bluuebunny/crossref_metadata_2025_split huggingface dataset:
Door-to-furosemide time and clinical outcomes in acute heart failure
Authors: Marques Pedro , Brito Maria T. , Vasques-Nóvoa Francisco , Ferreira João P. , Jardim Ana L. , Gouveia Rita , Besteiro Bruno , Vieira Joana T. , Gomes Filipa , Leite-Moreira Adelino , Bettencourt Paulo , Almeida Jorge , Friões Fernando 
Published: February 2023

Background and importance
Acute heart failure (AHF) is one of the main causes of unplanned hospitalization in patients >65 years of age and is associated with adverse outcomes in this population. Observational studies suggest that intravenous diuretic therapy given in the first hour of presentation for AHF was associated with favorable outcomes.

Objectives
To study the short-term prognostic associations of the timing of intravenous diuretic therapy in patients admitted to the emergency department (ED) for acute AHF.

Design, settings and participants
Patients treated in the ED with intravenous diuretics were selected from the Estratificação de Doentes com InsuFIciência Cardíaca Aguda (EDIFICA) registry, a prospective study including AHF hospitalized patients. Early and non-early furosemide treatment groups were considered using the 1-h cutoff: door-to-furosemide ≤1 h and >1 h.

Outcomes measure and analysis
Primary outcomes were a composite of heart failure re-hospitalizations or cardiovascular death at 30- and 90-days.

Main results
Four-hundred ninety-three patients were included in the analysis. The median (interquartile range) door-to-furosemide time was 85 (41–220) min, and 210 (43%) patients had diuretics in the first hour. Patients in the ≤1 h group had higher evaluation priority according to the Manchester Triage System, presented more often with acute pulmonary edema, warm-wet clinical profile, higher blood pressure, and signs of left-side heart failure, while >1 h group had higher Get With the Guidelines-heart failure risk score, more frequent signs of right-side heart failure, higher circulating B-type natriuretic peptides and lower albumin. Door-to-furosemide ≤ 1 h was independently associated with lower 30-day heart failure hospitalizations and composite of heart failure hospitalizations or cardiovascular death (adjusted analysis Heart Failure Hospitalizations: odds ratios (OR) 3.65; 95% confidence interval (CI), 1.22–10.9; P = 0.020; heart failure hospitalizations or cardiovascular death: OR 3.15; 95% CI, 1.49–6.64; P < 0.001). These independent associations lost significance at 90 days.

Conclusion
Door-to-furosemide ≤1 h was associated with a lower short-term risk of heart failure hospitalizations or cardiovascular death in AHF patients. Our findings add to the existing evidence that early identification and intravenous diuretic therapy of AHF patients may improve outcomes.
Use of a modified retrograde femoral rod as a custom length tibiotalocalcaneal nail
Authors: Waldron Jacob , Bandovic Ivan , Olson Adrian , Denisiuk Marek , Layson James , Afsari Alan , Best Benjamin J. 
Published: February 2023

Abstract:
There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.
A systematic review of patient-centered interventions for improving pain outcomes and reducing opioid-related risks in acute care settings
Authors: Seilern und Aspang Jesse , Schenker Mara L. , Port Ada , Leslie Sharon , Giordano Nicholas A. 
Published: February 2023

Abstract

Objectives:
This systematic review evaluates the literature for patient-oriented opioid and pain educational interventions that aim to optimize pain management using opioid-sparing approaches in the orthopaedic trauma population. The study protocol was registered with PROSPERO (CRD42021234006).

Data Sources:
A review of English-language publications in CINAHL (EBSCO), MEDLINE through PubMed, Embase.com, PsycInfo (EBSCO), and Web of Science Core Collection literature databases published between 1980 and February 2021 was conducted using PRISMA guidelines.

Study Selection:
Only studies implementing patient-oriented opioid and/or pain education in adult patients receiving acute orthopaedic care were eligible. Outcomes were required to include postinterventional opioid utilization, postoperative analgesia and amount, or patient-reported pain outcomes.

Data Extraction:
A total of 480 abstracts were reviewed, and 8 publications were included in the final analysis. Two reviewers independently extracted data from selected studies using a standardized data collection form. Disagreements were addressed by a third reviewer. Quality of studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis:
Descriptive statistics characterized study findings, and content analysis was used to discern themes across studies.

Conclusion:
Our findings indicate the merit for patient-centered educational interventions including verbal/written/audio–visual trainings paired with multimodal approaches to target opioid-sparing pain management and reduce short-term pain scores in urgent and acute care settings after acute orthopaedic injuries. The scarcity of published literature warrants further rigorously designed studies to substantiate the benefit of patient-centric education in reducing prolonged opioid utilization and associated risks after orthopaedic trauma.

Level of Evidence:
Therapeutic level III.
A systematic review of kissing as a risk factor for oropharyngeal gonorrhoea or chlamydia
Authors: Charleson Finley , Tran Julien , Kolobaric Adam , Case Richard , Fairley Christopher K. , Hocking Jane S. , Chow Eric P.F. 
Published: February 2023

ABSTRACT

Background
Tongue kissing is a poorly studied risk factor for sexually transmitted infections (STIs). We undertook the first systematic review to assess whether kissing is a risk factor for gonorrhoea or chlamydia of the oropharynx.

Methods
Online databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane) and reference lists were searched until September 30th, 2022. The eligibility criteria for studies included: any peer-reviewed study design in the English language; gonorrhoea or chlamydia diagnosed by NAAT, or an infection self-reported by a patient; tongue kissing or its equivalent measured as an exposure. Studies were appraised using a quality scoring tool and qualitatively synthesised.

Results
Of 8248 studies screened, six were eligible for review. All were conducted among men who have sex with men (MSM) in Australia, including three prospective cohort studies, two cross-sectional studies, and one age-matched case-control study. In summary, all five studies examining gonorrhoea found an unadjusted association between kissing and oropharyngeal gonorrhoea. Two cross-sectional studies found that tongue kissing was an independent risk factor for oropharyngeal gonorrhoea after adjusting for other confounders such as participant demographic characteristics and other sexual practices. In contrast, a single eligible prospective cohort study found no association between kissing and oropharyngeal chlamydia.

Conclusions
This systematic review summarised the existing evidence, which suggests that tongue kissing may be a risk factor for oropharyngeal gonorrhoea but not chlamydia. Reinforcing the message that oropharyngeal gonorrhoea could be transmitted through kissing may inform the development of novel approaches to prevent gonorrhoea.
The Value of Hearing Aids for the Italian NHS: A Cost-utility Analysis
Authors: Fornaro Giulia , Armeni Patrizio , Albera Andrea , Barbara Michele 
Published: February 2023

Objective:
Hearing loss (HL) prevalence in Italy is expected to increase due to population aging. Hearing aids (HAs) are the main tool for HL rehabilitation; however, cost-utility analyses of HAs are limited. Our objective was to estimate the cost-utility of HAs use.

Study Design:
Cost-utility analysis.

Setting:
Italian National Healthcare Service, societal perspective.

Patients, Intervention(s), and Main Outcome Measure(s):
A multistate Markov model was developed to model a cohort of 55-year-old individuals starting from normal hearing and moving across HL states to compare cost-utility and net monetary benefit of HA use accompanied by post-purchase service, HA use alone, and no treatment. Parameters were estimated using secondary data. Incremental cost-utility ratio (ICUR) and incremental net monetary benefit (INMB) were computed against a €16,625/quality-adjusted life year (QALY) willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analysis (DSA, PSA) was implemented to assess how uncertainty affected results. Scenario analysis was performed on different assumptions on costs, dropout and compliance rates.

Results:
The model suggests HAs use is a cost-effective strategy compared to no treatment (in the base case: incremental costs €429–€476, incremental QALY gain 0.18 and 0.19, ICUR €2‚404/QALY–€2‚450/QALY, INMB €2‚476–€2‚682 for male and female cohort, respectively). By assuming no dropout, INMBs increase up to €10,643–€10,728. DSA highlights that utility weights contribute the most to model uncertainty, PSA shows that the treatment has 97.8%–97.3% probability of being cost-effective at the WTP threshold considered.

Conclusions:
We proposed an original model to assess the cost-utility of HAs use; the application to the Italian setting suggests the treatment is cost-effective, reinforcing the importance of early uptake.
Decision Making for Active Surveillance in Vestibular Schwannoma
Authors: Smith Harrison , Odeh Ahmad , Kallogjeri Dorina , Piccirillo Jay F. 
Published: February 2023

Objective:
To describe the experiences of patients who elected for the active surveillance treatment option for their vestibular schwannoma (VS).

Study Design:
Twenty-two patients participated in semistructured patient interviews.

Setting:
Interviews were conducted between March and April 2021 via telephone with audio recordings and notes taken during each interview.

Patients:
Adults diagnosed with a VS and at any point after their diagnosis underwent a period of active surveillance were recruited based on the diagnosis made by MRI. Patients were excluded if they chose to undergo treatment immediately, had a diagnosis of neurofibromatosis type 2, or if they had a confirmed alternative diagnosis.

Intervention:
This intervention was a qualitative interview to assess patient experiences with their VS treatment decision.

Main Outcome Measures:
Identifying abstract categories that represent many of the stories told by the participants that produces a theory grounded in the data with explanatory power.

Results:
Factors that influenced patients’ treatment decisions were perceived physician bias, selfeducation, and personal accounts of VS patients through support groups, and side effects/complications of the various treatment options.

Conclusion:
Patients who opted for active surveillance as a treatment option reported high satisfaction with their decision and greater confidence in future treatments that would be necessary based on tumor growth. Future work should be done to increase shared decision making between the physician and patient to arrive at a treatment plan that aligns with their goals of care as well as potentially reducing overtreatment of VS.
Rates of Sensorineural Hearing Loss and Revision Surgery After Stapedotomy: A Single-institution Experience Using the Nitinol Prosthesis
Authors: Quimby Alexandra E. , Parekh Manan , Darwich Nabil F. , Hwa Tiffany P. , Eliades Steven J. , Brant Jason A. , Bigelow Douglas C. , Ruckenstein Michael J. 
Published: February 2023

Background:
Historically, stapedectomy complication rates are quoted as 1% profound postoperative sensorineural hearing loss (SNHL), 5%–10% nonprofound SNHL, and 5%–10% revision surgery.

Objective:
We sought to reassess rates of post-stapedotomy complications based on our experience using contemporary surgical technique.

Methods:
A retrospective case series was carried out at an academic tertiary referral center. Adult patients undergoing stapedotomy from 2013 to 2020 were included. Primary outcomes were rates of hearing loss and revision surgery. Rates of dizziness, tinnitus, dysgeusia, and proportions of patients who achieved air-bone gap (ABG) closure at 8–12 weeks postoperatively were also assessed.

Results:
Four hundred sixty-eight stapedotomies in 399 patients with a median follow-up duration of 99 days (range, 11–5134) were reviewed. One patient (0.21%) suffered profound SHNL and 15 (3.20%) patients suffered nonprofound SNHL. The revision rate for stapedotomies from our institution was 4.49% (21 total revision surgeries). In 277 operations (59.19%), the patient had closure of the ABG within 10 dB. A further 132 (28.21%) had closure of the ABG between 10 and 20 dB. Air pure-tone audiometry scores improved by an average of 25.03 dB. Eighty-three (17.74%) patients complained of postoperative dizziness, which resolved by the time of the first follow-up appointment in all but 26 (5.56%). Seventeen patients (3.63%) complained of tinnitus, and 22 (4.70%) complained of dysgeusia.

Conclusions:
SNHL, complications, and revision rates for stapedotomy in the modern era may be substantially lower than those currently presented to patients based on classic techniques and historical data.
Improving Documentation of Postdischarge Issue Mitigation during Postdischarge Phone Calls
Authors: Vepraskas Sarah , Osorio Snezana Nena , Bauer Sarah Corey , Stephany Alyssa , Gage Sandra 
Published: February 2023

Introduction:
Postdischarge phone calls (PDPCs) are recommended to identify and mitigate postdischarge issues such as missed follow-up appointments, medication errors, and failure to activate contingency plans. A current state assessment showed variability in documenting PDPC content and postdischarge issue mitigation. Therefore, the primary aim was to improve the postdischarge issue mitigation documentation rate from 65% to 100% over 16 months.

Methods:
An interdisciplinary quality improvement team used the Model for Improvement to perform planned sequential interventions over 16 months. The outcome measure was documentation of postdischarge issue mitigation. Process measures included PDPC template use and completion and postdischarge issue identification. Balancing measures included call attempts and caller perceptions of ease of documentation. Interventions included creating a flowsheet note template, creating caller template training sessions, and sharing team data and feedback. We gathered data via reports generated from the electronic medical record, chart review, and survey. Data were analyzed using statistical process control charts and established rules for detecting special cause variation.

Results:
The postdischarge issue mitigation documentation increased from 65% to 91% over 16 months. Template use and completion increased from 0% to 100% and 98%, respectively. The number of postdischarge issues identified remained unchanged. Call attempts increased from 40% to 59%. Caller perceptions remained unchanged.

Conclusions:
Documentation of postdischarge issues and issue mitigation promotes adequate communication with the patient’s care providers, improving the quality and safety of care. Data sharing to promote team engagement was the key factor in improving documentation of postdischarge issue mitigation.
“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”
Authors: Harrison Lucas M. , Mathew Denzil P. , Cole Naomi A. , Sachdeva Sanchit , Hallac Rami R. , Derderian Christopher A. 
Published: February 2023

Background:
Sagittal craniosynostosis results in variable degrees of frontal bossing and bilateral temporal pinching. This study assesses the three-dimensional (3D) changes in these regions utilizing curvature analysis and volumetric analysis before, and 1-year after, extended sagittal strip craniectomy with post-operative helmet therapy (ESC).

Methods:
A retrospective review of 3D photographs of 50 subjects treated with ESC and 50 age-matched controls was performed. Images were collected pre-operatively and 1-year post-operatively. The convexity of the forehead and concavity of the temples were quantified. CT scans of normal subjects and subjects with sagittal synostosis were analyzed to assess the percent of total intracranial volume in the anterior cranial fossa before and after ESC.

Results:
Forehead convexity in ESC pre-operatively (24.49±3.16 m -1) was significantly greater than controls (22.48±3.84 m -1; p=0.005). Forehead convexity significantly decreased after ESC (18.79±2.43 m -1; p<0.001) and did not differ from controls (19.67±3.08 m -1; p=0.115). The ESC group had more concave temples pre-operatively (-10.27±4.37 m -1) as compared to controls (-6.99±3.55 m -1; p<0.001). Temple concavity significantly decreased after ESC (-4.82±3.17 m -1; p<0.001) and did not differ from controls (-5.64±3.27 m -1; p=0.075). In the ESC group, the percent ICV in the anterior cranial fossa decreased from 22.03% to 18.99% after surgery while the anterior volume in controls was stable (17.74% to 16.81%).

Conclusions:
The ESC group had significantly greater forehead convexity, temple concavity and anterior cranial fossa volume compared to controls. One year after ESC, forehead convexity, temple concavity, and percent ICV in the anterior fossa were comparable to controls.
New Horizons in Vascular Imaging With Photon-Counting Detector CT
Authors: Wildberger Joachim E. , Alkadhi Hatem 
Published: February 2023

AbstractNoninvasive vascular imaging with computed tomography (CT) has become the clinical mainstay for many indications and body regions. The recent introduction of photon-counting detector (PCD)-CT into clinical routine has further broadened the spectrum of vascular applications. Technical improvements of PCD-CT, such as the decreased noise levels, improved contrast-to-noise ratio, and full spectral multienergy data information from every acquisition, have the potential to further impact on clinical decision making and ultimately on outcome of vascular patients. Early experience with the new PCD-CT technology demonstrates these improvements in various aspects. This review summarizes the main advantages of PCD-CT for vascular imaging a discussion of the PureLumen and PureCalcium algorithms.
IMMUNOSUPPRESSION CORRELATES WITH THE DETERIORATION OF SEPSIS-INDUCED DISSEMINATED INTRAVASCULAR COAGULATION
Authors: Sun Yini , Sun Hao , Feng Jianshuang , Wang Chaoyang , Zheng Jiayin , Ma Xiaochun 
Published: February 2023

ABSTRACT

Background: The dysregulated host responses play a crucial role in the pathophysiology process of sepsis-induced disseminated intravascular coagulation (DIC). The study aimed to characterize the dynamic alternation of immune-related biomarkers and their relationship with the progression of DIC during sepsis. Methods: A prospective, observational study was conducted in a tertiary care academic hospital. Six hundred forty patients with sepsis were classified into three groups according to the International Society on Thrombosis and Hemostasis (ISTH) score: 383 involved patients without DIC (ISTH = 0), 168 sepsis with nonovert DIC (ISTH = 1–4), and 89 sepsis with overt DIC (ISTH ≥5). Eighteen immune-related biomarkers and six routine coagulation variables were examined at D1, D3, and D7 upon enrollment. The association between the immune parameters and the DIC deterioration was assessed during sepsis. Results: The study showed a 40% coagulation disorder and a 14% incidence of overt DIC in patients with sepsis. The patients with overt DIC displayed pronounced immune disorders from D1 to D7 upon sepsis, which was characterized by the decreased percentage of monocyte HLA-DR (mHLA-DR), increased percentage of regulatory T cells, the levels of procalcitonin, neutrophil CD64 index, and systemic inflammatory cytokines relative to nonovert DIC or non-DIC patients. In multivariate analysis, the combination of anti-inflammatory cytokine IL-10 and mHLA-DR at D1 upon enrollment had a superior predictive value for predicting DIC deterioration in sepsis (area under the curve = 0.87, P < 0.0001). Conclusion: These data illustrate that immunosuppression can crosstalk with coagulation disorder during sepsis and present an additional evaluation tool to predict DIC deterioration.
Assessment of adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia: a multicenter cross-sectional study
Authors: Fekede Mulualem S. , Abebe Bereket A. , Awol Meron A. 
Published: February 2023

Background:
Preoperative fasting is compulsory before anesthesia to lower the risk of pulmonary aspiration. However, it is usually prolonged beyond the recommended time affecting the patient’s comfort and has several deleterious effects.

Objective:
To assess the adherence to preoperative fasting guidelines and associated patient discomfort in adult elective surgical patients in public hospitals of Addis Ababa, Ethiopia.

Materials and methods:
A multicenter cross-sectional study was conducted on 422 adult patients who underwent elective surgery at Addis Ababa public hospitals from February 20, to May 10, 2021. The collected data were entered into SPSS, version 24 for analysis. Spearman correlation and independent t test were used to assess the relationship between preoperative fasting time and explanatory variables, as appropriate. P value <0.05 was considered as statistically significant.

Results:
Majority (97.4%) of patients were instructed to fast from midnight regardless of the food type and schedule. Majority (98.1%) of the participants did not adhere to the preoperative fasting guidelines. The mean preoperative fasting time was 14.26±2.35 hours (range: 8–22 h) for solid foods and 13.89±2.37 hours (range: 8–21 h) for clear fluids. More than half (64%) of the participants felt preoperative discomfort, and factors contributing were thirst, hunger, mouth dryness, lengthy waiting of prior surgery, and tiredness. There was a moderate positive correlation between preoperative fasting time and severity of patient discomfort (P<0.001). There was also a strong positive correlation between total fasting time and the sequence of patient’s schedule (P<0.001).

Conclusions:
Preoperative fasting for solids and clear liquids was longer than the recommended international fasting guidelines. Preoperative fasting duration had an association with preoperative discomforting factors. Incorrect orders of instructions and changing sequences of schedule challenged the preoperative fasting adherence. Thus, preoperative fasting instructions should be clear, individualized; and health professionals need to communicate when surgery is delayed or changed.