bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Posterior Cornea and Posterior-To-Anterior Curvature Radii Ratio 1 Year After LASIK, PRK, and SMILE Treatment of Myopia
Authors: Moshirfar Majid , Cha David S. , Santos Jordan M. , Herron Michael S. , Hoopes Phillip C. 
Published: April 2024

Purpose:
The purpose of this study was to compare changes in the posterior curvature and the posterior–anterior radii ratio of the cornea, 1 year postoperatively in laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE).

Methods:
This retrospective study was performed at a single surgical center. 199 eyes were included in the study from 119 patients with manifest refraction spherical equivalents from −7.61 to −2.54 D. 67 eyes underwent LASIK, 89 underwent PRK, and 43 underwent SMILE. Both preoperative and 1-year postoperative front and back sagittal keratometry were measured at 4- to 6-mm zones around the corneal vertex. Corneal asphericity (Q-value) was measured at an 8-mm zone around the corneal vertex.

Results:
The average change in the posterior–anterior radii ratio after LASIK, PRK, and SMILE did not differ between surgery groups at 4 mm (LASIK: −0.075, PRK: −0.073, SMILE: −0.072, P = 0.720), 5 mm (LASIK: −0.072, PRK: −0.068, SMILE: −0.068, P = 0.531), or 6 mm (LASIK: −0.075, PRK: −0.071, SMILE: −0.072, P = 0.456) zones. Anterior Q-value significantly positively increased after all 3 surgeries (P < 0.001). The posterior Q-value also significantly positively increased after LASIK (P < 0.001) and SMILE (P < 0.001), but not after PRK (P = 0.227). Both anterior and posterior keratometric power decreased significantly after LASIK, PRK, and SMILE for all diameters.

Conclusions:
The change in the posterior–anterior radii ratio was not influenced by the type of refractive surgery performed, as indicated by statistically identical preoperative, postoperative, and delta values. In addition, the posterior cornea exhibited paracentral flattening after LASIK, SMILE, and PRK and increased oblateness after LASIK and SMILE.
Hospital Outcomes Among Children With Congenital Heart Disease and Adenovirus Pneumonia
Authors: Crawford Richard , Akmyradov Chary , Dachepally Rashmitha , Prodhan Parthak 
Published: April 2024

Background:
The aim of the study is to evaluate the mortality risk factors and hospitalization outcomes of adenovirus pneumonia in pediatric patients with congenital heart disease.

Methods:
In this retrospective multicenter cohort study utilizing the Pediatric Health Information System database, we analyzed congenital heart disease patients with adenovirus pneumonia from January 2004 to September 2018, categorizing them into shunts, obstructive lesions, cyanotic lesions and mixing lesions. Multivariate logistic regression analysis was employed to identify mortality risk factors with 2 distinct models to mitigate collinearity issues and the Mann–Whitney U test was used to compare the hospital length of stay between survivors and nonsurvivors across these variables.

Results:
Among 381 patients with a mean age of 3.2 years (range: 0–4 years), we observed an overall mortality rate of 12.1%, with the highest mortality of 15.1% noted in patients with shunts. Model 1 identified independent factors associated with increased mortality, including age 0–30 days (OR: 8.13, 95% CI: 2.57–25.67, P < 0.005), sepsis/shock (OR: 3.34, 95% CI: 1.42–7.83, P = 0.006), acute kidney failure (OR: 4.25, 95% CI: 2.05–13.43, P = 0.0005), shunts (OR: 2.95, 95% CI: 1.14–7.67, P = 0.03) and cardiac catheterization (OR: 6.04, 95% CI: 1.46–24.94, P = 0.01), and Model 2, extracorporeal membrane oxygenation (OR: 3.26, 95% CI: 1.35–7.87, P = 0.008). Nonsurvivors had a median hospital stay of 47 days compared to 15 days for survivors.

Conclusion:
The study revealed a 12.1% mortality rate in adenoviral pneumonia among children with congenital heart disease, attributed to risk factors such as neonates, sepsis, acute kidney failure, shunts, cardiac catheterization, extracorporeal membrane oxygenation use and a 3-fold longer hospital stay for nonsurvivors compared to survivors.
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Authors: Demirhan Salih , Orner Erika , Szymczak Wendy , Lee Philip J. , Aldrich Margaret 
Published: April 2024

Background:
Pediatric actinomycosis studies are limited to case reports or small case series. In this retrospective cohort study, we aimed to describe characteristics of skin and soft tissue actinomycosis in adolescents and children.

Methods:
We conducted the study from January 2019 to December 2022, including patients ≤21 years of age with at least 1-year follow-up data. All clinical cultures obtained under sterile conditions with Actinomyces growth were included.

Results:
One hundred four patients met inclusion criteria; median age 19 (interquartile range: 17–20) years, 68.3% female, 46.2% Black and 47.1% Hispanic. The median antibiotic treatment duration was 10 (7–10) days, and majority of patients received treatment with non-first-line Actinomyces antibiotics. Infectious disease consultation was requested for only 7 patients during their initial skin and soft tissue actinomycosis treatment. One-third of the patients with skin and soft tissue actinomycosis had documented recurrence within a median of 10 (interquartile range: 6–16) months of the initial episode. Monobacterial culture growth (85.7% vs. 63.8%, P = 0.02), patients with body mass index >25 (75% vs. 52.6%, P = 0.04) and patients with prior abscess in the same area (18.8% vs. 51.4%, P = 0.001) were significantly higher in patients with recurrent actinomycosis compared to the nonrecurrent group. In a univariate logistic regression model, they were found to be significantly associated with recurrence; monobacterial growth [odds ratio (OR): 3.4; 95% confidence interval (CI): 1.2–9.9], body mass index >25 (OR: 2.7; 95% CI, 1.1–7.0) and prior abscess (OR: 4.6; 95% CI: 1.9–11.2).

Conclusions:
Our study results highlight the importance of considering Actinomyces species in skin and soft tissue infections, especially in recurrent ones, and risk factors for recurrence. Suboptimal antibiotic utilization, very low numbers of consultations with infectious diseases and high recurrence rate suggest that providers should be informed and updated regarding this rare but hard-to-treat infection.
Subgroups of pelvic pain are differentially associated with endometriosis and inflammatory comorbidities: a latent class analysis
Authors: Ghiasi Marzieh , Chang Chi , Shafrir Amy L. , Vitonis Allison F. , Sasamoto Naoko , Vazquez Ana I. , DiVasta Amy D. , Upson Kristen , Sieberg Christine B. , Terry Kathryn L. , Holzman Claudia B. , Missmer Stacey A. 
Published: April 2024

Abstract
Chronic pelvic pain is heterogeneous with potentially clinically informative subgroups. We aimed to identify subgroups of pelvic pain based on symptom patterns and investigate their associations with inflammatory and chronic pain-related comorbidities. Latent class analysis (LCA) identified subgroups of participants (n = 1255) from the Adolescence to Adulthood (A2A) cohort. Six participant characteristics were included in the LCA: severity, frequency, and impact on daily activities of both menstruation-associated (cyclic) and non–menstruation-associated (acyclic) pelvic pain. Three-step LCA quantified associations between LC subgroups, demographic and clinical variables, and 18 comorbidities (10 with prevalence ≥10%). Five subgroups were identified: none or minimal (23%), moderate cyclic only (28%), severe cyclic only (20%), moderate or severe acyclic plus moderate cyclic (9%), and severe acyclic plus severe cyclic (21%). Endometriosis prevalence within these 5 LCA-pelvic pain–defined subgroups ranged in size from 4% in “none or minimal pelvic pain” to 24%, 72%, 70%, and 94%, respectively, in the 4 pain subgroups, with statistically significant odds of membership only for the latter 3 subgroups. Migraines were associated with significant odds of membership in all 4 pelvic pain subgroups relative to those with no pelvic pain (adjusted odds ratios = 2.92-7.78), whereas back, joint, or leg pain each had significantly greater odds of membership in the latter 3 subgroups. Asthma or allergies had three times the odds of membership in the most severe pain group. Subgroups with elevated levels of cyclic or acyclic pain are associated with greater frequency of chronic overlapping pain conditions, suggesting an important role for central inflammatory and immunological mechanisms.
Uncovering moderators of pain perception by women with endometriosis from Latin America and Spain: the roles of sociodemographics, racial self–identity, and pain catastrophizing
Authors: Flores Idhaliz , Torres-Reverón Annelyn , Navarro Eduardo , Nieves-Vázquez Cristina I. , Cotto-Vázquez Ariana C. , Alonso-Díaz Joanne M. , Bracero Nabal J. , Vincent Katy 
Published: April 2024

Abstract
A cross-sectional multinational collaborative study on women with endometriosis from Latin America and Spain uncovered high levels of painful symptomatology and high pain catastrophizing scores. Associations between pain perception/catastrophizing and race/ethnicity have been documented. This study was conducted to uncover factors moderating pelvic pain severity, including socioeconomic variables, self-identified race, and pain catastrophizing in women with endometriosis from Latin America and Spain, a population encompassing diverse racial and sociocultural contexts. Self-reported data on demographics, clinical history, Ob-Gyn history, pelvic pain intensity, and pain catastrophizing were collected with the Spanish World Endometriosis Research Foundation (WERF) Endometriosis Phenome Project (EPhect) Clinical Questionnaire (ECQ). Multiple logistic regression was conducted to analyze effects of self-identified race, demographic clusters (defined as countries with similar racial population distribution), socioeconomic factors, and pain catastrophizing on reporting severe vs moderate–mild levels of dysmenorrhea, dyspareunia, and pelvic pain. Self-identified race did not affect the likelihood of reporting severe pelvic pain; however, there were significant differences in reporting severe dysmenorrhea at worst among demographic clusters. Older age was associated with severe dyspareunia at worst and recent pelvic pain. Pain catastrophizing score was highly predictive of reporting most types of severe pelvic pain, regardless of race and demographic cluster. These results negate a role of racial categories as moderator of pain in women from Latin America and Spain and support integration of pain catastrophizing assessments and psychological interventions into the pain management plan to enhance therapeutic outcomes and QoL for patients with endometriosis.
HIV Inequities, the Therapeutic Alliance, Moral Injury, and Burnout: A Call for Nurse Workforce Participation and Action
Authors: Sprague Courtenay 
Published: April 2024

Abstract
Health inequities for those living with HIV have persisted for key populations in the United States and globally. To address these inequities, in accordance with Goals 2 and 3 of the National HIV/AIDS Strategy for the United States, the evidence indicates that the therapeutic alliance could be effective in addressing impediments that undermine HIV outcomes. Nonetheless, the therapeutic alliance relies on health care providers, particularly nurses, reporting burnout and moral injury, further exacerbated by COVID-19. Burnout and moral injury have forced the systemic undervaluing of nurses as a social–cultural norm to the fore—in part a legacy of the economic model that underpins the health care system. Given a looming health workforce shortage and negative effects for key populations with HIV already experiencing health inequities, historic opportunities now exist to advance national institutional reforms to support nurses and other health professionals. This opportunity calls for concerted attention, multisectoral dialogue, and action, with nurses participating in and leading policy and interventions.
Clinical Faculty Orientation Practices in the United States
Authors: Ross Jennifer Gunberg , Dunker Kimberly Silver , Morrell Martina , Duprey Melissa D. , Parson Tracy , Kim Lydia 
Published: April 2024

Background:
Due to the nursing faculty shortage, expert clinical nurses are working as novice clinical instructors (CIs). Orientation is needed to prepare these nurses to teach; however, lack of evidence-based guidelines for orientation programs can lead to variability among institutions.

Purpose:
The purpose of this study was to describe clinical nursing faculty orientation practices in the United States

Methods:
A descriptive convergent mixed methods design was used.

Results:
One hundred thirteen CIs participated. Of these, 70.8% were not provided with a formal orientation to their role. Duration, modality, and content varied widely among orientations. Four themes were derived from the qualitative data: Administrative Requirements, Transition to Clinical Educator, Mentorship, and Resilience.

Conclusions:
Clinical faculty orientation practices vary widely in the United States. Evidence-based guidelines are needed to streamline orientations to provide CIs with the requisite knowledge and skills to support clinical students.
Variations in Management and Clinical Outcomes for Children With Diabetic Ketoacidosis in an Academic Pediatric Versus Community Emergency Department Setting
Authors: Freeman John Nathan , Giroux Callie , King Timothy , Marbrey Christina , Maready Matthew , Pasha Simeen , Davis Justin 
Published: April 2024

Objectives
Our objectives were to characterize variations from standardized, evidence-based guidelines in the management of pediatric patients with diabetic ketoacidosis (DKA) based on initial presentation to a tertiary pediatric emergency department (PED) versus a community emergency department (OSH) and compare clinical outcomes.

Methods
We conducted a retrospective study on children 18 years and younger with DKA who presented to an OSH or PED over a 3-year period. Treatments monitored for variation included intravenous fluid management, insulin delivery, and sodium bicarbonate administrations. Clinical outcomes included time to anion gap correction and on insulin infusion, hypokalemia, hypoglycemia, rapid serum glucose decline, cerebral edema, mechanical ventilation, mortality, and time from initial presentation to hospital discharge.

Results
Children with DKA who presented to an OSH (n = 250) were more acidotic (pH 7.11 vs. 7.13, P = 0.001) and had larger anion gaps (28.8 vs. 25.5, P < 0.001) compared with children presenting to the PED (n = 237). The OSH patients were more likely to receive larger fluid boluses (>20 cc/kg or >1000 ml, 43% vs. 4%, P < 0.001), sodium bicarbonate (5% vs. 0%, P < 0.001), and intravenous bolus insulin (28% vs. 0%, P < 0.001). The OSH group were less likely to be started on maintenance intravenous fluids (70% vs. 99%, P < 0.001) or receive potassium in maintenance intravenous fluids (14% vs. 42%, P < 0.001). The OSH group had longer anion gap correction times (754 vs. 541 mins, P < 0.001), insulin infusion times (1018 vs. 854 min, P = 0.003), and times to hospital discharge (3358 vs. 3045 mins, P < 0.001). Incidence of hypokalemia, hypoglycemia, rapid glucose decline, cerebral edema, and deaths were similar between the 2 groups.

Conclusions
Our study demonstrated significant variations in the initial management of pediatric DKA patients by OSH facilities that deviated from an evidence-based treatment pathway utilized by a PED. Statewide quality improvement initiatives could help improve the overall clinical care provided to pediatric DKA patients.
Building Blocks—A Block-by-Block Approach to Better Emergency Care in Children
Authors: Katzir Yair , Ganor Lior , Berant Ron , Shahar-Nissan Keren 
Published: April 2024

Abstract
Regional anesthesia has gained prevalence over recent years in the emergency department setting, mainly in adults. Various frameworks have been suggested as toolkits encompassing the common procedures found in the adult setting. To date, no such framework exists for the pediatric emergency setting.

Objective
We describe a case series of regional nerve blocks, which comprise an adapted framework for the pediatric emergency setting and were performed by pediatric emergency medicine physicians.

Methods
A case series of 8 different ultrasound-guided nerve blocks and 1 anatomical block, performed in 11 pediatric patients, aged 7 weeks to 17 years.

Results
All blocks resulted in adequate analgesia. No procedural complications were observed.

Conclusion
We describe a set of nerve blocks performed by emergency medicine physicians in the pediatric population in an ED setting. In suitable settings, this is a safe and effective tool for procedural analgesia or for pain management. In such cases, performing an ultrasound-guided nerve block in the ED is a viable alternative for repeated doses of opiates, deep procedural sedation, or the operating theater. We propose this set of regional anesthesia procedures as a pediatric-adapted toolkit for the emergency physician to be performed in children in the ED setting. Adopting this set of procedures ensures better and safer care for children and provides a training framework for pediatric ED physicians.
Injury and Biological Factors Impact Shoulder Function following Autogenous Grafting of Spinal Nerves for Pan–Brachial Plexus Reconstruction
Authors: Li Neill Y. , Wu Kitty Y. , Loosbrock Michelle F. , Bishop Allen T. , Spinner Robert J. , Shin Alexander Y. 
Published: April 2024

Background:
Shoulder function after spinal nerve grafting in pan–brachial plexus injuries (pan-BPI) is not well described. The authors evaluated shoulder abduction (ABD) and external rotation (ER) after spinal nerve grafting to the suprascapular nerve, axillary nerve, or posterior division of the upper trunk and determined patient characteristics, injury severity and characteristics, and nerve graft factors that influenced outcomes.

Methods:
A total of 362 patients undergoing pan-BPI reconstruction and spinal nerve grafting for shoulder reanimation in a single institution between 2001 and 2018 were reviewed. Patient demographics, Injury Severity Score (ISS), graft characteristics, strength, range of motion for shoulder ABD and ER, and patient-reported outcomes were recorded. Patients were divided into 3 groups based on recovery of shoulder function: no return, ABD only, and ABD and ER.

Results:
A total of 110 patients underwent spinal nerve grafting, with 41 meeting inclusion criteria. Seventeen (41.5%) had no return of shoulder function, 14 (34.1%) had ABD alone, and 10 (24.4%) had ABD and ER. Patients with recovery of both ABD and ER were significantly younger (18.6 ± 5.56 years), had lower body mass index (22.4 ± 4.0), and had a lower ISS (10.5 ± 6.24; P = 0.003). Multivariable analysis found that with increasing age (OR, 0.786; 95% CI, 0.576, 0.941) and ISS (OR, 0.820; 95% CI, 0.606, 0.979), odds for return of ABD and ER decreased significantly.

Conclusions:
In pan-BPI, 24.4% of patients demonstrated return of both ABD and ER after spinal nerve grafting to suprascapular nerve and either axillary nerve or posterior division of the upper trunk. Age, body mass index, and ISS were associated with poorer recovery of shoulder function. Careful patient selection and consideration of age, body mass index, and ISS may improve outcomes of spinal nerve grafting for shoulder reanimation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Perioperative Estrogen Hormonal Therapy Does Not Increase Venous Thromboembolism Risk in Facial Feminization Surgery
Authors: Li Alexander Y. , Park Matthew J. , Fick Jennifer , Ousterhout Douglas K. , Deschamps-Braly Jordan C. 
Published: April 2024

Background:
Conflicting data exist regarding increased perioperative venous thromboembolism (VTE) risk with feminizing hormone therapy. The effect has been poorly studied within the transgender population. Acute perioperative cessation of feminizing hormone therapy often leads to unpleasant side effects and exacerbates gender dysphoria in the perioperative period. The authors sought to identify VTE incidence in patients undergoing facial feminization surgery while continuing hormone replacement therapy throughout the time of surgery.

Methods:
A 38-year retrospective cohort study within a 2-surgeon practice (D.K.O. and J.C.D.-B.) was designed to evaluate postoperative VTE in patients continuing hormone therapy. The primary outcome variable was postoperative VTE.

Results:
A total of 1715 patients underwent facial feminization surgery within our search window. A total of 953 patients met final inclusion criteria. One patient (0.10%) was diagnosed with a VTE postoperatively, comparable to reported literature rates for similar cosmetic and orthognathic procedures. The average Caprini score of all patients was 3.1 ± 1.0 and the average case length was 491.9 ± 111.0 minutes. Subgroup analysis of patients before and after internal practice changes identified 714 patients (77.7%) continuing full-dose hormonal therapy perioperatively, 197 (20.7%) undergoing hormonal dose reduction to 25% to 50% perioperatively, and 8 who were either not taking hormonal therapy or stopped in the perioperative period. There was no significant difference in VTE incidence among the 3 subgroups (P > 0.99).

Conclusions:
Perioperative use of feminizing hormonal therapy does not increase risk for perioperative VTE in patients undergoing facial feminization surgery. Therefore, it is reasonable to continue these medications through the time of surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Medical Weight Management Considerations in Plastic Surgery
Authors: Paranzino Alisha B. , Vieira Brittany , Apovian Caroline M. , Agarwal Shailesh 
Published: April 2024

Summary:
Obesity is one of the greatest public health concerns in the United States and has reached an epidemic scope over the past few decades. Plastic surgery in patients with obesity has been linked to higher complication rates both before and after weight loss. This article discusses the evolution and landscape of antiobesity medications as they apply to plastic surgery. Although bariatric surgery has been effective in long-term treatment, new pharmacologic advances in glucagon-like peptide-1 agonists, such as semaglutide, have demonstrated promising effectiveness. These medications pose several unique challenges, particularly with regard to perioperative management and risk of weight regain after discontinuation. An understanding of these new pharmacologic agents is crucial for plastic surgeons, who treat patients with obesity.