bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Management of Type II Displaced Dens Fractures Improves One-Year Mortality in Elderly Patients
Authors: Smith Spencer , Somogyi Rita , Lin Clifford , Yoo Jung 
Published: July 2022

Study Design.
Retrospective cross-sectional analysis of US national data collected by PearlDiver Inc. database.

Objective.
To determine the rates of surgical/non-surgical treatments and associated one-year mortality for displaced type II dens fractures without neurologic deficit.

Summary of Background Data.
Existing literature on dens fractures includes small series of patients, with highly variable surgical rates. These studies contain insufficient data to determine the benefits of surgical or non-surgical treatment as surgeon bias in treatment and selection of patients have significant effects on the results.

Methods.
Displaced type II dens fractures and upper cervical surgeries were identified using their respective ICD-10 diagnosis and CPT codes. Inclusion criteria included patients older than 65, diagnosed with a displaced type II dens fracture, absent neurological damage, during the years 2015-2018. Age, gender, ICD-10 diagnosis codes, CPT codes, displacement type, and Elixhauser Comorbidity Index scores were obtained through the PearlDiver database. Patient related variables and one-year mortality associated with surgical versus non-surgical treatment were compared using univariate chi-squared analysis, odds ratios, and multivariate logistic regression analysis.

Results.
Among the 5,300 patients who met our inclusion criteria, 59% (n=3,108) were female, the mean age was 76.6 (±3.9) years old, and the average ECI was 7.1 (±4.0). Only 8.3% (n=437) had surgical treatment for the displaced dens fracture. Multivariate logistic regression analysis for one-year mortality showed surgery was associated with decreased one-year mortality in all patients (z=−6.26; P<0.001), patients between the ages of 65 and 74 (z=−2.53; P=0.012), and patients over the age of 75 (z=−5.81; P<0.001).

Conclusion.
Despite surgery improving survival in elderly patients with type II dens fractures, surgical management is rarely pursued. Factors that independently increase the likelihood of surgery include younger age, male gender, and posterior displacement
Comparison of Endoscopic Facet Joint Denervation to the Percutaneous Technique Regarding Efficacy in Patients With Low Back Pain: A Randomized Controlled Trial
Authors: Woiciechowsky Christian 
Published: July 2022

Study Design.
This was a single-center prospective randomized controlled study.

Objective.
The aim was to compare the efficacy of endoscopic facet joint denervation (FJD) with that of the percutaneous technique in terms of pain, functional disability, and quality of life in patients with low back pain (LBP).

Summary of Background Data.
Different controlled studies in patients with LBP have shown short-term benefits from percutaneous FJD. Observational studies have demonstrated that endoscopic FJD may be more effective. As the superiority of the endoscopic technique has not been clearly demonstrated in previous studies, a prospective randomized controlled study was conducted.

Materials and Methods.
For this study, 40 patients with LBP lasting more than 6 months duration and at least 50% pain reduction on the visual analog scale after medial branch block under fluoroscopy, were assigned randomly to receive percutaneous or endoscopic FJD. The primary outcome was pain, as indicated by visual analog scale. Secondary outcomes were functional disability, as assessed by the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and quality of life, as assessed by the Short Form Health Survey (SF-36).

Results.
After the intervention, the pain level decreased significantly in both groups (P<0.001); however, the effect was still significant in the endoscopic group (EG) and diminished to lower than the statistical significance in the percutaneous group (PG) after 12 months. The ODI and RDQ scores also improved significantly in both groups (P<0.001). However, the ODI and RDQ were significantly better (P<0.001) in the EG after 12 months. In the SF-36, we observed significant improvement in both groups three months after the intervention. The effect decreased after six months in the PG and was predominantly not demonstrable after 12 months, whereas in the EG there was still a strong significant improvement on all scales (P<0.001) after 12 months.

Conclusion.
Percutaneous and endoscopic FJD reduced pain and improved functionality and quality of life. However, the effects decreased or disappeared in the PG after 12 months, whereas there was still a strong significant improvement in the EG.
The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention
Authors: Passias Peter G. , Kummer Nicholas A. , Williamson Tyler K. , Ahmad Waleed , Lebovic Jordan , Lafage Virginie , Lafage Renaud , Kim Han Jo , Daniels Alan H. , Gum Jeffrey L. , Diebo Bassel G. , Gupta Munish C. , Soroceanu Alexandra , Scheer Justin K. , Hamilton D. Kojo , Klineberg Eric O. , Line Breton , Schoenfeld Andrew J. , Hart Robert A. , Burton Douglas C. , Eastlack Robert K. , Mundis Gregory M. , Mummaneni Praveen , Chou Dean , Park Paul , Schwab Frank J. , Shaffrey Christopher I. , Bess Shay , Ames Christopher P. , Smith Justin S. ,   on behalf of the International Spine Study Group
Published: July 2022

Summary of Background Data.
The influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning.

Objective.
To assess the influence of baseline frailty status on the economic burden of CD surgery

Study Design.
Retrospective cohort.

Materials and Methods.
CD patients with frailty scores and baseline and two-year Neck Disability Index data were included. Frailty score was categorized patients by modified CD frailty index into not frail (NF) and frail (F). Analysis of covariance was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline sacral slope, T1 slope minus cervical lordosis, C2–C7 angle, C2–C7 sagittal vertical axis. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for services within a 30-day window including length of stay and death. This data is representative of the national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life-year (QALY) at two years was calculated for NF and F patients.

Results.
There were 126 patients included. There were 68 NF patients and 58 classified as F. Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P>0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P=0.793), resulting in equivocal costs per QALYs for both patients at two years ($90,113.79 vs. $80,866.66, P=0.097).

Conclusion.
F and NF patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to comparative cost-effectiveness with NF patients based on cost per QALYs at two years. Surgical correction for CD is an economical healthcare investment for F patients when accounting for anticipated utility gained and cost-effectiveness following the procedure.

Level of Evidence.
III.
Blockade of Osteoclast-Mediated Bone Resorption with a RANKL Inhibitor Enhances Bone Formation in a Rat Spinal Fusion Model
Authors: Payne Karin A. , Shaw Nichole M. , Erickson Christopher B. , Yarger Peter , Yu Yangyi , Baldini Todd , Kleck Christopher J. , Patel Vikas V. , Burger Evalina L. 
Published: July 2022

Study Design.
Rat spine fusion model.

Objective.
The present study aimed to determine whether administration of osteoprotegerin in a rat model of spinal fusion increases bone volume, bone density, and decreases osteoclasts in the fusion mass.

Summary of Background Data.
Osteoprotegerin is a soluble RANK-ligand inhibitor that blocks osteoclast differentiation and activation. This makes it a potential agent to control the remodeling process and enhance bone mass during spinal fusion.

Methods.
Forty-eight male Sprague-Dawley rats received a one-level spinal fusion of L4-L5 with bone allograft. Rats were then divided into four groups according to initiation of treatment: (1) saline on Day 0 (Saline), (2) osteoprotegerin on Day 0 (OPG D0), (3) osteoprotegerin on Day 10 (OPG D10), and (4) osteoprotegerin on Day 21 (OPG D21) post-surgery. After their initial injection, rats received weekly subcutaneous injections of osteoprotegerin (10 mg/kg) and were euthanized six weeks post-surgery. MicroCT analysis of the fusion site and histological analysis of bone surface for quantification of osteoclast lining was performed.

Results.
Increased bone volume in the fusion site and around the spinous process was seen in OPG D0 and OPG D10 when compared to Saline. Mean trabecular thickness was greater in all groups receiving osteoprotegerin compared to saline, with OPG D0 and OPG D10 having significantly greater mean trabecular thickness than OPG D21. All osteoprotegerin groups had less bone surface lined with osteoclasts when compared to Saline, with OPG D0 and OPG D10 having fewer than OPG D21.

Conclusions.
This study indicates that osteoprotegerin inhibited osteoclast bone resorption, which led to greater bone at the fusion site. Future studies investigating osteoprotegerin on its own or in combination with an osteogenic factor to improve spinal fusion outcomes are warranted to further elucidate its potential therapeutic effect.
Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers: Results of the Multi-Ethnic Alignment Normative Study (MEANS)
Authors: Sardar Zeeshan M. , Cerpa Meghan , Kelly Michael , Bourret Stephane , Hasegawa Kazuhiro , Wong Hee-Kit , Liu Gabriel , Dennis Hey Hwee Weng , Riahi Hend , Le Huec Jean-Charles , Lenke Lawrence 
Published: July 2022

Background.
Spinal alignment can have a significant impact on a patient’s overall quality of life. Predicting the ideal sagittal spinal alignment of a specific individual is still a difficult task. The Multi-Ethnic Alignment Normative Study (MEANS) investigated skeletal alignment, including the spine and lower extremities, of the largest multi-ethnic cohort of asymptomatic adult volunteers. In this analysis, the authors aim to assess normative values of spinopelvic parameters and the regional cervical, thoracic, and lumbar spinal alignment in asymptomatic volunteers stratified by age and sex.

Materials and Methods.
Asymptomatic volunteers between ages 18 and 80 years were enrolled prospectively from centers in France, Japan, Singapore, Tunisia, and the United States. Volunteers included reported no significant neck or back pain (Visual Analog Scale ≤2), nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low-dose stereoradiograph.

Results.
MEANS consisted of 468 volunteers with a mean age of 40.4±14.8 years. Mean cervical lordosis from C2 to C7 was −0.4±12.7°. The T1-slope averaged 23.0±7.9° and showed strong correlation (r=0.87) with the C7-slope mean of 19.8±8.6°. Thoracic kyphosis (TK) from T4 to T12 showed a mean of 37.4±10.9°. Average L1–S1 lumbar lordosis (LL) was −57.4±11.3°. The mean pelvic incidence (PI) measured 52.0±10.7° and pelvic tilt was 12.5±7.3°. Sacral slope averaged 39.5±8.2°. The average PI-LL was −5.4±10.7°. Approximately 60% of volunteers met the PI-LL criteria within ±10°, 8.3% were ≥10°, while 32.1% were ≤−10°. LL showed moderate correlation with PI (r=0.53) and TK (r=0.50), while there was no correlation between TK and PI. Multiple linear regression including PI, TK, and age resulted in the following equation LL=14.6+0.57 (PI)+0.57 (TK)−0.2 (age) (r=0.75).

Conclusions.
LL did not change with increasing age in asymptomatic volunteers. However, TK did increase with age leading to an increase in T1-slope and a compensatory increase in cervical lordosis. TK did not correlate with PI and was an independent variable in the prediction of LL.

Level of Evidence.
Level II—prospective cohort study.
Endoscopic Therapy for Pouch Leaks and Strictures: A Systematic Review
Authors: Lee Kate E. , Shen Bo 
Published: July 2022

BACKGROUND:
Patients with ulcerative colitis refractory to medication or familial adenomatous polyposis may require ileal pouch-anal anastomosis after a colectomy. IPAA is generally well tolerated. However, patients can experience posttreatment complications, including pouch strictures and leaks. Medical therapy has a limited role in mechanical fibrotic strictures, whereas surgery is invasive and costly. In the past few decades, endoscopic therapies have provided a less invasive and less costly intervention for pouch strictures and leaks.

OBJECTIVE:
This systematic literature review aimed to describe the status of advancements in endoscopic therapy for pouch leaks and strictures.

DATA SOURCES:
The sources used were PubMed and Cochrane databases.

STUDY SELECTION:
Studies between January 1990 and January 2022, in any language, were included. Articles regarding surgical management or pouches other than adult ileal pouch-anal anastomosis were excluded.

INTERVENTIONS:
Endoscopic management of acute and chronic leaks and strictures ileal pouch-anal anastomosis was included.

MAIN OUTCOME MEASURES:
Successful management (including persistent leak or stricture, pouch failure, subsequent endoscopy, or surgery) was measured.

RESULTS:
Sixty-one studies were included in this review, including 4 meta-analyses or systematic reviews, 11 reviews, 17 cohort studies, and 18 case series.

LIMITATIONS:
The limitations include qualitative review of all study types, with no randomized controlled studies available.

CONCLUSION:
Ileal pouch-anal anastomosis leaks are various in configuration, and endoscopic therapies have included clipping leaks at the tip of the “J” as well as endoscopic sinusotomy. Endoscopic therapies for pouch strictures have included endoscopic balloon dilation, endoscopic stricturotomy, and endoscopic stricturoplasty, which are now considered first-line therapies for pouch strictures. Endoscopic balloon dilation has shown safety and efficacy in single, short, and straight strictures and endoscopic stricturotomy for refractory long, fibrotic, anastomotic strictures. Endoscopic therapies can delay or prevent invasive surgeries. Key tenets of successful endoscopic therapy include patient and lesion candidacy, an experienced endoscopist, and adequate rescue surgery plans.
Relative Effectiveness of Cell-based Versus Egg-based Quadrivalent Influenza Vaccines in Children and Adolescents in the United States During the 2019–2020 Influenza Season
Authors: Imran Mahrukh , Ortiz Justin R. , McLean Huong Q , Fisher Lauren , O’Brien Dan , Bonafede Machaon , Mansi James A. , Boikos Constantina 
Published: July 2022

Background:
Egg-based influenza vaccine production can lead to the accumulation of mutations that affect antigenicity. The mammalian cell-based inactivated quadrivalent influenza vaccine (IIV4c) may improve effectiveness compared with egg-based vaccines. This study estimated the relative vaccine effectiveness (rVE) of IIV4c versus egg-based inactivated quadrivalent influenza vaccine (IIV4e) in preventing influenza-related medical encounters (IRME) among children and adolescents during the 2019–2020 US influenza season.

Methods:
This retrospective cohort study used a dataset linking primary and specialty care electronic medical records with medical and pharmacy claims data from US residents 4 through 17 years of age vaccinated with IIV4c or IIV4e during the 2019–2020 influenza season. Odds ratios (ORs) were derived from a doubly robust inverse probability of treatment-weighted approach adjusting for age, sex, race, ethnicity, region, index week, health status and two proxy variables for healthcare accessibility and use. Adjusted rVE was estimated by (1-ORadjusted)*100, and an exploratory analysis evaluated IRMEs separately for outpatient and inpatient settings.

Results:
The final study cohort included 60,480 (IIV4c) and 1,240,990 (IIV4e) vaccine recipients. Fewer IRMEs were reported in subjects vaccinated with IIV4c than IIV4e. The rVE for IIV4c versus IIV4e was 12.2% [95% confidence interval (CI): 7.5–16.6] for any IRME and 14.3% (9.3–19.0) for outpatient IRMEs. Inpatient IRMEs were much less frequent, and effectiveness estimates were around the null.

Conclusions:
Fewer IRMEs occurred in pediatric subjects vaccinated with IIV4c versus IIV4e. These results support the greater effectiveness of IIV4c over IIV4e in this population during the 2019–2020 US influenza season.
Infections With Stenotrophomonas maltophilia in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study
Authors: Richert-Przygonska Monika , Czyzewski Krzysztof , Dziedzic Magdalena , Zalas-Wiecek Patrycja , Gryniewicz-Kwiatkowska Olga , Gietka Agnieszka , Malas Zofia , Semczuk Katarzyna , Chelmecka Liliana , Zak Iwona , Salamonowicz-Bodzioch Malgorzata , Fraczkiewicz Jowita , Zajac-Spychala Olga , Bien Ewa , Irga-Jaworska Ninela , Plonowski Marcin , Wawrykow Pawel , Bartnik Magdalena , Pierlejewski Filip , Gamrot Zuzanna , Badowska Wanda , Stolpa Weronika , Musial Jakub , Szmydki-Baran Anna , Hutnik Lukasz , Tomaszewska Renata , Urbanek-Dadela Agnieszka , Zaucha-Prazmo Agnieszka , Gozdzik Jolanta , Styczynski Jan ,   for the Polish Society of Pediatric Oncology and Hematology
Published: July 2022

Background:
Infections caused by Stenotrophomonas maltophilia (SM) have documented high mortality rate in immunocompromised patients.

Aim:
This nationwide multicenter study was performed to analyze the epidemiology of SM infections in children undergoing anticancer therapy (pediatric hematology and oncology [PHO]) or hematopoietic cell transplantation (HCT) over 2012–2019, including incidence and outcome of SM infections, as well as treatment regimens and multidrug resistance.

Methods:
Cumulative incidence of SM infections was calculated using the competing risk analysis from the day of diagnosis (PHO setting) or from the day of transplantation (HCT setting). The Kaplan-Meier method was used to determine survival from infection.

Results:
During the study period of 8 years, a total number of 1356 HCTs and 7337 children newly diagnosed for malignancy were analyzed. Diagnosis of acute leukemia was a predisposing factor for SM infection. The cumulative incidence of SM infections was comparable in HCT patients in comparison to PHO (0.81% vs. 0.76%). High rate of trimethoprim/sulfamethoxazole susceptibility among SM isolates was observed in both groups of patients (80.8%). Although this was the drug of choice, survival rates from SM infections were significantly lower in HCT than in PHO (45% vs. 85%, P = 0.001, log-rank test). We found the transplant procedure and lack of clinical resolution after 18 days of antibiotic therapy to be independent mortality risk factors.

Conclusions:
The risk of SM infections and the occurrence of resistant bacterial strains in allo-HCT patients were comparable to PHO patients. Irrespective of target antibiotic therapy, the outcome of SM infections was better in the PHO setting.
TandemHeart-Associated Fever
Authors: Nagarakanti Sandhya , Bishburg Eliahu , Hasan Mustafa , Okoh Alexis , Baran David A. 
Published: July 2022

Abstract
Percutaneous mechanical circulatory support devices such as TandemHearts have been increasingly used in the treatment of patients with refractory cardiogenic shock. Fever can develop as a consequence without the development of an infection. Infectious disease physicians are commonly consulted for the onset of fevers after device placement, and it is been a challenge to identify the cause of fevers and delineate infection as cause of fever. Fever and associated infections have not been well characterized after TandemHeart placement. The aim of the current study is to correlate the development of fever with infections and describe the infectious complications associated with TandemHearts. The study included patients who received TandemHearts between 2013 and 2016. Data on demographics, indication for insertion, fever course if noted within 72 hours after the device placement, infection type, and outcome were collected. Among the included 52 patients, fever was noted in 23 (44.2%) and infections in 15 (29%) patients, and both fever and infection in 5 patients. The median onset of fever was 26 hours, and the median onset of infection was 72 hours after insertion. Fever without any documented infection was noted in 18 of 23 (78%). The median duration of fever in patients without infection was 18.5 hours, and that in patients with infection was 96 hours (P = 0.12). Infections included pneumonia in 7 of 15 (46.6%) and central line–associated blood stream infection in 4 of 15 (25%).
Nurse-Sensitive Indicator Quality Improvement Toolkit
Authors: McVey Caitlin , von Wenckstern Toni , Mills Courtney , Yager Lauren , McCauley Christopher , Rivera Yvana , Reed Elizabeth 
Published: July 2022

Background:
Existing best practices to monitor and prevent health care–associated infections (HAIs) were ineffective during the COVID-19 pandemic due to increased patient susceptibility toward infections, reduced resources, and increased use of agency nurses.

Problem:
A review of the US hospitals revealed a 60% increase in central line–associate bloodstream infections (CLABSIs) and a 43% increase in catheter-associated urinary tract infections (CAUTIs) in 2020. A large, academic, level 1 trauma center in Houston, Texas, experienced similar challenges at the start of the COVID-19 pandemic.

Approach:
An interdisciplinary team of nurses, infection preventionists, and hospital educators combined and adapted existing evidence-based practices in a novel way to create a nursing-led toolkit for quality improvement tracking, improving, and sustaining HAI improvements.

Outcomes:
CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%.

Conclusions:
The novel NSIQI Toolkit is a scalable tool for improving and sustaining CLABSI and CAUTI rates, which may have the potential for other nurse-sensitive quality indicators.
A Systematic Review of the Consumer Emergency Care Satisfaction Scale (CECSS)
Authors: Hoonakker Peter L. T. , Carayon Pascale , Brown Roger L. , Werner Nicole E. 
Published: July 2022

Background:
Patient experience is receiving increasing attention in the context of patient-centered care. However, there are relatively few instruments that measure patient experience that are valid and reliable.

Objective:
In this study, we systematically review the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examine its psychometric properties.

Methods:
We conducted a systematic literature search in the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Web of Science databases on articles that contain information on the CECSS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results:
Our systematic literature search resulted in 28 articles in which the CECSS was used.

Conclusions:
Results of our literature review show that from a psychometric perspective, the CECSS is a valid and reliable instrument. However, the results of our study also show that the CECSS has several weaknesses. We have made recommendations to improve the CECSS.