bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of a Novel Bidirectional Lateral Intercostal Artery Perforator Flap for Reconstructing Partial Mastectomy Defects
Authors: Schwartz Jean-Claude D. 
Published: March 2024

Summary:
Smaller breasts require volume replacement to allow for breast conservation for large tumor to breast size ratios. The lateral intercostal artery perforator (LICAP) flap is one of the most commonly used approaches to replace volume as it readily fills lateral breast defects where most cancers typically arise. The LICAP flap was initially described with the bulk of its tissue volume oriented posteriorly, lateral to the breast footprint. Recently, the “reverse LICAP” flap was described, which uses the same perforators but recruits tissue instead from below the inframammary fold. Here, we combine these two approaches, preserving the same perforators, but harvesting tissue from both below the inframammary fold and lateral to the breast footprint, to create a single, larger, bidirectional LICAP flap. This modified flap replaces more volume than previously described for uni-directional approaches allowing us to potentially avoid mastectomy or more extensive flap reconstructions. Here, we describe 10 consecutive patients where the bidirectional LICAP flap was used to facilitate oncoplastic breast conservation.
Improving Time to Angioembolization for Trauma Care: Novel Smartphone Application
Authors: Miles Gayla , Quinlan Ann 
Published: March 2024

BACKGROUND:
Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option.

OBJECTIVE:
To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care.

METHODS:
In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process.

RESULTS:
The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls.

CONCLUSION:
Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.
Trauma Patient-Centered Discharge Plan Form: A Pilot Study
Authors: Stricker Lisa G. , Running Alice , Lucas Amanda H. , McKenzie Barry A. 
Published: March 2024

BACKGROUND:
Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge.

OBJECTIVE:
This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients.

METHODS:
A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported.

RESULTS:
The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients).

CONCLUSIONS:
The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.
Transcutaneous osseointegration for amputees
Authors: Evans Andrew R. , Tetsworth Kevin , Quinnan Stephen , Wixted John J. 
Published: March 2024

Abstract
Transcutaneous osseointegration for amputees (TOFA) is an evolving technology that has the potential to revolutionize the interface between the amputee and their prosthesis, showing potential at many levels of amputation. While no amputation is without its challenges, TOFA requires a highly specialized prosthesis and a multidisciplinary team that includes specialized surgeons, physical therapists, wound care teams, and social workers who guide the amputee through surgery, postoperative rehabilitation, and the chronic wound care that goes into maintaining the prosthesis. The infrastructure required to facilitate care pathways that lead to reliable, successful outcomes are unique in each health care setting, including those in advanced health care systems such as the United States and Australia. This article details the emerging evidence supporting the use of this prosthetic interface design and many of the challenges that providers face when establishing programs to offer this type of care in the United States.
Medicaid Insurance Predicts Increased Postoperative Care Encounters Among Patients on Long-Term Opioid Therapy
Authors: Sharif Limi , Zubieta Caroline S. , Arora Akul , Gunaseelan Vidhya , Waljee Jennifer , Bicket Mark C. , Englesbe Michael , Brummett Chad M. 
Published: March 2024

Objective:
This study examined the association between insurance type and postoperative unplanned care encounters among patients on long-term opioid therapy prior to surgery.

Summary Background Data:
Preoperative long-term opioid therapy is associated with unique risks and poorer outcomes following surgery. To date, the extent to which insurance coverage influences postoperative outcomes in this population remains unclear.

Methods:
Among individuals receiving a supply of greater than 120 total days or at least 10 opioid prescriptions in the year prior to surgery, we examined patients with Medicaid or private insurance who underwent abdominopelvic surgery from 2017 to 2021 across 70 hospitals in the state of Michigan. The primary outcome was unplanned care encounters, defined as an emergency department visit or unplanned readmission within 30 days of discharge from surgery. Multivariable logistic regression was used to assess the likelihood of acute care events with insurance type as the primary covariate of interest.

Results:
Among 1212 patients on long-term opioid therapy prior to surgery, 45.6% (n = 553) had Medicaid insurance. Overall, one in eight (n=151) patients met criteria for a postoperative unplanned care encounter within 30 days. The probability of an unplanned encounter was 4.5 percentage points higher among patients with Medicaid insurance compared to private insurance (95% CI: 0.5%, 8.4%).

Conclusions:
Among patients on preoperative long-term opioid therapy, unplanned care encounters were higher among patients with Medicaid when compared to private insurance. While this is likely multifactorial, differences by insurance status may point to disparities in underlying social determinants of health and suggest the need for postoperative care pathways that address these gaps.
Association Of Opioid Prescribing And Consumption With Patient-Reported Experiences And Satisfaction Following Emergency Surgery In Michigan
Authors: Rosenthal Lindsay , Gunaseelan Vidhya , Waljee Jennifer , Bicket Mark , Englesbe Michael , Howard Ryan 
Published: March 2024

Objective:
To investigate the relationships between opioid prescribing, consumption, and patient reported outcomes (PROs) in emergency surgery patients.

Summary Background Data:
Overprescribing of opioids for pain management after surgery has become a public health concern and major contributor to opioid misuse and dependency. Current guidelines do not address opioid prescribing following emergency surgical procedures, highlighting the importance of understanding the relationship between opioid prescribing and consumption in this setting.

Methods:
Retrospective analysis of the quantity of opioids prescribed and patient-reported outcomes (PROs) in a population-based setting. The sample included adults 18 years and older undergoing emergency surgery across 69 hospitals in Michigan. Patients were included if they received a discharge opioid prescription and had valid data for opioid consumption and PROs. Surgical procedures took place between January 1, 2018 and December 31, 2020.

Results:
During the study period, a total of 3,742 patients underwent an emergency operation. The mean number of opioid pills prescribed was 9.6 and the mean number of opioid pills consumed was 4.6. In a two-model with logit in the first part and a linear regression in the second, prescription size was significantly associated with both the probability of consumption (aOR 1.02, 95% CI 1.01-1.04) and the amount of consumption conditional on any consumption (coefficient 0.70 95% CI 0.54-0.86).

Conclusions and Relevance:
Patients only consumed half of the opioids they were prescribed after undergoing emergency surgery. Additionally, patients who were given larger prescriptions consumed more opioids, but did not experience less pain, higher satisfaction, better quality of life, or less regret to undergo surgery. Overall, this suggests that opioids may be excessively prescribed to patients undergoing emergency surgical procedures, and that larger prescriptions do not improve the patient experience after surgery.
The Association of Preoperative Opioid Use with Post-Discharge Outcomes
Authors: Frangakis Stephan G. , Kavalakatt Bethany , Gunaseelan Vidhya , Lai Yenling , Waljee Jennifer , Englesbe Michael , Brummett Chad M. , Bicket Mark C. 
Published: March 2024

Objective:
To examine the association of prescription opioid fills over the year prior to surgery with postoperative outcomes.

Background:
Nearly one third of patients report opioid use in the year preceding surgery, yet an understanding of how opioid exposure influences patient-reported outcomes after surgery remains incomplete. Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.

Methods:
This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state’s prescription drug monitoring program to categorize patients’ preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).

Results:
Compared to opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. Predicted probabilities was higher among the opioid exposed versus naive group for reporting moderate pain (43.5% [95% CI 42.6 – 44.4%] vs 39.3% [95% CI 38.5 – 40.1%]) and severe pain (13.% [95% CI 12.5 – 14.0%] vs 10.0% [95% CI 9.5 – 10.5%]), and increasing probability was associated increased opioid exposure for both outcomes. Clinical outcomes (incidence of ED visits, readmissions, and reoperation within 30-days) and patient-reported outcomes (reported satisfaction, regret, and quality of life) were also worse with increasing preoperative opioid exposure for most outcomes.

Conclusions:
This study is the first to examine the effect of presurgical opioid exposure on both clinical and non-clinical outcomes in a broad cohort of patients, and shows that exposure is associated with worse postsurgical outcomes. A key question to be addressed is whether and to what extent opioid tapering before surgery mitigates these risks after surgery.
Association of Neighborhood-Level Socioeconomic Status With Prolapse Management Decision
Authors: Downing Perrin , Dong Shirley M. , Ardizzone Melissa A. , Lynch Courtney D. , Hickman Lisa C. 
Published: March 2024

ImportanceThis study identifies how neighborhood-level socioeconomic status (SES) may affect patients' treatment decisions for pelvic organ prolapse (POP).ObjectiveThis study aimed to evaluate the association of neighborhood-level SES with the decision of surgical versus conservative POP management.Study DesignThis was a retrospective cohort study of patients newly diagnosed with POP at a tertiary medical center between 2015 and 2021. Patients lost to follow-up or poor surgical candidates were excluded. Patient characteristics, demographics, and treatment selection were abstracted from the electronic health record. Conservative management was defined as expectant, pessary, and/or pelvic floor physical therapy. Five-digit zip codes were linked to the Area Deprivation Index and used as a surrogate for neighborhood-level SES. Area Deprivation Indices were dichotomized at or below the sample median (less disadvantaged area) and above the sample median (more disadvantaged area). Logistic regression models estimated the odds of choosing surgical versus conservative management as a function of the Area Deprivation Index.ResultsA total of 459 patients met the eligibility criteria (non-Hispanic White, 88.2%). The median age was 63 years (interquartile range, 52–70 years), and the majority had stage 2 POP (65.7%). Of all patients, 59.3% had Medicare/Medicaid, 39.9% were privately insured, and 0.9% were uninsured. Furthermore, 74.7% selected surgical management, and 25.3% chose conservative management. Increasing age and higher Pelvic Organ Prolapse Quantification System stage were significantly associated with selecting surgery (P= 0.01). Women residing in a more disadvantaged area had a 67% increased odds of choosing surgical over conservative management (adjusted odds ratio, 1.67; 95% confidence interval, 1.06–2.64) after adjusting for age, race/ethnicity, body mass index, and Pelvic Organ Prolapse Quantification System stage.ConclusionsResiding in a more disadvantaged zip code was associated with 67% increased odds of choosing surgical versus conservative POP management.
Acute emergence of the intestinal pathobiome after postinjury pneumonia
Authors: Munley Jennifer A. , Kelly Lauren S. , Park Gwoncheol , Drury Stacey K. , Gillies Gwendolyn S. , Coldwell Preston S. , Kannan Kolenkode B. , Bible Letitia E. , Efron Philip A. , Nagpal Ravinder , Mohr Alicia M. 
Published: March 2024

BACKGROUNDPrevious preclinical studies have demonstrated sex-specific alterations in the gut microbiome following traumatic injury or sepsis alone; however, the impact of host sex on dysbiosis in the setting of postinjury sepsis acutely is unknown. We hypothesized that multicompartmental injury with subsequent pneumonia would result in host sex-specific dysbiosis.METHODSMale and proestrus female Sprague-Dawley rats (n = 8/group) were subjected to either multicompartmental trauma (PT) (lung contusion, hemorrhagic shock, cecectomy, bifemoral pseudofracture), PT plus 2-hour daily restraint stress (PT/RS), PT with postinjury day 1Pseudomonas aeruginosapneumonia (PT-PNA), PT/RS with pneumonia (PT/RS-PNA), or naive controls. Fecal microbiome was measured on days 0 and 2 using high-throughput 16S rRNA sequencing and Quantitative Insights Into Microbial Ecology 2 bioinformatics analyses. Microbial α-diversity was assessed using Chao1 (number of different unique species) and Shannon (species richness and evenness) indices. β-diversity was assessed using principal coordinate analysis. Significance was defined asp< 0.05.RESULTSAll groups had drastic declines in the Chao1 (α-diversity) index compared with naive controls (p< 0.05). Groups PT-PNA and PT/RS-PNA resulted in different β-diversity arrays compared with uninfected counterparts (PT, PT/RS) (p= 0.001). Postinjury sepsis cohorts showed a loss of commensal bacteria along with emergence of pathogenic bacteria, with blooms ofProteusin PT-PNA andEscherichia-Shigellagroup in PT/RS-PNA compared with other cohorts. At day 2, PT-PNA resulted in β-diversity, which was unique between males and females (p= 0.004). Microbiome composition in PT-PNA males was dominated byAnaerostipesandParasuterella, whereas females had increasedBarnesiellaandOscillibacter. The PT/RS males had an abundance ofGastranaerophilalesandMuribaculaceae.CONCLUSIONMulticompartmental trauma complicated by sepsis significantly diminishes diversity and alters microbial composition toward a severely dysbiotic state early after injury, which varies between males and females. These findings highlight the role of sex in postinjury sepsis and the pathobiome, which may influence outcomes after severe trauma and sepsis.
Neuronal antibodies in nonparaneoplastic autoimmune cerebellar ataxias
Authors: Saiz Albert , Graus Francesc 
Published: March 2024

Purpose of review
To describe relevant advances in nonparaneoplastic autoimmune cerebellar ataxias (ACA) with neuronal antibodies.

Recent findings
Apart from metabotropic glutamate receptor 1(mGluR1) antibodies, in recent years, the number of neuronal antibodies against surface antigens in ACA has increased with the description of glutamate kainate receptor subunit 2 (GluK2) antibodies in young patients with cerebellitis. Around 20% of patients with contactin-associated protein-like 2 (CASPR2) encephalitis also present prominent cerebellar ataxia. However, isolate cerebellar ataxia is unusual (<4%). Outcome in patients with neuronal antibodies against surface antigens remains suboptimal despite the cerebellar ataxia probably is antibody-mediated.
Concerning neuronal antibodies against intracellular antigens, up to 25% of patients with glutamic acid decarboxylase (GAD) antibodies present transient episodes of vertigo or diplopia that antedate the development of the ACA. There is in-vitro evidence that septin-5 is partially exposed to the membrane and the antibodies may interfere with septin-5 function. The clinical significance of the remaining antibodies against intracellular antigens remains unclear.

Summary
The number of antibodies against surface antigens is increasing in ACA, but the response to the immunotherapy remains suboptimal. More studies are needed to clarify the role of most of the antibodies against intracellular antigens described in these patients.
Associations of HIV and prevalent type 2 diabetes mellitus in the context of obesity in South Africa
Authors: Magodoro IM , Castle AC , Tshuma N , Goedecke JH , Sewpaul R , Manasa J , Manne-Goehler J , Ntusi NAB , Nyirenda MJ , Siedner MJ 
Published: March 2024

SummaryIt is unclear how rising obesity among people with HIV (PWH) in sub-Saharan Africa (SSA) impacts their risk of type 2 diabetes mellitus (diabetes). Using a South African national cross-sectional sample of adult PWH and their peers without HIV (PWOH), we examined the associations between HIV and prevalent diabetes across the spectrum of body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WtHR). Analyses were sex stratified, and adjusted for age, sociodemographic and behavioral factors. The prevalence of diabetes among males was similar between PWH and PWOH, overall and at all levels of adiposity. In contrast, overall diabetes prevalence was higher among female PWOH than female PWH. However, there were differences according to adiposity such that, compared to female PWOH, relative diabetes prevalence in female PWH was reduced with obesity but accentuated with leanness. These differences in the relationship between adiposity and diabetes by HIV serostatus call for better mechanistic understanding of sex-specific adipose tissue biology in HIV in South Africa, and possibly in other HIV endemic settings in SSA.
Time to death and its determinants among neonates admitted to the Neonatal Intensive Care Unit (NICU) of Woldia Comprehensive Specialized Hospital, Amhara region, northeast Ethiopia: A five-year retrospective study
Authors: Fentaw Nuhamin , Demis Asmamaw 
Published: March 2024

AbstractBackgroundDespite an effort to reduce neonatal mortality, Ethiopia is still the leading among the countries with the highest neonatal death. While there have been studies conducted on the overall neonatal mortality rate, there is limited research specifically focusing on the time to death of neonates admitted to the Neonatal Intensive Care Unit (NICU).ObjectivesTo assess the survival time of neonatal death (time to death) and its determinants for neonates admitted to the NICU of Woldia Comprehensive Specialized Hospital (WCSH).MethodsA retrospective cohort study was conducted among 604 neonates admitted to the NICU of Woldia comprehensive specialized hospital from January 2018 to December 2022. The data were entered using Epi-Data version 4.6 and analysis was made using STATA version 14 software. To estimate failure probability, the Kaplan-Meier curve and life table estimate were calculated. The log-rank test was used to examine differences in death rates among different categories. The Cox proportional hazards model was employed to identify determinant variables. In the multivariate Cox analysis, variables with a hazard ratio p-value < 0.05 were considered statistically significant at a 95% confidence interval.ResultsThe findings of the study indicate that a total of 604 neonates were included and observed for a cumulative period of 3416 neonate-days. The median time to death among the neonates was 14 days. Out of the reviewed cases, 117 (19.37%) neonates died during the study period. Have no ANC checkup (AHR: 1.68; 95% CI: 1.12-2.52), having bad obstetrics history (AHR: 1.99, 95% CI: 1.28-3.10), having sepsis (AHR: 1.87, 95% CI: 1.23-2.86) and having asphyxia (AHR: 1.64, 95% CI: 1.05-2.58) were increased the hazard of neonatal death.ConclusionThe overall neonatal mortality incidence was high. ANC checkup, bad obstetrics history, and specific diagnoses, were found to significantly influence the hazard of neonatal mortality. Increase awareness and education programs for the community regarding the importance of ANC visits. Implement protocols for early identification and management of respiratory distress, sepsis and prenatal asphyxia is critical.