bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alternative blood products in trauma
Authors: Jan Kathryn M. , Mohapatra Shweta , Moon Tiffany S. 
Published: February 2023

Purpose of review
Hemorrhage and trauma-induced coagulopathy cause significant morbidity and mortality in trauma patients. Although blood products are the cornerstone of resuscitation, these resources are scarce, necessitating alternatives. This review examines the use of alternative blood products in trauma as well as the literature supporting their use.

Recent findings
There is no single true blood product alternative. In recent years, there has been great progress in understanding trauma-induced pathophysiology and blood component alternatives. Products such as tranexamic acid and prothrombin complex concentrate have become well established and are frequently utilized in trauma centers, and many more alternatives are still undergoing further research and development.

Summary
Stabilization of hemorrhage and resuscitation is priority in trauma-induced coagulopathy treatment. Alternative products such as tranexamic acid, recombinant factors, prothrombic complex concentrate, fibrinogen concentrates, and desmopressin may also be considered based on the clinical context. Viscoelastic hemostatic assays such as rotational thromboelastometry and thromboelastography can help guide these efforts. Following initial stabilization, additional interventions such as iron supplementation, erythropoietin stimulating agents, and vitamin D may help with chronic sequela.
A review of the utility of high-frequency oscillatory ventilation in burn and trauma ICU patients
Authors: Dilday Joshua , Leon David , Kuza Catherine M. 
Published: February 2023

Purpose of review
The purpose was to examine the utility of high-frequency oscillatory ventilation (HFOV) in trauma and burn ICU patients who require mechanical ventilation, and provide recommendations on its use.

Recent findings
HFOV may be beneficial in burn patients with smoke inhalation injury with or without acute lung injury/acute respiratory distress syndrome (ARDS), as it improves oxygenation and minimizes ventilator-induced lung injury. It also may have a role in improving oxygenation in trauma patients with blast lung injury, pulmonary contusions, pneumothorax with massive air leak, and ARDS; however, the mortality benefit is unknown.

Summary
Although some studies have shown promise and improved outcomes associated with HFOV, we recommend its use as a rescue modality for patients who have failed conventional ventilation.
Outcomes in pediatric anesthesia: towards a universal language
Authors: Marchesini Vanessa , Disma Nicola 
Published: February 2023

Purpose of review
The identification of valid, well defined and relevant outcomes is fundamental to provide a reliable and replicable measure that can be used to improve quality of clinical care and research output. The purpose of this review is to provide an update on what the pediatric anesthesia research community is pursuing on standardized and validated outcomes.

Recent findings
Several initiatives by different research groups have been established during the last years. They all aim to find validated outcomes using the standardized methodology of COMET (https://www.comet-initiative.org/). These initiatives focus on clinical and research outcomes on the field of anesthesia, perioperative medicine, pain and sedation in pediatric age.

Summary
Clinical outcomes are measurements of changes in health, function or quality of life and they help evaluating quality of care. In order for them to be relevant in quantifying quality improvement, they need to be well defined, standardized and consistent across trials. A great effort from researchers has been made towards the identification of set of outcomes with these features.
Pregnancy, Opioid Use Disorder and COVID-19: An Evaluation of Acute Care Presentations During a Pandemic
Authors: Gill Elizabeth , Ghimire Anupa D. , Robinett Derek A. , Booth James S. , Walter Lauren A. 
Published: February 2023

Introduction
The opioid epidemic has been exacerbated by the COVID-19 pandemic, resulting in increased acute care opioid-related and overdose visits. We sought to assess how the pandemic may have impacted an obstetric cohort impacted by opioid misuse in the acute care context.

Methods
A retrospective review of acute care presentations of patients with concomitant pregnancy (Z33.1) and opioid-related diagnostic codes (T10 codes and/or F11) was conducted over a 24-month period (pre-COVID = March 2019 through February 2020, post-COVID = March 2020 through February 2021). Descriptive statistics and χ
2 analysis of pre- versus post-COVID presentations were performed.

Results
A total of 193 individuals, 104 (53.9%) pre- and 89 (46.1%) post-COVID, accounting for 292 total encounters, 160 (54.8%) pre- and 132 (45.2%) post-COVID, were seen for acute care visits (P = 0.84). Age (P = 0.15), race (P = 0.59), and insurance status (P = 0.17) were similar pre- versus post-COVID. The majority of presentations, pre- (40.4%) and post-COVID (44.9%), were for opioid withdrawal (P = 0.74). Although post-COVID individuals were more likely to lack prenatal care (48.3% versus 39.4% pre-COVID), this trend was not significant (P = 0.19). Similar proportions of individuals were affected by pregnancy complications (51.9% pre-, 44.9% post-COVID; P = 0.30). Similar proportions of individuals were affected by adverse pregnancy outcomes (44.2% pre-, 48.3% post-COVID; P = 0.64).

Conclusion
The COVID-19 pandemic did not have a statistically significant effect on opioid-related acute care presentations or outcomes for obstetric patients. In this acute care cohort, however, opioid misuse had significant general impact on pregnancy complications and outcomes, suggesting unmet needs in this population.
Investigating Secondary Alcohol Outcomes in a Contingency Management Intervention among American Indian and Alaska Native Adults
Authors: Hirchak Katherine A. , Kordas Gordon , Lyons Abram J. , Herron Jalene , Jansen Kelley , Shaw Jennifer , McPherson Sterling M. , Roll John , Buchwald Dedra , McDonell Michael G. ,   the HONOR Study Team
Published: February 2023

Objective
The aim of the study is to investigate clinically meaningful, secondary outcomes in a randomized trial of a culturally adapted contingency management (CM) intervention for alcohol use in 3 diverse American Indian and Alaska Native communities.

Methods
Three American Indian and Alaska Native communities located in the Northern Plains, Alaska, and the Inland Northwest were partnering sites. A total of 158 individuals were randomized to either a 12-week CM intervention or a noncontingent (NC) control group. The CM group received reinforcers for providing alcohol-negative ethyl glucuronide (EtG < 150 ng/mL) urine samples, while the NC group received reinforcers unconditionally. Outcomes included EtG as a continuous measure (range, 0–2,000 ng/mL), EtG > 499 ng/mL (a measure of higher levels of recent alcohol use), longest duration of abstinence, and time-to-first alcohol-positive EtG during the trial. Generalized estimating equations along with Cox proportional hazard and negative binomial regressions were used.

Results
Participants randomized to the CM group had lower mean EtG levels (−241.9 ng/mL; 95% confidence interval [CI], −379.0 to −104.8 ng/mL) and 45.7% lower odds (95% CI, 0.31 to 0.95) of providing an EtG sample indicating higher levels of alcohol use during the intervention. Longest duration of abstinence was 43% longer for the CM group than the NC group (95% CI, 1.0 to 1.9). Risk of time-to-first drink during treatment did not differ significantly.

Conclusions
These secondary outcome analyses provide evidence that CM is associated with reductions in alcohol use and longer durations of abstinence (as assessed by EtG), both clinically meaningful endpoints and analyses that differ from the primary study outcome.
Examining Racial/Ethnic and Income Disparities on Tobacco Product Use Among US Adults Within Wave 5 of the PATH Study
Authors: Sun Ruoyan , Chana Sofia Mildrum , Hawes Elizabeth , Hendricks Peter S. , Cropsey Karen L. , Gaggar Amit , Scarinci Isabel C. 
Published: February 2023

Objective
The aim of this study was to examine the interactions between race/ethnicity and income across different types of tobacco products.

Methods
The prevalence of past 30-day use of cigarettes, traditional cigars, cigarillos, filtered little cigars, and electronic nicotine delivery systems (ENDS) among adults was examined by race/ethnicity and income levels based on wave 5 (2018–2019) data of the Population Assessment of Tobacco and Health study.

Results
Multivariate analysis across race/ethnicity and income showed that, although non-Hispanic Blacks (NHBs) were significantly more than likely to smoke cigarettes than non-Hispanic Whites (NHWs) at low- and high-income levels, such disparity only applied to low-income Hispanics compared with low-income NHWs. NHBs were significantly more likely to smoke traditional cigars, cigarillos, and filtered little cigars than NHWs at low and high incomes. No differences were found between Hispanics and NHWs with regard to traditional cigars and cigarillos. However, low-income Hispanics were significantly less likely to smoke filtered little cigars than NHWs, whereas high-income Hispanics were more likely to do so than NHWs. With regard to ENDS, significant differences were only found at the low-income bracket with NHBs and Hispanics being less likely to smoke these products than NHWs.

Conclusions
Our findings highlight significant interactions between race/ethnicity and income in the use of tobacco products, suggesting that income should be taken into account when designing interventions targeting different racial/ethnic groups.
Pandemics Interlaced: The Impact of the COVID-19 Pandemic on the Wellbeing of Sober Living Home Residents
Authors: Noonan Grace , Glenn Jason 
Published: February 2023

Objectives
This study aimed to discover how the COVID-19 pandemic altered the implementation of the social model of recovery in sober living homes (SLHs). Researchers analyzed associations between residents’ feelings of interconnectedness, social service utilization, and relapse predictors throughout the pandemic. This study provides an understanding of how the COVID-19 pandemic impacted treatment of substance use disorder (SUD).

Methods
This study used retrospective surveyed data from 105 SLH residents. Correlational analysis was used to determine the relationship between social service use, social connectivity, and relapse predictors at three different time points: February 2020, December 2020, and June 2021. Three residents underwent additional interviews.

Results
There was a decline in social service utilization from February 2020 to December 2020 with an associated decline in feelings of social connectivity. From December 2020 to June 2021, there was an increase in residents’ use of social services with an associated increase in connectivity. There was a significant negative correlation between relapse predictors and number of supportive services used in February 2020 (r = −0.217, P < 0.05) and in December 2020 (r = −0.352, P < 0.001). In June 2020, there was a significant negative correlation between interconnectedness and relapse predictors (r = −0.297, P < 0.05). The number of interviews was not sufficient for formal qualitative analysis.

Conclusions
The results suggest the COVID-19 pandemic possibly interrupted the course of recovery in SLHs. These findings offer insight to how the pandemic impacted individuals recovering from SUD and suggest that SUD treatment professionals should develop interventions to enhance social connectivity to deploy in response to global stressors.
Community Pharmacists’ Knowledge and Perceptions of Buprenorphine for Patients with Opioid Use Disorder
Authors: Tutag Lehr Victoria , Nolan Claire 
Published: February 2023

Objectives
The aims of the study are to evaluate community pharmacists’ knowledge and perceptions regarding buprenorphine for opioid use disorder and their willingness to dispense buprenorphine and to identify opportunities for education.

Methods
An electronic survey of Michigan pharmacists (n = 11,123) assessed demographics, training, buprenorphine knowledge, dispensing, perceptions of stigma, diversion, and confidence in patient/provider interactions. Composite scores for knowledge, stigma, diversion, and confidence were calculated. Cross-tabulations and logistic regressions examined associations.

Results
There were 775 surveys returned (response 7%, n = 11,123) with 390 community pharmacists completing the survey. Twenty-five percent practiced in a rural area. Common practice sites were chain or independent pharmacies (30% each). Ninety-seven percent had buprenorphine training, 50% from Accredited Continuing Pharmacy Education. Eighty percent reported that their pharmacy dispensed buprenorphine with 90% of rural pharmacists compared with 71% urban responding yes. Composite knowledge scores did not differ between urban or rural location (P > 0.05). Predictors of willingness to dispense buprenorphine were urban location (odds ratio, OR, 0.55; 95% confidence interval [CI], 0.34–0.91; P = 0.01), independent pharmacy (OR, 0.53; 95% CI, 0.30–0.94; P = 0.03), Accredited Continuing Pharmacy Education training (OR, 0.54; 95% CI, 0.34–0.87; P = 0.01), low stigma/diversion (OR, 0.51; 95% CI, 0.37–0.70; P = 0.00), and confidence in patient/provider interactions (OR, 0.14; 95% CI, 0.10–0.19; P = 0.00).

Conclusions
Most survey pharmacists practice at pharmacies that dispense buprenorphine for opioid use disorder, with a larger proportion from rural pharmacies reporting availability. Pharmacists at independent pharmacies in urban locations have increased willingness to dispense buprenorphine, with urban pharmacists having lower perceptions of diversion compared with rural. Differences in buprenorphine availability, pharmacist willingness to dispense, and perceptions are opportunities for education. Limitations include one state, response bias, self-assessed competencies, and small samples.
Financial Toxicity Is Common in Patients After Tibia Fracture
Authors: Mundy Lily R. , Zingas Nicolas H. , McKibben Natasha , Healey Kathleen , O'Hara Nathan N. , O'Toole Robert V. , Pensy Raymond A. 
Published: February 2023

Objectives:
To evaluate the presence of financial distress and identify risk factors for financial toxicity in patients after tibial shaft fracture.

Design:
A cross-sectional analysis.

Setting:
Level I trauma center.

Patients:
All patients within 4 years after tibial shaft fracture (open, closed, or fracture that required flap reconstruction).

Intervention:
Injury-related financial distress.

Main Outcome Measurements:
Financial distress related to the injury, as reported by the patient in a binary question. Financial toxicity using the LIMB-Q, scored from 0 to 100, with higher scores indicating more financial toxicity.

Results:
Data were collected from 142 patients after tibial shaft fracture [44% closed (n = 62), 41% open (n = 58), and 15% flap (n = 22)]. The mean age was 44 years (SD 17), 61% were men, and the mean time from injury was 15 months. Financial distress was reported by 64% of patients (95% confidence interval, 56% to 72%). Financial toxicity did not differ by fracture severity (P = 0.12). Medical complications were associated with a 14-point increase in financial toxicity (P = 0.04). Age older than 65 years (−15 points, P = 0.03) and incomes of $70,000 or more ($70,000–$99,999, −15 points, P = 0.02; >$100,000, −19 points, P < 0.01) protected against financial toxicity.

Conclusion:
We observed financial distress levels more than twice the proportion observed after cancer. Medical complications, lower incomes, and younger age were associated with increased financial toxicity.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
New Versus Old—How Reliable Is the New OTA/AO Classification for Trochanteric Hip Fractures?
Authors: Davidson Amit , Revach Yuval , Rodham Paul , Mosheiff Rami , Kandel Leonid , Weil Yoram A. 
Published: February 2023

Objective:
To evaluate the intraobserver and interobserver reliability of the 2018 OTA/AO trochanteric hip fracture (THF) classification compared with the 1983 OTA/AO Muller classification system. To further delineate the reliability of classifying stable and unstable THF using the 2 classification systems.

Design:
Radiographic observational study.

Setting:
Multicenter, one Level 1 and one Level 2 trauma centers.

Participants/Patients:
Seventy-three radiographic series of patients treated operatively for THF were evaluated by 6 orthopaedic surgeons.

Intervention:
The OTA/AO THF classification system was applied by each surgeon to 73 cases in 2 independent assessments performed 4 weeks apart: once by the old classification followed by the new 2018 OTA/AO classification. Each radiographic series included lateral hip and anteroposterior initial radiographs. Eight random cases were duplicated in each of the surveys to evaluate the intraobserver reliability.

Main Outcome Measurements:
Intraobserver and interobserver of the group, subgroup and fracture stability classification determined by the interclass coefficient (ICC) and Cohen kappa values.

Results:
The interobserver reliability for the group classification (31A1/A2/A3) was moderate using the new classification, whereas substantial agreement was shown using the old classification (0.49 and 0.69, respectively). The reliability of the fracture stability classification was higher using the old classification (0.70 vs. 0.52). Subgroup classifications interobserver agreement was fair for both classification systems, although lower reliability was shown in the old classification (0.34 vs. 0.31).

Conclusions:
The new OTA/AO classification has a lower interobserver reliability for THF classification when compared with the old one.
Optimizing Orthopaedic Trauma Implant Pricing Through a Data-Driven and Surgeon-Integrated Approach
Authors: Seltzer Ryan , Johnson Joseph R. , McFarlane Kelly , Chawla Amanda , Chamberlain Stephanie , Kohler Michael , Sheth Kunj , Wall James K. , Bishop Julius , Gardner Michael , Shea Kevin G. 
Published: February 2023

Objective:
To determine whether market-based pricing could be coupled with surgeon integration into negotiation strategies to achieve lower pricing levels for orthopaedic trauma implants. A secondary aim was to identify specific types of implants that may offer larger opportunities for cost savings.

Methods:
Market pricing levels were reviewed from 2 industry implant databases. This information was used by surgeons and supply chain management at our institution to select appropriate target pricing levels (25th percentile) for commonly used orthopaedic trauma implants. Target price values were provided to the existing 12 vendors used by our institution with a clear expectation that vendors meet these thresholds.

Results:
Benchmark modeling projected a potential savings of 20.0% over our prior annual spend on trauma implants. After 2 rounds of negotiation, savings amounted to 23.0% of prior annual spend. Total savings exceeded 1,000,000 USD with 11 of 12 vendors (91.7%) offering net savings. Total percent savings were highest for external fixators, drill bits, and K-wires. Plates and screws comprised the greatest proportion of our prior annual spend and achieved similar savings.

Conclusion:
A surgeon and supply chain coordinated effort led to major cost savings without a need for consolidation of vendors.

Level of Evidence:
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does the Option to Keep Explanted Orthopaedic Trauma Implants Influence Patient Satisfaction and Perception of Care? Results of a Survey Study
Authors: Mavrommatis Sophia , LaRoque Michael C. , Yang Gaonhia , Brahme Indraneel S. , Cole Peter A. 
Published: February 2023

Objective:
Orthopaedic trauma implants may be electively explanted after fracture healing; reasons include symptomatic implants, cosmetic/functional concerns, or personal expectations. Certain institutions provide the option to keep implants after removal, although this has been retracted in others. This study examines patients' desire for return of implants, reasons for desiring return, and influence of return on perceptions of care.

Methods:
A cohort of adult patients who underwent elective orthopaedic implant removal by a single surgeon at a Level I trauma center between 2008 and 2019, with the option to keep their removed implants, was identified. Surveys were sent to patients with contact information. Demographics, reasons for removal, satisfaction, and perceptions of care were studied.

Results:
The overall response rate was 47.4% (117 of 247). Respondents' mean age was 46.9 years, and 50% were female. Ninety-one percent kept their implants. Eighty-nine percent of patients felt that removal achieved their desired outcome, with decreasing pain cited as primary motivation for explantation (62%). Forty-five percent reported a strong desire to keep their implants, most commonly to show to family (49%). Seventy-four percent were happy to have this option. Thirty-seven percent of patients reported respecting their provider more for having this option, and 27% reported that this positively impacted their satisfaction.

Conclusions:
Patients perceive elective implant removal as highly effective. A majority were pleased to have the option to keep their implants, and many reported increased respect and satisfaction. Thus, providing patients with this option should be strongly considered to honor patient choice and optimize outcomes when feasible.
Do Adolescent Idiopathic Scoliosis Patients With Vitamin D Deficiency Have Worse Spine Fusion Outcomes?
Authors: Beling Alexandra , Hresko M. Timothy , Verhofste Bram , Miller Patricia E. , Pitts Sarah A. , Glotzbecker Michael P. 
Published: February 2023

Background:
Prior research has shown that patients with adolescent idiopathic scoliosis (AIS) have a higher prevalence of vitamin D deficiency compared with healthy peers. In adult orthopaedic populations, vitamin D deficiency has been shown to be a risk factor for higher reported pain and lower function. We investigated whether there was an association between vitamin D levels and AIS patient-reported outcomes, as measured by the Scoliosis Research Society (SRS-30) questionnaire.

Methods:
This was a single-center, cross-sectional study. Postoperative AIS patients were prospectively recruited during routine follow-up visits, 2 to 10 years after spine fusion. Vitamin D levels were measured by serum 25-hydroxyvitamin D (ng/mL). Patients were categorized based on vitamin D level: deficient (<20 ng/mL), insufficient (20 to 29 ng/mL), or sufficient (≥30 ng/mL). The correlation between vitamin D levels and SRS-30 scores was analyzed using multivariable analysis and pair-wise comparisons using Tukey method.

Results:
Eighty-seven AIS patients (83% female) were enrolled who presented at median 3 years (interquartile range: 2 to 5 y; range: 2 to 10 y) after spine fusion. Age at time of surgery was mean 15 (SD±2) years. Major coronal curves were a mean of 57 (SD±8) degrees preoperatively and 18 (SD±7) degrees postoperatively. It was found that 30 (34%) of patients were vitamin D sufficient, 33 (38%) were insufficient, and 24 (28%) were deficient. Although there was no correlation between vitamin D level and Pain, Mental Health, or Satisfaction domains (P>0.05), vitamin D–deficient patients were found to be younger (P<0.001) and had lower SRS-30 function (P=0.002), Self-image (P<0.001), and total scores (P=0.003).

Conclusions:
AIS patients with vitamin D deficiency (<20 ng/mL) are more likely to be younger age at time of surgery, and report lower Function, Self-image, and Total SRS-30 scores postoperatively. Further work is needed to determine whether vitamin D supplementation alters curve progression and patient outcomes.

Level of Evidence:
Level II—prognostic study.