bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absolute Versus Relative Near-Infrared Spectroscopy in Pediatric Cardiac Patients*
Authors: Iliopoulos Ilias , Cooper David S. , Reagor James A. , Koh Wonshill , Goldstein Bryan H. , Khoury Philip R. , Morales David L. S. , Batlivala Sarosh 
Published: February 2023

OBJECTIVES:
Near-infrared spectroscopy (NIRS) has been increasingly accepted as a noninvasive marker of regional tissue oxygenation despite concerns of imprecision and wide limits of agreement (LOA) with invasive oximetry. New generation absolute monitors may have improved accuracy compared with trend monitors. We sought to compare the concordance with invasive venous oximetry of a new generation absolute NIRS-oximeter (FORESIGHT ELITE; CASMED, Branford, CT) with a modern widely used trend monitor (INVOS 5100C; Medtronic, Minneapolis, MN).

DESIGN:
Prospective single-center study.

SETTING:
Tertiary pediatric heart center.

PATIENTS:
Children undergoing elective cardiac catheterization under general anesthesia. Time-paired venous oximetry samples (jugular and renal) were compared with NIRS-derived oximetry by two monitors using regression and Bland-Altman analysis.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We enrolled 36 children (19 female, 10 cyanotic) with median age 4.1 years (25–75%, 2.5–7.8 yr) and weight 16.7 kg (12.3–29.1 kg). The absolute difference between NIRS-derived and invasive jugular oximetry was less than 10% in 67% of occasions for both monitors. Correlation was fair (Spearman r
s = 0.40; p = 0.001) for the FORESIGHT ELITE and poor (r
s = 0.06; p = 0.71) for the INVOS 5100C. Bias and LOA were +6.7% (+22%, –9%) versus +1.3% (LOA = +24%, –21%), respectively. The absolute difference between NIRS-derived and invasive renal oximetry was less than 10% in 80% of occasions with moderate correlation (r
s = 0.57; p < 0.001) for the FORESIGHT ELITE and in 61% of occasions with moderate correlation (r
s = 0.58; p < 0.001) for the INVOS 5100C; bias and LOA were +3.6% (+19%, –12%) and –1.4 % (+27%, –30%), respectively. NIRS correlation with renal venous oximetry was worse for cyanotic versus noncyanotic patients (p = 0.02).

CONCLUSIONS:
Concordance and LOA of NIRS-derived oximetry with invasive venous oximetry in the cerebral and renal vascular beds was suboptimal for clinical decision-making. Cyanosis adversely affected NIRS performance in the renal site.
The Success of Resident-Associated Lumbar Punctures at a Large, Single-Center Children's Hospital
Authors: Rudloff James , Lendrum Elizabeth , Semenova Olga , Lipshaw Matthew J. , Valentino Caitlin 
Published: February 2023

Objectives
The frequency of lumbar punctures (LPs) has declined across US children's hospitals over the past decade, potentially decreasing procedural learning opportunities for pediatric resident trainees. Our study sought to determine whether the proportion of successful LPs performed by our pediatric residents has significantly changed over time.

Methods
This study is a single-center retrospective study to evaluate our pediatric resident LP success. We evaluated our primary outcome, proportion of overall LP success over time, using linear regression. We similarly used linear regression for proportion of successful resident-associated LPs over time. We calculated the median number of LPs of all pediatric residents during the study period.

Results
We analyzed 3143 LPs from April 2012 to December 2019. Both the overall number of LPs performed and the proportion of LPs that were successful have not significantly changed over an 8-year period (P > 0.05, P > 0.05). Similarly, the number of our resident-associated LPs and the proportion of successful resident-associated LPs have not changed over the study period (P > 0.05, P > 0.05). Our pediatric residents performed a median of 3 LPs (interquartile range: 2–4) in the pediatric emergency department (PED) over residency.

Conclusions
Despite national trends showing decreased LP rates at pediatric hospitals, we demonstrated stable proportions of LPs and success by our pediatric residents. Pediatric residents perform a relatively low number of LPs in the PED setting alone. Future research is needed to demonstrate whether these overall low numbers in the PED translate to procedural competency after residency graduation.
Interactions With Police in the Emergency Care of Children
Authors: Schultz Megan L. , Winn Madeline , Derse Arthur R. , Kaczor Frances , Levas Michael N. 
Published: February 2023

Objectives
Emergency medicine providers may interface with law enforcement personnel (LEP) on behalf of their pediatric patients for a variety of reasons, from reporting child abuse to caring for children who are in police custody. Given the unique nature of caring for minors who may not have legal or medical autonomy, interactions with LEP can raise ethical concerns for emergency providers, specifically with regard to legal representation, developmental immaturity, and the civil rights of children and their parents/guardians.

Methods
We review 4 patient scenarios, based on real cases experienced by the authors, to demonstrate the legal and ethical issues that may arise when LEP are involved in the emergency care of a child. These scenarios discuss parental/guardian visitation for children in police custody in the emergency department (ED), the practice of making arrests on hospital grounds, and police interviews of children in the ED.

Results
Using the ethical principles of autonomy, beneficence, and justice, we offer recommendations for emergency providers on how to advocate for their pediatric patients in LEP custody within the constraints and protections of the law. We also suggest best practices for hospital systems to develop policies surrounding LEP activity in the ED.

Conclusions
These nuanced situations require careful advocacy for the child and a collaborative approach between medical providers and LEP to balance the child's well-being with public safety. We offer recommendations here, and we maintain that clear, widely adopted best practices for the care of minors in LEP custody are long overdue.
Climate Change Adaptation Activities and Needs in US State and Territorial Health Agencies
Authors: Errett Nicole A. , Dolan Kathleen , Hartwell Cat , Vickery Jamie , Hess Jeremy J. 
Published: February 2023

Objective:
To characterize US State and Territorial Health Agencies' (S/THA) climate change adaptation activities and priorities to facilitate appropriate investments, skills development, and support that will strengthen health sector capacity in response to a changing climate.

Design:
In 2021, we conducted an online survey of S/THA staff requesting information on current activities related to climate change and health, the state of climate and health programming, and anticipated needs and priorities for assistance. We analyzed survey results using descriptive statistics.

Setting:
US State and Territorial Health Agencies.

Participants:
We received responses from 41 of 59 S/THAs (69.5%).

Main Outcome Measures:
Implementation of S/THA climate and health programs (CHPs); engagement in climate and health activities; maintenance of hazard early warning systems and action plans; employment of climate and health communications strategies; capability to assess risks and adaptation needs related to various climate-sensitive conditions; priorities and plans for climate change adaptation in relation to climate-sensitive health risks; climate change adaptation-related partnerships and collaborations; requests of the Association of State and Territorial Health Officials (ASTHO) for advancing climate change adaptation activities; and the impacts of the COVID-19 pandemic on climate change work.

Results:
Nineteen S/THAs reported having CHPs, the majority of which are federally funded. On average, S/THAs without CHPs reported engagement in fewer climate and health activities and more early warning activities. The S/THAs reported the highest levels of concerns regarding non–vector-borne infectious disease (66%), vector-borne infectious diseases (61%), and extreme heat (61%) hazards.

Conclusions:
As S/THAs with CHPs report substantially greater climate and health capacity than those without, additional federal and state investments (eg, Building Resilience Against Climate Effects [BRACE]) are urgently needed to catalyze climate and health capacity.
The Novel Design and Implementation of an Integrated Burn Rehabilitation Clinical Fellowship
Authors: Jean Stephanie , Shahrokhi Shahriar , Godleski Matthew 
Published: February 2023

Abstract
Postgraduate medical burn rehabilitation training has been limited, with very few academic physiatrists specializing in burn rehabilitation. As a result, there are no existing models for post-graduate burn rehabilitation education. A 12-month comprehensive clinical fellowship in burn rehabilitation was offered through a tertiary burn center with formal university accreditation. In this article, the clinical, educational, and skill-based goals developed and implemented for this novel fellowship was outlined to serve as a blueprint for future fellowships in burn rehabilitation, as well as reflections on the experience.
Extracorporeal Shock Wave Therapy vs. Corticosteroid Local Injection in Shoulder Impingement Syndrome
Authors: ElGendy Mohamed H. , Mazen Mohamed M. , Saied Ahmed Mostafa , ElMeligie Mohamed M. , Aneis Yasser 
Published: February 2023

Objective
The aim of this study was to examine the effects of combining extracorporeal shock wave therapy or local corticosteroid injections with a conventional physical therapy (CPT) program for patients with shoulder impingement syndrome.

Design
This was a prospective single-blinded, randomized controlled study.

Methods
Sixty patients with unilateral shoulder impingement syndrome >3 mos were allocated to group A (a 4-wk program of CPT plus a single local corticosteroid injection of 40 mg triamcinolone acetonide mixed with 1% xylocaine, n = 20), group B (CPT only, n = 20), and group C (CPT plus extracorporeal shock wave therapy, 2000 impulses, 0.2–0.3 mJ/mm2, one session per week for 3 wks, n = 20). Subacromial space, shoulder pain and disability index, and shoulder range of motion were assessed at baseline and 4 and 12 wks posttreatment.

Results
There were no between-group differences at 4 wks. At the 12-wk follow-up, no significant differences were found between groups A and B. There was a significant difference in favor of group C compared with group A with the expectation of shoulder internal rotation and subacromial space. Group C was also superior to group B in all outcomes except for subacromial space.

Conclusion
The addition of extracorporeal shock wave therapy to CPT induced more noticeable intermediate-term effects than CPT plus local corticosteroid injection or CPT alone.
Benefit of Outpatient Musculoskeletal Medicine Experience Early in Physical Medicine and Rehabilitation Residency
Authors: Cipriano Kevin , Desale Sameer , Chou Jiling , Malmut Laura 
Published: February 2023

ABSTRACT
Musculoskeletal care for persons with disabilities is an important competency in Physical Medicine and Rehabilitation (PM&R) training. The optimal timing of musculoskeletal medicine rotations in the PM&R residency curriculum is unknown. The objective of this study is to determine if outpatient experience in musculoskeletal medicine increases resident use of musculoskeletal examination skills in the inpatient setting. An 8-item multiple-choice questionnaire was administered monthly to 19 PM&R residents rotating on inpatient services inquiring about number and types of musculoskeletal examinations performed on each inpatient rotation. 71 surveys were collected with a 90% response rate. Significant increases were noted in number of knee examinations and shoulder examinations performed on inpatient rotations after residents completed two months of outpatient musculoskeletal medicine. Most PGY-2 residents (76%) felt that they would perform more musculoskeletal examinations on their inpatient rotations if they had more outpatient musculoskeletal experience at that point in their training. The results suggest that outpatient musculoskeletal experience increases resident use of musculoskeletal examination skills in the inpatient setting. Earlier outpatient musculoskeletal experience in combination with a greater focus on teaching musculoskeletal examination skills in the inpatient setting can support residents in learning how to provide comprehensive musculoskeletal care to individuals with disabilities.
“A Prospective, Randomized Study Comparing Closed Incision Negative Pressure Wound Therapy with Standard Care in Immediate Postmastectomy Breast Reconstruction.”
Authors: Pieszko Karolina , Pieszko Konrad , Wichtowski Mateusz , Cieśla Sławomir , Ławnicka Agnieszka , Jamont Robert , Boyd J Brian , Murawa Dawid 
Published: February 2023

Background:
Breast cancer remains the most common non-skin cancer among women. Prophylactic methods for reducing surgical-site complications after immediate breast reconstruction (IBR) are crucial to prevent acellular dermal matrices or prosthesis exposure and loss. We assessed the impact of closed-incision negative-pressure wound therapy (ciNPWT) versus standard dressings (ST) after IBR on surgical-site complications, superficial skin temperature (SST), skin elasticity, and subjective scar quality, to determine the potential benefit of prophylactic ciNPWT application.

Methods:
A multicenter, prospective, randomised, and controlled study of 60 adult female patients was conducted between January 2019 and July 2021. All patients had oncological indications for IBR using implants or expanders.

Results:
Application of ciNPWT correlated with a significant decrease in surgical-site complications within one year of surgery (total 40%; ST 60%; ciNPWT 20%; p=0.003) and resulted in more elastic scar tissue as measured with a Cutometer® (average coefficient of elasticity, 0.74; ST 0.7; ciNPWT 0.9; p<0.001). The SST of each scar one week after surgery was significantly higher in the ciNPWT group (average SST, 31.5; ST SST, 31.2; ciNPWT SST, 32.3; p=0.006). According to the Patient and Observer Scar Assessment Scale v2.0, subjective scar outcomes in both groups were comparable.

Conclusions:
This is the first prospective, randomised, and controlled study which demonstrated a significant decrease in surgical-site wound complications within one year of surgery in IBR patients receiving ciNPWT. A high probability of postoperative radiotherapy should be a relative indication for the use of ciNPWT.
A Systematic Review of Vascularized Toe and Non-Vascularized Toe Phalangeal Transfer for Reconstruction of Congenital Absence of Digits or Thumb”
Authors: Meyers Abigail , Bassiri Gharb Bahar , Rampazzo Antonio 
Published: February 2023

Background:
The aim of this study was to compare the indications, techniques, and outcomes of vascularized and non-vascularized toe-to-hand transfer surgery in patients with congenital hand differences.

Methods:
A systematic review was conducted according to PRISMA guidelines. Studies containing data on indications, surgical technique, and outcomes for patients with congenital absence or deficiency of digits or thumb treated with toe-to-hand transfer were included. Failure was defined as resorption of the transfer or necrosis necessitating removal.

Results:
Forty studies published between 1978-2020 were included. Three hundred nineteen patients (59.7%) had vascularized transfers, 214 (40.1%) non-vascularized, and one had both (0.2%). Symbrachydactyly was the most common indication in both groups (46.3% vascularized and 45.3% non-vascularized). The most commonly transplanted toe was the second one in the vascularized group (72.6 %) and fourth in the non-vascularized group (32.2%). Vascularized toe transfers were most commonly used to reconstruct the thumb (53.3%), as were non-vascularized transfers (30%).
Vascular complications occurred after 6.8% of vascularized transfers, though 94.7% were ultimately successful after re-operation. Resorption accounted for most complications after non-vascularized transfers. More secondary procedures were required after non-vascularized transfers. In the vascularized group, there was a higher success rate of 98.6% (95% CI 97.4%-99.7%), compared to 86.8% (95% CI 83.6%-90) in the non-vascularized group, (p<0.001).

Conclusions:
Our study found a higher success rate in vascularized transfers. The ideal technique must be assessed on an individual patient basis, accounting for baseline hand structure, as well as the ultimate aesthetic and functional goals.
Quality of life, patient satisfaction, and complications after nipple-sparing versus skin-sparing mastectomy followed by immediate breast reconstruction. A systematic review and meta-analysis.
Authors: Clarijs Marloes E. , Peeters Noelle J.M.C. Vrancken , van Dongen Sophie A.F , Koppert Linetta B. , Pusic Andrea L. , Mureau Marc A.M. , Rijken Bianca F.M. 
Published: February 2023

Background:
Nipple-sparing mastectomy (NSM) has emerged as an alternative procedure for skin sparing mastectomy (SSM), followed by immediate breast reconstruction. Because oncological safety appears similar, patient-reported outcomes (PROs) and complication risks may guide decision-making in individual patients. Therefore, the aim of this systematic review was to compare PROs and complication rates after NSM and SSM.

Methods:
A systematic literature review evaluating NSM versus SSM was performed using Embase, Medline and Cochrane databases. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Cohort Studies. Primary outcomes were PROs and complications. Studies that evaluated Breast-Q scores were used to perform meta-analyses on five Breast-Q domains.

Results:
Thirteen comparative studies including 3895 patients were selected from 1202 articles found. Meta-analyses of the Breast-Q domains showed a significant mean difference of 7.64 in the Sexual Well-being domain (p = 0.01) and 4.71 in the Psychosocial Well-being domain (p = 0.03), both in favor of NSM. Using the specifically designed questionnaires, no differences in overall satisfaction scores were found. There were no differences in overall complication rates between the two groups.

Conclusions:
Patient satisfaction scores were high after both NSM and SSM, however, NSM led to a higher sexual and psychosocial well-being. No differences in complication rates were found. In combination with other factors, such as oncological treatments, complication risk profile, and fear of cancer recurrence, the decision for NSM or SSM has to be made on an individual basis and only if NSM is considered to be oncologically safe.
“HoloLens in breast reconstruction: what is the future?”
Authors: Masterton Gary , Miller Robert , Patel Jaymin , Pratt Philip , Gosling Nicholas , Saour Samer 
Published: February 2023

Summary:
Autologous breast reconstruction utilising the deep inferior epigastric perforator flap has been established as the gold standard for perforator-based free flap breast reconstruction. This technique relies on the ability of the surgeons to identify the patients’ relevant abdominal vasculature to facilitate accurate dissection, optimise surgical outcomes and minimise morbidity. A technique is described in which the authors incorporate augmented reality through utilising HoloLens technology in their surgical planning to identify patients’ epigastric arteries and perforators. This technology allows the surgeon to superimpose computed tomography angiography (CTA) images directly onto the patient, facilitating an “in-vivo” appreciation of underlying anatomy prior to incision and dissection. This allows real-time surgical planning, increasing the value and tangibility of pre-operative CTA imaging with potential to enhance the accuracy and efficiency of the operative technique. Although the authors did not utilise the HoloLens technology to make clinical decisions they provide evidence of its accuracy and ease of use, offering a proof of concept. The potential of this technology is demonstrated and the authors encourage future application in the practice of free flap breast reconstruction and beyond.
Algorithm for Correction of Unaesthetic High Eyelid Folds
Authors: Wattanakrai Kamol , Chiemchaisri Nattawut , Wattanakrai Penpun 
Published: February 2023

Background:
Unaesthetic high eyelid fold is one of the most challenging problems for plastic surgeons. Several methods have been introduced to overcome different deformities. Decision-making on how to select the most appropriate procedure for each patient with diverse underlying causes requires ample surgical experiences. The authors present an algorithm as a guideline to manage this inconclusive situation

Methods:
A retrospective review of planned surgical correction among 368 patients with high eyelid folds in accordance with the advocated algorithm covering 6 years was conducted, graded and analyzed using both objective and subjective measurements. The follow-up period ranged from 1 month to 5 years (average =7months).

Results:
Of 368 cases, 232 (63.05 %), 96 cases (26.08%), and 40 cases (10.87%) were classified as excellent, good, and fair result, respectively. We did not have a poor result defined as failure in reducing the fold after we have followed this algorithm. The crease size before surgery, ranging from 9-13 mm (average =10.345 mm), was reduced to 6-9 mm (average =7.324 mm).

Conclusion:
We propose an algorithm to correct high eyelid folds supported by our clinical study over 6 years. Surgical techniques and rationale behind the procedures were discussed.
“Regret after Gender Affirming Surgery – A Multidisciplinary Approach to a Multifaceted Patient Experience”
Authors: Jedrzejewski Breanna Y. , Marsiglio Mary C. , Guerriero Jess , Penkin Amy ,   OHSU Transgender Health Program “Regret and Request for Reversal” workgroup, Berli Jens U. 
Published: February 2023

Introduction:
Lasting regret after g ender-affirming surgery (GAS) is a difficult multifaceted clinical scenario with profound impacts on individual wellbeing as well as a politically charged topic. Currently we lack professional guidelines or standards of care to help providers and patients navigate this entity . This article summarizes our Transgender Health Program’s cohesive multi-disciplinary lifespan approach to mitigate, evaluate , and treat any form of temporary or permanent regret after GAS.

Methods:
A multidisciplinary (primary care, pediatric endocrinology, psychology, social work, plastic surgery, urology, gynecology, and bioethics) workgroup including cisgender, transgender and gender diverse professionals met for a duration of 14 months. The incidence of individuals who underwent GAS at our program between 2016 and 2021 and subsequently expressed desire to reverse their gender transition was reported.

Results:
A total of 1989 individual underwent GAS, 6 patients (0,3%) were encountered that either requested reversal surgery or transitioned back to their sex-assigned at birth. A multi-disciplinary assessment and care pathway for patients who request reversal surgery is presented in the article.

Conclusions:
A care environment that welcomes and normalizes authentic expression of gender identity, affirms surgical goals without judgement, and de-stigmatizes the role of mental health in the surgical process are foundational to mitigating the occurrence of any form of regret. We hope this can provide a framework to distinguish between normal postoperative distress, temporary forms of grief and regret, and regret due to societal repercussions, surgical outcomes or gender identity.