bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Clinical Outcomes of Spinal Accessory to Suprascapular Nerve Transfer Through a Posterior Approach
Authors: Jimulia Devanshi T. , Duraku Liron S. , Parekh Jvalant N. , George Samuel , Chaudhry Tahseen , Power Dominic M. 
Published: September 2023

Background: Spinal accessory nerve (SAN) to suprascapular nerve (SSN) transfer can restore function to the rotator cuff following brachial plexus injuries. The traditional anterior approach using the lateral branch of the SAN causes denervation of the lateral trapezius limiting shoulder elevation. Suprascapular nerve pathology at the suprascapular notch may be missed resulting in poor reinnervation of the rotator cuff. The posterior approach uses the medial SAN and allows decompression and visualization of the SSN at the notch and nerve transfer coaptation closer to the target muscles with a shorter reinnervation distance. Methods: This is a review of 28 patients from 2014 to February 2020 who underwent SAN to SSN nerve transfer via a posterior approach. Patients were evaluated for SSN pathology, external rotation power, and range of motion. Data were evaluated for high-energy trauma (HET) and low-energy trauma/nontraumatic etiology subsets. Results: A total of 8 HET (40%) patients had pathology identified at the suprascapular notch during the posterior approach, including SSN scarring, ruptures, neuromata-in-continuity, and ossification of ligaments. British Medical Research Council grade greater than or equal to 4 shoulder external rotation was achieved in 75% patients with median range of motion 137.5°. Conclusions: Spinal accessory nerve to SSN transfer using a posterior approach allows visualization of pathology involving the SSN and coaptation of a medial SAN transfer close to the target muscles. Following HET, 8 cases (40%) had posterior pathology identified. Spinal accessory nerve to SSN transfer through a posterior approach shows improved external rotation power and range of motion.
Psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns: A cross-sectional survey study
Authors: Regalado Diego , Connolly Meghan E. , Krutsch Kaytlin , Stark Amy , Kendall-Tackett Kathleen , Garner Christine D. 
Published: September 2023

Background: Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population. Objectives: This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns. Design: Anonymous, online cross-sectional survey. Methods: Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS. Results: The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns. Conclusion: Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.
Prospective study comparing outcomes of primary intraplexal repair versus distal nerve transfers in Narakas grade I birth brachial plexus palsy
Authors: Thatte Mukund R. , Nayak Nayana S. 
Published: September 2023

To compare the results of intraplexal repair and distal nerve transfer in babies with birth brachial plexus palsy (BBPP), children with Narakas group I obstetric palsy were assigned to two groups of 16 each. Children in group A were treated with classical intraplexal repair and those in group B were treated by distal nerve transfers. At 6 months, all the children in group B had achieved Modified Medical Research Council (MMRC) grade 3 elbow flexion along with 8 of the 16 children in group A, which was a statistically significant difference. At 6 months, all the children in group B achieved MMRC grade 3 or higher shoulder abduction and 8 of the 16 children in group A had done so, which was also statistically significant. At the final follow-up, the distal transfer surgical treatment group had a significantly higher Mallet score. Distal nerve transfers have a significant advantage in early recovery in elbow flexion and shoulder abduction, but the outcomes became similar after 9 months. Level of evidence: III
Functional outcome of 2-D- and 3-D-guided corrective forearm osteotomies: a systematic review
Authors: Meesters Anne M. L. , Assink Nick , IJpma Frank F. A. 
Published: September 2023

We performed a systematic review to compare conventional (2-D) versus 3-D-guided corrective osteotomies regarding intraoperative results, patient-reported outcome measures, range of motion, incidence of complications and pain score. PubMed (MEDLINE), Embase and Cochrane CENTRAL were searched, and 53 articles were included, reporting 1257 patients undergoing forearm corrective osteotomies between 2010 and 2022. 3-D-guided surgery resulted in a greater improvement in median Disabilities of the Arm, Shoulder and Hand (DASH) score (28, SD 7 vs. 35, SD 5) and fewer complications (12% vs. 6%). Pain scores and range of motion were similar between 3-D-guided and conventional surgery. 3-D-guided corrective osteotomy surgery appears to improve patient-reported outcomes and reduce complications compared to conventional methods. However, due to the limited number of comparative studies and the heterogeneity of the studies, a large randomized controlled trial is needed to draw definitive conclusions. Level of evidence: III
Carpal fractures: epidemiology, classification and treatment of 6542 fractures from the Swedish Fracture Registry
Authors: Zander Maria E. L. , Swärd Elin , Björkman Anders , Wilcke Maria 
Published: September 2023

This study describes the age and sex distribution, trauma mechanism, treatment and influence of patient-reported outcomes of 6542 carpal fractures from the Swedish Fracture Registry (SFR). The most commonly fractured carpal bone was the scaphoid (60%), followed by the triquetrum (25%), hamate (5%) and trapezium (4%). The mean age at injury was 41 years, and 69% of patients were male. The age and sex distribution of carpal fractures differed substantially between the different carpal bones. Men were more likely to sustain a carpal fracture after high-energy trauma and were more likely to be treated surgically. Carpal fractures had a small negative effect on the Short Musculoskeletal Function Assessment Hand/Arm Index and EQ-5D scores 1 year after the injury. Level of evidence: IV
Chronic scrotal content pain: the experiences of patients undergoing microsurgical spermatic cord denervation
Authors: Banner Davina , Cassidy Darby , Appleby Colin , Dolan Shayna , Freeman Shannon , Klassen-Ross Tammy , Ghag Kiranpreet 
Published: September 2023

Background: Chronic scrotal content pain, sometimes referred to as chronic orchialgia, is a common urological condition that gives rise to persistent and often severe painful stimuli to the scrotum and surrounding structures. Despite its relative commonality, accounting for over 2% of urological visits, chronic scrotal content pain is complex to manage and patients may be required to access multiple providers and undergo invasive procedures, including microsurgical spermatic cord denervation (MSCD) surgery. Objective: The objective of this study was to understand the experiences and perspectives of persons with chronic scrotal content pain and accessing MSCD surgery. Design: An exploratory qualitative design, guided by interpretive description and integrated knowledge translation, was adopted. Methods: We conducted in-depth qualitative interviews with six patients with chronic scrotal content pain who underwent MSCD surgery in a surgical center in Western Canada. Data were analyzed thematically. Results: Analysis of the study data resulted in three core themes: living with chronic scrotal content pain, quality of life, and MSCD procedure and outcomes. We highlight the debilitating nature of pain and the broad impacts upon health, quality of life, and social functioning. Participants described how MSCD surgery offered an effective solution for persistent and debilitating pain. For the participants, MSCD surgery offered hope and the chance to regain their normality. Conclusion: For those with chronic scrotal content pain, access to a pain specialist, along with the adoption of a biopsychosocial approach to pain and early access to MSCD surgery, may improve patient experiences and outcomes. Considering the high prevalence of urological pain, greater interdisciplinary care is needed in order to support more effective and timely management.
Using Continuous Glucose Monitoring Values for Bolus Size Calculation in Smart Multiple Daily Injection Systems: No Negative Impact on Post-bolus Glycemic Outcomes Found in Real-World Data
Authors: Diaz-Garelli Franck , Shah Aakash , Mikhno Arthur , Agrawal Pratik , Kinnischtzke Amanda , Vigersky Robert A. 
Published: September 2023

Background: Recent evidence shows that it may be safe to estimate bolus sizes based on continuous glucose monitoring (CGM) rather than blood glucose (BG) values using glycemic trend-adjusted bolus calculators. Users may already be doing this in the real world, though it is unclear whether this is safe or effective for calculators not employing trend adjustment. Methods: We assessed real-world data from a smart multiple daily injections (MDIs) device users with a CGM system, hypothesizing that four-hour post-bolus outcomes using CGM values are not inferior to those using BG values. Our data set included 184 users and spanned 18 months with 79 000 bolus observations. We tested differences using logistic regression predicting CGM or BG value usage based on outcomes and confirmed initial results using a mixed model regression accounting for within-subject correlations. Results: Comparing four-hour outcomes for bolus events using CGM and BG values revealed no differences using our initial approach ( P > .183). This finding was confirmed by our mixed model regression approach in all cases ( P > .199), except for times below range outcomes. Higher times below range were predictive of lower odds of CGM-based bolus calculations (OR = 0.987, P < .0001 and OR = 0.987, P = .0276, for time below 70 and 54 mg/dL, respectively). Conclusions: We found no differences in four-hour post-bolus glycemic outcomes when using CGM or BG except for time below range, which showed evidence of being lower for CGM. Though preliminary, our results confirm prior findings showing non-inferiority of using CGM values for bolus calculation compared with BG usage in the real world.
The association of upper respiratory infections with neuro-radiological course and attack rate of multiple sclerosis: Results from a large prospective cohort
Authors: Ghasemi Moein , Farazandeh Dorreh , Amini Behnam , Sedaghat Mona , Najafi Anahita , Khayatzadeh Kakhki Simin , Torabi Pouya , Jafarimehrabady Niloofar , Bitaraf Ali , Shariati Houria , Gholampour Golsa , Kazemi Saminnaz , Naser Moghadasi Abdorreza , Vajihinejad Maryam 
Published: September 2023

Background Although upper respiratory infections (URIs) are linked to multiple sclerosis (MS) attacks, SARS-COV2 has not been compared to URIs for attack rates. Objectives This study aimed to evaluate the attack rate and the results of neuroimaging in MS patients with URIs caused by COVID-19 and non-COVID-19 infections (NC-URI). Methods From May 2020 to April 2021, we followed 362 patients with relapsing-remitting MS in a prospective cohort design. Patients were monitored regularly every 12 weeks; an magnetic resonance imaging (MRI) scan was performed at enrollment and every time a relapse occurred. Poisson analysis was used to determine exacerbation rate ratios (RR) and the MRI parameters were tested using chi-square analysis. Results 347 patients with an average age of 38 and a female ratio of 86% were included. A RR of 2.24 ( p < 0.001) was observed for exacerbations during the at-risk period (ARP). Attacks related to COVID-19 (RR = 2.13, p = 0.001) and NC-URIs (RR = 2.39, p < 0.001) were comparable regarding the increased risk of exacerbation ( p = 0.62). Exacerbations within or outside the ARP did not significantly alter the number of baseline GAD-enhancing lesions ( p > 0.05 for both). Conclusion COVID-19 has been shown to increase the risk of MS exacerbations, like other viral URIs.
Real world patient-reported and health care professional-perceived pain severity in outpatient fracture clinic procedures
Authors: Milton Lauren , Oliogu Etinosa , Finkelstein Samuel , Zhang Liying , Azevedo Lucas , Behroozian Tara , Yee Albert , Henry Patrick , Chow Edward , Finkelstein Joel 
Published: September 2023

Introduction Management of orthopaedic fractures involves acute intervention and follow up through to recovery. Patient-centered care needs to encompass all aspects of this treatment. Limited research is available on outpatient satisfaction and patient-reported outcomes from fracture clinic (FRCL). The purpose of this evaluation is to report on pain levels perceived by patients from minor orthopaedic procedures that were necessary for the continued management of fracture care. Methods Patients were recruited in the FRCL if they were planned to undergo minor orthopaedic procedures. They were asked to report the pain they experienced at baseline, during the procedure, 20 min post-procedure, and 24 h following the procedure on a verbal numeric rating scale of 0–10. Healthcare professionals (HCP) were then asked to rank their perception of the severity of pain from each procedure type. Finally, qualitative interviews were conducted on a convenience sample of patients. Results 51 patients were included in this evaluation. Halo pin, external fixation device, Kirschner wire, and screw removal exhibited a mean increase in pain from baseline greater than 3 units during the procedure. The external fixation device removal group showed the greatest pain reported with a statistically significant increase from baseline to the end of the procedure (mean = 7.1; p = 0.002). There was good concordance of pain perception by the HCP to patient experience. Qualitative interviewing revealed two major themes. Discussion This study provided valuable qualitative and quantitative insight into the pain perceptions by FRCL patients. This data may help improve the patient experience inside the FRCL.
Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) – protocol for a research collaboration
Authors: Fraser Simon DS , Stannard Sebastian , Holland Emilia , Boniface Michael , Hoyle Rebecca B , Wilkinson Rebecca , Akbari Ashley , Ashworth Mark , Berrington Ann , Chiovoloni Roberta , Enright Jessica , Francis Nick A , Giles Gareth , Gulliford Martin , Macdonald Sara , Mair Frances S , Owen Rhiannon K , Paranjothy Shantini , Parsons Heather , Sanchez-Garcia Ruben J , Shiranirad Mozhdeh , Zlatev Zlatko , Alwan Nisreen 
Published: September 2023

Background Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled ‘MELD-B’ to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. Aim Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses. Design We will develop deeper understanding of ‘burdensomeness’ and ‘complexity’ through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential ‘preventable moments’, defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.
Elevated serum TARC levels precede classic Hodgkin lymphoma diagnosis by several years
Authors: Diepstra Arjan , Nolte Ilja M. , van den Berg Anke , Magpantay Larry I. , Martínez-Maza Otoniel , Levin Lynn I. 
Published: September 2023

Abstract
Tumor cells in classic Hodgkin lymphoma produce high quantities of the thymus- and activation-related chemokine (TARC). We measured TARC levels in prediagnostic serum samples and found strikingly increased values in the vast majority of patients, as early as 6 years before diagnosis.
Light electric vehicles: the views of users and non-users
Authors: Mesimäki Johannes , Lehtonen Esko 
Published: September 2023

Abstract
Purpose
Light electric vehicles (LEVs), such as e-bikes, e-scooters and electric two-wheelers, can potentially assist the transition to a sustainable transport system due to their low energy and spatial demands. This exploratory survey study investigated and compared the views of LEV users and interested non-users on the vehicles’ advantages in Finland, Austria, Spain and Italy among urban residents (n = 4090) to understand factors influencing their adoption. Additionally, differences between personal and shared vehicles were investigated.

Method
The survey queried respondents on the advantages of either the LEV they used most often, or the LEV they were most interested in using. Of respondents, 26% were LEV users, 37% were non-users interested in using an LEV and 37% were uninterested non-users. Factors concerning comfort, accessibility, safety, and practicality of travel were formed. The effects of respondent type (user vs. non-users), LEV type, whether the LEV was shared or personal, age, gender and country were examined with a full-factorial ANOVA for each factor and some additional variables.

Findings
In general, LEVs were regarded well for travel comfort and supporting accessibility, but less positively for safety and assisting with practical aspects of travel. LEVs were also perceived environmentally friendly. Furthermore, users perceived LEVs more positively than non-users, while age and gender only mildly influenced views. The results suggest that increased familiarity with LEVs is associated with more favourable views concerning them. Existing positive views may have led to LEV use; however, experience could have changed these views as well. LEVs are novel vehicles with recognised benefits, but low familiarity may hinder adoption. Increasing familiarity with LEVs among non-users could encourage uptake, potentially supporting modal shifts from the car to LEVs and thus assist the transition to a more sustainable transport system.
Exploratory laparotomy during the battle of Mosul, 2016–2017: results from a tertiary civilian hospital in Erbil, Iraqi Kurdistan
Authors: Muhrbeck Måns , Egelko Aron , Haweizy Rawand Musheer , von Schreeb Johan , Älgå Andreas 
Published: September 2023

Abstract
Background
The Battle of Mosul (2016–2017) was an urban conflict resulting in over 9000 civilian deaths. Emergency Management Centre (EMC), located 90 km from Mosul, was designated as a civilian-run trauma centre as part of the novel Mosul Trauma Pathway. Patients necessitating exploratory laparotomy (ex-lap) provide a unique window into the system of care delivery in conflicts, given the importance of timely, resource-intensive care. However, there is insufficient knowledge regarding the presentation and outcomes for conflict-related ex-lap in civilian institutions.

Methods
This is a descriptive study retrospectively analyzing routinely collected data for all patients who underwent ex-lap at EMC for injuries sustained during the battle of Mosul. Differences in demographics, pre-hospital/hospital course, and New Injury Severity Scores (NISS) were analysed using student t-test, Hotelling T-squared, and linear regression.

Results
During the battle, 1832 patients with conflict-related injuries were admitted to EMC. Some 73/1832 (4.0%) underwent ex-lap, of whom 22/73 (30.1%) were children and 40/73 (54.8%) were non-combatant adults. Men constituted 51/73 (69%) patients. Gunshot wounds caused 19/73 (26.0%) injuries, while ordnances caused 52/73 (71.2%). Information regarding hospital course was available for 47/73 (64.4%) patients. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 min, p < 0.05). Median LOS was 6 days (IQR 4–9.5); however, 11/47 (23%) patients left against medical advice. Post-operative complications occurred in 11/47 (23.4%) patients; 6/11 (54.5%) were surgical site infections. There were 12 (25.5%) patients who underwent relaparotomies after index surgery elsewhere; 10/12 (83.3%) were for failed repairs or missed injuries. Median NISS was 18 (IQR 12–27). NISS were significantly higher for women (vs men; 28.5 vs 19.8), children (vs adults; 28.8 vs 20), and relaparotomy patients (vs primary laparotomy patients; 32.0 vs 19.0). Some 3 patients died, 2 of whom were relaparotomies.

Conclusion
At this civilian tertiary trauma centre, conflict-related exploratory laparotomies were associated with low morbidity and mortality. Long transport times, high rates of repeat laparotomies, and high numbers of patients leaving against medical advice raise questions regarding continuity of care along the Mosul Trauma Pathway.

Trial registration
The study protocol was registered at Clinicaltrails.gov, ID NCT03490305, prior to collection of data.