bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time Demand and Radiation Dose in 3D-Fluoroscopy-based Navigation-assisted 3D-Fluoroscopy-controlled Pedicle Screw Instrumentations
Authors: Balling Horst 
Published: September 2017

Study Design.
Prospective single-center cohort study to record additional time requirements and radiation dose in navigation-assisted O-arm-controlled pedicle screw (PS) instrumentations.

Objective.
The aim of this study was to evaluate amount of extra-time and radiation dose for navigation-assisted PS instrumentations of the thoracolumbosacral spine using O-arm 3D-real-time-navigation (O3DN) compared to non-navigated spinal procedures (NNSPs) with a single C-arm and postoperative computed tomography (CT) scan for controlling PS positions.

Summary of Background Data.
3D-navigation is reported to enhance PS insertion accuracy. But time-consuming navigational steps and considerable additional radiation doses seem to limit this modern technique's attraction. A detailed analysis of additional time demand and extra-radiation dose in 3D-navigated spine surgery is not provided in literature, yet.

Methods.
From February 2011 through July 2015, 306 consecutive posterior instrumentations were performed in vertebral levels T10-S1 using O3DN for PS insertion. The duration of procedure-specific navigational steps of the overall collective (I) and the last cohort of 50 consecutive O3DN-surgeries (II) was compared to the average duration of analogous surgical steps in 100 consecutive NNSP using a single C-arm. 3D-radiation dose (dose-length-product, DLP) of navigational and postinstrumentation O-arm scans in group I and II was compared to the average DLP of 100 diagnostic lumbar CT scans.

Results.
The average presurgical time from patient positioning on the operating table to skin incision was 46.2 ± 10.1 minutes (O3DN, I) and 40.6 ± 9.8 minutes (O3DN, II) versus 30.6 ± 8.3 minutes (NNSP) (P < 0.001, each). Intraoperative interruptions for scanning and data processing took 3.0 ± 0.6 minutes. DLPs averaged 865.1 ± 360.8 mGycm (O3DN, I) and 562.1 ± 352.6 mGycm (O3DN, II) compared to 575.5 ± 316.5 mGycm in diagnostic lumbar CT scans (P
< 0.001 (I), P ≈ 0.81 [II]).

Conclusion.
After procedural experience, navigated surgeries can be performed with an additional time demand of 13.0 minutes compared to NNSP, and with a total DLP below that of a diagnostic lumbar CT scan (P ≈ 0.81).

Level of Evidence: 4
Simulation training for family planning procedures
Authors: Goldthwaite Lisa M. , Tocce Kristina 
Published: September 2017

Purpose of review
To review the current evidence for use of simulation in family planning procedural training.

Recent findings
A variety of simulation models exist for abortion, contraception, and sterilization procedures, ranging from low to high fidelity. Most models for abortion and contraception are low fidelity, inexpensive, and provide opportunities for acquisition and practice of procedural skills. Hysteroscopic and laparoscopic simulation models for sterilization procedures are generally higher fidelity, and their use has been shown to increase knowledge, skill performance, and procedural comfort.

Summary
Existing evaluation of family planning simulation education shows consistently positive results related to improved procedural knowledge and comfort. Although some studies have shown increased provision of family planning services following simulation-training interventions, further evaluation is needed to determine the impact on clinical outcomes.
Conventional Corneal Collagen Cross-Linking Versus Transepithelial Diluted Alcohol and Iontophoresis-Assisted Corneal Cross-Linking in Progressive Keratoconus
Authors: Bilgihan Kamil , Yesilirmak Nilufer , Altay Yesim , Yuvarlak Armagan , Ozdemir Huseyin Baran 
Published: September 2017

Purpose:
To compare clinical outcomes of conventional corneal cross-linking (C-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL) for the treatment of progressive keratoconus (KC).

Methods:
Ninety-three eyes of 80 patients with KC were treated by C-CXL (n = 47) or DAI-CXL (n = 46). Visual acuity, keratometry, KC indexes, pachymetry, and aberrations were recorded before treatment and 1, 3, 6, and 12 months after treatment. The demarcation line was assessed 1 month after treatment.

Results:
A significant improvement in visual acuity was observed at month 3 and month 6 after DAI-CXL and C-CXL, respectively. A significant decrease in maximum keratometry was observed in both groups at month 6. The front symmetry index significantly improved in both groups after 6 months, whereas the Baiocchi Calossi Versaci index significantly improved only after DAI-CXL at month 12 (P = 0.01). Average keratometry and other KC indexes were stable during 12 months of follow-up. Central corneal thickness decreased by 28.6 and 40.2 μm after DAI-CXL and C-CXL at month 1, respectively (P < 0.01), and it reached baseline at the 12th month (P = 0.14) only in the DAI-CXL group. Higher-order aberrations, coma, and spherical aberration significantly worsened at month 1 (P < 0.01) only after C-CXL; however, they improved significantly at month 12 compared with baseline (P < 0.05) in both groups. The demarcation line was visible in all cases at month 1 at a mean depth of 302 ± 56 μm and 311 ± 57 μm after DAI-CXL and C-CXL, respectively (P = 0.7).

Conclusions:
The DAI-CXL protocol seems as effective as the C-CXL protocol in halting KC progression after 1 year of follow-up.
The Impact of Nondifferential Exposure Misclassification on the Performance of Propensity Scores for Continuous and Binary Outcomes
Authors: Wood Mollie E. , Chrysanthopoulou Stavroula , Nordeng Hedvig M.E. , Lapane Kate L. 
Published: September 2017

Purpose:To investigate the ability of the propensity score (PS) to reduce confounding bias in the presence of nondifferential misclassification of treatment, using simulations.Methods:Using an example from the pregnancy medication safety literature, we carried out simulations to quantify the effect of nondifferential misclassification of treatment under varying scenarios of sensitivity and specificity, exposure prevalence (10%, 50%), outcome type (continuous and binary), true outcome (null and increased risk), confounding direction, and different PS applications (matching, stratification, weighting, regression), and obtained measures of bias and 95% confidence interval coverage.Results:All methods were subject to substantial bias toward the null due to nondifferential exposure misclassification (range: 0%–47% for 50% exposure prevalence and 0%–80% for 10% exposure prevalence), particularly if specificity was low (<97%). PS stratification produced the least biased effect estimates. We observed that the impact of sensitivity and specificity on the bias and coverage for each adjustment method is strongly related to prevalence of exposure: as exposure prevalence decreases and/or outcomes are continuous rather than categorical, the effect of misclassification is magnified, producing larger biases and loss of coverage of 95% confidence intervals. PS matching resulted in unpredictably biased effect estimates.Conclusions:The results of this study underline the importance of assessing exposure misclassification in observational studies in the context of PS methods. Although PS methods reduce confounding bias, bias owing to nondifferential misclassification is of potentially greater concern.
Otolaryngologic management of Down syndrome patients: what is new?
Authors: Bassett Ethan C. , Musso Mary F. 
Published: September 2017

Purpose of review
The management of children with Down syndrome as it pertains to the otolaryngologist continues to evolve. Obstructive sleep apnea (OSA) has dominated the recent literature, but other topics including hearing loss, swallowing, and perioperative considerations are also reported.

Recent findings
The prevalence of OSA in children with Down syndrome ranges from 57 to 73% in certain cohorts, and, whereas adentonsillectomy can decrease Apnea–Hypopnea Index, up to 80% may have persistent OSA. Surgical techniques involving reduction of the base of tongue are effective for those who fail adenotonsillectomy, and it is expected that drug-induced sleep endoscopy may improve outcomes. New technology is also on the horizon that can assist with diagnosis and treatment including computational modelling and upper airway stimulation. Children with Down syndrome may not respond to medical management of eustachian tube dysfunction as well as normally developing children. In addition, there is a high prevalence of inner ear anomalies, increasing the risk for sensorineural hearing loss.

Summary
Questions remain pertinent to the otolaryngologist regarding the ideal management of children with Down syndrome. Additional studies are necessary, to optimize understanding and treatment of this complex population, in particular as opportunities develop with technological advances.
Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed Inpatient Adolescents
Authors: Viana Andres G. , Hanna Abigail E. , Raines Elizabeth M. , Woodward Emma C. , Paulus Daniel J. , Berenz Erin C. , Zvolensky Michael J. 
Published: September 2017

Abstract
The present investigation examined the role of anxiety symptom severity in the relation between emotional nonacceptance and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of trauma-exposed adolescents admitted for acute psychiatric care at an inpatient state hospital (N = 50; 52.0% women; 44% white; mean [SD] age, 15.1 [0.51] years; range, 12–17 years). Anxiety symptom severity partially accounted for the association between emotional nonacceptance and PTSD total symptoms, and fully accounted for the association between emotional nonacceptance and PTSD symptom cluster severity, even after controlling for covariates. Reverse model testing provided confidence in the direction of hypothesized effects. These findings add to a body of literature underscoring the detrimental effect of nonaccepting reactions to negative emotions in the context of PTSD and provide preliminary support for a possible underlying role of anxiety symptom severity in the association between emotional nonacceptance and PTSD symptoms.
Temporal Indices of Ankle Clonus and Relationship to Electrophysiologic and Clinical Measures in Persons With Spinal Cord Injury
Authors: Manella Kathleen J. , Roach Kathryn E. , Field-Fote Edelle C. 
Published: September 2017

Background and Purpose:
Clonus arising from plantar flexor hyperreflexia is a phenomenon that is commonly observed in persons with spastic hypertonia. We assessed the temporal components of a biomechanical measure to quantify ankle clonus, and validated these in persons with spasticity due to spinal cord injury.

Methods:
In 40 individuals with chronic (>1 year) spinal cord injury, we elicited ankle clonus using a standardized mechanical perturbation (drop test). We examined reliability and construct validity of 2 components of the drop test: clonus duration (timed with a stopwatch) and number of oscillations in the first 10-second interval (measured via optical motion capture). We compared these measures to the Spinal Cord Assessment Tool for Spastic reflexes (SCATS) clonus score and H-reflex/M-wave (H/M) ratio, a clinical and electrophysiologic measure, respectively.

Results:
Intra- and interrater reliability of clonus duration measurement was good [intraclass correlation coefficient, ICC (2, 1) = 1.00]; test-retest reliability was good both at 1 hour [ICC (2, 2) = 0.99] and at 1 week [ICC (2, 2) = 0.99]. Clonus duration was moderately correlated with SCATS clonus score (r = 0.58). Number of oscillations had good within-session test-retest reliability [ICC (2, 1) > 0.90] and strong correlations with SCATS clonus score (r = 0.86) and soleus H/M ratio (r = 0.77).

Discussion and Conclusions:
Clonus duration and number of oscillations as measured with a standardized test are reliable and valid measures of plantar flexor hyperreflexia that are accessible for clinical use. Tools for objective measurement of ankle clonus are valuable for assessing effectiveness of interventions directed at normalizing reflex activity associated with spasticity.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A179).
“Stuck in the ICU”: Caring for Children With Chronic Critical Illness*
Authors: Henderson Carrie M. , Williams Erin P. , Shapiro Miriam C. , Hahn Emily , Wright-Sexton Laura , Hutton Nancy , Boss Renee D. 
Published: September 2017

Objective:
Neonatal ICUs and PICUs increasingly admit patients with chronic critical illness: children whose medical complexity leads to recurrent and prolonged ICU hospitalizations. We interviewed participants who routinely care for children with chronic critical illness to describe their experiences with ICU care for pediatric chronic critical illness.

Design:
Semi-structured interviews. Interviews were transcribed and analyzed for themes.

Setting:
Stakeholders came from five regions (Seattle, WA; Houston, TX; Jackson, MS; Baltimore, MD; and Philadelphia, PA).

Subjects:
Fifty-one stakeholders including: 1) interdisciplinary providers (inpatient, outpatient, home care, foster care) with extensive chronic critical illness experience; or 2) parents of children with chronic critical illness.

Interventions:
Telephone or in-person interviews.

Measurements and Main Results:
Stakeholders identified several key issues and several themes emerged after qualitative analysis. Issues around chronic critical illness patient factors noted that patients are often relocated to the ICU because of their medical needs. During extended ICU stays, these children require longitudinal relationships and developmental stimulation that outstrip ICU capabilities. Family factors can affect care as prolonged ICU experience leads some to disengage from decision-making. Clinician factors noted that parents of children with chronic critical illness are often experts about their child’s disease, shifting the typical ICU clinician-parent relationship. Comprehensive care for children with chronic critical illness can become secondary to needs of acutely ill patients. Lastly, with regard to system factors, stakeholders agreed that achieving consistent ICU care goals is difficult for chronic critical illness patients.

Conclusions:
ICU care is poorly adapted to pediatric chronic critical illness. Patient, family, clinician, and system factors highlight opportunities for targeted interventions toward improvement in care.
Validation of a Portable Coagulometer for Routine In-Hospital Use for Newborns
Authors: Jerez Calero Antonio E. , Fernández Jiménez Dolores , Molina Oya Manuel , Narbona López Eduardo , Uberos Fernández José 
Published: September 2017

Objectives:
To verify the reliability and clinical benefits of the coagulation tests made by a point of care device in newborn admitted to a neonatal unit.

Design:
We made a statistical comparison between results obtained by the point of care device versus conventional laboratory analysis.

Setting:
Level 3 neonatal unit.

Patients:
Thirty-one infants admitted to the neonatal unit at the San Cecilio University Hospital (Granada, Spain) were recruited to this study.

Interventions:
All underwent a double analytical determination: a small drop of blood was taken for analysis with a portable coagulometer (qLabs Electrometer Plus) and the rest of the blood sample was analyzed with conventional hospital laboratory equipment.

Measurements and Main Results:
According to the linearity test performed, the measuring methods presented a good linear regression fit. Lin’s concordance coefficient showed a “good” agreement for activated partial prothrombin time and international normalized ratio (>0.61) and a moderate one for prothrombin time (0.41–0.6) for the sample of newborns.

Conclusions:
The portable coagulometer qLabs Electrometer Plus device has the potential to be an alternative to standard hospital coagulation autoanalyzers in a subset of patients where the amount of blood drawn can have significant risks. Our study is the first of its kind to analyze the use of this device with severely ill newborns.
Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction Operation
Authors: Scodellaro Thomas , McKenzie Jane M. , d’Udekem Yves , Butt Warwick , Namachivayam Siva P. 
Published: September 2017

Objectives:
To identify the prevalence, causes, risk factors, and outcomes associated with extubation failure following first stage single ventricle reconstruction surgery.

Design:
Retrospective cohort analysis of neonates who underwent a first stage single ventricle reconstruction operation. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt.

Setting:
The Royal Children’s Hospital, Melbourne.

Patients:
Data were collected for all infants who underwent a Norwood or Damus-Kaye-Stansel procedure between 2005 and 2014 at our institution.

Interventions:
None.

Measurements and Main Results:
Extubation failure occurred in 23 of 137 neonates (16.8%; 95% CI, 11.0–24.1%) who underwent a trial of extubation. Overall, 42 patients (30.7%) were extubated to room air, 88 (64.2%) to nasal continuous positive airway pressure, and seven (5.1%) to high-flow nasal cannulae, though there was no major difference in extubation failure rates between these three groups (p = 0.37). The median time to reintubation was 16.7 hours (interquartile range, 3.2–35.2), and male infants failed extubation more frequently (63.2% vs 87.0%; p = 0.02), although age, gestation, weight, cardiac diagnosis (hypoplastic left heart syndrome vs other single ventricle conditions), shunt type (modified Blalock-Taussig vs right ventricle-pulmonary artery shunt), intraoperative perfusion times, preextubation mechanical ventilation duration, preextubation acid-base status, and postoperative fluid balance were not related to extubation outcome. Infants who failed extubation had a higher intensive care mortality (19.4% vs 3.5%; p = 0.03) and in-hospital mortality (30.4% vs 6.1%; p < 0.001).

Conclusions:
There is a high prevalence of extubation failure following first stage single ventricle reconstruction, and this is associated with considerably worse patient outcomes. The high prevalence and also the wide variation in rates of extubation failure in reported literature provide with an opportunity for implementation of quality assurance activities to minimize this complication and improve outcomes.
Time to Asthma-Related Readmission in Children Admitted to the ICU for Asthma*
Authors: Tse Sze Man , Samson Christian 
Published: September 2017

Objectives:
To compare the time to asthma-related readmissions between children with a previous ICU hospitalization for asthma and those with a non-ICU hospitalization and to explore predictors of time to readmission in children admitted to the ICU.

Design:
Retrospective cohort study using a pan-Canadian administrative inpatient database from April 1, 2008, to March 31, 2014.

Setting:
All adult and pediatric Canadian hospitals.

Subjects:
Children 2–17 years old with a hospitalization for asthma.

Interventions:
None.

Measurements and Main Results:
A total of 26,168 children were hospitalized 33,304 times during the study period. The time to readmission was shorter in the ICU group compared with the non-ICU group (median time to readmission 27 mo in ICU vs 35 mo in non-ICU group). Preschool-aged children (hazard ratio, 1.48; 95% CI, 1.02–2.14) and increased length of stay (hazard ratio, 1.63; 95% CI, 1.17–2.27) were associated with a shorter time to readmission.

Conclusions:
Children previously admitted to the ICU for asthma had a shorter time to asthma-related readmission, compared with children who did not require intensive care, underlining the importance of targeted long-term postdischarge follow-up of these children. Children of preschool age and who have a lengthier hospital stay are particularly at risk for future morbidity.
The Expanded Use of Autoaugmentation Techniques in Oncoplastic Breast Surgery
Authors: Losken Albert , Hart Alexandra M. , Dutton James Walter , Broecker Justine S. , Styblo Toncred M. , Carlson Grant W. 
Published: September 2017

Background:
Autoaugmentation techniques have been applied to oncoplastic reductions to assist with filling larger, more remote defects, and to women with smaller breasts. The purpose of this report is to describe the use of autoaugmentation techniques in oncoplastic reduction and compare the results with those of traditional oncoplastic reduction.

Methods:
The authors queried a prospectively maintained database of all women who underwent partial mastectomy and oncoplastic reduction between 1994 and October of 2015. The autoaugmentation techniques were defined as (1) extended primary nipple autoaugmentation pedicle, and (2) primary nipple pedicle and secondary autoaugmentation pedicle. Comparisons were made to a control oncoplastic group.

Results:
There were a total of 333 patients, 222 patients (67.7 percent) without autoaugmentation and 111 patients (33 percent) with autoaugmentation (51 patients with an extended autoaugmentation pedicle, and 60 patients with a secondary autoaugmentation pedicle). Biopsy weight was smallest in the extended pedicle group (136 g) and largest in the regular oncoplastic group (235 g; p = 0.017). Superomedial was the most common extended pedicle, and lateral was the most common location. Inferolateral was the most common secondary pedicle for lateral and upper outer defects. There were no significant differences in the overall complication rate: 15.5 percent in the regular oncoplastic group, 19.6 percent in the extended pedicle group, and 20 percent in the secondary pedicle group.

Conclusions:
Autoaugmentation techniques have evolved to manage complex defects not amenable to standard oncoplastic reduction methods. They are often required for lateral defects, especially in smaller breasts. Autoaugmentation can be performed safely without an increased risk of complications, broadening the indications for breast conservation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
ACR–ACNM Practice Parameter for the Performance of Dopamine Transporter (DaT) Single Photon Emission Computed Tomography (SPECT) Imaging for Movement Disorders
Authors: Subramaniam Rathan M. , Frey Kirk A. , Hunt Christopher H. , Mercier Gustavo A. , Solnes Lilja B. , Colletti Patrick M. , Lu Yang , Savir-Baruch Bital , Williams Hadyn T. 
Published: September 2017

Abstract
This American College of Radiology and American College of Nuclear Medicine joint clinical practice parameter is for performance of dopamine transporter single photon emission computed tomography (SPECT) imaging, for patients with movement disorders. Parkinsonian syndrome (PS) consists of a group of neurodegenerative diseases including Parkinson disease (PD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), and dementia with Lewy bodies (DLB). Accurate diagnosis of PS is critical for clinical management. An important diagnostic dilemma is the differentiation of PS and non-neurodegenerative disorders, such as essential tremor (ET) or drug-induced tremor, due to the overlap of clinical symptoms. The management approach to these conditions is distinctly different. An abnormal iodine-123 ioflupane SPECT scan suggests a decreased amount of dopamine transporter in the striatum, that is, a diagnosis of nigrostriatal neurodegenerative PS, whereas a normal scan suggests ET or other nondegenerative parkinsonism (drug-induced, vascular, or psychogenic).