bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Alcohol Misuse on Requirements for Critical Care Services and Development of Hospital Delirium in Patients With COVID-19 pneumonia
Authors: Jolley Sarah E. , Mowry Christopher J. , Erlandson Kristine M. , Wilson Melissa P. , Burnham Ellen L. 
Published: January 2023

OBJECTIVES:
Alcohol misuse has been associated with increased morbidity in the setting of pulmonary infections, including the need for critical care resource utilization and development of delirium. How alcohol misuse impacts morbidity and outcomes among patients admitted with COVID-19 pneumonia is not well described. We sought to determine if alcohol misuse was associated with an increased need for critical care resources and development of delirium among patients hospitalized with COVID-19 pneumonia.

DESIGN:
Retrospective cohort study.

SETTING:
Twelve University of Colorado hospitals between March 2020 and April 2021.

PATIENTS:
Adults with a COVID-19 diagnosis.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was admission to the ICU. Secondary outcomes included need for mechanical ventilation, development of delirium, and in-hospital mortality. Alcohol misuse was defined by International Classification of Diseases, 10th Revision codes. Of 5,979 patients hospitalized with COVID-19, 26% required ICU admission and 15.4% required mechanical ventilation. Delirium developed in 4.5% and 10.5% died during hospitalization. Alcohol misuse was identified in 4%. In analyses adjusted for age, sex, body mass index, diabetes, and liver disease, alcohol misuse was associated with increased odds of ICU admission (adjusted odds ratio [aOR], 1.46; p < 0.01), mechanical ventilation (aOR, 1.43; p = 0.03), and delirium (aOR, 5.55; p < 0.01) compared with patients without misuse. Mortality rates were not associated with alcohol misuse alone, although the presence of both alcohol misuse and in-hospital delirium significantly increased odds of in-hospital death (aOR, 2.60; p = 0.04).

CONCLUSIONS:
Among patients hospitalized with COVID-19, alcohol misuse was associated with increased utilization of critical care resources including ICU admission and mechanical ventilation. Delirium was an important modifiable risk factor associated with worse outcomes in hospitalized patients with alcohol misuse, including increased odds of death.
Amyloidosis and Carpal Tunnel Syndrome: Surgical Technique for Extended Carpal Tunnel Release with Tenosynovium and Transverse Carpal Ligament Biopsies
Authors: Elzinga Kate , Khayambashi Shahin , Hahn Christopher , Mahe Etienne , Fine Nowell M. 
Published: January 2023

Background:
Carpal tunnel syndrome (CTS) is common in patients with transthyretin amyloidosis (ATTR), and many experience residual symptoms and/or develop recurrent disease following routine carpal tunnel release (CTR). An extended CTR with median nerve neurolysis is recommended for thorough nerve decompression. Tissue confirmation of amyloidosis can be performed at the time of CTR with biopsies of the transverse carpal ligament and/or tenosynovium.

Methods:
We describe a retrospective, single-center experience performing an extended CTR technique including unilateral and bilateral cases for 13 consecutive patients (18 wrists) with ATTR and symptomatic median neuropathy at the wrist.

Results:
The mean patient age was 83 (range 67–90) years and 11 (85%) were men. Notable intraoperative findings in all cases included thickened tenosynovium and median nerve epineurium, and adherence of the median nerve to the deep surface of transverse carpal ligament. Pathology findings were positive for amyloidosis from both the transverse carpal ligament and the tenosynovium biopsies in all patients.

Conclusions:
Extended CTR with simultaneous wrist tissue biopsy can be safely performed for ATTR patients with CTS. Characteristic intraoperative findings should increase clinical suspicion for undiagnosed ATTR and prompt performance of biopsy for diagnostic confirmation. Volar wrist tenosynovial biopsy is our preferred tissue for confirmation of ATTR, for patients with and without CTS, given its safety profile and 100% pathological yield in our series.
Content and Readability of Online Recommendations for Breast Implant Size Selection
Authors: Fanning James E. , Okamoto Lauren A. , Levine Emma C. , McGee Shayan A. , Janis Jeffrey E. 
Published: January 2023

Background:
Breast augmentation is one of the most frequently performed aesthetic procedures in the United States. Online information is often used by patients to make decisions when undergoing cosmetic procedures. It is vital that online medical information includes relevant decision-making factors and uses language that is understandable to broad patient audiences. Ideally, online resources should aid patient decisions in aesthetic surgical planning, especially implant size selection for breast augmentation. We describe patient decision-making factors and readability of breast implant size selection recommended by private practice plastic surgery webpages.

Methods:
Using a depersonalized, anonymous query to Google search engine, the terms “breast implant size factors” and “breast implant size decision” were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor.

Results:
The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information.

Conclusions:
Reported decision-making factors for implant size selection emphasize a plastic surgeon’s expertise but may enhance the patient’s role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.
High prevalence of liver fibrosis among general population: a Romanian population-based study
Authors: Trifan Anca , Muzica Cristina-Maria , Nastasa Robert , Zenovia Sebastian , Stratina Ermina , Stafie Remus , Rotaru Adrian , Singeap Ana-Maria , Cojocariu Camelia , Sfarti Catalin , Girleanu Irina , Chiriac Stefan , Cuciureanu Tudor , Huiban Laura , Stanciu Carol 
Published: January 2023

Although high mortality is associated with liver cirrhosis, patients usually have a good quality of life in the compensated phase, and the disease may progress undiagnosed for many years. Vibration-controlled transient elastography with controlled attenuation parameter is a useful noninvasive tool used to estimate both the severity of fibrosis and steatosis. Hence, we aimed to establish the prevalence of significant liver fibrosis diagnosed by vibration-controlled transient elastography in an apparently healthy population. Between December 2021 and March 2022, we conducted a prospective screening of liver fibrosis in apparently healthy participants from different counties of Northeastern Romania. All subjects’ medical history was recorded through a comprehensive questionnaire and underwent a liver stiffness measurement. Participants with abnormal liver stiffness measurement values were further evaluated by laboratory tests to identify the etiology of chronic liver disease. A total of 127 apparently healthy subjects were enrolled, mainly females (59.8%), with a mean age of 56±11 years. Overall, 12.6% of participants were found to have significant to advanced fibrosis, and 5.4% had liver cirrhosis. Among 184 participants with clinically significant fibrosis (≥8.0 kPa), 26.1% had a history of heavy alcohol intake, 22.3% tested positive for hepatitis B and C infection, and 2.1% with other etiologies. The remaining 49.5% participants with clinically significant fibrosis were diagnosed with NAFLD, with a mean controlled attenuation parameter value of 282±34 dB/m. The high prevalence of significant liver fibrosis in the general population of Romania is alarming and should raise awareness among clinicians and public health systems. Vibration-controlled transient elastography has demonstrated its usefulness as a screening tool to identify advanced liver fibrosis in general population and should be used in liver disease prevention strategies.
NK/T-cell Lymphoma With Orbital Involvement: A Case Report and Systematic Review of the Literature
Authors: Dhodapkar Rahul M. , Spadaro Jane Z. , Heng Jacob S. , Sinard John H. , Lee Yan Ho , Habib Larissa A. , Pointdujour-Lim Renelle 
Published: January 2023

Purpose:
To present the clinical course of a patient with recurrent NK/T-cell lymphoma (NKTL) involving the orbit and to review the literature on patients with NKTL involving the orbit.

Methods:
The PubMed database was searched for all cases of NKTL involving orbital, intraocular, or adnexal ocular structures.

Results:
Ninety-six patients were included in the final analysis. The mean age of diagnosis was 48.1 ± 16.8 years. The patients were 53/96 (55.2%) male and 43/96 (44.8%) female. Tumor location varied and included the orbit in 80/96 (83.3%), nasosinus in 56/96 (58.3%), uvea in 11/96 (11.5%), lacrimal gland in 9/96 (9.4%), lacrimal drainage system in 11/96 (11.5%), and conjunctiva in 7/96 (7.3%) cases. Management included surgical debulking in 29/96 (30.2%) cases, radiotherapy in 52/96 (54.2%) cases, and chemotherapy in 82/96 (85.4%) cases. Median survival was 6 months (95% CI: 5–9). Chemotherapy (hazard ratio = 0.80, 95% CI: 0.67–0.95, p = 0.013), radiotherapy (hazard ratio = 0.75, 95% CI: 0.64–0.87, p < 0.001), and orbital involvement being a recurrence of disease (hazard ratio = 0.79, 95% CI: 0.67–0.95, p = 0.009) were associated with improved survival. Advanced Ann Arbor stage (III–IV) at diagnosis (hazard ratio = 1.22, 95% CI: 1.08–1.38, p = 0.001), vision loss (hazard ratio = 1.18, 95% CI: 1.04–1.34, p = 0.009), proptosis (hazard ratio = 1.15, 95% CI: 1.01–1.30, p = 0.035) and periorbital swelling (hazard ratio = 1.15, 95% CI: 1.00–1.33, p = 0.048) were associated with poor survival.

Conclusions:
NK/T-cell lymphoma involving the orbit, globe, or ocular adnexa heralds a poor prognosis where early diagnosis and therapy are critical. The use of radiotherapy and chemotherapy is associated with improved survival.
Single flow diverter to manage multiple intracranial aneurysms in a parent artery
Authors: Lee Chien-Hui , Luo Chao-Bao , Lai Yen-Chun , Chang Feng-Chi , Lin Chung-Jung 
Published: January 2023

Background:
Endovascular coil embolization has become an important method in the management of intracranial aneurysm. However, simultaneously coiling multiple intracranial aneurysms (MIAs) in unilateral parent artery in one-stage may fail or insufficient in geographic difficult aneurysm. Flow diverter (FD) has the potential to manage MIAs with nonamenable to coiling. Herein, we report periprocedural morphologic change and outcomes using single FD to manage unruptured MIAs in a parent artery.

Methods:
Over a 3-year period, a total of 63 patients with 126 MIAs successful managed by single FD with complete angiographic follow-up. There were 49 women and 14 men, with ages ranging from 42 to 77 years (mean: 59 years). We retrospectively assessed the clinical data, aneurysm characteristic, angiographic and clinical outcomes of all patients and compared with 171 patients with single aneurysm managed by FD.

Results:
Sixty-one patients with 118 aneurysms (94%) located in internal carotid artery or middle cerebral artery (n = 4, 3%), two patients with four aneurysms (4%) were found in the basilar artery. The mean aneurysm size was 5.6 mm (range from 1.8 to 38 mm). Mean angiographic follow-up was 14 months. Complete obliteration of aneurysm was achieved in 102 aneurysms (83%), subtotal or partial aneurysm obliteration was demonstrated in 18 aneurysms (15%), unchanged aneurysm morphology in three (2%). Aneurysm morphology synchronized alteration in 55 patients (87%), other eight patients (13%) with 16 aneurysms showed different morphologic alteration in angiographic follow-up. Four patients (6.3%) had intraprocedural ischemic complication. During the follow-up period, 61 patients (97%) were neurologic stable; there was no hemorrhagic or ischemic event.

Conclusion:
Single FD was feasible to treat MIAs in a parent artery with both effective and safe in one-stage management. Most aneurysms synchronized alteration of morphology in a mid-term follow-up. The procedure was almost the same with FD managing single aneurysm, but longer FD is needed in MIAs.
A Seat at the Table: An Examination of Hospital Governing Board Diversity, 2011–2021
Authors: Silvera Geoffrey A. , Erwin Cathleen O. , Garman Andrew N. 
Published: January 2023

Goal:
Board diversity is increasingly important for hospitals and healthcare systems, with national attention focused on eliminating health disparities and improving health equity. Yet, it remains a challenge despite concerted efforts by leading professional associations (e.g., American College of Healthcare Executives) to galvanize their constituents around the importance of the issue.

Methods:
This study used survey data from The Governance Institute to explore the ethnoracial and gender diversity of hospital boards spanning 2011 through 2021.

Principal Findings:
The results showed modest gains in the mean number of female board members, although a small proportion of hospital boards still have no female representation. There was little change in the number of boards with ethnic minority representation until an uptick in 2021, likely in direct response to high-profile racial incidents and protests.

Practical Applications:
Intentional and sustained efforts are necessary to increase diversity and create a culture of inclusion that fosters meaningful engagement of diverse board members.
Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning
Authors: ZARANDONA DEL CAMPO Ainhoa , HERREROS MARIAS Nerea , TORVISCO MACIAS Alazne , BARANDICA BILBAO Ana María , RODRIGUEZ OTAZUA Lorea , AGUIRRE LARRACOECHEA Urko , VILLANUEVA ETXEBARRIA Ane , PORTUGAL PORRAS Vicente 
Published: January 2023

ABSTRACT

Background
Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later.

Purpose
This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors.

Methods
A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses.

Results
Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position.

Conclusions/Implications for Practice
The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.
Arachnoid cysts in paediatrics
Authors: Sarwar Shaheera , Rocker Joshua 
Published: January 2023

Purpose of review
Arachnoid cysts are incidentally found on neuroimaging at an increasing rate in the paediatric population. Hence, learning their clinical implications to better inform families is important. The purpose of this review is to outline the current understanding of epidemiology, disease and clinical features based on location, imaging and management of arachnoid cysts in paediatrics.

Recent findings
The prevalence of arachnoid cysts is 2.6% in paediatrics, with greater than 90% being asymptomatic. When they do cause symptoms, it is based primarily on their location and size. The most accurate diagnostic modality is MRI. Recent literature focuses primarily on the origin of arachnoid cysts, new approaches to treating symptomatic arachnoid cysts and long-term implications for patients.

Summary
Incidental arachnoid cysts are being found most often due to the more frequent use of neuroimaging. There is a higher prevalence for arachnoid cysts in men and they are more commonly found on the left side. Despite their impressive size or location, greater than 90% of these lesions are asymptomatic and require no intervention. However, follow up with neurosurgery to help determine the clinical significance of these lesions is essential.
Emerging systemic treatment for metastatic castration-resistant prostate cancer: a review of recent randomized controlled trials
Authors: Yanagisawa Takafumi , Kawada Tatsushi , Rajwa Pawel , Kimura Takahiro , Shariat Shahrokh F. 
Published: January 2023

Purpose of review
The landscape of therapy for metastatic castration-resistant prostate cancer (mCRPC) has seen an unprecedented transformation with the emergence of combination therapies. This review summarizes the current findings from randomized controlled trials (RCTs) assessing the oncologic outcomes of mCRPC.

Recent findings
In the first-line, treatment-naïve setting, recent RCTs demonstrated the oncologic benefit of adding AKT inhibitors or poly (adenosine diphosphate–ribose) polymerase (PARP) inhibitors to abiraterone in terms of radiographical progression-free survival. Although this is a strong surrogate endpoint, these agents have not yet shown overall survival (OS) improvement. In the second- or later-line settings, olaparib improved OS in patients with at least one alteration in BRCA1, BRCA2, or ATM gene and lutetium-177-prostate-specific membrane antigen-617 [177-Lu-prostate-specific membrane antigen (PSMA)-617] were superior to repeat androgen receptor signaling inhibitor (ARSI) therapy. In addition, 177-Lu-PSMA-617 had better progression-free survival compared with cabazitaxel but failed to result in an OS benefit. To date, there is no evidence for effective immune checkpoint inhibitor regimens/combinations for mCRPC.

Summary
According to recent RCTs, several novel agents and/or combinations exhibit promising oncologic outcomes. In the first-line setting, OS benefits compared with currently available regimens are still missing. Results from ongoing/well-designed phase 3 RCTs and real-world data regarding the sequential impact of currently available agents on outcomes of mCRPC patients after ARSI-based combination therapy for metastatic hormone-sensitive prostate cancer are awaited. Such data will improve clinical decision-making in the ever-intensifying treatment era.
Nurse Performance Metrics
Authors: DePesa Christopher D. , Jurgens Corrine Y. , Lee Christopher S. , O'Reilly-Jacob Monica 
Published: January 2023

OBJECTIVE
The purposes of this scoping review are: 1) to identify instances in the literature that describe measuring individual nurse performance and 2) characterize those metrics.

BACKGROUND
The impact of nurses on patient outcomes has been demonstrated at the unit or hospital level, with nurses measured in aggregate. There is an opportunity to evaluate individual nurse performance by creating metrics that capture it.

METHODS
A scoping review based on the framework published by the Joanna Briggs Institute was performed.

RESULTS
Researchers identified 12 articles. Three themes were trended: the emerging nature of these metrics in the literature, variability in their applications, and performance implications.

CONCLUSIONS
Individual nurse performance metrics is an emerging body of research with variability in the types of metrics developed. There is an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics and to use them to support nursing practice and patient care.
Chimeric Antigen Receptor T-Cell Therapy
Authors: Brookens Shawna K. , Posey Avery D. 
Published: January 2023

Abstract
Genetically engineered chimeric antigen receptor (CAR) T-cell therapy leverages the ability of the immune system to eliminate tumors and redirects cytotoxic functions toward cells expressing specified tumor-restricted antigens. Although 6 CAR T-cell therapies have received Food and Drug Administration (FDA) approval for the treatment of many hematological malignancies, limitations involving T cell–intrinsic, T cell–extrinsic, and therapeutic factors remain in the treatment of both liquid and solid tumors. Chimeric antigen receptor design, signals from the tumor microenvironment, tumor antigen escape mechanisms, and systemic inflammatory consequences of CAR T-cell infusion all influence the efficacy and feasibility of CAR T-cell therapy in different malignancies. Here, we review the core structure of the CAR, the evolution of different CAR generations, CAR T-cell therapy limitations, and current strategies being investigated to overcome the T cell–intrinsic, T cell–independent, and therapeutic barriers to successful CAR T-cell therapy.
Interesting Findings in 68Ga-FAPI-46 PET/CT Imaging in a Patient With Glioblastoma Multiforme
Authors: Mohammadzadeh Kosari Hadis , Kiamanesh Zahra , Sadeghi Ramin , Kamali Hassan , Aryana Kamran 
Published: January 2023

Abstract
A 55-year-old disabled man with glioblastoma multiforme was referred to us for fibroblast activation protein inhibitor (FAPI) PET/CT imaging. 68Ga-DOTA-FAPI-46 scan revealed uptake in the primary tumor and unexpected uptakes in soft tissue, especially in periarticular regions. These latter foci were compatible with calcifications on the CT. One in the breast was compatible with fibrotic tissue, but 2 other foci, in the rectus abdominis and gallbladder wall, could not be correlated with the CT findings. In Neurogenic heterotopic ossification, hypoxia-associated oxidative stress results in the metaplastic transformation of fibroblasts. Abnormal differentiation of fibroblasts in neurogenic heterotopic ossification before ossification could explain radiolabeled FAPI avidity in the mentioned areas.