bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Compared With Traditional Schedules for Routine Antenatal Visits
Authors: Balk Ethan M. , Danilack Valery A. , Bhuma Monika Reddy , Cao Wangnan , Adam Gaelen P. , Konnyu Kristin J. , Peahl Alex Friedman 
Published: June 2023

OBJECTIVE:
To assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules.

DATA SOURCES:
A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries.

METHODS OF STUDY SELECTION:
Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher.

TABULATION, INTEGRATION, AND RESULTS:
Five randomized controlled trials and five nonrandomized comparative studies compared reduced routine antenatal visit schedules with traditional schedules. Studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists–recommended services and patient experience measures.

CONCLUSION:
The evidence base is limited and heterogeneous and allowed few specific conclusions. Reported outcomes included, for the most part, standard birth outcomes that do not have strong plausible biological connection to structural aspects of antenatal care. The evidence did not find negative effects of reduced routine antenatal visit schedules, which may support implementation of fewer routine antenatal visits. However, to enhance confidence in this conclusion, future research is needed, particularly research that includes outcomes of most importance and relevance to changing antenatal care visits.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42021272287.
Televisits Compared With In-Person Visits for Routine Antenatal Care
Authors: Balk Ethan M. , Danilack Valery A. , Cao Wangnan , Bhuma Monika Reddy , Adam Gaelen P. , Konnyu Kristin J. , Peahl Alex Friedman 
Published: June 2023

OBJECTIVE:
To compare benefits and harms of televisits and in-person visits in people receiving routine antenatal care.

DATA SOURCES:
A search was conducted of PubMed, Cochrane databases, EMBASE, CINAHL, and ClinicalTrials.gov through February 12, 2022, for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms, as well as primary study designs. The search was restricted to high-income countries.

METHODS OF STUDY SELECTION:
Double independent screening was done in Abstrackr for studies comparing televisits and in-person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. Data were extracted into SRDRplus with review by a second researcher.

TABULATION, INTEGRATION, AND RESULTS:
Two randomized controlled trials, four nonrandomized comparative studies, and one survey compared visit types between 2004 and 2020, three of which were conducted during the coronavirus disease 2019 (COVID-19) pandemic. Number, timing, and mode of televisits and who provided care varied across studies. Low-strength evidence from studies comparing hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn (summary odds ratio [OR] 1.02, 95% CI 0.82–1.28) or preterm births (summary OR 0.93, 95% CI 0.84–1.03). However, the studies with stronger, although still statistically nonsignificant, associations between use of hybrid visits and preterm birth compared the COVID-19 pandemic and prepandemic eras, confounding the association. There is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits. Other outcomes were sparsely reported.

CONCLUSION:
People who are pregnant may prefer hybrid televisits and in-person visits. Although there is no evidence of differences in clinical outcomes between hybrid visits and in-person visits, the evidence is insufficient to evaluate most outcomes.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42021272287.
Validated Calculators Predicting Cesarean Delivery After Induction
Authors: Shao Shirley J. , Teal E. Nicole , Lewkowitz Adam K. , Gaw Stephanie L. , Sobhani Nasim C. 
Published: June 2023

OBJECTIVE:
To evaluate the performance of two previously published calculators in predicting cesarean delivery after induction of labor in an external population.

METHODS:
This was a cohort study including all nulliparous pregnant patients with singleton, term, vertex fetuses; intact membranes; and unfavorable cervices who underwent induction of labor between 2015 and 2017 at an academic tertiary care institution. Individual predicted cesarean risk scores were calculated with two previously published calculators. For each calculator, patients were stratified into three risk groups (lower, middle, and upper thirds) of approximately equivalent size. Predicted and observed incidences of cesarean delivery were compared with two-tailed binomial tests of probability in the overall population and in each risk group.

RESULTS:
A total of 846 patients met inclusion criteria, and 262 (31.0%) had cesarean deliveries, which was significantly lower than overall predicted rates of 40.0% and 36.2% with the two calculators (both P<.01). Both calculators significantly overestimated risk of cesarean delivery in higher risk tertiles (all P<.05). The areas under the receiver operating characteristic for both calculators were 0.57 or less in the overall population and in each risk group, suggesting poor predictive value. Higher predicted risk tertile in both calculators was not associated with any maternal or neonatal outcomes except wound infection.

CONCLUSION:
Both previously published calculators had poor performance in this population, with neither calculator accurately predicting the incidence of cesarean delivery. Patients and health care professionals might be discouraged regarding trial of labor induction by falsely high predicted risk-of-cesarean scores. We caution against widespread implementation of these calculators without further population-specific refinement and adjustment.
Orbital Artifacts on MRI
Authors: Rana Khizar , Juniat Valerie , Patel Sandy , Avey Greg , Lucarelli Mark J. , Selva Dinesh 
Published: June 2023

Purpose:
To describe artifacts on orbital MRI, which led to an incorrect radiology report.

Methods:
Retrospective chart review of patients identified from the orbital databases at the Royal Adelaide Hospital and University of Wisconsin Hospital. Patients who had artifacts on orbital MRI that led to an incorrect radiology report were included. Records were evaluated for age at imaging, gender, MRI sequence, laterality, and location of artifact, radiological characteristics and misdiagnosis, and cause of artifact.

Results:
Data were collected from 7 patients (3 male) who had a median age of 61 years at the time of imaging. Five artifacts resulted from fat-suppression failure with 4 of these cases misdiagnosed as inflammatory changes and 1 misdiagnosed as neoplastic infiltration. The OD was involved in 4 cases. Six cases were in the inferior orbit region.

Conclusions:
Fat-suppression failure artifacts may arise in the inferior orbit region and can be mistaken for inflammatory or neoplastic orbital disease. This may prompt additional investigations such as orbital biopsy. Clinicians should be aware of artifacts which can affect orbital MRI and lead to potential misdiagnosis.
Overuse of thyroid ultrasound
Authors: Acosta Gonzalo J. , Singh Ospina Naykky , Brito Juan P. 
Published: June 2023

Purpose of review
Thyroid ultrasound (TUS) is a common diagnostic test that can help guide the management of patients with thyroid conditions. Yet, inappropriate use of TUS can lead to harmful unintended consequences. This review aims to describe trends in the use and appropriateness of TUS in practice, drivers and consequences of inappropriate use, and potential solutions to decrease overuse.

Recent findings
TUS use has increased in the U.S. and is associated with increased diagnosis of thyroid cancer. Between 10–50% of TUSs may be ordered outside of clinical practice recommendations. Patients who receive an inappropriate TUS and are incidentally found to have a thyroid nodule may experience unnecessary worry, diagnostic interventions, and potential overdiagnosis of thyroid cancer. The drivers of inappropriate TUS use are not yet fully understood, but it is likely that a combination of clinician, patient, and healthcare system factors contribute to this problem.

Summary
Inappropriate TUS is a factor leading to the overdiagnosis of thyroid nodules and thyroid cancer, resulting in increased healthcare costs and potential harm to patients. To effectively address the overuse of this diagnostic test, it is necessary to gain a deeper understanding of the frequency of inappropriate TUS use in clinical practice and the factors that contribute to it. With this knowledge, interventions can be developed to reduce the inappropriate use of TUS, leading to improved patient outcomes and more efficient use of healthcare resources.
Soluble urokinase plasminogen activator receptor and procalcitonin for risk stratification in patients with a suspected infection in the emergency department: a prospective cohort study
Authors: Tong-Minh Kirby , Endeman Henrik , Ramakers Christian , Gommers Diederik , van Gorp Eric , van der Does Yuri 
Published: June 2023

Background and importance
Early identification of patients at risk of clinical deterioration may improve prognosis of infected patients in the emergency department (ED). Combining clinical scoring systems with biomarkers may result in a more accurate prediction of mortality than a clinical scoring system or biomarker alone.

Objective
The objective of this study is to investigate the performance of the combination of National Early Warning Score-2 (NEWS2) and quick Sequential Organ Failure Assessment (qSOFA) score with soluble urokinase plasminogen activator receptor (suPAR) and procalcitonin to predict 30-day mortality in patients with a suspected infection in the ED.

Design, settings and participants
This was a single-center prospective observational study, conducted in the Netherlands. Patients with suspected infection in the ED were included in this study and followed-up for 30 days. The primary outcome of this study was all cause 30-day mortality. The association between suPAR and procalcitonin with mortality was assessed in subgroups of patients with low and high qSOFA (<1 and ≥1) and low and high NEWS2 (<7 and ≥7).

Main results
Between March 2019 and December 2020, 958 patients were included. A total of 43 (4.5%) patients died within 30 days after ED visit. A suPAR ≥ 6 ng/ml was associated with an increased mortality risk: 5.5 vs. 0.9% (P < 0.01) in patients with qSOFA = 0 and 10.7 vs. 2.1% (P = 0.02) in patients with qSOFA ≥ 1. There was also an association between procalcitonin ≥0.25 ng/ml and mortality: 5.5 vs. 1.9% (P = 0.02) for qSOFA = 0 and 11.9 vs. 4.1% (P = 0.03) for qSOFA ≥ 1. Similar associations were found within patients with a NEWS < 7 (5.9 vs. 1.2% for suPAR and 7.0 vs. 1.7% for procalcitonin, P < 0.001).

Conclusion
In this prospective cohort study, suPAR and procalcitonin were associated with increased mortality in patients with either a low or high qSOFA and patients with low NEWS2.
Development and Implementation of a Maryland State Program Providing Hospital Payment Incentives for Reduction in Readmission Disparities
Authors: Rice Kyle , Schuster Alyson , Pack Allan , Dougherty Geoff B. 
Published: June 2023

Background:
Social factors are a key determinant of hospital readmission. We describe the development of the country’s first statewide policy providing hospitals with financial incentives to reduce readmission disparities.

Objective:
To describe the development and evaluation of a novel program that measures hospital-level disparity in readmission and rewards hospitals for improvement.

Research Design:
Observational study using inpatient claims.

Participants:
Baseline data included 454,372 all-cause inpatient discharges in 2018 and 2019. Of the included discharges, 34.01% involved Black patients, 40.44% involved female patients, 33.1% involved patients covered by Medicaid, and 11.76% involved patients who were readmitted. Mean age was 55.18.

Measures:
The key measure was the percentage change over time within the hospital in readmission disparity. Readmission disparity was measured using a multilevel model that gauged the association between social factors and readmission risk at a given hospital. Three social factors (Race, Medicaid coverage, and Area Deprivation Index) were combined into an index reflecting exposure to social adversity.

Results:
Of the State’s 45 acute-care hospitals, 26 exhibited improved disparity performance in 2019.

Limitations:
The program is limited to inpatients within a single state; the analysis does not provide evidence on the causal relationship between the intervention and readmission disparities.

Conclusion:
This represents the first large-scale effort in the US to link disparities to hospital payment. Because the methodology relies on claims data, it could easily be adopted elsewhere. The incentives are directed to within-hospital disparities, thus mitigating concerns about penalizing hospitals with patients with greater social exposure. This methodology could be used to measure disparity in other outcomes.
d-Mannose for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen: A Randomized Controlled Trial
Authors: Lenger Stacy M. , Chu Christine M. , Ghetti Chiara , Durkin Michael J. , Jennings Zoe , Wan Fei , Sutcliffe Siobhan , Lowder Jerry L. 
Published: June 2023

(Abstracted from Urogynecology (Phila) 2023;29:367–377
Up to 25% of women experience recurring urinary tract infections, which are typically managed through long-term antibiotic prophylaxis intended for common urogenital pathogens. Unfortunately, prolonged use of antibiotics can lead to several adverse effects such as allergic reactions, sequelae from microbiome alterations, drug interactions/toxicities, and antibiotic resistance. One commonly prescribed prophylactic therapy, vaginal estrogen therapy (VET), is used as a first-line nonantibiotic therapy for rUTIs.
Blastoid and Pleomorphic Mantle Cell Lymphoma Demonstrate Distinct Clinicopathologic and Genetic Features
Authors: Khanlari Mahsa , Mo Huan , Kim Do Hwan , Sakhdari Ali , Young Ken H. , Jain Preetesh , Wang Michael , Li Shaoying , Kanagal-Shamanna Rashmi , Miranda Roberto N. , Vega Francisco , Medeiros L. Jeffrey , Ok Chi Young 
Published: June 2023

The blastoid (B) and pleomorphic (P) variants of mantle cell lymphoma (MCL) are associated with aggressive clinical behavior. In this study, we collected 102 cases of B-MCL and P-MCL from untreated patients. We reviewed clinical data, analyzed morphologic features using an image analysis tool (ImageJ) and we assessed mutational and gene expression profiles. The chromatin pattern of lymphoma cells was assessed quantitatively by the pixel value. Cases of B-MCL showed a greater median pixel value with lower variation compared with P-MCL, indicating a homogeneously euchromatin-rich pattern in B-MCL. In addition, the Feret diameter of the nuclei was significantly smaller (median 6.92 vs. 8.49 µm per nucleus, P<0.001) and had a lesser degree of variation in B-MCL compared with P-MCL, indicating that B-MCL cells have smaller cells with a more monomorphic appearance. B-MCL showed a significantly higher median Ki-67 proliferation rate (60% vs. 40%, P=0.003), and affected patients had poorer overall survival compared with those with P-MCL (median overall survival: 3.1 vs. 8.8 y, respectively, P=0.038). NOTCH1 mutation was significantly more frequent in B-MCL compared with P-MCL (33% and 0%, respectively, P=0.004). Gene expression profiling showed 14 genes overexpressed in B-MCL cases and gene set enrichment assay for the overexpressed genes showed significant enrichment in the cell cycle and mitotic transition pathways. We also report a subset of MCL cases that has blastoid chromatin but a higher degree of pleomorphism in nuclear size and shape, designated here as hybrid MCL. Hybrid MCL cases had a similar Ki-67 proliferation rate, mutation profile, and clinical outcome to B-MCL and distinct from P-MCL. In summary, these data suggest biological differences between B-MCL and P-MCL cases justifying their separate designation when possible.
Developing and Implementing Racial Health Equity Plans in Four Large US Cities: A Qualitative Study
Authors: Castaneda Yvette , Jacobs Jacquelyn , Margellos-Anast Helen , De Maio Fernando G. , Nunez-Montelongo Lubia , Mettetal Eric , Benjamins Maureen R. 
Published: June 2023

Context:
Local health departments (LHDs) and their partners are critical components of the fight for racial health equity, particularly given the variation in levels of, and pathways to, inequities at the local level.

Objective:
To inform continued progress in this area, we qualitatively examined the development and implementation of equity-related plans and initiatives of LHDs within 4 large US cities: Baltimore, Boston, Chicago, and Philadelphia.

Design and Measures:
We conducted 15 semistructured interviews with 21 members of LHDs, academic institutions, health systems, and community-based organizations involved with health equity strategies or activities in their respective cities. Outcomes included perceptions of the effectiveness of the local health equity plan, participation in other equity-related initiatives, stakeholder engagement, and best practices.

Results:
We contacted 49 individuals, of whom 2 declined and 21 accepted our interview invitation. Recruitment was stopped after we reached saturation. Thematic analysis identified 5 themes across interviews: (1) organizations were flexible in reallocating resources to address racial and health equity; (2) multidisciplinary teams are necessary for effective development and implementation of health equity plans; (3) community collaboration is required for meaningful and sustainable change; (4) there is a direct relationship between racism, structural inequities, and health outcomes; and (5) health departments have prioritized health equity plan development, but further work is required to address root causes.

Conclusions:
In the United States, health departments have begun to develop and implement strategic health plans focused on equity. However, the extent to which these plans result in actual initiatives (both internal and external) varied across cities. The current study increases our understanding of how different partners are working to implement structural changes, programs, and policies to reach equity-related goals in our largest urban areas, providing valuable insight for urban health advocates across the country.
Understanding Health Equity in Public Health Practice in the United States
Authors: Brownson Ross C. , Mazzucca-Ragan Stephanie , Jacob Rebekah R. , Brownson Carol A. , Hohman Katherine H. , Alongi Jeanne , Macchi Marti , Valko Cheryl , Eyler Amy A. 
Published: June 2023

Context:
Understanding the extent to which equity-focused work is occurring in public health departments (eg, in chronic disease programs) can identify areas of success and what is needed to move the needle on health equity.

Objective:
The study objective was to characterize the patterns and correlates of equity-related practices in US state and territorial public health practice.

Design:
The design was a multimethod (quantitative and qualitative), cross-sectional study.

Setting:
The setting included US state and territorial public health departments.

Participants:
Chronic disease prevention practitioners (N = 600) completed self-report surveys in July 2022 through August 2022 (analyzed in September 2022 through December 2022).

Main Outcome Measures:
Health equity data were obtained across 4 domains: (1) staff skills, (2) work unit practices, (3) organizational priorities and values, and (4) partnerships and networks.

Results:
There was a wide range in self-reported performance across the health equity variables. The highest values (those agreeing and strongly agreeing) were related to staff skills (eg, the ability to describe the causes of inequities [82%]). Low agreement was reported for multiple items, indicating the lack of systems for tracking progress on health equity (32%), the lack of hiring of staff members who represent disadvantaged communities (33%), and limited use of principles for community engagement (eg, sharing decision-making authority with partners [34%]). Qualitative data provided tangible examples showing how practitioners and their agencies are turning an array of health equity concepts into actions.

Conclusions:
There is urgency in addressing health equity and our data suggest considerable room for enhancing health equity practices in state and territorial public health. To support these activities, our findings provide some of the first information on areas of progress, gaps in practice, and where to target technical assistance, capacity building efforts, and accreditation planning.
Successful Treatment and Long-Term Follow-Up of Parry-Romberg Syndrome with Anterolateral Thigh Adipofascial Flap
Authors: Zhao Jingyi , Guo Xiaoshuang , Lai Chenzhi , Song Guodong , Zong Xianlei , Jin Xiaolei 
Published: June 2023

Background:
Anterolateral thigh adipofascial free flap transfer is a frequently used method to reconstruct facial symmetry and restore facial soft-tissue contour in patients with Parry-Romberg syndrome, but long-term prognosis and outcomes are unclear.

Method:
The authors report their treatment experience with 42 patients between 2001 and 2017 using microsurgical free anterolateral thigh adipofascial flap transfer. Long-term follow-up results and final reconstructive outcomes were evaluated.

Results:
A total of 42 patients were included. The follow-up ranged from 5 to 21 years. All patients were satisfied with the surgery. Photographic evaluation revealed significant enhancement of postoperative appearance. Numbness or hypesthesia of the local area was the most common symptom noted in long-term follow-up.

Conclusions:
This study evaluated the long-term results of treating Parry-Romberg disease with microsurgery using ALT free flap in the authors’ department. Over 20 years of experience and the significant enhancement in overall appearance indicate a long-lasting, excellent outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Vertical Appearance of Urinary Bladder on Bone Scintigraphy Might Not Always Suggest Adjacent Pathology
Authors: Hao Min , Deng Zhiping , Shao Fuqiang 
Published: June 2023

Abstract
Previous publications suggested that vertical appearance of the urinary bladder on 99mTc-MDP whole-body bone scintigraphy was likely due to an adjacent abnormality. Here we report bone scan findings of a vertical appearance of the urinary bladder in a 66-year-old man with lung cancer without corresponding pathology nearby.