bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effectiveness of corticosteroid injectionversusnight splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial
Authors: Burton Claire , Rathod-Mistry Trishna , Blackburn Steven , Blagojevic-Bucknall Milica , Chesterton Linda , Davenport Graham , Dziedzic Krysia , Higginbottom Adele , Jowett Sue , Myers Helen , Oppong Raymond , van der Windt Danielle , Hay Elaine , Roddy Edward 
Published: April 2022

AbstractObjectivesThis follow-up study of the INSTinCTS (INjection vs SplinTing in Carpal Tunnel Syndrome) trial compared the effects of corticosteroid injection (CSI) and night splinting (NS) for the initial management of mild-to-moderate CTS on symptoms, resource use and carpal tunnel surgery, over 24 months.MethodsAdults with mild-to-moderate CTS were randomized 1:1 to a local corticosteroid injection or a night splint worn for 6 weeks. Outcomes at 12 and 24 months included the Boston Carpal Tunnel Questionnaire (BCTQ), hand/wrist pain intensity numeric rating scale (NRS), the number of patients referred for and undergoing CTS surgery, and healthcare utilization. A cost–utility analysis was conducted.ResultsOne hundred and sixteen participants received a CSI and 118 a NS. The response rate at 24 months was 73% in the CSI arm and 71% in the NS arm. By 24 months, a greater proportion of the CSI group had been referred for (28% vs 20%) and undergone (22% vs 16%) CTS surgery compared with the NS group. There were no statistically significant between-group differences in BCTQ score or pain NRS at 12 or 24 months. CSI was more costly [mean difference £68.59 (95% CI: −120.84, 291.24)] with fewer quality-adjusted life-years than NS over 24 months [mean difference −0.022 (95% CI: −0.093, 0.045)].ConclusionOver 24 months, surgical intervention rates were low in both groups, but less frequent in the NS group. While there were no differences in the clinical effectiveness of CSI and NS, initial treatment with CSI may not be cost-effective in the long-term compared with NS.
Controversies in rheumatology: ultrasound for monitoring of RA—do we need it?
Authors: Hammer Hilde Berner , Caporali Roberto 
Published: April 2022

AbstractClinical joint examination is the cornerstone for evaluation of patients with RA. However, since large discrepancies have been shown even between experienced rheumatologists in evaluation of joint inflammation, and tender joints may have limited value in reflecting inflammation, US has in recent decades been introduced in the clinical assessments of RA patients. US has high accordance with other imaging modalities and enables detection of clinically difficult pathologies and contributes to assessments of joints difficult to evaluate clinically. However, there is no general agreement on the optimal use of US in rheumatology, and the prevalence of machines as well as the level of experience differs greatly between countries. In addition, standardized use of US in treat-to-target follow-up of RA patients was found not to have any added value. Thus, how to use US in monitoring of RA patients is open for debate. The present article will discuss the pros and cons for using US in the clinical setting.
Perioperative Pain Management Issues Unique to Older Adults Undergoing Surgery
Authors: Shellito Adam D. , Dworsky Jill Q. , Kirkland Patrick J. , Rosenthal Ronnie A. , Sarkisian Catherine A. , Ko Clifford Y. , Russell Marcia M. 
Published: April 2022

Introduction:
The older population is growing and with this growth, there is a parallel rise in the operations performed on this vulnerable group. The perioperative pain management strategy for older adults is unique and requires a team-based approach for provision of high-quality surgical care.

Methods:
Literature search was performed using PubMed in addition to review of relevant protocols and guidelines from geriatric, surgical, and anesthesia societies. Systematic reviews and meta-analyses, randomized trials, observational studies, and society guidelines were summarized in this review.

Management:
The optimal approach to pain management for older adults undergoing surgery involves addressing all phases of perioperative care. Preoperative assessment of patients' cognitive function and presence of chronic pain may impact the pain management plan. Consideration should be also be given to intraoperative strategies to improve pain control and minimize both the dose and side effects from opioids (eg, regional anesthetic techniques). A multimodal postoperative pain management strategy minimizing opioids is crucial to providing adequate pain control while minimizing elderly-specific complications such as postoperative delirium and functional decline. Finally, pain management does not stop after the older adult patient leaves the hospital. Both discharge planning and postoperative clinic follow-up provide important opportunities for collaboration and intervention.

Conclusions:
An opioid-sparing pain management strategy for older adults can be accomplished with a comprehensive and collaborative interdisciplinary strategy addressing all phases of perioperative care.
Prolonged Opioid Use following Hand Surgery: A Systematic Review and Proposed Criteria
Authors: Moura Steven P. , Nicholson Showly , Hoftiezer Yannick Albert J. , Lans Jonathan , Chen Neal C. , Eberlin Kyle R. 
Published: April 2022

Background:
Prolonged opioid use after surgery has been a contributing factor to the ongoing opioid epidemic. The purpose of this systematic review is to analyze the definitions of prolonged opioid use in prior literature and propose appropriate criteria to define postoperative prolonged opioid use in hand surgery.

Methods:
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 130 studies were included for review. The primary outcome was the timepoint used to define prolonged opioid use following surgery. The proportion of patients with prolonged use and risk factors for prolonged use were also collected for each study. Included studies were categorized based on their surgical specialty.

Results:
The most common timepoint used to define prolonged opioid use was 3 months (n = 86, 67.2% of eligible definitions), ranging from 1 to 24 months. Although 11 of 12 specialties had a mean timepoint between 2.5 and 4.17 months, Spine surgery was the only outlier with a mean of 6.90 months. No correlation was found between the definition’s timepoint and the rates of prolonged opioid use.

Conclusions:
Although a vast majority of the literature reports similar timepoints to define prolonged postoperative opioid use, these studies often do not account for the type of procedures being performed. We propose that the definitions of postoperative prolonged opioid use should be tailored to the level and duration of pain for specific procedures. We present criteria to define prolonged opioid use in hand surgery.
FOLDABLE CAPSULAR VITREOUS BODY IMPLANTATION FOR COMPLICATED RETINAL DETACHMENT CAUSED BY SEVERE OCULAR TRAUMA
Authors: Li Meili , Tang Yu , Li Suyan , Zhang Zhengpei , Guan Lina , Li Jie , Xu Jing , Ji Sujuan 
Published: April 2022

Purpose:
To explore the effectiveness, safety and psychological impact of foldable capsular vitreous body (FCVB) implantation for complicated retinal detachment caused by severe ocular trauma.

Methods:
This was a prospective, single-arm, surgical interventional case series study. A standard 3-port 23-gauge pars plana vitrectomy was performed, and the FCVB was implanted into the vitreous cavity. Observed indicators, including the best-corrected visual acuity, intraocular pressure (IOP), retinal reattachment, complications, and patient satisfaction, were analyzed to evaluate the study.

Results:
A total of 28 cases (eyes) were enrolled, with a mean follow-up of 16.93 ± 9.67 months and an average age of 51.11 ± 10.14 years, including 22 men (78.57%). The FCVB was successfully implanted, and the retina was reattached in all cases. The postoperative best-corrected visual acuity improved in 7 cases, and remained unchanged in 21 cases (P > 0.05). The average IOP was 7.01 ± 2.43 mmHg before surgery and 8.54 ± 2.93 mmHg after surgery (P < 0.05). Complications such as FCVB displacement, endophthalmitis, secondary glaucoma, silicone oil emulsification, and escape did not occur during the follow-up period. Patients with FCVB implantation are highly satisfied. Most patients feel hope, positive, and optimistic about life.

Conclusion:
Foldable capsular vitreous body implantation for complicated retinal detachment caused by severe ocular trauma is effective and safe, and it allows patients to face life positively and optimistically.
The Effect and Optimal Timing of Extracorporeal Shock-wave Intervention to Patients with Spasticity After Stroke: A Systematic Review and Meta-Analysis
Authors: Ou-Yang Liang-Jun , Chen Po-Huang , Lee Cho-Hao , Li Tsung-Ying , Wu Yung-Tsan , Jhou Hong-Jie , Yu Tung-Yang 
Published: April 2022

ABSTRACT

Objective
This study investigated the efficacy of ESWT as well as the optimal intervention timing for ESWT for patients with spasticity after stroke.

Design
A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of ESWT versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of ESWT. The follow-up period of the outcomes was divided into the short (<2 weeks), mid (>2 weeks and ≤ 4 weeks), and long (>4 weeks and ≤ 3 months) terms.

Results
Thirteen studies with 677 participants were evaluated. Spasticity significantly improved throughout the follow-up duration. Limb functionality significantly improved in the short-term follow-up period. The meta-regression analysis showed that patients with stroke duration less than 45 months may be benefited from ESWT in improving limb function in all follow-up periods.

Conclusion
ESWT is an effective method for reducing spasticity in patients with stroke, and the effect could be maintained for up to 3 months. Its effects on limb functionality could persist for at least 2 weeks. Patients who had stroke for less than 45 months may have significant benefit from ESWT in all follow-up periods.
CENTER FOR TRAUMA SURVIVORSHIP IMPROVES POST-DISCHARGE FOLLOW-UP AND RETENTION
Authors: Goldstein Carma , Gore Amy , La Bagnara Susan , Jacniacka-Soto Ilona E. , Sieck Derrick , Yonclas Peter , Livingston David H. 
Published: April 2022

BACKGROUND
Although the need for high-level care persists post-discharge, severely injured trauma survivors have historically poor adherence to follow-up. We hypothesized that a dedicated Center for Trauma Survivorship (CTS) improves follow-up and facilitates post-discharge specialty care.

METHODS
Retrospective study of “CTS eligible” trauma patients before (Jan – Dec 2017) and after (Jan – Dec 2019) creation of the CTS. Patients with an ICU stay ≥2 days or a New Injury Severity Score ≥ 16 are CTS eligible. The before (PRE) cohort was followed through Dec 2018 and the after (CTS) cohort through Dec 2020. Primary outcome was follow-up within the hospital system exclusive of mental health and rehabilitative therapy appointments. Secondary outcomes include post-discharge surgical procedures and specialty-specific follow-up.

RESULTS
There were no significant differences in demographics or hospital duration in the PRE (n = 177) and CTS (n = 119) cohorts. Of the CTS group, 91% presented for outpatient follow-up within the hospital system, compared to 73% in the Pre group (p < 0.001). In the PRE cohort, only 39% were seen by the trauma service compared to 62% in the CTS cohort (p < 0.001). CTS patients also had increased follow-up with other providers (80% vs 65%; p = 0.006). Notably, 33% of CTS patients had additional surgery compared to only 20% in the PRE group (p = 0.011). CTS patients had over 20% more outpatient visits (1,280 vs 1,006 visits).

CONCLUSION
Despite the follow-up period for the CTS cohort occurring during the peak of the COVID-19 pandemic, limiting availability of outpatient services, our CTS significantly improved follow-up with trauma providers, as well as with other specialties. The CTS patients also underwent significantly more secondary operations. These data demonstrate that creation of a CTS can improve the post-discharge care of severely injured trauma survivors, allowing for care coordination within the healthcare system, retaining patients, generating revenue and providing needed follow-up care.

LEVEL OF EVIDENCE
Therapeutic, Level IV
Value in acute care surgery, part 2: Defining and measuring quality outcomes
Authors: Ross Samuel Wade , Wandling Michael W. , Bruns Brandon R. , Martin R. Shayn , Scott John W. , Doucet Jay J. , Davis Kimberly A. , Staudenmayer Kristan L. , Minei Joseph P. 
Published: April 2022

ABSTRACT
The prior article in this series delved into measuring cost in acute care surgery, and this subsequent work explains in detail how quality is measured. Specifically, objective quality is based on outcome measures, both from administrative and clinical registry databases from a multitude of sources. Risk stratification is key in comparing similar populations across diseases and procedures. Importantly, a move toward focusing on subjective outcomes like patient-reported outcomes measures and financial well-being are vital to evolving surgical quality measures for the 21st century.
N-acetylcysteine is associated with reduction of postconcussive symptoms in elderly patients: A pilot study
Authors: Mcpherson Ryan A. , Mangram Alicia J. , Barletta Jeffrey F. , Dzandu James K. 
Published: April 2022

INTRODUCTION

N-acetylcysteine (NAC) may be neuroprotective by minimizing postconcussion symptoms after mild traumatic brain injury (TBI), but limited data exist. This study evaluated the effects of NAC on postconcussion symptoms in elderly patients diagnosed with mild TBI.

METHODS
This prospective, quasirandomized, controlled trial enrolled patients 60 years or older who suffered mild TBI. Patients were excluded if cognitive function could not be assessed within 3-hours postinjury. Patients were allocated to receive NAC plus standard care, or standard care alone, based on the trauma center where they presented. The primary study outcome was the severity of concussive symptoms measured using the Rivermeade Postconcussion Symptoms Questionnaire (RPQ). Symptoms were evaluated on days 0, 7, and 30. The RPQ scores were compared both within and between treatment groups.

RESULTS
There were 65 patients analyzed (NAC, n = 34; control, n = 31) with an average age of 76 ± 10 years. Baseline demographics and clinical variables were similar. No group differences in head Abbreviated Injury Scale score or Glasgow Coma Scale score were observed. Baseline RPQ scores (6 [0–20] vs. 11 [4–20], p = 0.300) were indistinguishable. The RPQ scores on day 7 (2 [0–8] vs. 10 [3–18], p = 0.004) and 30 (0 [0–4] vs. 4 [0–13], p = 0.021) were significantly lower in the NAC group. Within-group differences were significantly lower in the NAC (p < 0.001) but not control group (p = 0.319).

CONCLUSION

N-acetylcysteine was associated with significant improvements in concussion symptoms in elderly patients with mild TBI. These results justify further research into using NAC to treat TBI.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures
Authors: Ashley Dennis W. , Christie Dudley B. , Long Eric L. , Adiga Rajani , Johns Tracy J. , Fabico-Dulin Josephine , Montgomery Anne 
Published: April 2022

BACKGROUND
Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life (QOL) scores (Rand SF-36 survey)?

METHODS
Eligible patients (pts) included 18 years or older with one or more of the following: flail chest, one or more bicortical displaced fractures (3–10), nondisplaced fractures with failure of medical management. Patients were randomized to either metal or resorbable plate fixation. Primary outcome was fracture alignment. Secondary outcomes were pain scores, opioid use, and QOL scores.

RESULTS
Thirty pts were randomized (15 metal/15 resorbable). Total ribs plated 167 (88 metal/79 resorbable). Patients with rib displacement at day of discharge (DOD) metal 0/14 (one pt died, not from plating) versus resorbable 9/15 or 60% (p = 0.001). Ribs displaced at DOD metal 0/88 versus resorbable 22/79 or 28% (p < 0.001), 48% in posterior location. Patients with increased rib displacement 3 months to 6 months: metal, 0/11 versus resorbable, 3/9 or 33% (p = 0.043). Ribs with increased displacement 3 months to 6 months metal 0 of 67 versus resorbable 6 of 49 or 12.2% (p < 0.004). Pain scores and narcotic use at postoperative Days 1, 2, 3, DOD, 2 weeks, 3 months and 6 months showed no statistically significant difference between groups. QOL scores were also similar at 3 months and 6 months. Trauma recidivism in outpatient period resulted in fracture of resorbable plates in two pts requiring a second surgery.

CONCLUSION
Metal plates provided better initial alignment with no displacement over time. Clinical outcomes were similar regarding pain, narcotic use, and QOL scores. Routine use of resorbable plates for posterior rib fractures is not warranted. Lateral repairs were technically most feasible for using resorbable plates but still resulted in significant displacement. Resorbable plates may not maintain rib alignment when exposed to subsequent injury.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II
Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement
Authors: Lee Patrick T. , Krecko Laura K. , Savage Stephanie , O’Rourke Ann P. , Jung Hee Soo , Ingraham Angela , Zarzaur Ben L. , Scarborough John E. 
Published: April 2022

BACKGROUND
Prevention of hospital-acquired conditions (HACs) is a focus of trauma center quality improvement. The relative contributions of various HACs to postinjury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients.

METHODS
Adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files who required 5 days or longer of hospitalization and had an Injury Severity Score of 9 or greater were included. Multiple imputation with chained equations was used for observations with missing data. The frequencies of six HACs and five adverse outcomes were determined. Multivariable Poisson regression with log link and robust error variance was used to produce relative risk estimates, adjusting for patient-, hospital-, and injury-related factors. Risk-adjusted population attributable fractions estimates were derived for each HAC-outcome pair, with the adjusted population attributable fraction estimate for a given HAC-outcome pair representing the estimated percentage decrease in adverse outcome that would be expected if exposure to the HAC had been prevented.

RESULTS
A total of 529,856 patients requiring 5 days or longer of hospitalization were included. The incidences of HACs were as follows: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. Pneumonia demonstrated the strongest association with in-hospital outcomes and resource utilization. Prevention of pneumonia in our cohort would have resulted in estimated reductions of the following: 22.1% for end organ dysfunction, 7.8% for mortality, 8.7% for prolonged hospitalization, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The impact of other HACs was comparatively small.

CONCLUSION
We describe a method for comparing the contributions of HACs to outcomes of hospitalized trauma patients. Our findings suggest that trauma program improvement efforts should prioritize pneumonia prevention.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Sustained Minimal Residual Disease Negativity in Multiple Myeloma is Associated with Stool Butyrate and Healthier Plant-Based Diets
Authors: Shah Urvi A. , Maclachlan Kylee H. , Derkach Andriy , Salcedo Meghan , Barnett Kelly , Caple Julia , Blaslov Jenna , Tran Linh , Ciardiello Amanda , Burge Miranda , Shekarkhand Tala , Adintori Peter , Cross Justin , Pianko Matthew J. , Mailankody Sham , Korde Neha , Hultcrantz Malin , Hassoun Hani , Tan Carlyn , Lu Sydney , Patel Dhwani , Diamond Benjamin , Shah Gunjan , Scordo Michael , Lahoud Oscar , Chung David J. , Landau Heather , Usmani Saad , Giralt Sergio , Taur Ying , Landgren C. Ola , Block Gladys , Block Torin , Peled Jonathan U. , van den Brink Marcel RM , Lesokhin Alexander M. 
Published: April 2022

AbstractSustained minimal residual disease (MRD) negativity is associated with long-term survival in multiple myeloma (MM). The gut microbiome is affected by diet, and in turn can modulate host immunity, for example through production of short-chain fatty acids including butyrate. We examined the relationship of dietary factors, stool metabolites, and microbial diversity with sustained MRD negativity in patients on lenalidomide maintenance. At 3 months, higher stool butyrate concentration (p=0.037), butyrate producers (p=0.025) and α-diversity (p=0.0035) were associated with sustained MRD-negativity. Healthier dietary proteins, (from seafood and plants), correlated with butyrate at 3 months (p=0.009) and sustained MRD-negativity (p=0.05). Consumption of dietary flavonoids, plant nutrients with antioxidant effects, correlated with stool butyrate concentration (anthocyanidins p=0.01, flavones p=0.01, and flavanols p=0.02). This is the first study to demonstrate an association between a plant-based dietary pattern, stool butyrate production and sustained MRD-negativity in MM; providing rationale to evaluate a prospective dietary intervention.Statement of SignificanceWe demonstrate an association between diet, the gut microbiome, and sustained MRD-negativity in MM. A healthy diet, with adequate plant and seafood protein, and containing flavonoids, associates with stool diversity, butyrate production and sustained MRD-negativity. These findings suggest dietary modification should be studied to enhance myeloma control.Key PointsIn MM on lenalidomide maintenance, stool butyrate concentration at 3 months was associated with higher rates of MRD negativity at 12 months.Increased seafood and plant proteins, dietary flavonoids, and diversity of dietary flavonoids correlated with stool butyrate concentrations.