bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic Intrawound Antibiotics Significantly Reduce the Risk of Deep Infections in Fracture Fixation: Subgroup Meta-analyses of the Type of Fracture, Antibiotics, and Organism
Authors: Awad Mohamed E. , Chung Ji Young , Griffin Nicole , Stoneback Jason W. , Alfonso Nicholas A. 
Published: June 2023

Objectives:
To analyze the efficacy of subgroups of various intrawound local antibiotics in reducing the rate of fracture-related infections.

Data Sources and Study Selection:
PubMed, MEDLINE via Ovid, Web of Science, Cochrane database, and Science Direct were searched for articles in English on July 5, 2022, and December 15, 2022.

Study Selection:
All clinical studies comparing the incidence of fracture-related infection between the administration of prophylactic systemic and topical antibiotics in fracture repair were analyzed.

Data Extraction:
Cochrane collaboration's assessment tool and the methodological bias and the methodological index for nonrandomized studies were used to detect bias and evaluate the quality of included studies, respectively.

Data Synthesis:
RevMan 5.3 software (Nordic Cochrane Centre, Denmark) was used to conduct the meta-analyses and generate forest plots.

Conclusions:
From 1990 to 2021, 13 studies included 5309 patients. Nonstratified meta-analysis showed that intrawound administration of antibiotics significantly decreased the overall incidence of infection in both open and closed fractures, regardless of the severity of open fracture and antibiotics class [OR = 0.58, (P = 0.007)] [OR = 0.33, (P < 0.00001)], respectively. The stratified analysis revealed that prophylactic intrawound antibiotics significantly lowered infection rate in open fracture patients with Gustilo–Anderson type I (OR = 0.13, P = 0.004), type II (OR = 0.29, P = 0.0002), type III (OR = 0.21, P < 0.00001), when either tobramycin PMMA beads (OR = 0.29, P < 0.00001) or vancomycin powder (OR = 0.51, P = 0.03) was applied. This study demonstrates prophylactic administration of intrawound antibiotics significantly decreases the overall incidence of infection in all subgroups of surgically fixated fractures but does not affect the patient's length of hospital stay.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome
Authors: DeKeyser Graham , Bunzel Eli , O'Neill Dillon , Nork Sean , Haller Justin , Barei David 
Published: June 2023

Objectives:
Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies.

Design:
Retrospective cohort study.

Setting:
Two, Level-1, academic, trauma centers.

Patients:
Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation.

Intervention:
Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau.

Outcomes:
The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI.

Results:
Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42–3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group (P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's (P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room.

Conclusions:
Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Backout of Distal Interlocking Screws after Retrograde Femoral Nailing with a Novel Device – A Case Series
Authors: Minhas Arjun , Berkay Fehmi , Hudson Tanner , Froehle Andrew W. , Horne Brandon , Orr Charlotte , Venkatarayappa Indresh , Jerele Jennifer 
Published: June 2023

Abstract

Objective:
To report upon a series of patients who have experienced the backout of distal interlocking screws after retrograde femoral nailing with the DePuy Synthes RFN-AdvancedTM Retrograde Femoral Nailing System (DePuy Synthes, Raynham, MA, USA).

Design:
Retrospective Case Series

Setting:
Level 1 Trauma Center

Patients:
Twenty-seven skeletally-mature patients with femoral shaft or distal femur fractures who underwent operative fixation with the DePuy Synthes RFN-AdvancedTM Retrograde Femoral Nailing System (RFNA) with 8 patients subsequently experiencing backout of distal interlocking screws.

Intervention:
The study intervention included retrospective review of patients’ charts and radiographs.

Main Outcome Measurement:
The incidence rate of distal interlocking screw backout.

Results:
Thirty percent of patients experienced the backout of at least one distal interlocking screw (mean: 1.625) after undergoing retrograde femoral nailing with the RFN-AdvancedTM system. Thirteen total screws backed out postoperatively. Screw backout was identified an average of 61 days postoperatively (range: 30 – 139). All patients complained of implant prominence and pain along the medial or lateral aspect of the knee. Five patients elected to return to the operating room to remove the symptomatic implant. The oblique distal interlocking screws comprised 62% of screw backouts.

Conclusions:
Given the high incidence rate of this complication, the associated costs of reoperation, and patient discomfort, we believe a further investigation into this implant complication is warranted.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Preoperative Opioid Prescribers and Lumbar Fusion
Authors: Lambrechts Mark J. , Toci Gregory R. , Fried Tristan B. , Issa Tariq Z. , Karamian Brian A. , Carter Michael V. , Breyer Garrett M. , Curran John G. , Hassan Waqas , Jeyamohan Hareindra , Minetos Paul D. , Stolzenberg David , Mehnert Michael , Canseco Jose A. , Woods Barrett I. , Kaye Ian David , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: June 2023

Study Design:
Retrospective cohort study.

Objective:
To determine the impact of multiple preoperative opioid prescribers on postoperative patient opioid usage and patient-reported outcome measures after single-level lumbar fusion.

Summary of Background Data:
Prior literature has identified opioid prescriptions from multiple postoperative providers increase opioid usage rates. However, there is limited evidence on how multiple preoperative opioid prescribers affect postoperative opioid usage or clinical outcomes after a single-level lumbar fusion.

Patients and Methods:
A retrospective review of single-level transforaminal lumbar interbody fusion or posterolateral lumbar fusions between September 2017 and February 2020 at a single academic institution was performed. Patients were excluded if they were not identifiable in our state’s prescription drug-monitoring program. Univariate comparisons and regression analyses identified factors associated with postoperative clinical outcomes and opioid usage.

Results:
Of 239 patients, 160 (66.9%) had one or fewer preoperative prescribers and 79 (33.1%) had >1 prescribers. On regression analysis, the presence of multiple preoperative prescribers was an independent predictor of increased improvement in Visual Analog Scale (∆VAS) Back (β=−1.61, P=0.012) and the involvement of a nonoperative spine provider was an independent predictor of increased improvement in ∆VAS Leg (β = −1.53, P = 0.034). Multiple preoperative opioid prescribers correlated with an increase in opioid prescriptions postoperatively (β = 0.26, P = 0.014), but it did not significantly affect the amount of morphine milligram equivalents prescribed (β = −48.79, P = 0.146). A greater number of preoperative opioid prescriptions predicted worse improvements in VAS Back, VAS Leg, and Oswestry Disability Index and predicted increased postoperative opioid prescriptions, prescribers, and morphine milligram equivalents.

Conclusions:
Multiple preoperative opioid prescribers predicted increased improvement in postoperative back pain, whereas preoperative involvement of a nonoperative spine provider predicted improvements in leg pain after surgery. The number of preoperative opioid prescriptions was a better metric for predicting poor postoperative outcomes and increased opioid consumption compared with the number of preoperative opioid prescribers.
Analysis of Influencing Factors of Vertebral Height Loss After Pedicle Screw Fixation of Thoracolumbar Fracture
Authors: Shi Zongpo , Zhang Chen , Wang Boyao , Nicolas Yap San Min , Chen Ji , Yang Gaungxu 
Published: June 2023

Study Design:
Retrospective case-control study.

Objective:
To explore the related factors of vertebral height loss (VHL) after pedicle screw fixation of thoracolumbar fracture and to determine the optimum prediction point.

Summary of Background Data:
With the widespread application of thoracolumbar fracture internal fixation, VHL after the operation is increasingly presented. However, there is no unified conclusion on the specific cause of VHL and how to predict it.

Methods:
A total of 186 patients were selected and divided into the loss group (n = 72) and the not-loss group (n = 114) according to whether the fractured vertebral height was lost after the operation. The two groups were compared concerning sex, age, body mass index, osteoporosis self-assessment tool for Asians (OSTA), fracture types, number of fractured vertebrae, preoperative Cobb angle and compression degree, number of screws, and extent of vertebral restore. Univariate analysis and Multivariate logistic regression analysis were performed to identify the independent factors for the VHL with the receiver operating characteristic curve and the optimal prediction value was calculated according to area under the curve.

Results:
Multivariate logistic regression analysis showed that OSTA (P < 0.05) and preoperative vertebral compression (P < 0.05) were significantly correlated with postoperative VHL, which were independent risk factors for postoperative VHL. The OSTA of 2.32 and the preoperative vertebral compression degree of 38.5% were the best prediction points for postoperative VHL based on the Youden Index analysis.

Conclusions:
The OSTA and preoperative vertebral compression were independent risk factors for VHL. The risk of postoperative VHL was significantly higher when the OSTA was ≤2.32 or the preoperative vertebral compression was ≥38.5%.

Level of Evidence:
Level III.
3D-printed Titanium Prosthetic Reconstruction of Unilateral Bone Deficiency After Surgical Resection of Tumor Lesions in the Upper Cervical Spine
Authors: Shen Jun , Yang Minglei , Zhong Nanzhe , Jiao Jian , Xiao Jianru 
Published: June 2023

Main points:
Operational excision of tumor lesions in the upper cervical spine remains a tremendous challenge to surgeons due to the local complex anatomic relationships. Meanwhile, no commercially available device has been specially designed to address bone deficiency after surgical resection. Here, we described the reconstruction of unilateral bone deficiency after surgical resection of a giant cell tumor of the tendon sheath originating from the lateral atlantoaxial joint with the employment of a 3D printing technique and reviewed the relevant literature. In our study, 3 patients with giant cell tumor of the tendon sheath in the upper cervical spine achieved complete tumor removal, and received unilateral bone reconstruction with one-armed 3D-printed titanium prosthesis. During the follow-up, these patients remained neurologically intact and got back to a normal life without wearing the braces. Images demonstrated the satisfactory placement of 3D-printed prosthesis with no failure of fixation and no subsidence. In addition, 6 articles describing the employment of 3D-printed prostheses or models for tumor surgery in the upper cervical spine were reviewed, and satisfactory clinical outcomes were reported in these studies. Hence, 3D-printed titanium prosthetic reconstruction of bone deficiency in the upper cervical spine was a safe and effective technique.

Level of Evidence:
Level IV.
Long-Term Intake of Linezolid Elevates Drug Exposure and Reduces Drug Clearance and Elimination in Adults With Drug-Resistant Pulmonary Tuberculosis
Authors: Jeyakumar Shanmugam Murugaiha , Bhui Namrata K. , Singla Neeta , Vilvamani Sudha , Mariappan Muthu Vijayalakshmi , Padmapriyadarsini Chandrasekaran , Bhatnagar Anuj K. , Solanki Rajesh , Sridhar Rathinam 
Published: June 2023

Purpose:
Pharmacokinetic (PK) studies are critical for dose optimization, and there is a paucity of linezolid (LZD) PK data for prolonged use in drug-resistant tuberculosis (DR-TB). Therefore, the authors evaluated the pharmacokinetics of LZD at two-time intervals in DR-TB during long-term use.

Methods:
PK evaluation of LZD was performed at the end of the 8th and 16th weeks of treatment in a randomly selected subset of adult pre-extensively drug-resistant pulmonary tuberculosis patients (n = 18) from a multicentric interventional study (Building Evidence to Advance Treatment of TB/BEAT study; CTRI/2019/01/017310), wherein a daily dose of 600 mg LZD was used for 24 weeks. Plasma LZD levels were measured using a validated high-pressure liquid chromatography (HPLC) method.

Results:
The LZD median plasma Cmax was comparable between the 8th and 16th weeks [18.3 mg/L, interquartile range (IQR: 15.5–20.8 and 18.8 mg/L, IQR: 16.0–22.7, respectively)]. However, the trough concentration increased significantly in the 16th week (3.16 mg/L, IQR: 2.30–4.76), compared with the 8th week (1.98 mg/L, IQR: 0.93–2.75). Furthermore, compared with the 8th week, in the 16th week, there was a significant increase in drug exposure (AUC0-24 = 184.2 mg*h/L, IQR: 156.4–215.8 versus 233.2 mg*h/L, IQR: 187.9–277.2), which corroborated with a longer elimination half-life (6.94 hours, IQR: 5.55–7.99 versus 8.47 hours, IQR:7.36–11.35) and decreased clearance (2.91 L/h, IQR: 2.45–3.33 versus 2.19 L/h, IQR: 1.49–2.78).

Conclusions:
Long-term daily intake of 600 mg LZD resulted in a significant elevation in trough concentration (>2.0 mg/L) in 83% of the study participants. Furthermore, increased LZD drug exposure may be partly because of decreased clearance and elimination. Overall, the PK data underscore the need for dose adjustment when LZDs are intended for long-term treatment.
Changes in Psychotropic Drug Blood Levels After SARS-CoV-2 Vaccination: A Two-Center Cohort Study
Authors: Kuzin Maxim , Gardin Fabian , Götschi Markus , Xepapadakos Franziskos , Kawohl Wolfram , Seifritz Erich , Trauzeddel Antje , Paulzen Michael , Schoretsanitis Georgios 
Published: June 2023

Background:
Limited evidence from case reports suggests that coronavirus disease 2019 (COVID-19) vaccination may interact with the treatment outcomes of psychiatric medications. Apart from clozapine, reports on the effect of COVID-19 vaccination on other psychotropic agents are scarce. This study aimed to investigate the impact of COVID-19 vaccination on the plasma levels of different psychotropic drugs using therapeutic drug monitoring.

Methods:
Plasma levels of psychotropic agents, including agomelatine, amisulpride, amitriptyline, escitalopram, fluoxetine, lamotrigine, mirtazapine, olanzapine, quetiapine, sertraline, trazodone, and venlafaxine, from inpatients with a broad spectrum of psychiatric diseases receiving COVID-19 vaccinations were collected at 2 medical centers between 08/2021 and 02/2022 under steady-state conditions before and after vaccination. Postvaccination changes were estimated as a percentage of baseline.

Results:
Data from 16 patients who received COVID-19 vaccination were included. The largest changes in plasma levels were reported for quetiapine (+101.2%) and trazodone (−38.5%) in 1 and 3 patients, respectively, 1 day postvaccination compared with baseline levels. One week postvaccination, the plasma levels of fluoxetine (active moiety) and escitalopram increased by 31% and 24.9%, respectively.

Conclusions:
This study provides the first evidence of major changes in the plasma levels of escitalopram, fluoxetine, trazodone, and quetiapine after COVID-19 vaccination. When planning COVID-19 vaccination for patients treated with these medications, clinicians should monitor rapid changes in bioavailability and consider short-term dose adjustments to ensure safety.
The Patient Safety Adoption Framework: A Practical Framework to Bridge the Know-Do Gap
Authors: Moyal-Smith Rachel , Margo Judy , Maloney Francine L. , Boulanger Jason , Lautner Patti , Folcarelli Patricia , Benjamin Evan 
Published: June 2023

Objectives
Many patient safety initiatives fail to be adopted and implemented, even when proven effective. This creates the well-recognized know-do gap, referring to the discrepancy between what healthcare workers know should be done based on evidence and what takes place in practice. We aimed to develop a framework to improve the adoption and implementation of patient safety initiatives.

Methods
We conducted a background literature review followed by qualitative interviews with patient safety leaders to identify barriers and facilitators to adoption and implementation. Inductive thematic analysis was used to generate themes that informed the development of the framework. We used a consensus-building approach to co-create the framework and guidance tool with an Ad Hoc Committee made up of subject-matter experts and patient family advisors. The framework was tested for utility, feasibility, and acceptability through qualitative interviews.

Results
The Patient Safety Adoption Framework contains 5 domains and 6 subdomains. The domains are leadership (subdomains: prioritization, accountability, governance), culture and context, process (subdomains: co-creation, high reliability, engagement), meaningful measurement, and person-centeredness. A guidance tool was developed to provide practical guidance for improvement teams using the framework. Testing affirmed the framework and guidance tool with a high degree of acceptability, feasibility, and utility among implementers and subject-matter experts.

Conclusions
The Patient Safety Adoption Framework provides the essential components necessary to facilitate the adoption and implementation of patient safety initiatives. The framework offers a roadmap for healthcare organizations striving to close the know-do gap.
Intersecting Vulnerabilities: Unraveling the Complex Relationship between Women, Climate Change, and Mental Health in Bangladeshi Communities
Authors: Goudet Jean-Marc , Arif Faria Binte , Owais Hasan , Ahmed Helal Uddin , Ridde Valéry 
Published: June 2023

AbstractClimate change is one of the biggest challenges that humanity is facing in the 21st century, and its impact is being felt all over the world. It is well documented that the impacts of climate change have a significant effect on human health, including mental health. This paper focuses on the gender effect of climate impacts on mental health based on qualitative study conducted in two fragile communities in Bangladesh. This study was conducted using qualitative methods, including participant observation, in-depth interviews, and focus group discussions. The study was carried out in two fragile communities in Bangladesh, which were selected based on their vulnerability to climate change impacts. The participants were selected using snowball sampling. A total of 59 interviews and 3 Focus Group Discussions (FGDs) were conducted. Climate change impacts have a significant effect on mental health in both men and women. However, there are gender differences in the experience of climate change impacts on mental health. Women are more vulnerable to climate change impacts on mental health due to their gender roles and responsibilities. Responsible for taking care of their families, they have to face additional challenges due to climate change impacts, such as increased workload, water scarcity, and food insecurity, social insecurity as many of their husband migrates to the cities for jobs. Women also face social and cultural barriers, which exacerbates their vulnerability to climate change impacts on mental health. Men, on the other hand, face challenges related to their livelihoods and economic security due to climate change impacts. This study highlights the gender differences in the experience of climate change impacts on mental health in two fragile communities in Bangladesh. Socioeconomic and environmental determinants appear to be embedded and lead to psychological suffering in relation to social roles and gender norms. Interventions should be designed to address the specific needs and challenges faced by women in these communities. Policymakers should take a gender-sensitive approach to address the mental health impacts of climate change in these communities. This study contributes to the growing body of research on the gendered impacts of climate change with a trajectory approach and provides insights for future research in this area.
Immunogenicity of a Two Dose Regimen of Moderna mRNA Beta/Omicron BA.1 Bivalent Variant Vaccine Boost in a Randomized Clinical Trial
Authors: Rouphael Nadine G. , Branche Angela R. , Diemert David J. , Falsey Ann R. , Losada Cecilia , Baden Lindsey R. , Frey Sharon E. , Whitaker Jennifer A. , Little Susan J. , Kamidani Satoshi , Walter Emmanuel B. , Novak Richard M. , Rupp Richard , Jackson Lisa A. , Babu Tara M. , Kottkamp Angelica C. , Luetkemeyer Anne F. , Immergluck Lilly C. , Presti Rachel M. , Bäcker Martín , Winokur Patricia L. , Mahgoub Siham M. , Goepfert Paul A. , Fusco Dahlene N. , Atmar Robert L. , Posavad Christine M. , Netzl Antonia , Smith Derek J. , Telu Kalyani , Mu Jinjian , Makowski Mat , Makhene Mamodikoe K. , Crandon Sonja , Montefiori David C. , Roberts Paul C. , Beigel John H. 
Published: June 2023

AbstractIn this brief report, we compare the magnitude and durability of the serologic response of one versus two doses (separated by 56 days) of a variant vaccine (Moderna mRNA-1273 Beta/Omicron BA.1 bivalent vaccine) in adults.