bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Care and Outcomes in Solid Organ Transplant Patients undergoing Lower Extremity Fracture Treatment
Authors: Chiou Daniel , Mooney Bailey H. , Shi Brendan , Upfill-Brown Alexander , Kallini Jennifer , SooHoo Nelson , Johnson Eric E. 
Published: February 2024

OBJECTIVE:
Determine the postoperative outcomes in solid-organ transplant (SOT) patients undergoing operative treatment of lower extremity fractures.

METHODS:

Design: Retrospective comparative study

Setting:
Academic Level 1 Trauma center

Patient Selection Criteria:
Patients who underwent SOT and operative treatment for lower extremity fracture from 2013-2021 were identified, excluding pathologic fractures.

Outcome Measures and Comparisons: postoperative complications, length of stay, time to death, 90-day and 1-year readmission rates, readmission causes, discharge location, and immunosuppressive regiments.

RESULTS:
61 patients with an average age of 67 (range 29-88) were included. The mortality rate was 37.7%. The average follow-up was 15.2 months (range of 2 weeks to 10 years). The majority of patients (42.6%) had received a liver transplant, and femoral neck fractures constituted the largest fracture group (39.4%). The average length of stay was 10 days, with the shortest being one day and the longest being 126 days (SD 18). The majority of patients were not discharged home (56.6%). Only two suffered from a postoperative complication requiring another procedure: hardware removal and liner exchange for periprosthetic joint infection, respectively. There was a 27.9% 90-day readmission rate with two deaths within that period with the most common being altered mental status (29.4%), genitourinary infections (17.6%), repeat falls (11.8%), and low hemoglobin requiring transfusion (11.8%). The longest average time to death analyzed by transplant type was found among lung transplant patients (1076 days, 62.5% mortality), followed by liver transplant patients (949 days 35.0% mortality), then kidney transplant patients (834 days, 38.9% mortality). The shortest time to death was 71 days from index procedure.

CONCLUSIONS:
Family members of solid-organ transplant patients undergoing operative treatment of lower extremity fractures should be made aware of the high risk for 90-day readmission postoperatively (27.9%) and overall mortality (12.5%). Providers should be aware of the need for multidisciplinary involvement for inpatient care, monitoring postoperative complications and facilitating discharge planning.

LEVEL OF EVIDENCE:
Level IV. See Instructions for Authors for a complete description of levels of evidence.
Evolution of Clinical Characteristics and Outcomes of Critically Ill Patients 90 Years Old or Older Over a 12-Year Period: A Retrospective Cohort Study
Authors: Daniels Rikus , Müller Jakob , Jafari Claudia , Theile Pauline , Kluge Stefan , Roedl Kevin 
Published: February 2024

Objectives:
The global population is aging, and the proportion of very elderly patients 90 years old or older in the ICU is expected to increase. The changes in the comorbidities and outcomes of very elderly patients hospitalized in the ICU that have occurred over time are unknown.

Design:
Retrospective observational cohort study.

Setting:
ICUs at a single academic hospital in Germany.

Patients:
Ninety years old or older and admitted to the ICU between January 1, 2008, and April 30, 2019.

Interventions:
None.

Measurements and Main Results:
Of the 92,958 critically ill patients, 1,108 were 90 years old or older. The study period was divided into two halves: January 1, 2008–August 30, 2013, and September 1, 2013–April 30, 2019. The number of patients 90 years old or older increased from the first period (n = 391; 0.90% of total admissions) to the second period (n = 717; 1.44%). The patients’ demographic characteristics were similar between the both time periods. The median Charlson Comorbidity Index was higher during the first period (1 [interquartile range, 1–3]) than compared with the second time period (1 [0–2]; p = 0.052). The Simplified Acute Physiology Score (SAPS) II was higher during the first time period (38 [29–49]) than during the second period (35 [27–45]; p = 0.005). Vasopressor therapy was necessary in 40% (n = 158) and 43% (n = 310) of patients in each time period, respectively (p = 0.363). Invasive mechanical ventilation was administered in 37% (n = 146) and 34% (n = 243) of patients in each time period, respectively (p = 0.250). The median length of the ICU stay was significantly lower in the first time period than in the second time period (1.4 vs. 1.7 d; p = 0.002). The ICU (18% vs. 18%; p = 0.861) and hospital (31% vs. 29%; p = 0.395) mortality rates were comparable between the two groups. The 1-year mortality was significantly lower during the second time period than during the first time period (61% vs. 56%; p = 0.029). Cox regression analysis revealed that the SAPS II, medical cause of admission, mechanical ventilation requirement, and vasopressor use were associated with 1-year mortality.

Conclusions:
The number of patients 90 years old or older who were treated in the ICU has increased in recent years. While the patients’ clinical characteristics and short-term outcomes have not changed significantly, the long-term mortality of these patients has improved in recent years.
Depression and Pesticide Exposure Among Male Farmers in Greece
Authors: Frengidou Elisavet , Galanis Petros , Chatzimichael Konstantinos , Kioulos Elias , Malesios Chrysovalantis 
Published: February 2024

Objective
The objective of this study was to evaluate the relationship between pesticide exposure and depression.

Methods
A cross-sectional study was performed in a study population of 252 Greek male farmers using the Center for Epidemiological Studies Depression scale. Cumulative pesticide exposure was categorized in three mutually exclusive groups related to lifetime pesticide use: low (<275 days, the reference group), intermediate (276 to 1200 days), and high (>1200 days). Acute pesticide exposure was categorized in pesticide poisoning events and high pesticide exposure events. Multivariable logistic regression analysis was performed, and odds ratios, 95% confidence intervals, and P values were presented.

Findings
After adjusting for confounding factors, a positive significant association was found between both high-exposure group and high pesticide exposure events and depressive symptoms.

Conclusions
Apart from acute, high cumulative pesticide exposure may as well contribute to the development of depression.
Addressing Race and Culture During Clinical Education Experiences
Authors: Naidoo Keshrie , Plummer Laura , Powell Camille 
Published: February 2024

Abstract
In 2022–2023, 27.7% of the students enrolled in Doctor of Physical Therapy programs identified as from a minoritized group, representing a 50% increase since 2015–2016 which is promising. However, students from racial/ethnic minoritized groups have additional barriers to overcome, such as isolation, exclusion, bias, and discrimination during clinical education experiences (CEE). Clinical educators may avoid conversations about race and culture due to decreased time, training, and comfort, and not wanting to “other” students from minoritized groups. However, talking about race and culture can increase trust and communication between learners and educators, decrease discrimination and stereotyping, and increase compassion and mutual understanding. The authors provide stepwise progression for educators to begin to prepare for addressing race/culture and supporting students from minoritized backgrounds during CEEs.
Trauma-Informed Approaches in Pelvic Health: Exploratory Understandings of Adverse Childhood Experiences, Trauma, and Trauma-Informed Care
Authors: Springer Kristen , Patton Rebecca , Hagaman Heather , Martin Daniel 
Published: February 2024

Background:
Although pelvic floor clinicians (PFCs) typically approach evaluations and interventions through a client-centered lens, trauma-informed care (TIC) is a relatively new clinical approach. Because of the high prevalence of adverse childhood experiences (ACEs) and adult traumatic experiences among clients with pelvic floor dysfunction and complex pelvic pain, TIC should be integrated into all pelvic health practices.

Objectives:
This study explores PFCs' current understanding of ACEs, trauma, and TIC.

Study Design:
Exploratory concurrent.

Methods:
When recruiting PFCs, purposive and convenience sampling methods were administered. There was no minimum or maximum age, sex, or gender requirement, and all races and ethnicities were encouraged to participate. The interviews were recorded, transcribed, and coded, abiding by phenomenological methodology.

Results:
Each research question was exceedingly addressed through both the survey and qualitative interview responses.

Conclusion:
This study outlines how PFCs actively translate a trauma-informed framework into their clinical practices while revealing their most prevalent areas of improvement, areas of future growth, and urgency for collaboration across the specialty.
The use of andexanet alfa vs. 4-factor prothrombin complex concentrates in the setting of life-threatening intracranial hemorrhage
Authors: Irizarry-Gatell Vivian M. , Bacchus Michael W. , De Leo Edward K. , Zhang Yang , Lagasse Carrie A. , Khanna Anna Y. , Harris Neil S. , Zumberg Marc S. 
Published: February 2024

Objective
Andexanet alfa is a targeted reversal agent for life threatening hemorrhage associated with direct acting oral anticoagulants (DOACs), but there is uncertainty regarding the benefit when compared to 4-factor prothrombin complex concentrate (4F-PCC) for this indication. We investigated the clinical outcomes and cost associated with reversal of DOACs in the setting of life-threatening intracranial hemorrhage (ICH).

Methods
A retrospective evaluation was conducted to evaluate patients with ICH in the setting of anticoagulation with DOAC from 9/1/2013 to 4/30/2020. Patients were included in the study if they received reversal with either andexanet alfa or 4F-PCC.

Results
Eighty-nine patients were included in the study. There was no statistically significant difference in 30-day mortality between patients who received andexanet alfa or 4F-PCC (52% vs. 35%, P = 0.14). Radiographic stability of bleed was identified in 57% of patients receiving andexanet alfa vs. 58% of patients receiving 4F-PCC (P = 0.93). Median length of stay was not different between the andexanet alfa and 4F-PCC populations (7 days [IQR 6 – 12] vs. 6 days [IQR 3–12], P = 0.66). Median cost of reversal agent was higher in patients receiving andexanet alfa compared to 4F-PCC ($15 000 [IQR 15 000–$27 000] vs. $11 650 [IQR $8567–$14 149]).

Conclusion
Among patients with life-threatening intracranial hemorrhage in the setting of DOAC therapy, no clinical differences were observed with respect to selection of reversal agent. Prothrombin complex concentrates remain a viable alternative to reversal of DOAC therapy though multicenter, randomized, prospective studies are needed to further evaluate the role of 4F-PCC in the reversal of DOAC therapy.
Distribution and Characteristics of Colonic Diverticula in Northern China
Authors: Yang Fang , Sun Xueyue , Jiang Kui 
Published: February 2024

Objective:
The prevalence of colonic diverticula is rising in eastern countries, possibly related to aging and the adoption of a western lifestyle. However, limited data exist regarding the distribution and endoscopic features of colonic diverticula in this population. This study aimed to assess the number, size, depth, and location of colonic diverticula in our study cohort.

Patients and Methods:
We collected data from patients who underwent colonoscopy at the Endoscopy Center of Tianjin Medical University General Hospital and Bao Di Clinical College of Tianjin Medical University. We thoroughly evaluated and documented any colonic diverticula encountered during the procedures. Logistic regression analysis was employed to explore associations between participant characteristics and the presence of colonic diverticula.

Results:
Our study included a total of 27,021 eligible patients from our colonoscopy database, among whom 1529 individuals (5.67%) exhibited one or more diverticulosis. Patients with colonic diverticula (mean age: 58.6) were significantly older and exhibited a male predominance compared with those without diverticula. Cases of right-sided, left-sided, and bilateral diverticulosis were recorded in 1161 (76.0%), 170 (11.1%), and 198 patients (12.9%), respectively. Patients with right-sided diverticula (mean age: 55.2), more common in males, were younger than those with left-sided diverticula (mean age: 67.1, P < 0.05), which were more frequent in females (P < 0.001). Individuals aged 60 years or older (odds ratio: 4.32, P < 0.001) and those with bilateral diverticulosis (odds ratio: 21.2, P < 0.001) had a higher likelihood of having a greater burden of diverticula.

Conclusion:
Colonic diverticula in Northern China predominantly manifests as right-sided, more common in males, and associated with older age. Notably, patients with right-sided diverticulosis tend to be younger than those with left-sided diverticula. In addition, a higher burden of diverticula is more prevalent in individuals aged 60 years or older and those with a bilateral distribution pattern.
Venous thromboembolism: diagnostic advances and unaddressed challenges in management
Authors: Mathews Rick , Hinds Monica T. , Nguyen Khanh P. 
Published: February 2024

Purpose of review
This review summarizes recent advances in developing targeted diagnostics for venous thromboembolism (VTE) and unaddressed knowledge gaps in patient management. Without addressing these critical data needs, the morbidity in VTE patients will persist.

Recent findings
Recent studies investigating plasma protein profiles in VTE patients have identified key diagnostic targets to address the currently unmet need for low-cost, confirmatory, point-of-care VTE diagnostics. These studies and a growing body of evidence from animal model studies have revealed the importance of inflammatory and vascular pathology in driving VTE, which are currently unaddressed targets for VTE therapy. To enhance the translation of preclinical animal studies, clinical quantification of thrombus burden and comparative component analyses between modeled VTE and clinical VTE are necessary.

Summary
Lead candidates from protein profiling of VTE patients’ plasma offer a promising outlook in developing low cost, confirmatory, point-of-care testing for VTE. Additionally, addressing the critical knowledge gap of quantitatively measuring clinical thrombi will allow for an array of benefits in VTE management and informing the translatability of experimental therapeutics.
Iron Deficiency in Anemic Children Surviving Critical Illness: Post Hoc Analysis of a Single-Center Prospective Cohort in Canada, 2019–2022
Authors: Du Pont-Thibodeau Geneviève , Li Shu Yin Han , Ducharme-Crevier Laurence , Jutras Camille , Pantopoulos Kostas , Farrell Catherine , Roumeliotis Nadia , Harrington Karen , Thibault Céline , Roy Noémi , Shah Akshay , Lacroix Jacques , Stanworth Simon J. 
Published: February 2024

OBJECTIVES:Many children leave the PICU with anemia. The mechanisms of post-PICU anemia are poorly investigated, and treatment of anemia, other than blood, is rarely started during PICU. We aimed to characterize the contributions of iron depletion (ID) and/or inflammation in the development of post-PICU anemia and to explore the utility of hepcidin (a novel iron marker) at detecting ID during inflammation.DESIGN:Post hoc analysis of a single-center prospective study (November 2019 to September 2022).SETTING:PICU, quaternary center, Canada.PATIENTS:Children admitted to PICU with greater than or equal to 48 hours of invasive or greater than or equal to 96 hours of noninvasive ventilation. We excluded patients with preexisting conditions causing anemia or those admitted after cardiac surgery.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Hematological and iron profiles were performed at PICU discharge on 56 participants of which 37 (37/56) were diagnosed with anemia. Thirty-three children (33/56; 59%) were younger than 2 years. Median Pediatric Logistic Organ Dysfunction score was 11 (interquartile range, 6–16). Twenty-four of the 37 anemic patients had repeat bloodwork 2 months post-PICU. Of those, four (4/24; 16%) remained anemic. Hematologic profiles were categorized as: anemia of inflammation (AI), iron deficiency anemia (IDA), IDA with inflammation, and ID (low iron stores without anemia). Seven (7/47; 15%) had AI at discharge, and one had persistent AI post-PICU. Three patients (3/47; 6%) had IDA at discharge; of which one was lost to follow-up and the other two were no longer anemic but had ID post-PICU. Eleven additional patients developed ID post-PICU. In the exploratory analysis, we identified a diagnostic cutoff value for ID during inflammation from the receiver operating characteristic curve for hepcidin of 31.9 pg/mL. This cutoff would increase the detection of ID at discharge from 6% to 34%.CONCLUSIONS:The burden of ID in children post-PICU is high and better management strategies are required. Hepcidin may increase the diagnostic yield of ID in patients with inflammation.
Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care
Authors: Gutman Colleen K. , Koyama Atsuko , Pickett Michelle , Holmstrom Sara , Ahmad Fahd A. , Hoch Ariel , Lehto Elizabeth , Schneider Kari , Stukus Kristin S. , Weber Emily , Stich Cassandra , Chernick Lauren S. 
Published: February 2024

Objectives
More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians.

Methods
We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ2 to compare subgroups.

Results
Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%).

Conclusions
Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.
Surgical Specialty Consultation for Pediatric Facial Laceration Repair
Authors: Miller Andrew F. , Levy Jason A. , Lyons Todd W. 
Published: February 2024

Objective
We sought to describe patterns of and indications for surgical specialty consultation for facial laceration repair in pediatric emergency departments (PEDs).

Methods
We performed a multicenter survey of PED leadership throughout the United States and Canada evaluating the practice patterns of surgical specialty consultation for patients presenting for facial lacerations requiring repair. We measured demographics of PEDs, factors influencing the decision to obtain a surgical specialty consultation, and the presence and components of consultation guidelines. Factors related to consultation were ranked on a Likert scale from 1 to 5 (1 = Not at all important, 5 = Extremely important). We evaluated relationships between reported rates of surgical specialty consultation and PED region, annual PED volume, and reported factors associated with PED consultation.

Results
Survey responses were received from 67/124 (54%) queried PEDs. The median self-reported rate of surgical specialty consultation for facial lacerations was 10% and ranged from 1% to 70%, with resident physicians performing the repair 71% of the time a subspecialist was consulted. There was regional variability in specialty consultation, with the highest and lowest rate in the Midwest and Canada, respectively (P = 0.03). The top 4 influential factors prompting consultation with the highest percentage of responses of “Extremely Important” or “Very Important” were: discretion of the physician caring for the patient (95%), parental preference (39%), limited PED resources (32%), and patient requires sedation (32%). Surgical specialty consult guidelines were used in only 6% of PEDs with consensus that depth necessitating more than 2-layer repair or involvement of critical structures should prompt consultation.

Conclusions
Surgical specialty usage in the management of patients who present with facial lacerations to PEDs has significant variation related to patient, provider, and department-level factors that influence the decision to consult. Lack of consult guidelines represent a potential opportunity to standardize care delivery to this common presentation.
Updated Markov Model to Determine Optimal Management Strategy for Patients with Paraesophageal Hernia and Symptoms, Cameron Ulcer, or Comorbid Conditions
Authors: DeMeester Steven R , Bernard Lisa , Schoppmann Sebastian F , McKay Sarah C , Roth J Scott 
Published: February 2024

BACKGROUND:The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year-old Markov analysis. Recently, we have shown that elective laparoscopic hernia repair (ELHR) provides an increase in life-years (L-Ys) compared with WW in most healthy patients aged 40 to 90 years. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients.STUDY DESIGN:A Markov model with updated variables was used to compare L-Ys gained with ELHR vs WW in hypothetical people with any type of PEH and symptoms, Cameron lesions, and/or comorbid conditions.RESULTS:In men and women aged 40 to 90 years with PEH-related symptoms and/or Cameron lesions, ELHR led to an increase in L-Ys over WW. The presence of comorbid conditions impacted life expectancy overall, but ELHR remained the preferred approach in all but 90-year-old patients with symptoms but no Cameron lesions.CONCLUSIONS:Using a Markov model with updated values for key variables associated with management options for patients with a PEH, we showed that life expectancy was improved with ELHR in most men and women aged 40 to 90 years, particularly in the presence of symptoms and/or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH.