bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time to Completion of Pediatric PROMIS Computerized Adaptive Testing Measures and the SRS-22r in an Adolescent Idiopathic Scoliosis Population
Authors: Paranjape Chinmay S. , de Araujo Olivia B. , Reider Lisa M. , Sponseller Paul D. , Carlini Anthony R. , McLaughlin Kevin , Bachmann Keith R. , Mitchell Stuart L. 
Published: August 2022

Background:
Patient-reported outcome measures are useful tools to quantify patients’ pre-treatment and post-treatment symptoms. Historically used “legacy measures”, such as the Scoliosis Research Society-22 revised questionnaire (SRS-22r), are often disease-specific and can be time-intensive. Recently developed Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing (CAT) measures may reduce administrative burdens and permit more efficient outcome collection within clinic workflows. In an era of medicine where payments are becoming tied to outcomes, we sought to assess the time to completion (TTC) of 8 pediatric PROMIS CAT measures and the SRS-22r in adolescents with idiopathic scoliosis.

Materials and Methods:
Patients presenting to a large, urban tertiary referral hospital were prospectively enrolled into the study. Subjects were first-time survey respondents in various phases and types of treatment for adolescent idiopathic scoliosis. In total, 200 patients ranging from 10 to 17 years old completed 8 Pediatric PROMIS CATs and the SRS-22r. PROMIS CATs administered include Physical Activity, Mobility, Anxiety, Depressive symptoms, Peer Relationships, Physical Stress Experiences, Pain Behavior and Pain Interference. TTC was calculated using start and stop timestamps in the REDCap software.

Results:
The mean (±SD) TTC for each PROMIS CAT was 1.1 (±0.9) minutes with physical activity, mobility, anxiety, depressive symptoms, peer relationships, physical stress experiences, pain behavior, and pain interference taking 1.2, 1.4, 1.0, 0.9, 1.2, 1.0, 1.0, and 1.2 minutes on average to complete, respectively. Mean TTC for the SRS-22r was 5.2 (±3.0) minutes.

Conclusions:
In this pediatric orthopaedic cohort, completion of 8 PROMIS CATs demonstrated minimal test-taker burden and time required for completion. These findings support rapid and easily integrable PROMIS CATs in clinical practice to aid in increased delivery of efficient, patient-centered care.

Level of Evidence:
III, cross-sectional study.
A Multiple Baseline Trial of an Electronic ICU Discharge Summary Tool for Improving Quality of Care*
Authors: Stelfox Henry T. , Brundin-Mather Rebecca , Soo Andrea , Whalen-Browne Liam , Kashyap Devika , Sauro Khara M. , Bagshaw Sean M. , Fiest Kirsten M. , Taljaard Monica , Parsons Leigh Jeanna 
Published: August 2022

Objective:
Effective communication between clinicians is essential for seamless discharge of patients between care settings. Yet, discharge summaries are commonly not available and incomplete. We implemented and evaluated a structured electronic health record–embedded electronic discharge (eDischarge) summary tool for patients discharged from the ICU to a hospital ward.

DESIGN:
Multiple baseline trial with randomized and staggered implementation.

SETTING:
Adult medical-surgical ICUs at four acute care hospitals serving a single Canadian city.

PATIENTS:
Health records of patients 18 years old or older, in the ICU 24 hours or longer, and discharged from the ICU to an in-hospital patient ward between February 12, 2018, and June 30, 2019.

INTERVENTION:
A structured electronic note (ICU eDischarge tool) with predefined fields (e.g., diagnosis) embedded in the hospital-wide electronic health information system.

MEASUREMENTS AND MAIN RESULTS:
We compared the percent of timely (available at discharge) and complete (included goals of care designation, diagnosis, list of active issues, active medications) discharge summaries pre and post implementation using mixed effects logistic regression models. After implementing the ICU eDischarge tool, there was an immediate and sustained increase in the proportion of patients discharged from ICU with timely and complete discharge summaries from 10.8% (preimplementation period) to 71.1% (postimplementation period) (adjusted odds ratio, 32.43; 95% CI, 18.22–57.73). No significant changes were observed in rapid response activation, cardiopulmonary arrest, death in hospital, ICU readmission, and hospital length of stay following ICU discharge. Preventable (60.1 vs 5.7 per 1,000 d; p = 0.023), but not nonpreventable (27.3 vs 40.2 per 1,000d; p = 0.54), adverse events decreased post implementation. Clinicians perceived the eDischarge tool to produce a higher quality discharge process.

CONCLUSIONS:
Implementation of an electronic tool was associated with more timely and complete discharge summaries for patients discharged from the ICU to a hospital ward.
Optimum Methotrexate Exposure in Patients With Suspected or Confirmed CNS Invasive Hematological Malignancies: A Systematic Critical Review
Authors: Faria Monteiro Joaquim , Rita Damas , Rui Bergantim , Fernanda Trigo 
Published: August 2022

Background and Methods:
The present review aims to evaluate the current state-of-the-art dosing regimens of high-dose (HD) and intrathecal methotrexate (MTX) using therapeutic drug monitoring (TDM) to optimize its therapeutic response and minimize associated toxicity, particularly in the central nervous system (CNS).

Results:
MTX is administered systemically in a HD regimen (>1 g/m2) for the treatment of various hematological neoplasms. HD-MTX treatment becomes complicated by marked interindividual drug elimination variability. TDM is specified to manage this high variability. Approximately 3%–7% of adults with acute lymphoblastic leukemia are diagnosed with CNS involvement, and the incidence of CNS relapse in patients, despite receiving prophylaxis, ranges from 5% to 10%. HD-MTX penetrates the blood–brain barrier and can be administered intrathecally, making this drug an important component of chemotherapy regimens for patients with hematologic malignancies involving the CNS or those at high risk of CNS relapse.

Conclusions:
The major evidence found was that an MTX area under the curve target between 1000 and 1100 μmol hour−1 L is associated with better clinical outcomes. However, there seems to be a clinical gap in the prospective validation of HD and IT MTX management to optimize clinical outcomes and minimize toxicity, using the relationship between exposure level (area under the curve MTX) and optimal response to MTX, at systemic and CNS exposure.
Data-driven Normative Reference of Pediatric Cranial Bone Development
Authors: Liu Jiawei , Elkhill Connor , LeBeau Scott , French Brooke , Lepore Natasha , Linguraru Marius George , Porras Antonio R. 
Published: August 2022

Background:
Available normative references of cranial bone development and suture fusion are incomplete or based on simplified assumptions due to the lack of large datasets. We present a fully data-driven normative model that represents the age- and sex-specific variability of bone shape, thickness, and density between birth and 10 years of age at every location of the calvaria.

Methods:
The model was built using a cross-sectional and multi-institutional pediatric computed tomography image dataset with 2068 subjects without cranial pathology (age 0–10 years). We combined principal component analysis and temporal regression to build a statistical model of cranial bone development at every location of the calvaria. We studied the influences of sex on cranial bone growth, and our bone density model allowed quantifying for the first time suture fusion as a continuous temporal process. We evaluated the predictive accuracy of our model using an independent longitudinal image dataset of 51 subjects.

Results:
Our model achieved temporal predictive errors of 2.98 ± 0.69 mm, 0.27 ± 0.29 mm, and 76.72 ± 91.50 HU in cranial bone shape, thickness, and mineral density changes, respectively. Significant sex differences were found in intracranial volume and bone surface areas (P < 0.01). No significant differences were found in cephalic index, bone thickness, mineral density, or suture fusion.

Conclusions:
We presented the first pediatric age- and sex-specific statistical reference for local cranial bone shape, thickness, and mineral density changes. We showed its predictive accuracy using an independent longitudinal dataset, we studied developmental differences associated with sex, and we quantified suture fusion as a continuous process.
Reconsidering Fordyce's classic article, “Pain and suffering: what is the unit?” to help make our model of chronic pain truly biopsychosocial
Authors: Sullivan Mark D. , Sturgeon John A. , Lumley Mark A. , Ballantyne Jane C. 
Published: August 2022

Abstract
The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 article by Wilbert “Bill” Fordyce, “Pain and suffering: what is the unit?” In this article, Fordyce suggested that pain-related disability and suffering should be viewed as “transdermal,” as having causes both inside and outside the body. We consider Fordyce's article theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience—from nociception to multisensory indicators of safety or danger—can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and nonmedical providers to tackle chronic pain.
Correlation analysis of I-131 SPECT/CT uptake parameters with the success ablation treatment of thyroid remnant in patients with low-intermediate-risk differentiated thyroid cancer
Authors: Zhang Qian , Xu Weina 
Published: August 2022

Objective
To predict the successful outcome of radioactive iodine-131 (I-131) ablation treatment for differentiated thyroid cancer (DTC) patients using quantitative parameters from therapeutic I-131 SPECT/CT.

Methods
This retrospective study enrolled 145 DTC patients (41 males and 104 females) who had radioactive iodine-131 (I-131) (RAI) ablation therapy following thyroidectomy surgery from July 2020 to May 2021. The median age was 47 years (24-65 years). All the patients underwent therapeutic I-131 thyroid SPECT/CT scan after RAI ablation. The I-131 uptake quantitative parameters SUVmax, SUVmean %ID and ∆Tg (defined as the Tg level before RAI ablation minus the Tg level after six months) were assessem. Successful ablation treatment was defined as the level of TSH-stimulated Tg≤1 ng/mL and the disappearance of the thyroid bed on a whole-body I-131 scan six months or later after ablation treatment.

Results
The quantitative parameters from therapeutic I-131 SPECT/CT of the successful ablation (n=130) group with SUVmax 7.74 (3.84, 18.78) g/ml, SUVmean 4.02 (2.11, 6.39) g/ml and %ID 2.21% (0.67%, 7.30%) were significantly higher than those of the unsuccessful (n=15) group 0.75 (0.53, 1.28) g/ml, 0.44 (0.29, 0.79) g/ml and 0.16% (0.06%, 1.48%) (Z=-5.87, -5.71 and -4.99, all P < 0.001). SUVmax, SUVmean and %ID were positively correlated with ΔTg (all P < 0.001). Receiver operating characteristics curve analysis showed that %ID performed better predict value than either SUVmax (AUC=0.914, and 0.874, P=0.009) or SUVmean (AUC= 0.863 P=0.002). SUVmax, SUVmean and%ID (OR =1.50, 2.85 and 1.01 all P < 0.001) were all independent predictors of successful RAI ablation.

Conclusion
The quantitative parameters of therapeutic I-131 SPECT/CT were related to the efficacy of ablation treatment, and %ID could predict the successful outcome of ablation treatment for DTC patients.
Treatment of Microcirculatory Disturbances in Acute Pancreatitis
Authors: Antkowiak Ryszard , Bialecki Jacek , Chabowski Mariusz , Domoslawski Pawel 
Published: August 2022

Abstract
Acute pancreatitis is a serious inflammatory condition. Research has shown an increase in the number of pancreatitis-associated hospitalizations, with a marked decline in the mortality rates down to 0.79% in patients with acute pancreatitis and 0.26% in patients with exacerbation of chronic pancreatitis. Up to one-third of patients develop pancreatic tissue necrosis, with a mortality rate of 30%. One of the mechanisms is the disturbances in pancreatic microcirculation due to the release of endothelin, a long-acting vasoconstrictor. The development of pancreatitis causes the release of other inflammatory mediators, which reduce blood flow in the microcirculation. The activation of intracellular trypsinogen initiates a cascade of mechanisms in pancreatitis. There is no specific treatment for acute pancreatitis. Protease inhibitors are not effective in treating severe acute pancreatitis. There is an important role of low-molecular-weight heparin in attenuating necrosis and restoring perfusion of the pancreas. Other drugs used are endothelin receptor antagonists, antagonist of interleukin-1 and interleukin-6 receptors, α-tocopherol, tumor necrosis factor-α and platelet-activating factor inhibitors, acetylsalicylic acid, and local intra-arterial injection of lidocaine. The prophylactic use of antibiotics is not recommended. The treatment outcome of acute pancreatitis is still unsatisfactory.
Glucocorticosteroid and Silicone Gel During Patch Application Without Clinical Scar Improvement After Central Venous Catheter Removal: A Randomized Trial
Authors: Nissen Ida Bo , Handrup Mette Møller , Bang Karen , Hasle Henrik 
Published: August 2022

Introduction:
We studied whether glucocorticosteroid during patch occlusion has a beneficial effect on scar outcome in children and adolescents treated for cancer.

Methods:
A double-blinded placebo-controlled randomized clinical trial was performed. The main outcome was the Vancouver Scar Scale. Secondary outcomes were scar width and scar quality measured using the Patient and Observer Scar Assessment Scale. The patients were divided into an intervention groups and a control group. The intervention group was randomized into active and placebo group. The active treatment consisted of cream with glucocorticosteroid and fusidic acid. The placebo treatment consisted of cream with fusidic acid. Both groups received silicone gel patch after central venous catheter removal. The control group received no specific skin care.

Results:
Assessment at 12 months showed that the intervention group had a significantly lower Vancouver Scar Scale and a smaller scar (0,1 cm) compared with the control group (P=0.00, P=0.02) but no benefit of glucocorticosteroid. The Patient and Observer Scar Assessment Scale showed no significant difference between the intervention and control groups (P=0.84, P=0.36).

Conclusions:
Silicone gel sheet alone or in combination with application of glucocorticosteroid during sheet occlusion does not clinically improve scar outcome after removal of central venous catheter in children treated for neoplastic diseases.
Skin Tensioning Concept in Rhinoplasty Using a Semifixed Support Mechanism
Authors: Cabbarzade Cavid 
Published: August 2022

Background:
As the skin on the nose shows outwardly, if we do not consider the volume of skin on the nose that is reduced, the results may be unsatisfactory. Although redraping the skin over a wide area may help, excess skin cannot be adequately controlled in some cases.

Materials and Methods:
During skin tensioning, a semifixed support mechanism was applied to keep the nasal tip stable and maintain its position while simultaneously allowing stretching and mobility in accordance with its normal function. The dorsal and infratip/columellar skin was stretched by using the support of the most projected part of the nasal tip. The skin was pulled posteriorly to obtain sufficient tensioning and excised at the columellar incision line.

Results:
Of the 94 patients who underwent skin tensioning, 82 were women, and 12 were men. The ages of the patients ranged from 18 to 59 years. Ninety-one patients were primary rhinoplasty patients, and 3 patients were secondary rhinoplasty patients. Skin tensioning was performed in 31 patients with overprojection, 24 patients with thick skin, 17 patients with low skin elasticity, 12 patients with excessive skin elasticity, 7 patients with an advanced long nose, and 3 patients with scar tissue due to previous surgery. No serious complications, either functional or aesthetic, related to skin tensioning was encountered.

Conclusion:
The skin tensioning technique using a semifixed support mechanism helped to achieve a required reduction with a sufficiently defined appearance of the nose in patients with difficult skin.
Preoperative Transfusion and Surgical Outcomes for Children with Sickle Cell Disease
Authors: Salvi Pooja S , Solomon Daniel G , Cowles Robert A 
Published: August 2022

BACKGROUND:
Current guidelines recommending preoperative transfusion to a hemoglobin level of 9 to 10 g/dL for patients with sickle cell disease (SCD) are based on imperfect evidence. The benefit of preoperative transfusion in children specifically is not known. This study aimed to evaluate whether preoperative RBC transfusion is associated with different rates of sickle cell crisis and surgical complications, compared with no preoperative transfusion, among children with SCD undergoing common abdominal operations.

STUDY DESIGN:
The NSQIP-Pediatrics database (2013 to 2019) was queried. Patients who underwent cholecystectomy, splenectomy, or appendectomy with a preoperative Hct level of less than 30% were included. The primary outcome was 30-day readmission for sickle cell crisis. Secondary outcomes were 30-day surgical complications and hospital length of stay. Propensity score matching methods were used to obtain two statistically similar cohorts of patients comprised of those who were preoperatively transfused and those who were not.

RESULTS:
Among 357 SCD patients, 200 (56%) received preoperative transfusion. In the matched cohort of 278 patients (139 per group), there was no statistically significant difference in 30-day readmission for sickle cell crisis in the transfused and non-transfused groups (5.8% vs 7.2%, p = 0.80). The rate of 30-day surgical complications did not differ between matched groups (10.8% vs 9.4%, p = 0.84). Subgroups defined by presenting Hct levels of 27.3% or greater or less than 27.3%, American Society of Anesthesiologists classification, wound class, and index operation were not associated with an altered risk of sickle cell crisis or surgical complications after preoperative transfusion compared with no transfusion.

CONCLUSIONS:
Preoperative transfusion for children with SCD undergoing semi-elective abdominal operations was not associated with improved outcomes. Prospective investigation is warranted to strengthen guidelines and minimize unnecessary perioperative transfusions in this population.
Effect of Background Music in the Operating Room on Surgical Outcomes: A Prospective Single-Blinded Case-Control Study
Authors: Co Michael , Fong Sze Man , Lau Yik Ching Christy 
Published: August 2022

BACKGROUND:
The effect of playing background music on surgical outcomes has been controversial. This prospective case-control study aims to evaluate the impact of music tempo in general surgical settings.

STUDY DESIGN:
Six hundred consecutive patients with nonmetastatic breast cancer receiving breast cancer surgery have been recruited since April 2017. Patients were then assigned to 3 arms in consecutive order. The surgeon operated without music in study arm A; the surgeon operated with slow music in study arm B; and in study arm C, the surgeon operated with fast background music. Patients’ clinical records were reviewed by an independent blinded assessor.

RESULTS:
Baseline demographic data were comparable among the 3 study arms. Seven (3.5%) patients from study arm A developed minor complications (Clavien-Dindo class I and II); none developed major complications (Clavien-Dindo class III or above). Six (3.0%) patients from study arm B and C, respectively (slow/fast music groups), developed minor complications; none developed a major complication. Mean blood loss was also similar among the 3 study arms (5.1, 5.1, and 5.2 mL, respectively; p > 0.05). Operating time was significantly shorter in study arm C: 115 minutes (90–145), compared with 125 minutes (100–160) in study arm A (p < 0.0001) and 120 minutes (95–155) in study arm B (p = 0.0024). After a median follow-up of 40 months (3–56), 40 months (3–56), and 39.5 months (3–56), the local recurrence rates were 1.5%, 1%, and 1%, respectively (p > 0.05).

CONCLUSION:
Playing music in the operating room is safe in general surgical settings in experienced hands.
Outcomes of the Early Specialization Program in Vascular Operation
Authors: Potts John R , Buyske Jo , Klingensmith Mary E 
Published: August 2022

BACKGROUND:
The Early Specialization Program (ESP) in vascular surgery (VS) began as a “pilot program” in 2003. There is only one published report on ESP outcomes.

STUDY DESIGN:
The general surgery (GS) and VS programs of all institutions using the ESP were contacted. Data gathered included demographics of ESP enrollees, participants’ case logs (CLs), and CLs of participants’ residency graduating classmates. National CLs, program and institutional data, and participants’ certification status were publicly available.

RESULTS:
Nine institutions have enrolled 34 participants. Four withdrew, and four are in the GS component. Of 26 who have completed ESP, residency CLs were available for 20. Participants’ percentile rankings among national contemporaries were lower than 13th for surgeon–junior cases (SJCs), higher than 73rd for surgeon–chief cases (SCCs), and 49th for total major cases (TMCs). They were lower than the 40th percentile in all domains except operative trauma (52; SD 23.8) and vascular (84.7; SD 22.1). As a percentage of the mean (% mean) for their own graduating classes, participants performed 91.8% (SD 16.5) as many SJCs, 143.7% (SD 45.1) as many SCCs, and 105% (SD 11.4) as many TMCs. Participants performed more than 79 % mean in every domain, including 213.4% (SD 82.4) as many vascular cases. As fellows, they ranked higher than the 50th percentile nationally in all but two categories. Twenty-four of 26 certified in GS. GS certification has lapsed for 5, 17 remain initially certified, and 2 have re-certified. All have current VS certification.

CONCLUSION:
Although infrequently employed, ESP remains an effective option for those who seek both GS and VS certification.