bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid-sparing Anesthesia Decreases In-hospital and 1-year Postoperative Opioid Consumption Compared With Traditional Anesthesia
Authors: Ahmad Amer H. , Carreon Leah Y. , Glassman Steven D. , Harpe-Bates Jennifer , Sampedro Benjamin C. , Brown Morgan E. , Daniels Christy L. , Schmidt Grant O. , Hines Bren , Gum Jeffrey L. 
Published: August 2023

Study Design.
Propensity-matched cohort.

Objective.
The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption.

Summary of Background Data.
The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure.

Materials and Methods.
Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared.

Results.
Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P=0.014), surgical time (201 vs. 233 min, P<0.001) emergence to extubation time (9.1 vs. 14.2 min, P<0.001), and recovery room time (119 vs. 140 min, P=0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P=0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P=0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P=0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P=0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients.

Conclusions.
OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities.
The association between timing in pregnancy of drought and excess rainfall, infant sex, and birthweight: Evidence from Nepal
Authors: Diamond-Smith Nadia G. , Epstein Adrienne , Zlatnik Marya G. , Treleaven Emily 
Published: August 2023

Background:
Past research on the impact of climatic events, such as drought, on birth outcomes has primarily been focused in Africa, with less research in South Asia, including Nepal. Existing evidence has generally found that drought impacts birthweight and infant sex, with differences by trimester. Additionally, less research has looked at the impact of excess rain on birth outcomes or focused on the impact of rainfall extremes in the preconception period. Using data from a large demographic surveillance system in Nepal, combined with a novel measure of drought/excess rainfall, we explore the impact of these on birthweight by time in pregnancy.

Methods:
Using survey data from the 2016 to 2019 Chitwan Valley Study in rural Nepal combined with data from Climate Hazards InfraRed Precipitation with Station, we explored the association between excess rainfall and drought and birthweight, looking at exposure in the preconception period, and by trimester of pregnancy. We also explore the impact of excess rainfall and drought on infant sex and delivery with a skilled birth attendant. We used multilevel regressions and explored for effect modification by maternal age.

Results:
Drought in the first trimester is associated with lower birthweight (β = −82.9 g; 95% confidence interval [CI] = 164.7, −1.2) and drought in the preconception period with a high likelihood of having a male (odds ratio [OR] = 1.41; 95% CI = 1.01, 2.01). Excess rainfall in the first trimester is associated with high birthweight (β = 111.6 g; 95% CI = 20.5, 202.7) and higher odds of having a male (OR = 1.48; 95% CI = 1.02, 2.16), and in the third trimester with higher odds of low birth weight (OR = 2.50; 95% CI = 1.40, 4.45).

Conclusions:
Increasing rainfall extremes will likely impact birth outcomes and could have implications for sex ratios at birth.
From a Chicken Model to a Patient: Microsurgical Repair of a Brachial Artery in Mozambique
Authors: Santos Pedro , Gonzalez Mauro , Davis Greta L. , Pusic Andrea L. , Rohde Christine H. 
Published: August 2023

Summary:
In sub-Saharan Africa, options for reconstruction of traumatic injuries are limited due to lack of access to microsurgery-trained surgeons. Recently, the Plastic Surgery Foundation-sponsored Surgeons in Humanitarian Alliance for Reconstruction, Research and Education group hosted a virtual microsurgery skills course for junior plastic surgeons in this region. In this report, we describe a case of complete brachial artery transection requiring microsurgical techniques and use of vein graft for repair at our provincial hospital in Mozambique. By highlighting this case, we aimed to describe a direct clinical application of the Surgeons in Humanitarian Alliance for Reconstruction, Research and Education virtual microsurgery skills course and to demonstrate the profound impact such courses can have on patient outcomes in low-and middle-income countries with limited or no access to microsurgery-trained surgeons. Further, through newly gained familiarity with standard microsurgery instruments used in reconstructive procedures, we were able to improvise and develop modified instruments to overcome lack of resources at our institution.
More Data Drives Strategy at a Rural Hospital
Authors: Fattig Martin 
Published: August 2023

All leaders of healthcare organizations, individually and collectively, must make critically important decisions every day. But how are those decisions made? What factors must leaders take into account? And how has the way they make those decisions changed over the years?
In today's fast-moving world, healthcare leaders face increasing pressures to make far-reaching decisions not only accurately, but also more quickly than ever. Especially for a small critical access hospital, there is little room for error or delay. At Nemaha County Hospital, we have found that clinical and business decisions drawn from more reliable data are much better than those based on anecdotal information.
Efficacy of the Buried Temporary Suture Tarsorrhaphy: A Novel Technique
Authors: Ryu Christine , Chundury Rao V. 
Published: August 2023

Purpose:
To describe a buried variation of the temporary suture tarsorrhaphy and determine its efficacy period.

Methods:
This retrospective case review includes 11 patients needing corneal protection. Six patients had lagophthalmos from facial nerve palsy, 4 had cicatricial ectropion, and 1 had neurotrophic keratopathy. A total of 14 buried temporary suture tarsorrhaphies (BTSTs) were placed. The duration of the BTST was the main outcome. The corneal status before and throughout the BTST was monitored. The eyelids were examined for any undesired changes from the BTST.

Results:
The mean duration of the BTST was 97.5 days, with a maximum of 273 days. Aside from one spontaneous dehiscence 5 days after placement, all BTSTs held until intentional removal. Five BTSTs were removed for a more definitive surgical procedure, 6 were removed after resolution of the initial indication, and 2 are still in place as the patient awaits surgery. All cases of keratopathy improved after BTST placement. There were no complications and no undesired eyelid changes.

Conclusions:
The BTST is a simple, fast, safe, and effective procedure that can be performed in the clinic or inpatient to immediately improve ocular surface coverage. As a minimally invasive procedure that can easily last several months, the BTST is an excellent option for patients who require more intense intervention than medical management alone. It can also securely bridge patients to a permanent solution such as lateral canthal resuspension.
Visual Outcomes Following Surgical Debulking in Exophytic Optic Nerve Sheath Meningiomas
Authors: Goodyear Kendall , Roelofs Kelsey A. , Chen Angela C. , Goldberg Robert A. 
Published: August 2023

Purpose:
To report a case of a globular primary optic nerve sheath meningioma managed surgically with improvement in vision and review the literature for outcomes of purely intraorbital exophytic-globular primary optic nerve sheath meningiomas managed surgically.

Methods:
A literature review was conducted using Google Scholar and PubMed with the search terms “primary optic nerve sheath meningioma,” “surgery,” “exophytic,” and “globular.” Articles were included if they were available in English. Individual cases from the reviewed articles were included if the tumor was purely intraorbital with a globular or exophytic morphology, was managed with total or subtotal surgical excision, and visual outcomes were reported. Cases were excluded if the tumor extended intracanalicularly or intracranially, tumor morphology was unknown, or surgical management consisted of biopsy, optic nerve sheath decompression, or optic canal decompression rather than tumor debulking.

Results:
A total of 28 patients with intraorbital globular-exophytic primary optic nerve sheath meningiomas managed surgically have been reported in the literature. Vision improved in 29% (n = 8/28) and remained stable in 43% (n = 12/28) of patients. Furthermore, patients with good (Snellen notation ≥ 0.5) vision (n = 10) typically retained good vision postoperatively and at follow-up, with 1 patient experiencing a decline to poor (Snellen ≤0.1) vision at the last follow-up (92 months postoperatively). Similarly, patients with fair (Snellen notation >0.1 and <0.5) vision (n = 5) often improved to good vision (n = 3) or stayed at fair vision (n = 1), with 1 declining to poor vision at postoperative hospital discharge.

Conclusions:
Surgical management of exophytic or globular optic nerve meningiomas does not universally lead to vision loss and may be appropriate in select patients.
Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier
Authors: Porat Rein Adi , Abulafia Adi , Assayag Elishai , Goldberg Mordechai , Zadok David 
Published: August 2023

Purpose:
To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens.

Setting:
Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel.

Design:
Retrospective, consecutive case series.

Methods:
This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt.

Results:
17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA (P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear.

Conclusions:
A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.
Overcoming the hurdles of steatotic grafts in liver transplantation: Insights into survival and prognostic factors
Authors: Akabane Miho , Imaoka Yuki , Esquivel Carlos O. , Melcher Marc L. , Kwong Allison , Sasaki Kazunari 
Published: August 2023

With increasing metabolic dysfunction–associated steatotic liver disease, the use of steatotic grafts in liver transplantation (LT) and their impact on postoperative graft survival (GS) needs further exploration. Analyzing adult LT recipient data (2002–2022) from the United Network for Organ Sharing database, outcomes of LT using steatotic (≥30% macrosteatosis) and nonsteatotic donor livers, donors after circulatory death, and standard-risk older donors (age 45–50) were compared. GS predictors were evaluated using Kaplan-Meier and Cox regression analyses. Of the 35,345 LT donors, 8.9% (3,155) were fatty livers. The initial 30-day postoperative period revealed significant challenges with fatty livers, demonstrating inferior GS. However, the GS discrepancy between fatty and nonfatty livers subsided over time (p= 0.10 at 5 y). Long-term GS outcomes showed comparable or even superior results in fatty livers relative to nonsteatotic livers, conditional on surviving the initial 90 postoperative days (p= 0.90 at 1 y) or 1 year (p= 0.03 at 5 y). In the multivariable Cox regression analysis, the high body surface area (BSA) ratio (≥1.1) (HR 1.42,p= 0.02), calculated as donor BSA divided by recipient BSA, long cold ischemic time (≥6.5 h) (HR 1.72,p< 0.01), and recipient medical condition (intensive care unit hospitalization) (HR 2.53,p< 0.01) emerged as significant adverse prognostic factors. Young (<40 y) fatty donors showed a high BSA ratio, diabetes, and intensive care unit hospitalization as significant indicators of a worse prognosis (p< 0.01). Our study emphasizes the initial postoperative 30-day survival challenge in LT using fatty livers. However, with careful donor-recipient matching, for example, avoiding the use of steatotic donors with long cold ischemic time and high BSA ratios for recipients in the intensive care unit, it is possible to enhance immediate GS, and in a longer time, outcomes comparable to those using nonfatty livers, donors after circulatory death livers, or standard-risk older donors can be anticipated. These novel insights into decision-making criteria for steatotic liver use provide invaluable guidance for clinicians.
Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents*
Authors: Pryce Patrice , Gangopadhyay Maalobeeka , Edwards Jeffrey D. 
Published: August 2023

OBJECTIVES:
Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children.

DESIGN:
Single-center prospective observational study.

SETTING:
Urban academic children’s hospital from January to December 2021.

PATIENTS:
One hundred forty-five children (2–18 yr old, admitted ≥ 2 d) and their parents.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03–100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients’ risk for PTSD (aOR = 3.5 [95% CI, 0.56–21.31]; p = 0.18).

CONCLUSIONS:
ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child’s PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department
Authors: Faris Nagham , Mesto Mohamad , Mrad Sandra , El Kebbi Ola , Asi Noor , Sawaya Rasha D. 
Published: August 2023

Objectives
Caring for pediatric lacerations in the emergency department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention.

Methods
We conducted a prospective, single-center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying 2 key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days after encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and adverse effects of EMLA.

Results
We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. The PDSA cycles used educational interventions, direct provider feedback about noncompliance, and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, no adverse events but an increase in LOS of patients who received EMLA compared with those who did not (1.79 ± 0.66 vs 1.41 ± 0.83 hours, P < 0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications.

Conclusions
With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.
Patient Safety Culture Analysis in Dental Hospital Using Dental Office Survey on Patient Safety Culture Questionnaire: A Cross-cultural Adaptation and Validation Study
Authors: Arbianti Kusuma , Amalia Rosa , Hendrartini Julita , Kuntjoro Tjahjono 
Published: August 2023

Background
The culture of safety and patient safety management in dental practice lags compared with medical practice. Hospitals strive to pursue quality and safety of healthcare services, with evidence of patient safety incidents in medical practice demonstrating the importance of promoting a safety culture. Measuring patient safety culture is a necessary first step to improving safety culture in clinical settings. As a hospital, dental hospital should improve the quality and culture of patient safety. Thus, our objective was to conduct a cross-cultural adaptation of a US measure of dental office patient safety culture for use in Indonesian dental hospitals.

Method
A cross-sectional study was conducted on 200 respondents at a dental hospital in Java, Indonesia. The first stage includes cultural adaptation and translation, followed by developing a questionnaire that was tested through expert agreement and analysis of validity and reliability using Spearman, Cronbach correlation coefficients, and correlation coefficients between classes. The Dental Office Survey on Patient Safety Culture consists of 58 items and 10 dimensions (overall perceptions of patient safety and quality, organizational learning, teamwork, staff training, work pressure and pace, management support for patient safety, office processes and standardization, communication about errors, communication openness, and patient care tracking/follow-up).

Results
A total of 200 respondents with a response rate of 61.5% and 77 invalid responses due to incomplete filling, so 123 respondents were analyzed. The validity test results on 38 question items from 10 dimensions, with a sign of 0.05%, 35 items are declared valid.

Conclusions
The Indonesian version of the Dental Office Survey on Patient Safety Culture shows good validity and good reliability and has the potential to be used to evaluate patient safety culture in dental hospitals in Indonesia.
Preventing Potential Patient Harm Through Clinical Content Interventions During Oncology Clinical Trial Implementation
Authors: Loo Vivian C. , Kim Sarah , Johnson Lisa M. , Kay Howard , Yi Annie , Chen Jason , Asmar-Abdien Lisa O. 
Published: August 2023

Objectives
Clinical trial documents are complex and may have inconsistencies, leading to potential site implementation errors and may compromise participant safety. This study characterizes the frequency and type of administrative and potential patient safety interventions (PPSIs) made during the review of oncology trial documents for clinical trial implementation by centralized clinical content specialists.

Methods
A dedicated group of centralized clinical content specialists reviewed trial documents, including the protocol, laboratory manual, and pharmacy/cellular therapy manual, and collected intervention data over a 1-year period. Each trial was categorized by study phase and sponsor type, and multiple interventions could be identified per trial. Interventions were deemed administrative or PPSIs, with PPSIs further subcategorized as medication, laboratory, procedure related, or other.

Results
Of 585 clinical trials reviewed, 269 (46%) required intervention(s). Among 1001 interventions, 171 (17.1%) were PPSIs. Most PPSIs were medication related (45.6%), with drug dosing interventions most frequently identified (53.8%). Phase 1 trials had the highest proportion of PPSIs (0.35:1) and administrative interventions (2:1) per trial compared with all other phases. Investigator-initiated trials saw the highest proportion of PPSIs per trial (0.44:1) of all sponsor types.

Conclusions
This study demonstrates a gap in patient safety when assessing trial documents for clinical trial implementation. One solution to address this gap is the utilization of a centralized team of clinical specialists to preemptively review trial documents, thereby enhancing patient safety during clinical trial conduct.