bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicare Advantage and Home Health Care
Authors: Ma Chenjuan , Rajewski Martha , Smith Jamie M. 
Published: March 2024

Objectives:
Home health care serves millions of Americans who are “Aging in Place,” including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees.

Methods:
A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist.

Results:
Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits.

Conclusions:
Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.
Noninvasive assessment of liver fibrosis and portal hypertension
Authors: Duarte-Rojo Andres , Patel Keyur , Rockey Don C. 
Published: March 2024

Purpose of review
The result of ongoing liver injury – and disease, regardless of cause – is fibrosis, and fibrosis appears to be a critically important result of ongoing injury. Further, in a number of different liver diseases, the presence of fibrosis has prognostic value. Therefore, the assessment of fibrosis is of critical clinical importance. Given the importance of fibrosis, there has been a rapid evolution in the use of noninvasive liver tests. This review highlights a number of the core principles surrounding.

Recent findings
The use of noninvasive test has progressed rapidly over the last decade and data are rapidly accumulating. New terminology has been adapted by the American Association for the Study of Liver Disease (AASLD) for noninvasive assessment of liver disease and termed ‘NILDA’ (Non-Invasive Liver Disease Assessment). Blood based such as APRI and or FIB-4 and imaging tests such as liver stiffness measurement (LSM) have moderate to high degrees of accuracy for detection of advanced liver fibrosis (≥ F2) and even higher accuracy for detection of severe fibrosis (F4 or cirrhosis). NILDA are particularly effective at the ends of the liver disease spectrum. For example, a very low LSM (less than 7 kPa) essentially excludes significant fibrosis or portal hypertension, and a very high LSM (> 25 kPa) makes significant fibrosis with portal hypertension (cirrhosis) highly likely.

Summary
NILDA are currently front and center in terms of assessment of the severity of liver disease. In all patients with known or suspected liver disease, noninvasive blood tests, including APRI and or FIB-4, should be the initial choice to assess the severity of liver fibrosis and/or portal hypertension. In most patients, these tests should be followed with imaging evaluation. The most commonly available imaging is LSM, which appears to be more accurate in predicting fibrosis severity, and is superior to blood tests in the assessment of portal hypertension. In situations in which there is diagnostic uncertainly, liver biopsy with or without HVPG remains an important consideration.
Proprotein convertase subtilisin/kexin type 9-inhibition across different patient populations
Authors: Stürzebecher Paulina Elena , Laufs Ulrich 
Published: March 2024

Purpose of reviewMonoclonal antibodies (mAb) targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) have been established in cardiovascular risk prevention. The purpose of this review is to summarize the effects of PCSK9 inhibitors across different patient populations.Recent findingsLong-term data on the use of evolocumab and alirocumab shows persisting low- density lipoprotein cholesterol (LDL-C) lowering and good tolerability. PCSK9 inhibitors are effective and safe in both sexes, in pediatric patients as well as in the elderly. Initiation of PCSK9 mAb during acute myocardial infarction is safe and leads to beneficial morphological plaque changes. The PCSK9 inhibitors evolocumab, alirocumab and inclisiran lower LDL-C in patients with heterozygous familial hypercholesterolemia (FH), while the response of patients with homozygous FH is heterogeneous. New areas of application beyond lipid lowering are currently investigated.SummaryPCSK9 inhibitors are safe, well tolerated, and effective in primary and secondary prevention in a wide range of patient populations.
Sustainable equipment donation in otolaryngology in low-resource settings
Authors: de Cates Catherine , Guéroult Aurélien M. , Narantsolmon Gan-Erdene 
Published: March 2024

Purpose of reviewThe purpose of this review is to examine current practices in surgical equipment donation to lower- and middle-income countries (LMICs) with a particular focus on otolaryngology-head and neck surgery (OHNS). This is designed as a pragmatic review to guide potential donor communities to implement sustainable OHNS equipment donation in LMICs.Recent findingsLMICs are increasingly reliant on international equipment donation. In terms of OHNS services, global OHNS have compiled a list of essential equipment for baseline care in LMICs. Especially in terms of audiology, OHNS equipment donation has the potential to have a significant impact on populational health. However, there is a scarcity of research on donated equipment in OHNS. A suggested blueprint for sustainable equipment donation follows these steps: establish partnerships, assess needs, source equipment, and follow-up and evaluate the intervention. Key further considerations for sustainability include remanufacturing and repurposing methods, maintenance, and contextual understanding.SummarySustainable equipment donation in otolaryngology is an important part of global health equity and healthcare delivery in low-resource settings. Despite the good intentions behind medical equipment donations, there are many challenges; donors and recipients should engage in collaborative, needs-based planning processes that result in long-term sustainability, local capacity building, and community participation.
Myopia control: Seeing beyond efficacy
Authors: Bullimore Mark A. , Jong Monica , Brennan Noel A. 
Published: March 2024

SIGNIFICANCE
The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.
Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors—compliance, quality of vision, quality of life, and safety—are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
Pain Neuroscience Education Following Arthroscopic Rotator Cuff Repair for Patients With Rotator Cuff Tears
Authors: Kararti Caner , Özyurt Fatih , Kodak Muhammed İhsan , Basat Hakkı Çağdaş , Özsoy Gülşah , Özsoy İsmail , Tayfur Abdulhamit 
Published: March 2024

Objective
This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair.

Design
A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group (n = 18) or control group (n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15–60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment.

Results
The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group (P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures.

Conclusions
This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair.
True Incidence of Marginal Mandibular Nerve Palsy following Neonatal Mandibular Distraction Osteogenesis
Authors: Myers Sarah , Beiriger Justin W. , Bruce Madeleine K. , Matinrazm Sayna , Dvoracek Lucas , Raghuram Anjali , Irgebay Zhazira , Glenney Anne E. , Mocharnuk Joseph , Kass Nicolás M. , Smetona John , Losee Joseph E. , Goldstein Jesse A. 
Published: March 2024

Background:
In children with Pierre Robin sequence (PRS), mandibular distraction osteogenesis (MDO) is routinely performed to alleviate airway obstruction; however, it involves risk of injury to the marginal mandibular nerve (MMN). The authors hypothesize that MMN palsy incidence following MDO, reported at 1% to 15%, is underestimated. This study investigates the true incidence of MMN palsy after MDO to better guide follow-up care and improve treatment of this complication.

Methods:
A retrospective review of PRS patients who underwent MDO at a single, tertiary pediatric hospital between September of 2007 and March of 2021 was conducted. Patients who underwent MDO younger than 1 year of age and had postoperative clinical evaluations detailing MMN function were included. Logistic regression analysis was performed to investigate predictors of MMN injury.

Results:
Of 93 patients who underwent MDO, 59.1% met inclusion criteria, 56.4% were female, 43.6% were syndromic, and average age at MDO was 1.52 ± 2.04 months. The average length of mandibular distraction was 17.3 ± 4.36 mm, the average duration of intubation was 6.57 ± 2.37 days, and the average time until hardware removal was 111.1 ± 23.6 days. Sixteen patients (29.1%) presented with permanent MMN dysfunction, consisting of 8 patients with bilateral weakness and 8 with unilateral weakness. An additional 5 patients (9.1%) presented with transient MMN weakness that resolved within 1 year. Average length of follow-up postoperatively was 6.02 years, and no significant predictors of nerve injury were found.

Conclusion:
In this 14-year review of patients with PRS who underwent MDO, 38.2% demonstrated evidence of MMN palsy (permanent, 29.1%; transient, 9.1%), which is much greater than previously described.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Travel Burden to American Cleft Palate and Craniofacial Association–Approved Cleft and Craniofacial Teams: A Geospatial Analysis
Authors: Brown Madyson I. , Kuyeb Boris K. , Galarza Laura I. , Benedict Katherine C. , Hoppe Ian C. , Humphries Laura S. 
Published: March 2024

Background:
Despite the existence of cleft and craniofacial teams approved by the American Cleft Palate and Craniofacial Association (ACPA), access to multidisciplinary team-based care remains challenging for patients from rural areas, leading to disparities in care. The authors investigated the geospatial relationship between US counties and ACPA-approved centers.

Methods:
The geographic location of all ACPA-approved cleft and craniofacial centers in the United States was identified. Distance between individual US counties (n = 3142) and their closest ACPA-approved team was determined. Counties were mapped based on distance to nearest cleft or craniofacial team. Distance calculations were combined with US Census data to model the number of children served by each team and economic characteristics of families served. These relationships were analyzed using independent t tests and analysis of variance.

Results:
Over 40% of US counties did not have access to an ACPA-approved craniofacial team within a 100-mile radius (n = 1267) versus 29% for cleft teams (n = 909). Over 90% of counties greater than 100 miles from a craniofacial team had a population less than 7500 (n = 1150). Of the counties more than 100 miles from a cleft team, 64% had a child poverty rate greater than the national average (n = 579). Counties with the highest birth rate and more than 100 miles to travel to an ACPA team are in the Mountain West.

Conclusions:
Given the time-sensitive nature of operative intervention and access to multidisciplinary care, the lack of equitable distribution in certified cleft and craniofacial teams is concerning. Centers may better serve families from distant areas by establishing satellite clinics, conducting telehealth visits, and training local primary care providers in referral practices.
A Geospatial Analysis of Hand Trauma Care: A Statewide Cross-Sectional Study
Authors: Florczynski Matthew M. , Zhang Yahui , Cichocki Meghan N. , Chung William T. , Wang Lu , Hemmila Mark R. , Chung Kevin C. 
Published: March 2024

Background:
Traumatic hand injuries often present with high acuity, but little is known about the influence of geospatial and socioeconomic factors on the timely delivery of care.

Methods:
This cross-sectional study used the Michigan Trauma Quality Improvement Program database, a statewide registry with 35 level I or II trauma centers. Adult patients sustained hand trauma requiring urgent operative treatment between 2016 and 2021. Zip codes of injury location were linked with the corresponding percentage score on the Area Deprivation Index (ADI), a comprehensive measure of neighborhood disadvantage. Multiple regression analyses were used to determine associations of patient, injury, and geospatial characteristics with the odds of sustaining acute hand trauma and time to operative treatment.

Results:
Among 1826 patients, the odds of sustaining acute hand trauma based on the ADI followed a bimodal distribution. Female sex, smoking, obesity, work-related injury, and residence in a minor city were associated with increased odds, whereas younger age, comorbidities, and rural residence were associated with decreased odds. For 388 patients who underwent surgery within 48 hours, time to treatment was significantly increased in the highest ADI quintile, for patients who underwent fracture fixation, and for those with severe global injury severity. Multisystem injuries, moderate global injury severity, and direct admission to an orthopedic service were associated with shorter times to treatment.

Conclusions:
Patients in areas with greater neighborhood disadvantage may experience delayed operative care after acute hand trauma. This study highlights the importance of considering underserved populations and geospatial factors when determining the allocation of hand surgery resources.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
LigaSure-Assisted Submandibular Gland Excision in Deep-Plane Neck Lift: Review of 83 Patients
Authors: Basaran Karaca , Comert Mehmet 
Published: March 2024

Background:
In performing a neck lift, the size and location of the submandibular gland (SMG) must be evaluated to achieve the ideal neck contour. Many surgeons, however, avoid SMG excision because of the technical difficulty and risks of hematoma and nerve damage. LigaSure (Valleylab, Boulder, CO) is a bipolar energy–based instrument that permanently seals vessels and connective tissue. Its use can make the SMG excision step easy and safe by reducing surgical risks.

Methods:
A total of 83 patients who underwent SMG excision between 2018 and 2022 were included in the study. All patients’ SMGs were partially excised using the LigaSure device, and the complication rates were documented.

Results:
Patients were followed up for an average period of 21 months (range, 9 months to 2.4 years). No perioperative intraglandular bleeding or postoperative hematoma was observed in any patient. No sialoma cases were observed postoperatively. Only 3 patients underwent repeated seroma aspirations. Transient lower lip weakness was observed in 7 patients, who all recovered in the first 6 months postoperatively.

Conclusion:
LigaSure-assisted SMG excision in deep-plane neck lift surgery was found to be technically easier to perform, time saving, safe, and highly effective in preventing hematoma and intraoperative bleeding.

CLINCAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Prevalence of Concomitant Distal Suprascapular Nerve Injury in Patients with Root-Level Brachial Plexus Palsy: A Clinical Anatomic Study of Injury Pattern
Authors: Bertelli Jayme A. , Lanzarin Leonardo D. , Ghizoni Marcos F. , Hill Elspeth J. R. 
Published: March 2024

Background:
Root-level suprascapular nerve palsy is commonly reconstructed by means of spinal accessory nerve transfer in brachial plexus injury, but some patients do not recover. The authors hypothesize that this relates to concomitant undetected lesions distal to the nerve transfer coaptation.

Methods:
A total of 67 patients with plexus injury and C5/C6 root involvement were included in this prospective study between March of 2021 and October of 2022. During spinal accessory to suprascapular nerve transfer, the entire suprascapular nerve was explored using cresenteric clavicular osteotomy, and anatomic variations and injury patterns categorized.

Results:
Proximal root involvement was C5 to C6 (n = 8), C5 to C7 (n = 13), C5 to C8 (n = 17), or C5 to T1 (n = 29). Mean time from injury to surgery was 5.6 months. The suprascapular nerve was found to be injured in 16 of 67 cases (24%). In 9 cases (13%), the lesion was proximal to the suprascapular fossa. In 3 cases (4%), the suprascapular nerve was injured both proximally and within the fossa, and in 4 cases (6%), in the fossa or distal to it. Therefore, in 7 cases (10%), a traditional suprascapular nerve transfer would not successfully bypass the zone of injury of the suprascapular nerve in the fossa. Of the 16 cases of concomitant suprascapular nerve injury, 1 of 8 in occurred in C5 to C6 root injury, 4 of 13 of C5 to C7 root injury, 5 of 17 of C5 to C8 root injury, and 6 of 39 in total paralysis.

Conclusions:
Concomitant distal suprascapular nerve injury in brachial plexus stretch palsy occurred in 24% of the cases. This warrants attention from the surgeon to identify distal lesions and to perform the nerve transfer beyond any secondary lesions.
Disparity Reduction in U.S. Breast Reconstruction: An Analysis from 2005 to 2017 Using 3 Nationwide Data Sets
Authors: Rubenstein Robyn N. , Nelson Jonas A. , Azoury Saïd C. , Kim Minji , Boe Lillian A. , Chu Jacqueline J. , Stern Carrie S. , Tadros Audree B. , Mehrara Babak J. , Matros Evan 
Published: March 2024

Background:
Following passage of the Women’s Health and Cancer Rights Act of 1998 (WHCRA), a steady rise in breast reconstruction rates was reported; however, a recent update is lacking. This study aimed to evaluate longitudinal trends in breast reconstruction (BR) rates in the United States and relevant sociodemographic factors.

Methods:
Mastectomy cases with and without BR from 2005 through 2017 were abstracted from the National Surgical Quality Improvement Program database; the Surveillance, Epidemiology, and End Results Program database; and the National Cancer Database (NCDB). BR rates were examined using Poisson regression. Multivariable logistic regression analysis of NCDB data were used to identify predictors of reconstruction. Race and insurance distributions were evaluated over time.

Results:
Of 1,554,381 mastectomy patients, 507,631 (32.7%) underwent BR. Annual reconstruction rates per 1000 mastectomies increased from 2005 to 2012 (National Surgical Quality Improvement Program incidence rate ratio [IRR], 1.077; Surveillance, Epidemiology, and End Results Program IRR, 1.090; and NCDB IRR, 1.092) and stabilized from 2013 to 2017. NCDB data showed that patients who were younger (≤59 years), privately insured, had fewer comorbidities, and underwent contralateral prophylactic mastectomy were more likely to undergo BR (all P < 0.001). Over time, the increase in BR rates was higher among Black (252.3%) and Asian (366.4%) patients than among White patients (137.3%). BR rates increased more among Medicaid (418.6%) and Medicare (302.8%) patients than among privately insured patients (125.3%).

Conclusions:
This analysis demonstrates stabilization in immediate BR rates over the past decade; reasons behind this stabilization are likely multifactorial. Disparities based on race and insurance type have decreased, with a more equitable distribution of BR rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Update and approach to patients with brain abscess
Authors: Omland Lars Haukali , Nielsen Henrik , Bodilsen Jacob 
Published: March 2024

Purpose of review
The epidemiology of brain abscess has changed in recent decades. Moreover, acute and long-term management remains challenging with high risks of mortality and neurological sequelae. This review describes recent advances in epidemiology, diagnosis, and treatment of brain abscess.

Recent findings
The incidence of brain abscess is increasing, especially among elderly individuals. Important predisposing conditions include dental and ear-nose-throat infections, immuno-compromise, and previous neurosurgery. Molecular-based diagnostics have improved our understanding of the involved microorganisms and oral cavity bacteria including anaerobes are the predominant pathogens. The diagnosis relies upon a combination of magnetic resonance imaging, neurosurgical aspiration or excision, and careful microbiological examinations. Local source control by aspiration or excision of brain abscess combined with long-term antimicrobials are cornerstones of treatment. Long-term management remains important and should address neurological deficits including epilepsy, timely diagnosis and management of comorbidities, and potential affective disorders.

Summary
A multidisciplinary approach to acute and long-term management of brain abscess remains crucial and source control of brain abscess by neurosurgery should be pursued whenever possible. Numerous aspects regarding diagnosis and treatment need clarification. Nonetheless, our understanding of this complicated infection is rapidly evolving.