bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mindfulness-based Interventions for Chronic Low Back Pain
Authors: Paschali Myrella , Lazaridou Asimina , Sadora Jason , Papianou Lauren , Garland Eric L. , Zgierska Aleksandra E. , Edwards Robert R. 
Published: November 2023

Objective:
This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the US each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized.

Design:
Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for, randomized controlled trials (RCTs), pilot RCTs and single-arm studies that explored the effectiveness of MBIs in CLBP.

Methods:
Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7.

Results:
Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included Mindfulness Meditation, Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindfulness Oriented Recovery Enhancement, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy, Meditation-CBT, Mindfulness-Based Care for Chronic Pain, Self-Compassion course and Loving-Kindness course. Pain intensity scores were reported using a numerical rating scale (0-10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP.

Conclusion:
MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data and the high variability in study methodologies. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.
Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools
Authors: Arina Pietro , Kaczorek Maciej R. , Hofmaenner Daniel A. , Pisciotta Walter , Refinetti Patricia , Singer Mervyn , Mazomenos Evangelos B. , Whittle John 
Published: November 2023

Background
The utilization of artificial intelligence and machine learning as diagnostic and predictive tools in perioperative medicine holds great promise. Indeed, many studies have been performed in recent years to explore the potential. The purpose of this systematic review is to assess the current state of machine learning in perioperative medicine, its utility in prediction of complications and prognostication, and limitations related to bias and validation.

Methods
A multidisciplinary team of clinicians and engineers conducted a systematic review using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Multiple databases were searched, including Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, PubMed, Medline, Embase, and Web of Science. The systematic review focused on study design, type of machine learning model used, validation techniques applied, and reported model performance on prediction of complications and prognostication. This review further classified outcomes and machine learning applications using an ad hoc classification system. The Prediction model Risk Of Bias Assessment Tool (PROBAST) was used to assess risk of bias and applicability of the studies.

Results
A total of 103 studies were identified. The models reported in the literature were primarily based on single-center validations (75%), with only 13% being externally validated across multiple centers. Most of the mortality models demonstrated a limited ability to discriminate and classify effectively. The PROBAST assessment indicated a high risk of systematic errors in predicted outcomes and artificial intelligence or machine learning applications.

Conclusions
The findings indicate that the development of this field is still in its early stages. This systematic review indicates that application of machine learning in perioperative medicine is still at an early stage. While many studies suggest potential utility, several key challenges must be first overcome before their introduction into clinical practice.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Obstetric and Neonatal Outcomes After Transferring More Than One Embryo in Patients With Preimplantation Genetic Testing
Authors: Gerber Rachel S. , Kappy Michelle , Gingold Julian , Wu Haotian , Lieman Harry J. , Singh Manvinder , Pollack Staci E. , Jindal Sangita 
Published: November 2023

OBJECTIVE:
To compare obstetric and neonatal outcomes after single embryo transfer (SET) compared with multiple embryo transfer (MET) from frozen-thawed transfer cycles of embryos that underwent preimplantation genetic testing for aneuploidies (PGT-A).

METHODS:
We conducted a retrospective cohort study from the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) national database. Clinical and demographic data were obtained from the SART CORS database for all autologous and donor egg frozen-thawed transfer cycles of embryos that underwent PGT-A between 2014 and 2016, after excluding cycles that used frozen oocytes, fresh embryo transfer, and transfers of embryos from more than one stimulation cycle. Multivariable linear and log-binomial regression models were used to estimate the relative and absolute difference in live-birth rate, multiple pregnancy rate, gestational age at delivery, and birth weight between SET compared with MET.

RESULTS:
In total, 15,638 autologous egg transfer cycles and 944 donor egg transfer cycles were analyzed. Although the live-birth rate was higher with MET compared with SET in the autologous oocyte cycles (64.7% vs 53.2%, relative risk [RR] 1.24, 95% CI, 1.20–1.28), the multiple pregnancy rate was markedly greater (46.2% vs 1.4%, RR 32.56, 95% CI, 26.55–39.92). Donor oocyte cycles showed similar trends with an increased live-birth rate (62.0% vs 49.7%, RR 1.26, 95% CI, 1.11–1.46) and multiple pregnancy rate (54.0% vs 0.8%) seen with MET compared with SET. Preterm delivery rates and rates of low birth weight were significantly higher in MET compared with SET in both autologous and donor oocyte cycles and were also higher in the subanalysis of singleton deliveries that resulted from MET compared with SET.

CONCLUSION:
Despite some improvement in live-birth rate, nearly half of the pregnancies that resulted from MET of embryos that underwent PGT-A were multiples. Compared with SET, MET is associated with significantly higher rates of neonatal morbidity, including preterm delivery and low birth weight. The transfer of more than one embryo that underwent PGT-A should continue to be strongly discouraged, and patients should be counseled on the significant potential for adverse outcomes.
Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With Critical Coronavirus Disease 2019 (COVID-19) Acute Respiratory Distress Syndrome
Authors: Shamshirsaz Amir A. , Byrne John J. , Ramsey Patrick S. , Cahill Alison G. , Turrentine Mark A. 
Published: November 2023

OBJECTIVE:
To estimate the maternal survival and live-birth rates in pregnant women with acute respiratory distress syndrome (ARDS) secondary to critical coronavirus disease 2019 (COVID-19) who are treated with extracorporeal membrane oxygenation (ECMO) by performing a systematic review and meta-analysis.

DATA SOURCES:
From database inception through August 2023, we explored MEDLINE, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials. Studies reporting maternal survival and live-birth rates in pregnant women with critical COVID-19 undergoing ECMO were included.

METHODS OF STUDY SELECTION:
Two reviewers separately ascertained studies, obtained data, and evaluated study quality. Summary estimates of maternal survival and live-birth rates were measured, and 95% CIs were calculated.

TABULATION, INTEGRATION, AND RESULTS:
Nine retrospective case series and 12 retrospective cohort studies were identified with 386 pregnant women with critical COVID-19 who underwent ECMO. Studies evaluated women that were treated from January 2020 to October 2022. Four studies were from the United States; three were from Turkey; two were from France; two were from Israel; and one each was from Columbia, Germany, Italy, Kuwait, Poland, Republic of Srpska, the United Arab Emirates, the United Kingdom, a consortium from Belgium, France, Switzerland, and an international registry. The pooled estimate of the maternal survival rate among pregnant patients who were initiated on ECMO was 75.6% (95% CI, 66.0–84.1%, I
2=72%). The pooled estimate of the live-birth rate among pregnant patients who were initiated on ECMO was 83.7% (95% CI, 76.8-89.6%, 153 neonates, I
2=11%). When the case series and cohort studies were examined separately, the results were similar.

CONCLUSION:
Among pregnant women with acute respiratory distress syndrome attributable to critical COVID-19 who were managed with ECMO, maternal survival and live-birth rates were high.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42023442800.
Network Meta-analysis of C5 Palsy after Anterior Cervical Decompression of 3-6 Levels
Authors: Takase Hajime , Haze Tatsuya , Yamamoto Daisuke , Inagaki Naoko , Nitta Manabu , Hidetoshi Murata , Yamamoto Tetsuya 
Published: November 2023

Study Design.
Systematic review and meta-analysis.

Objective.
Using a network meta-analysis, this study aimed to compare the risks of C5 palsy after three different procedures of anterior cervical decompression.

Summary of Background Data.
C5 palsy is a well-known complication affecting quality of life after anterior procedures. Due to the limited evidence on the various procedures available, we evaluate the basis for selection to prevent palsy and achieve maximal decompression in cases spanning 3-6 levels.

Methods.
We conducted a comprehensive search for C5 palsy and complications after three representative procedures, including anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and their combination (Hybrid), involving 3-6 intervertebral levels. The incidence of C5 palsy was compared using a network meta-analysis.

Results.
We identified 1655 patients in 11 studies that met inclusion criteria. Sixty-nine patients (4.2%) developed delayed C5 palsies. The incidences among ACDF, ACCF, and Hybrid cases were 2.3% (16/684, 95% confidence interval [CI] 1.4−3.8%), 6.4% (39/613, 95%CI 4.7−8.6%), and 3.9% (14/358, 95%CI 2.3−6.5%), respectively (P<0.01). A network meta-analysis was performed for 15 pairwise comparisons across the three procedure arms: ACDF versus Hybrid, 7/232 (3.0%) versus 11/234 (4.7%); Hybrid versus ACCF, 14/301 (4.3%) versus 18/224 (8.0%); ACCF versus ACDF, 38/523 (7.8%) versus 16/619 (2.6%). Compared with ACDF, the risk of C5 palsy was significantly higher in ACCF (odds ratio [OR] 2.72, 95%CI 1.47−5.01), while ACDF versus Hybrid did not significantly differ in risk (OR 1.56, 95%CI 0.68−3.60).

Conclusion.

We determined that ACCF was associated with a higher risk of postoperative C5 palsy than ACDF in cases spanning 3-6 intervertebral levels. If practicable, ACDF surgery may be an appropriate choice for cases requiring anterior decompression of 3-6 levels.

Level of Evidence.
3
Changes in the Utilization of Cervicothoracic Injections Between 2010 and 2020
Authors: Ratnasamy Philip P. , Oghenesume Oghenewoma P. , Maloy Gwyneth C. , Grauer Jonathan N. 
Published: November 2023

Study Design:
Descriptive epidemiologic study.

Objective:
To analyze trends and patient characteristics of those undergoing cervicothoracic transforaminal, interlaminar, and facet injections over time.

Background:
Cervicothoracic transforaminal, interlaminar, and facet injections are considered for varied spinal pathologies. Evolving literature, changing physician preferences, insurance reimbursement policies, and patient factors may influence the utilization of such injections over time.

Methods:
Patients undergoing cervicothoracic transforaminal, interlaminar, and facet injections 2010–2020 were identified in the M151Ortho PearlDiver database using Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index, insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, and West) were extracted and assessed over study intervals based on prevalence per 100,000 covered lives.

Results:
Cervicothoracic transforaminal, interlaminar, and facet injections were identified for 195,221 (11.3%), 951,191 (55.2%), and 575,228 (33.4%) patients, respectively. Patient characteristics for each injection type were defined. The annual number of injections performed per 100,000 covered lives decreased during the study period for transforaminal (17.1% decrease) and interlaminar (9.3% decrease) but increased for facet (3.7% increase) injections (P<0.0001 for each). Stratifying by patient insurance type, administration of transforaminal, interlaminar, and facet injections per 100,000 covered lives was proportionally greatest for commercially insured patients (55%, 50%, and 45%, respectively), and proportionally smallest for Medicaid patients (10%, 13%, and 13%, respectively). Anesthesiology physicians performed the most injections, followed by physical medicine and rehabilitation physicians, with both provider types most frequently performing interlaminar injections, followed by facet and transforaminal injections.

Conclusion:
Annual cervicothoracic transforaminal and interlaminar injection utilization declined by 17.1% and 9.3% from 2010 to 2020, whereas facet injection administration increased by 3.7% over the same interval. Evolving practice patterns are important to consider in characterizing the overall landscape of spine care.
Staged Intracranial Free Tissue Transfer and Cranioplasty for a Refractory Nasal-cranial Base Fistula
Authors: Emanuels Andrew F. , Cherukuri Sai , Van Gompel Jamie J. , Stokken Janalee , Mardini Samir , Gibreel Waleed 
Published: November 2023

Summary:
After a transnasal endoscopic resection of a high-grade adenoid cystic carcinoma that underwent adjuvant chemoradiation, there was delayed recurrence managed by en bloc resection through an open craniofacial approach. Subsequently, the patient developed a chronic nasocranial fistula with secondary infection and bone flap resorption. This resulted in infectious episodes with secondary scalp incisional dehiscence and hardware exposure which required multiple bone debridement procedures, hardware removal, prolonged IV antibiotics, and hyperbaric oxygen treatment. The nasocranial fistula and chronic frontal bone osteomyelitis persisted despite the previous interventions. The patient underwent a frontal bone removal and obliteration of the anterior cranial base fistula with a free vastus lateralis muscle flap. At 4 weeks postoperatively, the intranasal portion of the muscle flap had completely mucosalized. After a 6-week course of IV antibiotics, a secondary cranioplasty using a custom-made poly-ether-ether-ketone implant was performed. The patient remained disease- and infection-free for the duration of follow-up (17 months).
Impact of Previous Cataract Surgery in Corneal Donors on the Outcome of Descemet Membrane Endothelial Keratoplasty
Authors: Trouvain André M. , Szurman Peter , Wahl Silke , Siegel Rudolf , Boden Karl Thomas , Seitz Berthold , Fries Fabian N. , Rickmann Annekatrin 
Published: November 2023

Purpose:
The aim of this study was to investigate differences between phakic, pseudophakic, and scarred stromal donor tissue for their influence on complication rates during preparation or implantation and on the postoperative outcome of Descemet membrane endothelial keratoplasty (DMEK).

Methods:
We retrospectively compared 484 eyes undergoing DMEK, divided into 3 subgroups of donor tissue (1: phakic, 2: pseudophakic, and 3: scarred stromal). Visual acuity, central corneal thickness (CCT), and endothelial cell count were monitored preoperatively and postoperatively at 6 weeks and 3, 6, 12, and 24 months. The incidence of intraoperative and postoperative complications was analyzed.

Results:
The risk of adherence and tearing during preparation was significantly higher in group 2 than in the other groups (p’s < 0.001). No significant difference was found for visual acuity (p’s ≥ 0.368) and long-term CCT, but CCT recovery took longer in group 2 (P = 0.003), normalizing after 3 months (p’s ≥ 0.096). The overall mean endothelial cell count was lower in group 2 compared with the other groups (P = 0.011). No difference in the rebubbling rate was detected (P = 0.890). However, the risk of repeat keratoplasty for phakic grafts was lower compared with group 2 (P = 0.008).

Conclusions:
Pseudophakic donor grafts are more difficult to prepare and implant, resulting in longer recovery times and a higher risk of graft failure. However, when the preparation is uneventful and no graft failure occurs, pseudophakic grafts show a comparable outcome. Given the shortage of corneal donors and the high prevalence of pseudophakic corneal donors, they should not generally be excluded from corneal donation for DMEK.
Providers' Perceptions of the Effectiveness of Electronic Health Records in Identifying Opioid Misuse
Authors: Glenn Jeffrey , Gibson Danica , Thiesset Heather F. 
Published: November 2023

Goal:
This study aimed to understand prescribing providers' perceptions of electronic health record (EHR) effectiveness in enabling them to identify and prevent opioid misuse and addiction.

Methods:
We used a cross-sectional survey designed and administered by KLAS Research to examine healthcare providers' perceptions of their experiences with EHR systems. Univariate analysis and mixed-effects logistic regression analysis with organization-level random effects were performed.

Principal Findings:
A total of 17,790 prescribing providers responded to the survey question related to this article's primary outcome about opioid misuse prevention. Overall, 34% of respondents believed EHRs helped prevent opioid misuse and addiction. Advanced practice providers were more likely than attending physicians and trainees to believe EHRs were effective in reducing opioid misuse, as were providers with fewer than 5 years of experience.

Practical Applications:
Understanding providers' perceptions of EHR effectiveness is critical as the health outcome of reducing opioid misuse depends upon their willingness to adopt and apply new technology to their standardized routines. Healthcare managers can enhance providers' use of EHRs to facilitate the prevention of opioid misuse with ongoing training related to advanced EHR system features.
Combination of aspirin and rosuvastatin for reduction of venous thromboembolism in severely injured patients: a double-blind, placebo-controlled, pragmatic randomized phase II clinical trial (The STAT Trial)
Authors: Barrett Christopher D. , Moore Hunter B. , Moore Ernest E. , Chandler James , Sauaia Angela 
Published: November 2023

Introduction
Venous thromboembolism (VTE) remains a significant source of postinjury morbidity and mortality. Beta-hydroxy beta-methylglutaryl-CoA (HMG-CoA) reductase inhibitors (rosuvastatin) significantly reduced pathologic clotting events in healthy populations in a prior trial. Furthermore, acetylsalicylic acid (ASA) has been shown to be noninferior to prophylactic heparinoids for VTE prevention following orthopedic surgery. We hypothesized that a combination of rosuvastatin/ASA, in addition to standard VTE chemoprophylaxis, would reduce VTE in critically ill trauma patients.

Methods
This was a double-blind, placebo-controlled, randomized trial, evaluating VTE rates in two groups: ASA + statin (Experimental) and identical placebos (Control). Injured adults, 18–65 years old, admitted to the surgical intensive care unit without contraindications for VTE prophylaxis were eligible. Upon initiation of routine VTE chemoprophylaxis (i.e. heparin/heparin-derivatives), they were randomized to the Experimental or Control group. VTE was the primary outcome.

Results
Of 112 potentially eligible patients, 33% (n = 37, median new injury severity scale = 27) were successfully randomized, of whom 11% had VTEs. The Experimental group had no VTEs, while the Control group had 6 VTEs (4 PEs and 2 DVTs) in 4 (22%) patients (P = 0.046). The Experimental treatment was not associated with any serious adverse events. Due to the COVID-19 pandemic, the study was interrupted at the second interim analysis at <10% of the planned enrollment, with significance declared at P < 0.012 at that stage.

Discussion
The combination of ASA and rosuvastatin with standard VTE prophylaxis showed a favorable trend toward reducing VTEs with no serious adverse events. An appropriately powered phase III multicenter trial is needed to further investigate this therapeutic approach.

Level of Evidence
Level II, Therapeutic
Bronchoscopic interventions for chronic bronchitis
Authors: Tana Anand , Zhang Chenchen , DiBardino David , Orton Christopher M. , Shah Pallav L. 
Published: November 2023

Purpose of review
Chronic bronchitis is a phenotype of chronic obstructive pulmonary disease (COPD), characterized by chronic cough and sputum production, associated with an increased rate of COPD exacerbations and hospital admissions, a more rapid decline in lung function and reduced life expectancy. Despite optimal medical therapy, chronic bronchitis remains difficult to treat. Interventional bronchoscopic procedures offer novel therapeutic approaches to this highly symptomatic condition.

Recent findings
A characteristic feature of chronic bronchitis is the presence of an abnormal epithelium with excessive mucus producing cells, parasympathetic overactivity, and airway inflammation. Metered cryospray and bronchial rheoplasty are designed to target this abnormal epithelium to reduce mucus production and inflammation. Targeted lung denervation aims to reduce parasympathetic overactivity, which may drive mucus hypersecretion. Here, we review the available evidence to determine the safety and efficacy across the bronchoscopic interventions.

Summary
Interventional bronchoscopy is a rapidly expanding field and its application in the treatment of chronic bronchitis has been recognized by the Global initiative for chronic Obstructive Lung Disease (GOLD). The outcomes from the latest clinical trials will guide future treatment approaches in patients with difficult to treat chronic bronchitis.