bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgeon Experience Matters: An Exact Matched Analysis of TLIF Outcomes Demonstrates No Difference in Surgical Outcomes Between Experienced Neurosurgeons and Orthopedic Surgeons
Authors: Shukla Geet G. , Matur Abhijith V. , Childress Kelly , Tao Xu , Garcia-Vargas Julia , Mehta Jay , Garner Rebecca M. , Gibson Justin , Cass Daryn , Vorster Phillip , Wu Andrew , Street Seth , Duah Henry O. , Motley Benjamin , Cheng Joseph , Adogwa Owoicho 
Published: July 2023

Study Design:
Retrospective cohort study.

Objective:
To compare surgical and medical complications profile between neurosurgeons and orthopedic surgeons after transforaminal lumbar interbody fusion (TLIF) procedures.

Background:
Studies comparing the impact of spine surgeon specialty (neurosurgery vs. orthopedic spine) on TLIF outcomes have been inconclusive and failed to control for operative learning curves and surgical maturity. Orthopedic spine surgeons perform fewer spine procedures in residency, although these differences may be attenuated by mandatory fellowship before starting practice. Any observed differences are likely attenuated with increasing surgeon experience.

Materials and Methods:
Using an all-payer claims database, PearlDiver Mariner, 120 million patient records were analyzed between 2010 and 2022, to identify individuals with lumbar stenosis or spondylolisthesis who underwent index one- to three-level TLIF procedures. International Classification of Diseases—Ninth Edition (ICD-9), International Classification of Diseases—10th Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to query the database. Only Neurosurgeons and Orthopedic spine surgeons who had performed at least 250 procedures were included in the study. Patients undergoing surgery for tumor, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with all-cause surgical or medical complications in a linear regression model.

Results:
1:1 exact matching created two equal groups of 18,195 patients without baseline differences who underwent TLIF procedures by neurosurgeons or orthopedic surgeons. There was no difference in all-cause surgical complications between neurosurgeons and orthopedic spine surgeons (relative risk=1.008, 95% CI: 0.850–1.195, P=0.965). All-cause medical complication rate was higher in the neurosurgery cohort (relative risk=1.144, 95% CI: 1.042–1.258, P=0.005).

Conclusion:
The results of this study suggest that after accounting for surgical maturity, neurosurgeons and orthopedic spine surgeons have similar surgical outcomes. However, neurosurgeons have higher all-cause medical complication rates compared with orthopedic spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.
In-person, Hybrid, and Virtual Grand Rounds in Plastic Surgery: Impact and Participant Perceptions
Authors: Hyland Colby J. , Xiang David H. , Yang Alan Z. , Helliwell Lydia A. , Broyles Justin M. 
Published: July 2023

Background:
Many plastic surgery residency programs adapted to the COVID-19 pandemic by implementing virtual grand rounds. This study aimed to assess the impact of virtual grand rounds and how attendees perceived virtual grand rounds to inform future programmatic planning.

Methods:
This was a quality improvement initiative involving a cross-sectional survey and retrospective review of administrative records for the 2017–2018 (in-person) and 2021–2022 (virtual) academic years for two academic plastic surgery training programs in Boston, MA. Respondents were residents, fellows, and faculty within the two multisite plastic surgery residency training programs.

Results:
There were 39 respondents (51% faculty, 41% residents, and 8% fellows). There was no evidence of different preferences for the format of future grand rounds (P = 0.08), with most preferring hybrid, defined as in person for speakers and others who could attend. Most respondents indicated a more accessible learning environment (86.8%) and lack of in-person interaction (82.1%) as reasons for liking and not liking virtual grand rounds, respectively. Excluding outliers, attendance in 2021–2022 was on average 7.4% points greater than that in 2017–2018 (P < 0.001), or six to seven more individuals at each session. There were significantly more out-of-state speakers in 2021–2022 (84%) as compared to 2017–2018 (28%) (P = 0.0008).

Conclusions:
Virtual grand rounds improved attendance and the geographic diversity of speakers. Attendees preferred a hybrid format for future grand rounds, citing advantages and disadvantages to both in-person and virtual formats.
Consensus-based Recommendations for Vibration Amplification of Sound Energy at Resonance Ultrasound-assisted Liposuction
Authors: Ruff Paul G. , Garcia Onelio , Nykiel Matthew J. , Galanis Charles J. 
Published: July 2023

Background:
Ultrasound-assisted liposuction (UAL) is a popular and minimally invasive cosmetic procedure. Third-generation devices such as the vibration amplification of sound energy at resonance (VASER)lipo system are used for body contouring with enhanced tissue specificity. Despite the widespread use of VASER UAL, published guidelines and recent expert consensus recommendations are lacking. The objective of this study is to develop an expert consensus on the recommendations for use of VASER UAL.

Methods:
In a modified Delphi process, a panel of five US-based, expert plastic surgeons participated in three rounds of consensus building that spanned 4 months to align on guidance statements for the use of VASER as an adjunct to liposuction.

Results:
After the experts responded to an online questionnaire that assessed device settings, postoperative instructions, side effects or complications, and best practices, 32 initial consensus statements were developed. By round 3, these consensus statements for VASER UAL had been reduced and refined to a total of 18.

Conclusions:
To improve patient outcomes, clinicians must understand key factors and best practices when using VASER UAL, including device settings, provider technique, managing side effects, potential complications, and postoperative care. The consensus statements developed herein aim to provide clinicians with expert-backed recommendations for the use of VASER UAL.
Point-of-Care Tissue Oxygenation Assessment with SnapshotNIR for Alloplastic and Autologous Breast Reconstruction
Authors: Moritz William R. , Daines John , Christensen Joani M. , Myckatyn Terence , Sacks Justin M. , Westman Amanda M. 
Published: July 2023

Background:
In breast reconstruction, mastectomy and free flaps are susceptible to vascular compromise and tissue necrosis. The SnapshotNIR device (Kent Imaging, Calgary, AB, Canada) utilizes near-infrared spectroscopy to measure tissue oxygen saturation (StO2) and hemoglobin concentration. Here, we report on the use of this device for StO2 monitoring among patients receiving alloplastic or autologous breast reconstruction.

Methods:
Patients receiving immediate alloplastic reconstruction after mastectomy or autologous reconstruction were enrolled. Preoperative, intraoperative, and postoperative images were taken of the flaps. StO2 and hemoglobin were measured at the following locations: superior and inferior breast, free flap skin paddle (when applicable), and un-operated control skin. Linear mixed effects model for repeated measurements was used to model measurements to estimate the area effect difference across time, time effect difference across area, and pairwise comparisons between two areas at each time point.

Results:
Thirty-two breasts underwent alloplastic reconstruction; 38 breasts underwent autologous reconstruction. No enrollees developed skin necrosis. StO2 was highest after mastectomy and closure in alloplastic reconstructions. StO2 was observed to decline at follow-up in autologous reconstructions. Mean preoperative StO2 was highest in breasts that had previously undergone mastectomy and alloplastic reconstruction.

Conclusions:
The SnapshotNIR device detected normal spatial and temporal differences in tissue oxygenation over the operative course of alloplastic and autologous breast reconstruction. A multi-institutional, prospective clinical trial is needed to determine the sensitivity and specificity of this device for detecting skin flap necrosis.
Acute effect of various dosages of sugar ingestion on vascular function in offspring of hypertensive and normotensive parents
Authors: Kositanurit Weerapat , Korakot Manta , Burana Chuti , Varachotisate Pachara , Kerr Stephen J. , Boonla Chanchai , Kulaputana Onanong 
Published: July 2023

Objectives:
We aimed to study vascular function in healthy men with a parental history of hypertension compared to those without. Acute effect of various dosages of sugar ingestion on vascular function was also investigated in both groups.

Methods:
Thirty-two healthy men were recruited and divided into two groups, offspring of hypertensive parents (OHT) and offspring of normotensive parents (ONT). Participants were orally given 15, 30, and 60 g of sucrose solution compared to water. Peak forearm blood flow (FBF), forearm vascular resistance (FVR), pulse wave velocity (PWV), and oxidative stress markers were measured at baseline and after sucrose intake at 30, 60, 90, and 120 min.

Results:
At baseline, peak FBF was significantly lower (22.40 ± 1.18 vs. 25.24 ± 0.63 ml × dl−1 × min−1, P < 0.001), FVR was significantly higher (3.73 ± 0.42 vs. 3.30 ± 0.26 mmHg × ml−1 × dl × min, P = 0.002), and PWV was significantly faster (6.31 ± 0.59 vs. 5.78 ± 0.61 m/s, P = 0.017) in OHT than ONT. After each sucrose intake, peak FBF significantly declined and was lowest at 30 min in both groups. The reduction in peak FBF was seen in all doses of sucrose and the higher dose of sucrose intervened, the longer reduction in peak FBF observed.

Conclusions:
Vascular function was attenuated in healthy men with a family history of hypertension and became worse after sucrose ingestion even at the low dose. Our findings suggest that the ones, especially those with a parental history of hypertension, should reduce sugar consumption as low as possible.
Using plasma aldosterone concentrations at 1 h of saline infusion test for the diagnosis of primary aldosteronism
Authors: Phonanuwong Ratikorn , Jannoo Sirirat , Chanthanuwat Surawadee , Soonthornpun Supamai 
Published: July 2023

Objective:
Saline infusion test (SIT) requires 2 l of isotonic saline for intravenous infusion over 4 h to suppress plasma aldosterone concentration (PAC). To shorten the procedure time and minimize the volume load, we study the performance of SIT at 1, 2 and 4 h for diagnosing primary aldosteronism.

Methods:
This is a cross-sectional study. PAC was measured before and 1, 2 and 4 h after saline infusion at a rate of 500 ml/h in patients suspected to have primary aldosteronism. Primary aldosteronism was diagnosed based on 4 h PAC, adrenal imaging and/or adrenal venous sampling (AVS).

Results:
Of the 93 patients, 32 had primary aldosteronism. The area under the receiver operating characteristic (ROC) curve of the 1, 2 and 4 h PAC were not statistically different. All of the nonprimary aldosteronism group had a 1 h PAC lower than 15 ng/dl and all of the primary aldosteronism group had a 1 h PAC higher than 5 ng/dl. Nearly 30% of the nonprimary aldosteronism and primary aldosteronism groups had a 1 h PAC between 5 and 15 ng/dl (equivocal range) and could be discriminated by using percentage suppression of 1 h PAC from baseline. Using 1 h PAC of more than 15 ng/dl together with percentage suppression of 1 h PAC from baseline of less than 60 when 1 h PAC was 5–15 ng/dl, primary aldosteronism could be detected with a sensitivity of 93.7% and specificity of 96.7%.

Conclusion:
The 1 h SIT has a similar diagnostic performance to the standard SIT. Using 1 h PAC together with percentage suppression from baseline when 1 h PAC is equivocal, primary aldosteronism can be diagnosed with good accuracy.
Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review
Authors: DeJong Lempke Alexandra F. , Whitney Kristin E. , Stracciolini Andrea , Ackerman Kathryn E. , d’Hemecourt Pierre A. , Willwerth Sarah B. , Meehan William P. 
Published: July 2023

Objective:
To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame.

Design:
Retrospective chart review.

Setting:
Outpatient hospital-affiliated Injured Runners Clinic.

Patients:
Children and adolescent runners (6-17 years) with RRIs.

Independent Variables:
We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors.

Main Outcome Measures:
We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis.

Results:
There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ2 = 9271, P < 0 .001; N = 591; 25.4% of all visits).

Conclusion:
We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.
Financial Toxicity Among Breast Cancer Patients
Authors: Kuang Yi , Yuan Xiaoyi , Zhu Zheng , Xing Weijie 
Published: July 2023

Background
Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied.

Objectives
The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs.

Methods
We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute.

Results
A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life.

Conclusion
Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes.

Implications for Practice
More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.
Experiences of Using Patient Decision Aids for Decisions About Cancer Treatment
Authors: Longcoy Li-Ting Huang , Mathew Asha , Jang Min Kyeong , Mayahara Masako , Doorenbos Ardith Z. 
Published: July 2023

Background
Inconsistent results have been found regarding the effects of patient decision aids (PtDAs) in supporting patients’ decision-making for cancer treatment.

Objective
This qualitative meta-aggregation presents the experiences of using PtDAs, as perceived by adult patients with cancer, and highlights the components they perceived as important.

Methods
We used the 3-phase process for meta-aggregation suggested by Joanna Briggs Institute to identify published studies with qualitative evidence from CINAHL, Ovid-MEDLINE, APA PsycINFO, and EMBASE databases. The selected studies involved adults with various cancer diagnoses. The phenomenon of interest and the context for this review were people’s experiences of using PtDAs for decisions about first-line cancer treatment.

Results
A total of 16 studies were included. The authors achieved consensus on 5 synthesized findings about PtDAs: (1) improved understanding of treatment options and patient values and preferences; (2) served as platforms for expressing concerns, obtaining support, and having meaningful conversations with healthcare providers; (3) facilitated active personal and family engagement in decision-making; (4) enabled recall of information and evaluation of satisfaction with decisions; and (5) presented potential structural barriers.

Conclusions
This study used qualitative evidence to demonstrate the usefulness of PtDAs and identify aspects patients with cancer find particularly beneficial.

Implications for Practice
Nurses play a crucial role in supporting patients and family caregivers throughout the decision-making process for cancer treatment. Patient decision aids that balance complex treatment information with simple language and illustrations or graphs can enhance patients’ comprehension. The integration of values clarification exercises into care can further improve patients’ decisional outcomes.
Neonatal Intensive Care Unit to Home Discharge Communication: A Quality Improvement Project
Authors: Pattnaik Priyam , Nafday Suhas , Angert Robert 
Published: July 2023

Introduction:
Neonatal intensive care unit (NICU) graduates require complex services after discharge. The NICU discharge process at Children’s Hospital at Montefiore-Weiler, Bronx, NY (CHAM-Weiler) lacked a system for routine primary care provider (PCP) notification. Here, we describe a quality improvement project to improve communication with PCPs to ensure communication of critical information and plans.

Methods:
We assembled a multidisciplinary team and collected baseline data on discharge communication frequency and quality. We used quality improvement tools to implement a higher-quality system. The outcome measure was the successful delivery of a standardized notification and discharge summary to a PCP. We collected qualitative data through multidisciplinary meetings and direct feedback. The balancing measures comprised additional time spent during the discharge process and relaying erroneous information. We used a run chart to track progress and drive change.

Results:
Baseline data indicated that 67% of PCPs did not receive notifications before discharge, and when PCPs did receive notifications, the discharge plans were unclear. PCP feedback led to proactive electronic communication and a standardized notification. The key driver diagram allowed the team to design interventions that led to sustainable change. After multiple Plan-Do-Study-Act cycles, delivery of electronic PCP notifications occurred more than 90% of the time. Surveys of pediatricians who received notifications indicated that the notifications were highly valued and aided in the transition of care for these at-risk patients.

Conclusion:
A multidisciplinary team, including community pediatricians, was key to improving the rate of PCP notification of NICU discharge to more than 90% and transmitting higher-quality information.
Hydrogen-Generating Silicon-Based Agent Improves Fat Graft Survival in Rats
Authors: Otani Naoya , Tomita Koichi , Kobayashi Yuki , Kuroda Kazuya , Kobayashi Hikaru , Kubo Tateki 
Published: July 2023

Background:
Regulating excessive inflammation and oxidative stress in fat grafting may improve retention rates. Hydrogen effectively combats oxidative stress and inflammation and reportedly inhibits ischemia–reperfusion injury in various organs. However, with conventional methods of hydrogen administration, incorporating hydrogen continuously into the body over a long period of time is difficult. The authors hypothesized that a silicon (Si)-based agent they recently developed would aid in fat grafting, as it can generate large amounts of hydrogen continuously in the body.

Methods:
Fat grafting was performed on the backs of rats fed either a normal or 1.0 wt% Si-based agent-containing diet. To investigate synergistic effects with adipose-derived stromal cells (ASCs), which improve retention rates of fat grafting, fat grafting with ASCs (1.0 × 105/400 mg fat) was also performed in each rat. Postoperative retention rates of grafted fat over time, inflammatory indices, apoptosis, oxidative stress markers, histologic findings, and expression levels of inflammation-related cytokines and growth factors were compared among the 4 groups.

Results:
Intake of Si-based agent and addition of ASCs significantly reduced inflammatory indices, oxidative stress, and apoptosis of grafted fat, and improved long-term retention rates, histologic measures, and grafted fat quality. Under the experimental conditions, intake of the Si-based agent and addition of ASCs yielded comparable improvements in fat graft retention. Combining the 2 enhanced these effects.

Conclusions:
Oral administration of a hydrogen-generating Si-based agent may improve grafted fat retention by regulating the inflammatory response and oxidative stress in grafted fat.

Clinical Relevance Statement:
This study demonstrates improved grafted fat retention rates using a Si-based agent. This Si-based agent has the potential to expand the range of therapeutic indications of hydrogen-based therapy to conditions for which hydrogen has yet to be found effective, such as fat grafting.
Diagnostic stewardship: what impacts antibiotics use?
Authors: Coffey KC , Morgan Daniel J , Claeys Kimberly C 
Published: July 2023

Purpose of review
The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing.

Recent findings
Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use.

Summary
Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.