-free days, or rate of empyema.

CONCLUSION
Initial observation in select patients is safe and may result in better outcomes. The identified predictors of failed observation can help in clinical decision making regarding the need for TT in patients with traumatic hemothorax.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.