bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extended Reality International Grand Rounds: An Innovative Approach to Medical Education in the Pandemic Era
Authors: Salavitabar Arash , Popov Vitaliy , Nelson Jeremy , Benedict Michelle D. , Inniss Donovan A. , Mahajan Arushi P. , Cohen Mark S. , Owens Sonal T. 
Published: February 2022

Problem
While bedside training has always presented its own unique challenges, the COVID-19 pandemic era has intensified barriers to suitable provider and trainee experiences for both patient care and medical education.

Approach
This project introduced an innovative solution with the Extended Reality International Grand Rounds, a collaboration between the University of Michigan Center for Medical and Surgical Extended Reality and Imperial College London. Three complex cases were presented to trainees through a wireless, extended reality (XR) headset and augmented by holographic visual aids and expert commentary. This pilot rounding experience was performed through the first-person view of one clinician at the bedside.

Outcomes
In 2020, 140 attendees participated in XR International Grand Rounds, and 82 (59%) and 61 (44%) completed pre- and postsurveys, respectively. Survey analysis showed that the majority of respondents (65, 79.3%) had very little to no baseline experience with XR technologies and nearly all (75, 91.5%) agreed that the development and implementation of XR curricula are important in medical training, indicating an unmet need. Nearly all respondents (59, 96.7%) found value in the ability to visualize patients’ clinical findings in the XR rounding experience and 60 (98.4%) found value in the ability to visualize patient-specific imaging and test findings in an XR format. Limiting exposure to high-risk patients and care team members with this innovative format was believed to be important to 79 (96.3%) respondents at baseline and that perception was unchanged following the event.

Next Steps
This solution to a long-standing dilemma, newly stressed by a unique era in medicine, was a successful collaboration using state-of-the-art XR technology. Next steps will include introducing more advanced physical exam visualization and detection and comprehensive evaluation of the patient experience, as well as expanding the international experience in a format that is scalable to other interested institutions.
Single dose IV Antibiotic for Low-Energy Extremity Gunshot Wounds
Authors: Nguyen Mai P. , Savakus Jonathan C. , Simske Natasha M. , Reich Michael S. , Furdock Ryan , Golob Joseph F. , McDonald Amy A. , Como John J. , Vallier Heather A. 
Published: February 2022

Objective:
To prospectively determine infection rate following low-energy extremity GSWs with a single dose IV antibiotic protocol.

Summary Background Data:
Previous work suggests that a single IV antibiotic dose, without formal surgical debridement, mitigates infection risk.

Methods:
Over 35 months 530 adults with low-energy GSWs to the extremities were included. Three hundred fifty-two patients (66%) had ≥30 days follow-up. Patients were administered a single dose of first-generation IV cephalosporin antibiotics, and those with operative fractures received 24-hour perioperative antibiotics. Injury characteristics, treatment, protocol adherence, and outcomes (infection) were assessed between the protocol group (single-dose antibiotics) and the non-protocol group (no antibiotics or extra doses of antibiotics).

Results:
Compliance with the single-dose protocol occurred in 66.8%, while 33.2% received additional antibiotics or no antibiotics. The deep infection rate requiring surgical debridement was 0.8%, while the combined rate of all infections was 11.1%. Age, sex, injury location, multiple injuries, fracture presence, and type of surgery did not affect infection rate. Adherence to the antibiotic protocol was associated with a reduction in infection risk (odds ratio = 0.39, 95% confidence interval 0.19–0.83, P = 0.01). Receipt of additional antibiotics outside of our single-dose protocol did not predict further reduction in rate of infection (P = 0.64).

Conclusions:
A standardized protocol of single-dose IV antibiotic appears effective in minimizing infection after low-energy GSW to the extremities.

Level of Evidence:
Therapeutic Level II.
Assessing Public Interest in Elective Surgery During the COVID-19 Pandemic
Authors: Snyder Austin , Lanuti Michael , Muniappan Ashok , Price Melissa C. , Som Avik , Little Brent P. 
Published: February 2022

Objective:
To determine trends in internet search volume for elective surgery terms during the first peak of the coronavirus disease 2019 (COVID-19) pandemic using Google Trends data.

Background:
Postponement of much-needed elective and urgent oncologic surgeries takes a toll on patients and the health care system. The COVID-19 pandemic has led to a decline in elective surgery volume, partially due to the cancellation of elective surgeries at the start of the pandemic.

Methods:
We performed a cross-sectional analysis of internet search volume trends for elective surgery terms during the first peak of the COVID-19 pandemic using Google Trends data and compared to a control group of terms representing common urgent and oncologic surgeries.

Results:
Search volume for elective surgery terms (“knee replacement,” “spinal fusion,” “hip replacement,” “laminectomy,” “cataract surgery”) revealed a decrease of up to 54% compared to the prepandemic period, a significantly greater decrease than search volume for urgent and oncologic surgery terms (“C-section,” “cholecystectomy,” “CABG,” “colectomy,” “lobectomy,” and “mastectomy”).

Conclusions:
The first phase of the COVID-19 pandemic led to sharp declines in search volume for essential elective surgical procedures, which may have been partially due to the cancellation of elective surgeries, but patient factors such as a temporary decline in interest in elective surgery might have also played a role. Attention to internet search volume may be used during future public health crises to monitor public engagement and interest in important health topics, including preventive health measures such as cancer screening.
An Exploratory Investigation of Pupillometry As a Measure of Tinnitus Intrusiveness on a Test of Auditory Short-Term Memory
Authors: Barrett Doug J.K. , Souto David , Pilling Michael , Baguley David M. 
Published: February 2022

Objectives:
The purpose of the current study was to investigate the potential of pupillometry to provide an objective measure of competition between tinnitus and external sounds during a test of auditory short-term memory.

Design:
Twelve participants with chronic tinnitus and twelve control participants without tinnitus took part in the study. Pretest sessions used an adaptive method to estimate listeners’ frequency discrimination threshold on a test of delayed pitch discrimination for pure tones. Target and probe tones were presented at 72 dB SPL and centered on 750 Hz±2 semitones with an additional jitter of 5 to 20 Hz. Test sessions recorded baseline pupil diameter and task-related pupillary responses (TEPRs) during three blocks of delayed pitch discrimination trials. The difference between target and probe tones was set to the individual’s frequency detection threshold for 80% response-accuracy. Listeners with tinnitus also completed the Tinnitus Handicap Inventory (THI). Linear mixed effects procedures were applied to examine changes in baseline pupil diameter and TEPRs associated with group (tinnitus versus control), block (1 to 3) and their interaction. The association between THI scores and maximum TEPRs was assessed using simple linear regression.

Results:
Patterns of baseline pupil dilation across trials diverged in listeners with tinnitus and controls. For controls, baseline pupil dilation remained constant across blocks. For listeners with tinnitus, baseline pupil dilation increased on blocks 2 and 3 compared with block 1. TEPR amplitudes were also larger in listeners with tinnitus than controls. Linear mixed effects models yielded a significant group by block interaction for baseline pupil diameter and a significant main effect of group on maximum TEPR amplitudes. Regression analyses yielded a significant association between THI scores and TEPR amplitude in listeners with tinnitus.

Conclusions:
Our data indicate measures of baseline pupil diameter, and TEPRs are sensitive to competition between tinnitus and external sounds during a test of auditory short-term memory. This result suggests pupillometry can provide an objective measure of intrusion in tinnitus. Future research will be required to establish whether our findings generalize to listeners across a full range of tinnitus severity.
Describing Intersectional Health Outcomes
Authors: Mahendran Mayuri , Lizotte Daniel , Bauer Greta R. 
Published: February 2022

Background:
Intersectionality theoretical frameworks have been increasingly incorporated into quantitative research. A range of methods have been applied to describing outcomes and disparities across large numbers of intersections of social identities or positions, with limited evaluation.

Methods:
Using data simulated to reflect plausible epidemiologic data scenarios, we evaluated methods for intercategorical intersectional analysis of continuous outcomes, including cross-classification, regression with interactions, multilevel analysis of individual heterogeneity (MAIHDA), and decision-tree methods (classification and regression trees [CART], conditional inference trees [CTree], random forest). The primary outcome was estimation accuracy of intersection-specific means. We applied each method to an illustrative example using National Health and Nutrition Examination Study (NHANES) systolic blood pressure data.

Results:
When studying high-dimensional intersections at smaller sample sizes, MAIHDA, CTree, and random forest produced more accurate estimates. In large samples, all methods performed similarly except CART, which produced less accurate estimates. For variable selection, CART performed poorly across sample sizes, although random forest performed best. The NHANES example demonstrated that different methods resulted in meaningful differences in systolic blood pressure estimates, highlighting the importance of selecting appropriate methods.

Conclusions:
This study evaluates some of a growing toolbox of methods for describing intersectional health outcomes and disparities. We identified more accurate methods for estimating outcomes for high-dimensional intersections across different sample sizes. As estimation is rarely the only objective for epidemiologists, we highlight different outputs each method creates, and suggest the sequential pairing of methods as a strategy for overcoming certain technical challenges.
Development and Current Role of Sodium Glucose Cotransporter Inhibition in Cardiorenal Metabolic Syndrome
Authors: Clements Jennifer N. 
Published: February 2022

Abstract:
Sodium–glucose cotransporter-2 inhibitors were approved as adjunct therapy for the management of type 2 diabetes and have become a high-level recommendation for this population with cardiorenal metabolic syndrome. In addition, evidence continues to grow supporting this class of medications for people with heart failure and chronic kidney disease, regardless of diabetes status. This narrative review summarizes the sodium–glucose cotransporter inhibitors for cardiorenal metabolic syndrome.
Therapeutic Drug Monitoring for Rufinamide in Japanese Patients With Epilepsy: Focus on Drug Interactions, Tolerability, and Clinical Effectiveness
Authors: Yamamoto Yoshiaki , Inoue Yushi , Usui Naotaka , Imai Katsumi , Kagawa Yoshiyuki , Takahashi Yukitoshi 
Published: February 2022

Background:
The purposes of this study were to assess drug interactions between rufinamide and concomitant antiepileptic drugs (AEDs) and to identify the therapeutic window for rufinamide.

Methods:
Serum samples (n = 1531) were obtained from 178 patients (aged 2–57 years), and clinical records were retrospectively reviewed to evaluate the safety and efficacy of rufinamide (mean observation time, 1073 ± 846 days).

Results:
Rufinamide exhibited linear pharmacokinetics at doses of up to 60 mg/kg (range, 50–3200 mg/d). Concomitant use of the enzyme-inducing AEDs such as phenytoin, carbamazepine, and phenobarbital reduced rufinamide concentrations by 43.4%, 13.2%, and 30.3%, respectively. By contrast, concomitant use of valproate significantly elevated rufinamide concentrations. Clinical response was seen in 41 patients (23.0%), with a median therapeutic concentration (interquartile range) of 20.6 mcg/mL (13.3–27.0). There was no difference in the therapeutic concentrations between seizure types, but patients with tonic/atonic seizures tended to have higher rufinamide concentrations. During the study period, adverse events were reported in 64 patients (35.8%), including somnolence, gastrointestinal disorders, dizziness, and irritability/behavior disorders. Conditional logistic regression analysis showed that patients administered a concentration greater than 20 mcg/mL had an 8.6-fold higher incidence of adverse events.

Conclusions:
Therapeutic drug monitoring for rufinamide is clinically useful for predicting drug interactions between rufinamide and concomitant AEDs. When a patient has tonic/atonic seizures, careful titration is required for concentrations greater than 20 mcg/mL.
The Impact of and Barriers to Cardiac Rehabilitation Following Cardiac Surgery in the Adult With Congenital Heart Disease
Authors: Jacobsen Roni M. , Beacher Daniel , Beacher Laura , Earing Michael G. , Ginde Salil , Bartz Peter J. , Cohen Scott 
Published: February 2022

Introduction:
There is a paucity of literature evaluating the impact of and barriers to participation in cardiac rehabilitation (CR) in the adult congenital heart disease population. The aims of this study were to evaluate the impact of CR on physical activity and health-related quality of life, as well as to evaluate the barriers to participation in CR in a post-operative adult congenital heart disease population.

Methods:
Patients ≥18 yr of age seen in the Wisconsin Adult Congenital Heart Disease Program and post–open sternotomy surgery from 2010-2015 were eligible for inclusion. Subjects were mailed a novel physical activity survey and the validated EuroQOL-5D 3L health questionnaire. A retrospective medical record review was performed to extract demographic and clinical data.

Results:
One hundred thirty-five patients underwent open sternotomy surgery from 2010-2015. Of these, 22 were excluded because of intellectual disability, three opted out, and three survey packets were returned to the sender. A total of 54 of the remaining 107 patients returned completed surveys. Of these, 47 (87%) were referred to CR. Thirty-five patients completed the entire CR program (74%). Those who completed CR were more likely to develop a home/independent exercise program (P = .027). Barriers to completing CR included insurance coverage, psychiatric disease, and a perception that CR would not be of benefit.

Conclusion:
Completing CR was associated with developing a home/independent exercise program in post-sternotomy adult patients with congenital heart disease. Barriers to participating in and completing CR in this population could lead to an improved completion rate if modified.
POSTERIOR SEGMENT OCULAR FINDINGS IN CRITICALLY ILL PATIENTS WITH COVID-19
Authors: Romero-Castro Rosa M. , Ruiz-Cruz Matilde , Alvarado-de la Barrera Claudia , González-Cannata María G. , LUNA-VILLALOBOS Yara A. , García-Morales Ana K. , Ablanedo-Terrazas Yuria , González-Navarro Mauricio , Ávila-Ríos Santiago 
Published: February 2022

Purpose:
To describe ophthalmological fundoscopic findings in patients with COVID-19 admitted to the intensive care unit of the largest third-level referral center for COVID-19 in Mexico City.

Methods:
In this cross-sectional single-center study, consecutive patients admitted to the intensive care unit with a diagnosis of COVID-19 underwent fundus examination with an indirect ophthalmoscope. Clinical photographs were taken using a posterior-pole camera. We explored the association between ocular manifestations and demographic characteristics, inflammatory markers, hemodynamic factors, and comorbidities.

Results:
Of 117 patients examined, 74 were men; the median age was 54 years (range: 45–63 years). Forty-two patients had ophthalmological manifestations (unilateral in 23 and bilateral in 19), and 10 of these patients had more than one ophthalmological manifestation. Ocular findings were papillitis (n = 13), cotton wool spots (n = 12), retinal hemorrhages (n = 5), retinal nerve fiber layer edema (n = 8), macular whitening (n = 5), retinal vascular tortuosity (n = 4), papillophlebitis (n = 3), central retinal vein occlusion (n = 1), and branch retinal vein occlusion (n = 1). Ocular fundus manifestations were not associated with demographic characteristics, inflammatory markers, hemodynamic factors, or comorbidities.

Conclusion:
More than one-third of patients with severe COVID-19 had ophthalmological manifestations. The most frequent fundoscopic findings were optic nerve inflammation, microvasculature occlusion, and major vascular occlusions. We recommend long-term follow-up to prevent permanent ocular sequelae.
Predictive Factors for Concurrent Tegmen Dehiscence in Superior Canal Dehiscence Syndrome
Authors: Formeister Eric J. , Zhang Lisa , Dent James , Aygun Nafi , Carey John P. 
Published: February 2022

Objectives:
To describe factors predictive of tegmen dehiscence in subjects with superior semicircular canal dehiscence syndrome (SCDS).

Study Design:
Retrospective case series.

Setting:
Tertiary referral center.

Patients:
Subjects with SCDS who underwent middle fossa craniotomy (MFC) for plugging/resurfacing.

Main Outcome Measures:
Operative and radiographic findings of tegmen dehiscences, preoperative low frequency air-bone gaps (LF-ABGs), ocular vestibular evoked myogenic potential (oVEMP) amplitudes, size of superior semicircular canal dehiscence (SCD), and history of obesity or obstructive sleep apnea (OSA).

Results:
One hundred thirty six patients (avg. age, 50.6 yr, 55.1% female) underwent MFC for repair of SCDS. Tegmen dehiscences were commonly found intraoperatively (tegmen tympani dehiscence [TTD] in 19.9% [11% with dural contact of ossicles], tegmen mastoideum dehiscence [TMD] in 28.7%). There were no differences in preoperative LF-ABGs and preoperative oVEMP amplitudes with respect to tegmen status. The sensitivity and specificity of computed tomography (CT) for predicting an intraoperatively confirmed TTD was 85 and 74%, respectively, and 44 and 79% for TMD. History of obesity and OSA did not differ between those with and without tegmen dehiscences. The presence of contralateral SCD and increasing cross-sectional area of SCD were both significantly associated with concurrent tegmen defects.

Conclusions:
Obesity, OSA, preoperative oVEMP, and LF-ABG do not differ between those with SCD alone and those with SCD and concurrent tegmen dehiscences. Likewise, CT scans have relatively low sensitivity for identifying tegmen dehiscences. The presence of concurrent tegmen defects is more common in subjects with larger SCD cross-sectional areas and contralateral SCD.
Anatomical Variations of the Epitympanum and the Usable Space for Middle Ear Implants Analyzed With CT-assisted Imaging Using a Tablet-based Software
Authors: Grueninger Ivo , Lippl Lisa , Canis Martin , Simon Florian , Spiro Judith E. , Spiegel Jennifer L. , Hempel John Martin , Müller Joachim , Volgger Veronika 
Published: February 2022

Objective:
To evaluate interindividual anatomical variations of the epitympanum and the usable space for implantation of active middle ear implants (AMEI) as well as the usefulness of a tablet-based software to assess individual anatomy on computed tomography (CT) scans.

Patients:
CT scans of 126 patients, scheduled for cochlea implantation (50.8% men; 0.6–90.0 yr) without middle ear malformations or previous middle ear surgery and with slice thickness ≤0.7 mm were analyzed.

Main Outcome Measures:
Since no standardized measurements to assess the size of the epitympanum are available, relevant distances were defined according to anatomical landmarks. Three independent raters measured these distances using a tablet-based software. Interrater correlation was computed to evaluate the quality of the measurement process. Descriptive data were analyzed for validation and for evaluation of interindividual anatomical variations. Influence of age and sex on the taken measurements was assessed.

Results:
No relevant correlation between age or sex and the anatomy of the epitympanum was found. Interrater correlation ranged from Spearman's ρ = 0.3–0.9 and there were significant differences between individual rater results for various combinations. Descriptive data revealed high interindividual anatomical variance of the epitympanum, especially regarding the distance between incus and skull base.

Conclusion:
The reported descriptive data regarding the anatomy of the epitympanum emphasizes the importance of preoperative planning, especially since the height of the epitympanum showed great interindividual variance potentially limiting implantation of AMEIs. The herein used tablet-based software seems to be convenient for preoperative assessment of individual anatomy in the hand of otosurgeons.
Patient Sentiments Influencing Management Strategy for Single-sided Deafness
Authors: Fritz Christian G. , Dwyer Sarah M. , Renker Jaclyn M. , Luryi Alexander L. , Doerfer Karl W. , Bojrab Dennis I. , Hong Robert S. , Babu Seilesh C. 
Published: February 2022

Objective:
Assess opinions that influence treatment choice for single sided deafness (SSD).

Study Design:
Retrospective chart review.

Setting:
Tertiary neurotology referral center.

Patients:
Patients with SSD were recruited between December 2020 and February 2021. Included patients were self-selected by voluntary completion of the study questionnaire.

Main Outcome Measure(s):
Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for Adults (HHIA), and a questionnaire containing 25 areas of inquiry relevant to management strategy decision making.

Results:
In comparison to the surgical management group, patients opting for nonsurgical amplification were significantly more concerned about device visibility (p = 0.005, 1.32 ± 0.22 versus 2.67 ± 0.37), undergoing surgery (p = 0.017, 1.64 ± 0.23 versus 2.89 ± 0.51), and the thought of harboring an implanted device (p = 0.003, 1.46 ± 0.22 versus 2.82 ± 0.35). Patients with a major hearing handicap (grade 2–4) placed significantly less emphasis on out-of-pocket costs (p = 0.049, 2.38 ± 0.17 versus 2.94 ± 0.21) and were less concerned about experiencing discomfort from the device (p = 0.033, 3.13 ± 0.11 versus 3.56 ± 0.16) or ease of device use (p = 0.040, 3.20 ± 0.13 versus 3.63 ± 0.13) when compared with the minor handicap group.

Conclusions:
Lingering concerns about device visibility, undergoing surgery, and harboring an implanted device underscore the need for thorough patient counseling during SSD device selection consultations. These efforts should aim to address esthetic and surgical risk concerns while emphasizing the potential for improvements in quality of life.