bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations
Authors: Forster Brian L. , Thomas Fridtjof , Arnold Sandra R. , Snider Mark A. 
Published: February 2023

Background
Severe asthma exacerbations in pediatric patients occur frequently and can require pediatric intensive care unit (PICU) admission.

Objective
To determine if early administration of intravenous magnesium sulfate (IVMg) to pediatric patients experiencing severe asthma exacerbations, defined as a respiratory clinical score (RCS) of 9 to 12, resulted in fewer PICU admissions.

Methods
Retrospective chart review of pediatric patients aged from 2 to 17 years presenting with a severe asthma exacerbation to a single tertiary care pediatric emergency department. Univariable and multivariable logistic regression analyses were used to determine if admission to the PICU was associated with early IVMg treatment, within 60 minutes of registration.

Results
A total of 1911 patients were included in the study, of which 1541 received IVMg. The average time to IVMg was 79 minutes, with 35% of the patients receiving it within 60 minutes of arrival. Two hundred forty-eight (13%) were admitted to the PICU, 641 (34%) were admitted to the general inpatient floor, and 1022 (53%) were discharged home. Factors associated with increased odds ratio (OR) of PICU admission were: early IVMg (OR, 1.63; 95% CI: 1.16–2.28), arrival mode to the emergency department via ambulance (OR, 2.23; 95% CI: 1.45–3.43), history of PICU admission for asthma (OR, 1.73; 95% CI: 1.22–2.44), and diagnosis of status asthmaticus (OR, 8.88; 95% CI: 3.49–30.07). Calculated OR of PICU admission subcategorized by RCS for early IVMg patients, after controlling for PICU risk factors, are as follows: RCS 9 (reference), RCS 10 (OR, 2.52; 95% CI: 0.89–2.23), RCS 11 (OR, 2.19; 95% CI: 1.3–3.70), and RCS 12 (OR, 4.12; 95% CI: 2.13–7.95).

Conclusions
Early administration of IVMg to pediatric patients experiencing severe asthma exacerbations does not result in fewer PICU admissions.
Qualitative Analysis of a Roundtable Exercise “Reflecting on the COVID-19 Experience of Public Health Professionals”
Authors: Strand Mark A. , Sidhu Savita , Hohman Adam , Jansen Rick , McDonough Stephen 
Published: February 2023

Context:
Public health professionals around the country faced significant challenges responding to the COVID-19 pandemic. Reflecting on their experience is an essential element in making sense of their experience and learning from it.

Objective:
The objective of this qualitative study was to (1) describe the lived experiences of public health professionals working during the COVID-19 pandemic, (2) discuss the effectiveness of a guided reflection exercise to help public health professionals process these experiences, and (3) provide lessons learned and best practices to inform preparation for a future infectious disease pandemic.

Design:
Qualitative focus group study design.

Setting:
This activity was conducted at a Midwestern state public health professional meeting.

Participants:
Forty-eight public health professionals self-selected to participate in this study.

Results:
Five themes were elicited in this analysis, including Communication, Leadership and Collaboration, Data Management, Community Relationships, and Resources and Planning. In addition, public health professionals reported numerous lessons learned, including the need for more leadership from the state government, the conflicted response of their communities, and the benefits of community solidarity where it was present.

Conclusions:
This article provides a detailed account of public health workers' experiences during the COVID-19 pandemic. It also provides lessons learned that will help public health workers lead more effectively in the future. Guided reflection on a traumatic professional experience can assist participating individuals in making sense of their experience and learning important lessons from it.
Association between knee extension strength and functional capacity after intensive care unit discharge: A six-month prospective cohort study
Authors: Pinto-Ramos João , Moreira Tiago , Costa Liliana , Costa Frederico , Barroso Joana , Sousa-Pinto Bernardo 
Published: February 2023

Abstract

Introduction
Assessing functional improvement after Intensive Care Unit (ICU) discharge is particularly challenging. We aimed to measure the association between (i) changes in knee extension muscle strength or quadriceps femoris and rectus femoris muscle thickness, and (ii) changes in functionality/function-related measurements in post-ICU patients.

Methods
This prospective cohort study included adult patients without previous disability, consecutively selected after ICU discharge. We measured some parameters, such as Short Form 36 (SF-36), 6 Minutes Walking Test (6MWT), 1-Minute Sit-to-Stand (1MSTS), and Short Physical Performance Battery (SPPB) at baseline and three and six months after discharge. We assessed the correlation and built regression models to assess the association between evolution in knee extension strength or muscle thickness and evolution in functional tests.

Results
Thirty patients completed the follow-up. Moderate correlation was found between knee extension strength change and SF-36 Physical Function (correlation coefficient [ρ] = 0.53), 6MWT (ρ = 0.38), 1MSTS (ρ = 0.52) and SPPB (ρ = 0.38). Baseline values and changes in knee extension strength moderately predicted evolution in SF-36 Physical function (r2
= 0.32; p = 0.006). Changes in muscle thickness were overall not associated with changes in functional variables.

Conclusion
Changes in knee extension muscle strength may inform on functional progression over time after ICU discharge, although confirmatory studies are needed.
The Relationship Between Patient-Specific Factors and Discharge Destination After COVID-19 Hospitalization
Authors: Lewis Christopher W. , Gray Elizabeth , Dreyer Sean , Goodman Daniel , Jayabalan Prakash 
Published: February 2023

Objective
The aim of this study was to determine the discharge destinations and associated patient-specific factors among patients hospitalized with COVID-19.

Design
A retrospective cohort study was carried out at a single-site tertiary acute care hospital.

Results
Among 2872 patients, discharge destination included home without services (n = 2044, 71.2%), home with services (n = 379, 13.2%), skilled nursing facility (117, 4.1%), long-term acute care hospital (n = 39, 1.3%), inpatient rehabilitation facility (n = 97, 3.4%), acute care facility (n = 23, 0.8%), hospice services (n = 20, 0.7%), or deceased during hospitalization (n = 153, 5.3%). Adjusting by covariates, patients had higher odds of discharge to a rehabilitation facility (skilled nursing facility, long-term acute care hospital, or inpatient rehabilitation facility) than home (with or without services) when they were older (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.80–3.11; P < 0.001), had a higher Charlson Comorbidity Index score (3–6: OR, 2.36; 95% CI, 1.34–4.15; P = 0.003; ≥7: OR, 2.76; 95% CI, 1.56–4.86; P < 0.001), were intubated or required critical care (OR, 2.15; 95% CI, 1.48–3.13; P < 0.001), or had a longer hospitalization (3–7 days: OR, 12.48; 95% CI, 3.77–41.32; P < 0.001; 7–14 days: OR, 28.14; 95% CI, 8.57–92.43; P < 0.001). Patients were less likely to be discharged to a rehabilitation facility if they received remdesivir (OR, 0.44; 95% CI, 0.31–0.64; P < 0.001).

Conclusions
Patient-specific factors associated with COVID-19 hospitalization should be considered by physicians when prognosticating patient rehabilitation.
Risk factors for disabling and non-disabling neck pain in a large cohort of adolescents
Authors: Sarto Fabio , Sarto Diego , Cattelan Manuela , Masiero Stefano 
Published: February 2023

Abstract

Objectives
Neck pain (NP) is extremely common and represents a substantial economic burden to our society. We aimed to investigate risk factors for non-disabling and disabling neck pain in a large cohort of Italian adolescents with a cross-sectional study.

Design
Six thousand, two hundred eighty-one students (14–19 years old) answered an online questionnaire, investigating: anthropometric data, lifestyle-related items, NP frequency and intensity, need for medical examination and several risk factors. Students who had to give up social activities due to neck complaints constituted the disabling NP group (DIS-NP).

Results
Our findings revealed that sex, age, sports practice, hours of sleep and family history were risk factors (p < 0.001) for NP in our cohort. Moreover, DIS-NP suffered from NP more frequently (p < 0.001) and with higher levels of pain (p < 0.001) compared to the non-disabling group. The number of hours of sleep was the only risk factor that showed a trend to differ comparing the DIS-NP group with the non-disabling NP one (p = 0.057).

Conclusion
Different risk factors for NP were detected in a very large cohort of adolescents.
This study may pave the way for future prospective studies and for the development of preventive strategies for NP in adolescents.
Quality of Life 9-13 years after Autologous or Alloplastic Breast Reconstruction: ‘Which Breast Remains Best?’
Authors: Sadok N. , Refaee M. , Eltahir Y. , de Bock G.H. , van Veen M.M. , Werker P.M.N. 
Published: February 2023

Background:
The aim of this study was to evaluate the long-term patient satisfaction and quality of life 9-13 years after autologous versus alloplastic breast reconstruction (BR) and compare the data to those of an earlier study.

Methods:
This is a nine-year follow-up study of 92 women who underwent BR (47 autologous, 45 alloplastic) between 2006 and 2010 and filled out the Breast-Q questionnaire in 2010. Changes in Breast-Q scores were analyzed by using a change score from baseline (2010) to follow-up (2019), which was presented by a mean change score with 95% confidence intervals. Linear regression analyses were performed to test which patient characteristics were related to the Breast-Q change scores.

Results:
The response rate at follow-up was 60% (25 autologous, 30 alloplastic). Responders at follow-up had a lower Body Mass Index and had less frequently undergone unilateral BR compared to the non-responders. Both women undergoing autologous and alloplastic BR significantly decreased in satisfaction with breasts (-4 points), satisfaction with outcome (-8 points) and satisfaction with nipples (-20 points) over time. None of the patient characteristics, including reconstruction technique, were related to the Breast-Q change scores.

Conclusion:
Satisfaction with breasts, outcome and nipples slightly decreases over time for women undergoing alloplastic and autologous BR. Women undergoing autologous BR seem to remain more satisfied with their breasts 9-13 years after BR compared to women undergoing alloplastic BR. Due to the small sample size, conclusions should be carefully drawn. However, the results were in line with the expectations based on previous literature.
Breast Hypertrophy – A Real Pain in The Back
Authors: Lessard Lucie , Papanastasiou Constantine , Fortin Maryse , Ouellet Jean A. 
Published: February 2023

Background:
Bilateral breast hypertrophy (BBH) comes with signs and symptoms ranging from mild to debilitating. Bilateral breast reduction (BBR) is one of the most frequently performed plastic surgery procedures and its effects on parameters such as spinal balance, paraspinal muscle function, and physical performance have not been thoroughly evaluated. The objective of this study is to evaluate the effects of BBR using advanced spine imaging modalities, and pain resolution.

Methodology:
A prospective, observational cohort study was carried out at the McGill University Health Centre. The following measures were recorded preoperatively and postoperatively for each patient: patient questionnaires (Breast-Q and Pain), MRI, and EOS low-radiation spinal scan.

Results:
Significant postoperative pain reduction was recorded and up to 148% improvement in physical tests. Improvement in all questionnaire and Breast-Q categories was documented. Preoperative and postoperative MRI did demonstrate a statistically significant absence of permanent anatomic skeletal sequelae. Postoperative improvement in thoracic kyphosis was documented.

Conclusion:
Quality of life scores are uniformly improved following BBR. Key findings following BBR include significant pain reduction and no evidence of spinal skeletal change.
This is a finding of major importance in view of the practice of many insurance companies/third-party payer and health care systems which utilize the Schnur scale. The Schnur scale associates a weight for resection with body size which is not directly predictive of pain relief.
This may beckon the need for more precise or different guidelines based on these quantitative findings.
“Systematic Analysis of time- and dose-dependent Effects of Hyaluronidase on the Degradation of different Hyaluronan-based Fillers in vitro.”
Authors: Gerber Peter Arne , Buhren Bettina A. , Bölke Edwin , Philipp-Dormston Wolfgang G. , Homey Bernhard , Schrumpf Holger 
Published: February 2023

Background:
Hyaluronidase (HYAL) is regarded the gold standard for the management of complications associated with Hyaluronan (HA)-based fillers (HA-fillers). Therefore, the understanding of interactions of HA-fillers and HYAL is essential.

Methods:
Nine different commercially available HA-fillers (Belotero range, Juvederm range, Restylane range) with varying degrees of crosslinking were used for the analysis. Fluorescently dyed HA-fillers were individually incubated with varying doses of HYAL (bovine HYAL “Hylase Dessau”, Riemser Pharma, Germany; 5, 10, and 20 U/ml) or NaCl and monitored by time-lapse microscopy. HA-filler degradation was assessed as a decrease in fluorescence intensity of HA-filler plus HYAL compared to HA-filler plus control, quantified by computerized image analysis.

Results:
HA-fillers show significant differences in their reaction to HYAL. Levels of degradation of HA-fillers are positively correlated with increasing concentrations of HYAL. At the highest concentration of HYAL (20 U/ml) all fillers except one (Belotero Volume; BELVOL) reached a significant level of degradation at 5 to 9 hours.

Conclusions:
Here we show that most HA-fillers can be dissolved by HYAL in a dose- and time-dependent manner. Of note, the fillers´ technology and degree of crosslinking seem to exert stronger effects on the degradability by HYAL as compared to the concentration of HA.
“Indocyanine Green Angiography Overpredicts Postoperative Necrosis Compared to Multispectral Reflectance Imaging in a Prospective Cohort of Patients Undergoing Breast Reconstruction”
Authors: George Robert E. , Elwood Eric T. , Jones Glyn E. 
Published: February 2023

Background:
Sufficient perfusion is foundational to successful reconstructive surgery. Various technologies have been developed to help determine if tissue is adequately perfused, or if it will be prone to necrosis postoperatively. Indocyanine green (ICG) angiography is one such method which utilizes fluorescence and analyzes tissue perfusion. Multispectral reflectance imaging (MSRI) is an alternative technology which analyzes optical properties of oxygenated and deoxygenated hemoglobin to determine tissue viability. Because tissue in low perfusion states may still survive due to sufficient oxygenation, the authors hypothesized that compared to MSRI, ICG angiography overpredicts necrosis, potentially resulting in unnecessary resection of viable tissue. This study expands upon preliminary work to investigate this hypothesis.

Methods:
This was a prospective cohort of patients undergoing prepectoral direct implant reconstruction at a single institution. Each patient was examined intraoperatively with both ICG angiography and MSRI. Decisions to resect tissue were made in conjunction with MSRI and ICG images were collected purely for data analysis. Patients were followed postoperatively for at least two months for signs of postoperative necrosis.

Results:
53 cases were included. ICG angiography accurately predicted viability in 40/40 (100%) patients and incorrectly predicted necrosis in 11/13 (84.6%). Simultaneously, MSRI predicted necrosis in 0 patients and accurately predicted viability in 96.2% (51/53) of patients. There was no statistically significant difference in demographic data among patients predicted to experience necrosis via ICG angiography vs those predicted to have entirely viable tissue.

Conclusions:
This study suggests that ICG angiography is prone to overpredicting postoperative necrosis in comparison to MSRI.
Arthroscopic versus open distal hemi-trapeziectomy without interposition in CMC thumb joint osteoarthritis 2-year results of a randomized controlled trial
Authors: van Laarhoven Cecile M.C.A. , Baas Martijn , Qi Hongchao , Coert J.Henk , Zuidam J. Michiel , Koch A. Richard 
Published: February 2023

Background:
Distal hemi-trapeziectomy is suggested as alternative for total trapeziectomy for carpometacarpal (CMC) thumb joint osteoarthritis, when the scaphotrapeziotrapezoidal (STT) joint is unaffected. This can be performed as arthroscopic or open procedure, with suggested advantages for the less invasive arthroscopic technique. To determine which technique has better outcome on subjective and objective measures, we performed a prospective randomized controlled trial.

Methods:
We randomized 90 thumbs in the open (45) and arthroscopic (45) group and evaluated results at pre-operative, 3, 12 and 24 months follow up. The primary outcome was the Patient Rated Wrist and Hand Evaluation (PRWHE) to assess pain and function. Also, we evaluated pinch, grip and range of motion, together with return to work, satisfaction and complications.

Results:
Full follow up was obtained in 62 thumbs (32 open group, 30 arthroscopic group). For both groups, the PRWHE improved from pre-operative to 12 and 24 months follow up. Also, grip power, key- and tip-pinch improved at final follow up for both groups. Between groups, there were no clinical important differences between PRWHE, power of grip or pinch and range of motion. Operation time was shorter for the open group, also return to work was slightly shorter after open surgery. Satisfaction was comparable between groups.

Conclusions:
This study shows good functional improvement and pain reduction obtained with a hemi-trapeziectomy. No arthroscopic benefits could be substantiated in the results. Because of shorter operation time for the open procedure, with further equal outcomes compared to the arthroscopic technique, we prefer open hemi-trapeziectomy.
Measuring success in headache surgery: A comparison of different outcomes measures.
Authors: Albano Nicholas J. , Israel Jacqueline S. , Carbullido Mary K. , Stilp Emmaline K. , Leverson Glen , Voils Corrine I. , Afifi Ahmed M. 
Published: February 2023

BACKGROUND:
Studies of migraine surgery have relied on quantitative, patient-reported measures like the Migraine Headache Index (MHI) and validated surveys to study the outcomes and impact of headache surgery. It is unclear whether a single metric or a combination of outcomes assessments is best suited to do so.

METHODS:
All patients who underwent headache surgery had an MHI calculated and completed the Headache Impact Test (HIT-6TM), Migraine Disability Assessment Test (MIDAS), Migraine Specific Quality of Life Questionnaire (MSQ) and an institutional ad hoc survey pre- and postoperatively.

RESULTS:
Seventy-nine percent of patients (n=27) experienced greater than or equal to 50% MHI reduction. MHI decreased significantly from a median of 210 preoperatively to 12.5 postoperatively (85%, p <0.0001). HIT-6TM scores improved from 67 to 61 (14%, p < 0.0001). MIDAS scores improved from 57 to 20 (67%, p = 0.0022). The MSQ demonstrated improvement in quality of life scores within all three of its domains (p <0.0001). Our ad hoc survey demonstrated that participants “strongly agreed” that, (1) surgery helped their symptoms, (2) they would choose surgery again, and (3) they would recommend headache surgery to others.

CONCLUSION:
Regardless of how one measures it, headache surgery is effective. We demonstrate that surgery significantly improves patients’ quality of life and decreases the effect of headaches on patients’ functioning, but headaches can still be present to a substantial degree. The extent of improvement in migraine burden and quality of life in these patients may exceed the amount of improvement demonstrated by current measures.
Umbilical Complications Following DIEP Flap Breast Reconstruction: Demonstrating the Added Benefit of Preoperative Imaging
Authors: Huang Hao , Jung Wooram F. , Otterburn David M. 
Published: February 2023

Background:
Despite the umbilicus being an essential aesthetic unit, current literature in umbilical outcomes following abdominally based breast reconstruction is limited. In this study, we aim to elucidate the incidence and predictors of umbilical complications following DIEP flaps, with a particular emphasis on past abdominal surgery by type and measures that can be easily obtained from preoperative imaging.

Methods:
An IRB-approved retrospective review of 258 patients who underwent DIEP flap reconstruction from 2011 to 2020 was performed. Patient demographics, preoperative labs, and intraoperative factors were appraised. Preoperative CTA or MRA was used to measure umbilical stalk height, abdominal wall thickness, and total fascial diastasis. Patients with and without perfusion-related umbilical complications were compared.

Results:
Forty patients (15.5%) developed umbilical complications, including 20 patients with epidermolysis/scab, 12 with dehiscence, and 14 with partial necrosis. Patients with complications had a significantly higher rate of hypertension, prior abdominal midline incision, more lateral perforators per flap, longer umbilical stalk, and larger stalk height to abdominal wall thickness ratio (p<0.05). Logistic regressions revealed that stalk height (p=0.006) and stalk height to abdominal wall thickness ratio (p<0.001) were the only significant predictors, with the latter having a greater area under the receiver operating characteristic curve (AUC=0.79, p<0.001).

Conclusions:
Radiographic measurements of umbilical stalk height and stalk height to abdominal wall thickness ratio reliably predict the occurrence of umbilical complications, with the ratio having a more robust predictive ability. We propose the use of routine preoperative imaging to identify high-risk patients who may benefit from prophylactic measures.