bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cup and Cage Reconstruction for Metastatic Acetabular Lesions Provides Functional Improvement and Cost-efficiency
Authors: Krumme John W. , Laubach Logan K. , Sharma Viraj , Domson Gregory F. 
Published: June 2024

Objective:
Pathologic acetabular lesions have multiple surgical options proposed and no clearly defined optimal solution at this time. In this study, we present our cage and cup reconstruction method and analyze postoperative outcomes against previously published studies.

Patients and Methods:
Twenty-four patients from 2014 to 2020 with acetabular pathologic lesions treated with an antiprotrusio cage and cup reconstruction were identified. Patient charts were reviewed for operative time, blood loss, Musculoskeletal Tumor Society functional scores, follow-up, and complications.

Results:
The average blood loss was 727 mL, and the average postoperative Musculoskeletal Tumor Society score was 70.3, with an average improvement of 35.2 points from preoperative scores. The average cost of our construct per year was $1177 for patients surviving >1 year after surgery. Eleven (45%) patients had died of disease at an average survival time of 14.2 months.

Conclusion:
Our study compares well with historic reconstruction strategies for metastatic acetabular disease, showing that this cup/cage reconstruction provides a durable and perioperatively safe approach that provides functional improvement while remaining cost-efficient.

Level of Evidence:
Level IV.
Beyond Unplanned ICU Transfers: Linking a Revised Definition of Deterioration to Patient Outcomes
Authors: Byrd Thomas F. , Phelan Tom A. , Ingraham Nicholas E. , Langworthy Benjamin W. , Bhasin Ajay , Kc Abhinab , Melton-Meaux Genevieve B. , Tignanelli Christopher J. 
Published: June 2024

OBJECTIVES:
To develop an electronic descriptor of clinical deterioration for hospitalized patients that predicts short-term mortality and identifies patient deterioration earlier than current standard definitions.

DESIGN:
A retrospective study using exploratory record review, quantitative analysis, and regression analyses.

SETTING:
Twelve-hospital community-academic health system.

PATIENTS:
All adult patients with an acute hospital encounter between January 1, 2018, and December 31, 2022.

INTERVENTIONS:
Not applicable.

MEASUREMENTS AND MAIN RESULTS:
Clinical trigger events were selected and used to create a revised electronic definition of deterioration, encompassing signals of respiratory failure, bleeding, and hypotension occurring in proximity to ICU transfer. Patients meeting the revised definition were 12.5 times more likely to die within 7 days (adjusted odds ratio 12.5; 95% CI, 8.9–17.4) and had a 95.3% longer length of stay (95% CI, 88.6–102.3%) compared with those who were transferred to the ICU or died regardless of meeting the revised definition. Among the 1812 patients who met the revised definition of deterioration before ICU transfer (52.4%), the median detection time was 157.0 min earlier (interquartile range 64.0–363.5 min).

CONCLUSIONS:
The revised definition of deterioration establishes an electronic descriptor of clinical deterioration that is strongly associated with short-term mortality and length of stay and identifies deterioration over 2.5 hours earlier than ICU transfer. Incorporating the revised definition of deterioration into the training and validation of early warning system algorithms may enhance their timeliness and clinical accuracy.
The GLAND-IQ Technique for Surgical Correction of Moderate to Severe Gynecomastia
Authors: Gilardino Mirko S. , Vela-Lasagabaster Arturo 
Published: June 2024

Summary:
Surgical correction of gynecomastia currently ranks in the top five cosmetic procedures performed in men in the United States. Although removal of excess gland is relatively straightforward, the combination of glandular/fatty excess, significant skin redundancy, nipple ptosis, and nipple-areolar complex hypertrophy poses a significant challenge in the male patient desiring inconspicuous scars. The latter renders any form of skin and nipple reduction/elevation using traditional mastopexy patterns or breast amputation with free nipple grafting less favorable due to the surgical stigmata and scars produced with these techniques. To that end, we present our experience treating cases of moderate to severe gynecomastia involving significant skin excess (defined as Simon grade IIb and III) with a technique focused on avoiding visible extra-areolar scars, called the glandular excision, liposuction-assisted, areolar mastopexy for nipple repositioning and skin reduction with internal quilting sutures.
Predictors of Multidimensional Profiles of Participation After Traumatic Brain Injury: A TBI Model Systems Study
Authors: Juengst Shannon B. , Kumar Raj G. , Venkatesan Umesh M. , O'Neil-Pirozzi Therese M. , Evans Emily , Sander Angelle M. , Klyce Daniel , Agtarap Stephanie , Erler Kimberly S. , Rabinowitz Amanda R. , Bushnik Tamara , Kazis Lewis E. , Whiteneck Gale G. 
Published: June 2024

Objectives:
To identify personal, clinical, and environmental factors associated with 4 previously identified distinct multidimensional participation profiles of individuals following traumatic brain injury (TBI).

Setting:
Community.

Participants:
Participants (n = 408) enrolled in the TBI Model Systems (TBIMS) Participation Module, all 1 year or more postinjury.

Design:
Secondary data analysis of cross-sectional data from participants in a multicenter TBIMS module study on participation conducted between May 2006 and September 2007. Participants provided responses to questionnaires via a telephone interview at their study follow-up (1, 2, 5, 10, or 15 years postinjury).

Main Measures:
Participants provided responses to personal (eg, demographic), clinical (eg, function), environmental (eg, neighborhood type), and participation measures to create multidimensional participation profiles. Data from measures collected at the time of injury (preinjury questionnaire, injury characteristics) were also included. The primary outcome was assignment to one of 4 multidimensional participation profile groups based on participation frequency, importance, satisfaction, and enfranchisement. The measures used to develop the profiles were: Participation Assessment with Recombined Tools-Objective, Importance, and Satisfaction scores, each across 3 domains (Productivity, Social Relationships, Out and About in the Community) and the Enfranchisement Scale (contributing to one's community, feeling valued by the community, choice and control).

Results:
Results of the multinomial regression analysis, with 4 distinct participation profile groups as the outcome, indicated that education, current employment, current illicit drug use, current driving status, community type, and FIM Cognitive at follow-up significantly distinguished participation profile groups. Findings suggest a trend toward differences in participation profile groups by race/Hispanic ethnicity.

Conclusions:
Understanding personal, clinical, and environmental factors associated with distinct participation outcome profiles following TBI may provide more personalized and nuanced guidance to inform rehabilitation intervention planning and/or ongoing clinical monitoring.
Diagnostic accuracy of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and neutrophil–lymphocyte-to-platelet ratio biomarkers in predicting bacteremia and sepsis in immunosuppressive patients with cancer: literature review
Authors: Martinez Jose Manuel , Espírito Santo Ana , Ramada Diana , Fontes Filipa , Medeiros Rui 
Published: June 2024

Abstract

Background:
This literature review explores the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil–lymphocyte-to-platelet ratio (NLPR) biomarkers, as potential indicators for predicting bacteremia and sepsis in patients with cancer.

Objective:
Tracing the evolution of interest in this area since 2001, the aim of this review was to report a comprehensive overview of current knowledge and gaps, particularly in patients undergoing immunosuppression.

Summary of Findings:
The literature research indicates the potential of NLR, PLR, and other biomarkers in diagnosing and predicting sepsis, with some studies emphasizing their value in mortality prediction. A specific focus on bacteremia shows the effectiveness of NLR and PLR as early indicators and prognostic tools, though mostly in noncancer patient populations. While NLR and PLR are promising in general cancer patient populations, the review addresses the challenges in applying these biomarkers to patients with neutropenic and lymphopenic cancer. The NLPR could be considered a significant biomarker for inflammation and mortality risk in various medical conditions, yet its diagnostic accuracy in patients with immunosuppressed cancer is not extensively validated.

Conclusion:
This review offers a snapshot of the current research on biomarkers in patients with immunocompromised cancer in the sepsis and bacteremia area. More focused research on their application is necessary. This gap underscores an opportunity for future studies to enhance diagnostic and prognostic capabilities in this high-risk group.
Reporting on Neurological Decline as Identified by Hourly Neuroassessments
Authors: Brazel Marcus , Harris Jennifer , Carroll Dawn , Davidson Judy , Levchak Philip J. , Malhotra Atul , LaBuzetta Jamie Nicole 
Published: June 2024

ABSTRACTBACKGROUND:Hourly neurological examinations (neuro exam) have been widely used to monitor for a decline in neurological status, allowing for timely intervention. There are, however, limited data behind this common practice. The objective of this study was to identify how frequently neurological decline occurred across various diagnoses and whether that decline (1) was identified by a scheduled neurocheck and (2) altered management.METHODS:A cross-sectional survey was performed in a neurological intensive care unit at a tertiary care academic medical center. Clinical neuroscience nurses caring for patients with hourly neurological assessments completed a brief survey at 12-hour shift completion.RESULTS:Data were collected from 212 nurse's shifts. Neurological changes were identified by nurses in 14% (n = 30) of shifts. The neurological change was identified during a scheduled neurocheck 67% of the time, with the detection of changes more likely to occur during a scheduled neuro exam than at other times (P< .05). There was no change to the care plan in 55% of the cases of neurological decline. Patients with subarachnoid hemorrhage were more likely to have a decline detected.CONCLUSION:Findings suggest that many patients undergo hourly neurological exams without ever identifying a neurological deterioration. In many instances of neurodeterioration, there was no change to the treatment plan pursued. Primary diagnoses and neurological changes may not be entirely independent, and therefore, hourly neuro exams may have greater yield in some diagnoses than others. Replication is warranted with a larger sample to evaluate the risks and benefits of neuroassessments.
The 1-minute preceptor to improve diagnostic reasoning in a primary care nurse practitioner residency program
Authors: Kopelson Kristin , de Peralta Shelly , Pike Nancy A. 
Published: June 2024

ABSTRACT

Background:
The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, and Educator (RIME) framework to measure progress are used in physician training. Little is known about the use of these tools in nurse practitioner (NP) training.

Local problem:
Precepting NP trainees at the Veterans Affairs (VA) is not standardized. A standardized approach to precepting NP residency trainees using the OMP model and RIME scoring was evaluated for improvement and helpfulness.

Methods:
A quality-improvement project with two Plan-Do-Study-Act (PDSA) cycles were conducted over a 12-week period. Mean RIME scores, preceptor self-efficacy, and use of teaching skills were measured preintervention and postintervention. Data were analyzed using a paired sample t-test and descriptive statistics.

Interventions:
A convenience sample of preceptors and trainees was recruited from a large VA medical center. A 1-hour workshop educated preceptors with role playing and return demonstrations on OMP techniques and RIME scoring. The teachings were applied to standardize precepting and assess diagnostic reasoning. Trainee self-scoring and results triggered conversations to fulfil the identified gaps.

Results:
Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p < .001) post 12-week intervention. Mean RIME scores improved between PDSA cycle 1 and cycle 2 (2.07 [0.25] vs. 2.48 [0.39], p < .001). Preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful.

Conclusion:
Use of the OMP improved diagnostic reasoning in NP trainees. The OMP and RIME framework provided standardization of precepting and trainee discussions on improvements.
The impact of normothermic machine perfusion and acuity circles on waitlist time, mortality, and cost in liver transplantation: A multicenter experience
Authors: Wehrle Chase J. , Hong Hanna , Gross Abby , Liu Qiang , Ali Khaled , Cazzaniga Beatrice , Miyazaki Yuki , Tuul Munkhbold , Modaresi Esfeh Jamak , Khalil Mazhar , Pita Alejandro , Fernandes Eduardo , Kim Jaekeun , Diago-Uso Teresa , Aucejo Federico , Kwon David C. H. , Fujiki Masato , Quintini Cristiano , Schlegel Andrea , Pinna Antonio , Miller Charles , Hashimoto Koji 
Published: June 2024

Ex situ normothermic machine perfusion (NMP) helps increase the use of extended criteria donor livers. However, the impact of an NMP program on waitlist times and mortality has not been evaluated. Adult patients listed for liver transplant (LT) at 2 academic centers from January 1, 2015, to September 1, 2023, were included (n=2773) to allow all patients ≥6 months follow-up from listing. Routine NMP was implemented on October 14, 2022. Waitlist outcomes were compared from pre-NMP pre-acuity circles (n=1460), pre-NMP with acuity circles (n=842), and with NMP (n=381). Median waitlist time was 79 days (IQR: 20–232 d) at baseline, 49 days (7–182) with acuity circles, and 14 days (5–56) with NMP (p<0.001). The rate of transplant-per-100-person-years improved from 61-per-100-person-years to 99-per-100-person-years with acuity circles and 194-per-100-person-years with NMP (p<0.001). Crude mortality without transplant decreased from 18.3% (n=268/1460) to 13.3% (n=112/843), to 6.3% (n=24/381) (p<0.001) with NMP. The incidence of mortality without LT was 15-per-100-person-years before acuity circles, 19-per-100 with acuity circles, and 9-per-100-person-years after NMP (p<0.001). Median Model for End-Stage Liver Disease at LT was lowest with NMP, but Model for End-Stage Liver Disease at listing was highest in this era (p<0.0001). The median donor risk index of transplanted livers at baseline was 1.54 (1.27–1.82), 1.66 (1.42–2.16) with acuity circles, and 2.06 (1.63–2.46) with NMP (p<0.001). Six-month post-LT survival was not different between eras (p=0.322). The total cost of health care while waitlisted was lowest in the NMP era ($53,683 vs. $32,687 vs. $23,688, p<0.001); cost-per-day did not differ between eras (p=0.152). The implementation of a routine NMP program was associated with reduced waitlist time and mortality without compromising short-term survival after liver transplant despite increased use of riskier grafts. Routine NMP use enables better waitlist management with reduced health care costs.
Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia
Authors: Rataj Alison , Alcusky Matthew , Baek Jonggyu , Ott Brian , Lapane Kate L. 
Published: June 2024

Background:
Several antidementia medications have been approved for symptomatic treatment of cognitive and functional impairment due to Alzheimer disease. Antipsychotics are often prescribed off-label for behavioral symptoms.

Objective:
The aim of this study was to describe the basis for regional variation in antidementia and antipsychotic medication use.

Setting:
US nursing homes (n=9735), hospital referral regions (HRR; n=289).

Subjects:
Long-stay residents with dementia (n=273,004).

Methods:
Using 2018 Minimum Data Set 3.0 linked to Medicare data, facility information, and Dartmouth Atlas files, we calculated prevalence of use and separate multilevel logistic models [outcomes: memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics. We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV).

Results:
Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs. For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05–1.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06–1.14)] were associated with more antipsychotic use. Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44–1.96). Resident/facility factors accounted for much regional variation in antipsychotics (PCVSTATE: 27.80%; PCVHRR: 39.54%). For antidementia medications, HRR-level factors accounted for most regional variation (memantine PCVSTATE: 37.44%; ChEI PCVSTATE: 39.02%).

Conclusion:
Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia suggesting the need for evidence-based protocols to guide the use of these medications.
Biochemical monitoring of 21-hydroxylase deficiency: a clinical utility of overnight fasting urine pregnanetriol
Authors: Hasegawa Yukihiro , Itonaga Tomoyo , Ishii Tomohiro , Izawa Masako , Amano Naoko 
Published: June 2024

Purpose of review
21-Hydroxylase deficiency (21-OHD), the most common form of congenital adrenal hyperplasia, is an autosomal recessive disorder caused by pathogenic variants in CYP21A2. Although this disorder has been known for several decades, many challenges related to its monitoring and treatment remain to be addressed. The present review is written to describe an overview of biochemical monitoring of this entity, with particular focus on overnight fasting urine pregnanetriol.

Recent findings
We have conducted a decade-long research project to investigate methods of monitoring 21-OHD in children. Our latest studies on this topic have recently been published. One is a review of methods for monitoring 21-OHD. The other was to demonstrate that measuring the first morning PT level may be more practical and useful for biochemical monitoring of 21-OHD. The first morning pregnanetriol (PT), which was previously reported to reflect a long-term auxological data during the prepubertal period, correlated more significantly than the other timing PT in this study, with 17-OHP, before the morning medication.

Summary
In conclusion, although the optimal method of monitoring this disease is still uncertain, the use of overnight fasting urine pregnanetriol (P3) as a marker of 21-OHD is scientifically sound and may be clinically practical.
Neonatal skin health and associated dermatological conditions
Authors: Rezaei Shawheen J. , Linggonegoro Danny , Admani Shehla 
Published: June 2024

Purpose of review
This review describes recent developments in neonatal skincare management and situates these findings within the preexisting literature on neonatal dermatology.

Recent findings
The studies included in this review expand research methods evaluating skincare management to different contexts across the world. Several studies explore the roles of emollient therapy, disinfection, and skin-to-skin contact on improving neonates’ long-term health outcomes. Recent findings also assess the impact of neonatal interventions on atopic dermatitis risk later in life as well as epidemiological and microbiome variables that may predict this risk. Additionally, updates on various dermatological conditions unique to neonates are discussed in further detail.

Summary
Neonatal skincare management differs in notable ways from that of other age groups. The presentation of dermatologic diseases as well as the rare conditions that affect neonates make their clinical management unique. The recent literature on neonatal dermatology can help inform clinicians regarding important considerations in treating their neonatal population.
Development and Validation of a Ready-to-Talk Measure for Use in Adolescents and Young Adults Living With Advanced Cancer
Authors: Bell Cynthia J. , Spruit Jessica L. , Deatrick Janet A. , Weaver Meaghann S. , Dickens David S. , Hinds Pamela S. , Kavanaugh Karen L. 
Published: June 2024

Background
In the era of evolving and emerging therapies, adolescents and young adults (AYAs) living with advanced cancer experience a high degree of uncertainty, making palliative care and end-of-life (PCEOL) discussions difficult. Clinical conversations determine values/preferences that guide shared decision-making and goals of treatment, including end-of-life care when cancer progresses. Initiating PCEOL conversations is challenging for clinicians.

Objective
This study describes the development and validation of an instrument that measures AYA readiness to engage in PCEOL clinical conversations.

Methods
A Ready-to-Talk Measure (R-T-M) was developed, guided by the revised conceptual model of readiness across 3 domains (awareness, acceptance, and willingness). Content experts evaluated validity, and 13 AYAs with advanced cancer participated in cognitive interviews. Acceptability (item applicability, clarity, interpretation, sensitivity, missingness) and experiences (benefit, burden) were analyzed.

Results
The scale content validity index was ≥0.90 for each domain. Forty-two of the 55 R-T-M items were acceptable without any change. Three items were deleted. Ten items were modified, and 3 were added. Adolescents and young adults wanted more items about friends/siblings and about AYA unique qualities for clinicians to know them better. Adolescents and young adults acknowledged benefit through talking about difficult, relevant topics.

Conclusion
Ready-to-Talk Measure validity was strengthened by deleting or modifying unclear or misinterpreted items and by adding items. Next steps include psychometric analysis to determine reliability/dimensionality and stakeholder input to make the R-T-M a clinically useful tool.

Implications for Practice
Ready-to-Talk Measure assessment of readiness to engage in PCEOL conversations while identifying unique preferences of AYAs holds promise for facilitating ongoing discussions.
The Effect of the COVID-19 Pandemic on Suicide Trends in Pretoria, South Africa
Authors: Robinson Kay-Leigh , Pretorius Candice , Blumenthal Ryan , Meyer Pieter 
Published: June 2024

Abstract
Suicide is one of the worldwide leading causes of unnatural death. Pretoria is a capital city of South Africa and is the fourth most populated city in South Africa. Between 16 and 22 suicide cases are recorded daily in South Africa.
Case files from the Pretoria Medico-Legal Laboratory were reviewed between 1 January 2015 to 31 December 2021, which spanned the COVID-19 pandemic. All cases of possible and probable suicides were included. One-way analysis of variance and Pearson chi2 tests were conducted to determine statistical significance in the observed trends.
A total of 1820 possible and probable suicide cases were identified. The year following the outbreak of the COVID-19 pandemic accounted for the largest number of suicides. White males were the most heavily represented population, followed by Black males. Hanging was the most common method for males, whereas poisoning via ingestion and/or overdose was more commonly used by females.
Suicides in Pretoria have increased since previous studies from 9.74% and 10.2% to 13.32%. Methods used have changed among various population groups over the past two decades. This paper examined changes in suicide trends in Pretoria compared to previous studies and highlighted correlations between suicide trends and COVID-19 lockdown measures.