bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Perioperative Management of Patients Undergoing Complex Spine Surgery: A Global Perspective
Authors: Blacker Samuel N. , Woody Nathan , Abate Shiferaw Ananya , Burbridge Mark , Bustillo Maria A. , Hazard Sprague W. , Heller Benjamin J. , Lamperti Massimo , Mejia-Mantilla Jorge , Nadler Jacob W. , Rath Girija Prasad , Robba Chiara , Vincent Anita , Admasu Azarias K. , Awraris Meron , Lele Abhijit V. 
Published: May 2023

Background:
The aim of this survey was to understand institutional spine surgery practices and their concordance with published best practices/recommendations.

Methods:
Using a global internet-based survey examining perioperative spine surgery practice, reported institutional spine pathway elements (n=139) were compared with the level of evidence published in guideline recommendations. The concordance of clinical practice with guidelines was categorized as poor (≤20%), fair (21%–40%), moderate (41%–60%), good (61%–80%), or very good (81%–100%).

Results:
Seventy-two of 409 (17.6%) institutional contacts started the survey, of which 31 (7.6%) completed the survey. Six (19.4%) of the completed surveys were from respondents in low/middle-income countries, and 25 (80.6%) were from respondents in high-income countries. Forty-one incomplete surveys were not included in the final analysis, as most were less than 40% complete. Five of 139 (3.6%) reported elements had very good concordance for the entire cohort; hospitals with spine surgery pathways reported 18 elements with very good concordance, whereas institutions without spine surgery pathways reported only 1 element with very good concordance. Reported spine pathways included between 7 and 47 separate pathway elements. There were 87 unique elements in the reviewed pathways. Only 3 of 87 (3.4%) elements with high-quality evidence demonstrated very good practice concordance.

Conclusions:
This global survey-based study identified practice variation and low adoption rates of high-quality evidence in the care of patients undergoing complex spine surgery.
Extracorporeal shockwaves therapy versus corticosteroid injection for the treatment of non-calcific rotator cuff tendinopathies: a randomized trial
Authors: Ebadi Safoora , Karimzad Yousef , Aflakian Negar , Forogh Bijan , Mansoori Korosh , Babaei-Ghazani Arash 
Published: May 2023

Background:
Rotator cuff tendinopathy is the most common cause of painful shoulder. There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in the rotator cuff calcific tendinopathy, but evidence supporting its use in non-calcifying tendinopathy is lacking. The current study aimed to compare the clinical effectiveness of corticosteroid injections versus ESWT until 3 mo of follow-up for the management of painful non-calcific rotator cuff tendinopathies.

Methods:
A total of 33 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 16 and 17 cases. The first group received corticosteroid injection under ultrasound guidance and the second group received three sessions of shockwave within 3 consecutive weeks consisted of 2000 pulse energy, 5 Hz frequency, and pressure of 4 bar using a radial shock wave device. Two outcome measures of VAS and Quick-DASH were obtained to evaluate patients before treatment, and 2 and 12 wk after treatment.

Discussion:
Regarding both VAS and the score of the Quick-DASH questionnaire, no statistically significant difference was observed between these 2 therapeutic interventions (ultrasound-guided corticosteroid injection and shockwave). Both interventions reduced the patient’s pain to the same extent (P-value=0.955 for VAS, and P-value=0.865 for Quick DASH questionnaire score). Moreover, within-group changes showed that both groups’ improvements were significant in the time intervals of 1 to 2 and 1 to 3.

Conclusions:
Corticosteroid injection and radial shockwave, both can be effective to the same extent in reducing pain and improving function in non-calcific shoulder tendinopathy.

Level of Evidence:
Level I.
Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU With COVID-19*
Authors: van Diepen Sean , McAlister Finlay A. , Chu Luan Manh , Youngson Erik , Kaul Padma , Kadri Sameer S. 
Published: May 2023

OBJECTIVES:Although COVID-19 vaccines can reduce the need for intensive care unit admission in COVID-19, their effect on outcomes in critical illness remains unclear. We evaluated outcomes in vaccinated patients admitted to the ICU with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the association between vaccination and booster status on clinical outcomes.DESIGN:Retrospective cohort.SETTING AND PATIENTS:All patients were admitted to an ICU between January 2021 (after vaccination was available) and July 2022 with a diagnosis of COVID-19 based on a SARS-CoV-2 polymerase chain reaction test in Alberta, Canada.INTERVENTIONS:None.MEASUREMENT:The propensity-matched primary outcome of all-cause in-hospital mortality was compared between vaccinated and unvaccinated patients, and vaccinated patients were stratified by booster dosing. Secondary outcomes were mechanical ventilation (MV) duration ICU length of stay (LOS).MAIN RESULTS:The study included 3,293 patients: 743 (22.6%) were fully vaccinated (54.6% with booster), 166 (5.0%) were partially vaccinated, and 2,384 (72.4%) were unvaccinated. Unvaccinated patients were more likely to require invasive MV (78.4% vs 68.2%), vasopressor use (71.1% vs 66.6%), and extracorporeal membrane oxygenation (2.1% vs 0.5%). In a propensity-matched analysis, in-hospital mortality was similar (31.8% vs 34.0%, adjusted odds ratio [OR], 1.25; 95% CI, 0.97–1.61), but median duration MV (7.6 vs 4.7 d;p< 0.001) and ICU LOS (6.6 vs 5.2 d;p< 0.001) were longer in unvaccinated compared to fully vaccinated patients. Among vaccinated patients, greater than or equal to 1 booster had lower in-hospital mortality (25.5% vs 40.9%; adjusted OR, 0.50; 95% CI, 0.0.36–0.68) and duration of MV (3.8 vs 5.6 d;p= 0.025).CONCLUSIONS:Nearly one in four patients admitted to the ICU with COVID-19 after widespread COVID-19 vaccine availability represented a vaccine-breakthrough case. Mortality risk remains substantial in vaccinated patients and similar between vaccinated and unvaccinated patients after the onset of critical illness. However, COVID-19 vaccination is associated with reduced ICU resource utilization and booster dosing may increase survivability from COVID-19-related critical illness.
Development of the Scientific, Transparent and Applicable Rankings (STAR) tool for clinical practice guidelines
Authors: Yang Nan , Liu Hui , Zhao Wei , Pan Yang , Lyu Xiangzheng , Hao Xiuyuan , Liu Xiaoqing , Qi Wen’an , Chen Tong , Wang Xiaoqin , Zhang Boheng , Zhang Weishe , Li Qiu , Xu Dong , Gao Xinghua , Jin Yinghui , Sun Feng , Meng Wenbo , Li Guobao , Wu Qijun , Chen Ze , Wang Xu , Estill Janne , Norris Susan L. , Du Liang , Chen Yaolong , Wei Junmin 
Published: May 2023

Abstract

Background:
This study aimed to develop a comprehensive instrument for evaluating and ranking clinical practice guidelines, named Scientific, Transparent and Applicable Rankings tool (STAR), and test its reliability, validity, and usability.

Methods:
This study set up a multidisciplinary working group including guideline methodologists, statisticians, journal editors, clinicians, and other experts. Scoping review, Delphi methods, and hierarchical analysis were used to develop the STAR tool. We evaluated the instrument's intrinsic and interrater reliability, content and criterion validity, and usability.

Results:
STAR contained 39 items grouped into 11 domains. The mean intrinsic reliability of the domains, indicated by Cronbach's α coefficient, was 0.588 (95% confidence interval [CI]: 0.414, 0.762). Interrater reliability as assessed with Cohen's kappa coefficient was 0.774 (95% CI: 0.740, 0.807) for methodological evaluators and 0.618 (95% CI: 0.587, 0.648) for clinical evaluators. The overall content validity index was 0.905. Pearson's r correlation for criterion validity was 0.885 (95% CI: 0.804, 0.932). The mean usability score of the items was 4.6 and the median time spent to evaluate each guideline was 20 min.

Conclusion:
The instrument performed well in terms of reliability, validity, and efficiency, and can be used for comprehensively evaluating and ranking guidelines.
Surgical Approaches to Orbital Fractures: A Practical and Systematic Review
Authors: Palavalli Manoj H. , Huayllani Maria T. , Gokun Yevgeniya , Lu Yurong , Janis Jeffrey E. 
Published: May 2023

Background:
Orbital fractures constitute a significant percentage of all midface injuries. Here, we present a contemporary evidence-based review of the major surgical approaches for orbital wall fractures and analyze the literature to compare all major surgical procedures and their complication rates.

Method:
A systematic review was conducted to compare surgical approaches (subciliary, transcaruncular, transconjunctival, subtarsal, and endoscopic) and postoperative complications in patients who underwent surgical fixation of orbital wall fractures. A database search in PubMed (PubMed Central, MEDLINE and Bookshelf) was performed for all articles containing the terms “orbital,” “wall,” “fracture,” and “surgery” with different combinations.

Results:
A total of 950 articles were obtained and 25 articles were included, representing an analysis of 1137 fractures. The most frequent surgical approach was the endoscopic (33.3%) followed by the external surgical approaches, specifically transconjunctival (32.8%), subciliary (13.5%), subtarsal (11.5%), and transcaruncular (8.9%). The transconjunctival approach had a statistically significantly higher rate of complications (36.19%), followed by the subciliary (21.4%), and endoscopic approach (20.2%, P < 0.0001). The subtarsal approach had a statistically significantly lower rate of complications (8.2%) followed by the transcaruncular approach (14.0%, P < 0.0001).

Conclusion:
The subtarsal and transcaruncular approaches were observed to have the lowest rates of complications, whereas the transconjunctival, subciliary, and endoscopic approaches were reported to have higher rates of complications.
Etiological cure prevents further decompensation and mortality in patients with cirrhosis with ascites as the single first decompensating event
Authors: Tonon Marta , Balcar Lorenz , Semmler Georg , Calvino Valeria , Scheiner Bernhard , Incicco Simone , Barone Anna , Paternostro Rafael , Gambino Carmine G. , Bauer David Josef M. , Accetta Antonio , Hartl Lukas , Brocca Alessandra , Jachs Mathias , Trauner Michael , Mandorfer Mattias , Angeli Paolo , Reiberger Thomas , Piano Salvatore 
Published: May 2023

Background and Aims:
Removal/suppression of the primary etiological factor reduces the risk of decompensation and mortality in compensated cirrhosis. However, in decompensated cirrhosis, the impact of etiologic treatment is less predictable. We aimed to evaluate the impact of etiological treatment in patients with cirrhosis who developed ascites as single index decompensating event.

Approach and Results:
Patients with cirrhosis and ascites as single first decompensation event were included and followed until death, liver transplantation, or Q3/2021. The etiology was considered “cured” (alcohol abstinence, hepatitis C cure, and hepatitis B suppression) versus “controlled” (partial removal of etiologic factors) versus “uncontrolled.” A total of 622 patients were included in the study. Etiology was “cured” in 146 patients (24%), “controlled” in 170 (27%), and “uncontrolled” in 306 (49%). During follow-up, 350 patients (56%) developed further decompensation. In multivariable analysis (adjusted for age, sex, varices, etiology, Child-Pugh class, creatinine, sodium, and era of decompensation), etiological cure was independently associated with a lower risk of further decompensation (HR: 0.46; p = 0.001). During follow-up, 250 patients (40.2%) died, while 104 (16.7%) underwent LT. In multivariable analysis, etiological cure was independently associated with a lower mortality risk (HR: 0.35, p < 0.001).

Conclusions:
In patients with cirrhosis and ascites as single first decompensating event, the cure of liver disease etiology represents a main treatment goal since this translates into considerably lower risks of further decompensation and mortality.
Association between modifiable vascular risk factors and rapid progression of postradiation carotid artery stenosis
Authors: Cheng Ya-Wen , Chen Chih-Hao , Yeh Shin-Joe , Tsai Li-Kai , Wang Chun-Wei , Tang Sung-Chun , Jeng Jiann-Shing 
Published: May 2023

Background:
Postradiotherapy carotid vasculopathy is a clinically relevant complication in patients with head and neck cancer receiving radiotherapy. In this study, we investigated the factors associated with the development and progression of carotid artery stenosis (CAS) in such patients.

Methods:
Patients who received radiotherapy for head and neck cancers between October 2011 and May 2019 at a medical center in Taiwan were eligible for inclusion in this study. This study included patients who underwent two consecutive carotid duplex examinations within an interval of 1 to 3 years. The factors associated with ≥50% CAS at baseline and follow-up were analyzed.

Results:
In total, 694 patients (mean age, 57.8 ± 9.9 years; men, 75.2%; nasopharyngeal cancer, 73.3%) were included. The mean interval between radiotherapy and carotid duplex examination was 9.9 ± 5.9 years. At baseline, 103 patients had ≥50% CAS, which was significantly associated with tobacco smoking, hypercholesterolemia, and a prolonged interval between radiotherapy and carotid duplex examination. A total of 586 patients did not have CAS at baseline; of them, 68 developed ≥50% CAS during follow-up. Hypertension and hypercholesterolemia were identified as independent risk factors for CAS progression.

Conclusion:
Modifiable vascular risk factors, such as hypertension and hypercholesterolemia, appear to be significantly associated with the rapid progression of postradiotherapy CAS in patients with head and neck cancer.
The clinical safety of generic and brand clopidogrel in patients undergoing carotid endarterectomy: a randomized controlled trial
Authors: Kakamad Fahmi H. , Baqi Dana H. , Hassan Marwan N. , Salih Karzan M. , Rahim Hawbash M. , Mohammed Shvan H. , Abdalla Berun A. , Salih Rawezh Q. , Ali Rebwar A. , Kakamad Suhaib H. , Abdullah Hiwa O. 
Published: May 2023

Introduction:
Although some recent studies have found that original and generic clopidogrel brands are acceptable and have the same pharmacokinetic and pharmacodynamic properties, there is insufficient evidence to compare the clinical effectiveness and safety of brand and generic clopidogrel. The current study aims to evaluate the clinical safety of brand and generic clopidogrel by comparing clinical outcomes in patients undergoing carotid endarterectomy (CEA).

Method:
This was a single centre, parallel-arm, phase III, open-label, and randomized group sequential trial. It was conducted to compare the clinical safety of a brand and three generic clopidogrel forms in patients who have undergone CEA. All enrolled subjects were treated perioperatively with dual antiplatelet (aspirin and clopidogrel). The involved participants were assigned randomly into four groups based on the type of clopidogrel. Safety parameters were measured, including haematoma, blood draining from drainage, mouth deviation, tongue deviation, and stroke. SPSS software was used to perform the data analysis.

Results:
The trial included 80 patients in total (20 patients per group). Thirty-one (38.8%) patients were male. The mean age of patients was 65.6 years (49–79). Eighteen (22.5%) patients had a history of previous coronary intervention, and seventeen (21.3%) had symptomatic carotid artery stenosis. Overall, Plavix or Piax combined with aspirin were linked to better clinical safety than the other two generic clopidogrel, as the amount of bleeding was nearly two times lower in patients treated with Plavix or Piax (270±92.39 and 271.5±80.60, respectively) compared to PlavigrelAwa or Plavineer (505.7±169.1 and 496.5±174.6, respectively) (P≤0.001).

Conclusion:
The findings of the current study showed diversity in clinical safety of different clopidogrel formulations that were provided perioperatively in CEA patients.
Does Revision Carpal Tunnel Release Result in Long-term Outcomes Equivalent to Single Carpal Tunnel Release? A Matched Case-Control Analysis.
Authors: Westenberg Ritsaart F. , DiGiovanni Peter L. , Schep N.W.L. , Eberlin Kyle R. , Chen Neal C. , Coert J.H. 
Published: May 2023

Aims:
The aims of this study are: (1) to evaluate the long-term patient reported outcomes (PROM’s) after revision CTR and compare these outcomes with patients who had a single CTR and a comparable age, sex, race, type of initial surgery and follow-up time, and (2) assess which factors are associated with worse PROM’s after revision CTR.

Methods:
We retrospectively identified 7351 patients who had a single CTR and 113 patients who had a revision CTR for CTS between 01/2002 and 12/2015 at five academic urban hospitals. Of these 113 revision CTR cases, there were 37 patients who completed a follow-up questionnaire including the BCTQ, the NRS Pain and Satisfaction. Those who completed the follow-up questionnaire were randomly matched to five controls (patients who had a single CTR) based on age, sex, race, type of initial surgery, and follow-up time. Of these 185 matched controls, 65 patients completed the follow-up questionnaire.

Results:
A linear mixed effects model using the matched sets as a random effect showed that patients who had a revision CTR had a higher total BCTQ score, NRS pain score, and a lower satisfaction score at time of follow-up than patients who only had a single CTR. Multivariable linear regression showed that thenar muscle atrophy prior to the revision surgery was independently associated with more pain after revision surgery.

Conclusion:
Patients improve after revision CTR, but generally have more pain, a higher BCTQ score, and are less satisfied at long-term follow-up compared to patient who had a single CTR.
Insurance Status Predicts Hand Therapy Adherence Following Flexor Tendon Repair: A Retrospective Cohort Study”
Authors: McLaughlin Matthew T. , Moura Steven P. , Edalatpour Armin , Seitz Allison J. , Michelotti Brett F. 
Published: May 2023

Background:
Many patients are not adherent to hand therapy rehabilitation following surgical repair of traumatic flexor tendon injuries, which can negatively affect surgical outcomes and long-term hand function. We aimed to identify the factors that predict patient non-adherence to hand therapy following flexor tendon repair surgery.

Methods:
This retrospective cohort study included 154 patients who underwent surgical repair of flexor tendon injuries at a level I trauma center between January 2015 and January 2020. A manual chart review was performed to collect demographic data, insurance status, injury characteristics, and details of the postoperative course including health care utilization.

Results:
Factors significantly associated with occupational therapy no-shows included Medicaid insurance (OR, 8.35; 95% CI, 2.91 to 24.0; p < 0.001), self-identified Black race (OR, 7.28; 95% CI, 1.78 to 29.7; p = 0.006), and current cigarette smoker status (OR, 2.69; 95% CI, 1.18 to 6.15; p = 0.019). Patients without insurance attended 73.8% of their OT visits and patients with Medicaid attended 72.0% of their visits, which were significantly lower rates than those with private insurance 90.7% (p=0.026 and p=0.001, respectively). Patients with Medicaid were 8 times more likely to seek emergency department care postoperatively than patients with private insurance (p=0.002).

Conclusions:
Significant disparities in hand therapy adherence following flexor tendon repair surgery exist between patients with different insurance statuses, races, and tobacco use. Understanding these disparities can help providers identify at-risk patients to improve hand therapy utilization and postoperative outcomes.
Impact of Median MELD at Transplant Minus 3 National Policy on Quality of Transplanted Livers for Patients With and Without Hepatocellular Carcinoma
Authors: Mazur Rafal D. , Cron David C. , Chang David C. , Yeh Heidi , Dageforde Leigh Anne D. 
Published: May 2023

Background.
Patients with hepatocellular carcinoma (HCC) have been overprioritized in the deceased donor liver allocation system. The United Network for Organ Sharing adopted a policy in May 2019 that limited HCC exception points to the median Model for End-Stage Liver Disease at transplant in the listing region minus 3. We hypothesized this policy change would increase the likelihood to transplant marginal quality livers into HCC patients.

Methods.
This was a retrospective cohort study of a national transplant registry, including adult deceased donor liver transplant recipients with and without HCC from May 18, 2017, to May 18, 2019 (prepolicy) to May 19, 2019, to March 1, 2021 (postpolicy). Transplanted livers were considered of marginal quality if they met ≥1 of the following: (1) donation after circulatory death, (2) donor age ≥70, (3) macrosteatosis ≥30% and (4) donor risk index ≥95th percentile. We compared characteristics across policy periods and by HCC status.

Results.
A total of 23 164 patients were included (11 339 prepolicy and 11 825 postpolicy), 22.7% of whom received HCC exception points (prepolicy versus postpolicy: 26.1% versus 19.4%; P = 0.03). The percentage of transplanted donor livers meeting marginal quality criteria decreased for non-HCC (17.3% versus 16.0%; P < 0.001) but increased for HCC (17.7% versus 19.4%; P < 0.001) prepolicy versus postpolicy. After adjusting for recipient characteristics, HCC recipients had 28% higher odds of being transplanted with marginal quality liver independent of policy period (odds ratio: 1.28; confidence interval, 1.09-1.50; P < 0.01).

Conclusions.
The median Model for End-Stage Liver Disease at transplant in the listing region minus 3 policy limited exception points and decreased the quality of livers received by HCC patients.
Middle-income country perspectives on global mental health
Authors: Adams Amy S. , Sibeko Goodman , Stein Dan J. 
Published: May 2023

Purpose of review
Despite being a relatively new discipline, global mental health (GMH) has made substantial advances, paying particular attention to optimising the provision of mental health services in low- and middle-income countries (LMICs). Much of the work done in GMH has focused on low-income countries (LIC), but middle-income countries (MIC) such as Brazil, China, India, and South Africa, have particular characteristics that may impact the nature of this work. Here we examine key GMH issues, including mental health legislation, burden of disease, task-sharing, and mental health clinical and research capacity-building, in the MIC context.

Recent findings
In MICs there is particular concern about an increase in non-communicable diseases, including mental disorders. MICs have more resources than LICs, but the treatment gap in these settings remains significant. MICs are better equipped than LICs to mobilize task-sharing programs, and these can potentially include more highly educated community health workers. In MICs there have been important advances in mental health legislation, but more is needed regarding implementation and the promotion of human rights. Clinical and research capacity-building initiatives in MIC contexts are easier to establish and have potential to be more ambitious in scope.

Summary
GMH has developed important universal principles that apply across low-, middle-, and high-income countries. Nevertheless, particular issues in MICs may require moulding of more general GMH frameworks.