bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Illness Severity Scores and In-hospital Mortality After Aneurysmal Subarachnoid Hemorrhage
Authors: Yuwapattanawong Kornkamon , Chanthima Phuriphong , Thamjamrassri Thanyalak , Keen Jade , Qiu Qian , Fong Christine , Robinson Ellen F. , Dhulipala Vasu B. , Walters Andrew M. , Athiraman Umeshkumar , Kim Louis J. , Vavilala Monica S. , Levitt Michael R. , Lele Abhijit V. 
Published: March 2022

Introduction:
The purpose of this study was to examine the association with in-hospital mortality of 8 illness severity scores in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods:
In a retrospective cohort study, we investigated the association with in-hospital mortality of admission Hunt and Hess (HH) score, Fisher grade, severity of illness and risk of mortality scores, and serial Glasgow coma scale (GCS) score in patients with aSAH. We also explored the changes in GCS between admission and discharge using a multivariate model adjusting for age, clinical vasospasm, and external ventricular drain status.

Results:
Data from 480 patients with aSAH, of which 383 (79.8%) aneurysms were in the anterior circulation, were included in analysis. Patients were female (n=340, 70.8%) with a median age of 56 (interquartile range: 48 to 66) years. The majority (n=332, 69.2%) had admission HH score 3 to 5, Fisher grade 3 to 4 (n=437, 91%), median severity of illness 3 (range: 1 to 4), median risk of mortality 3 (range: 1 to 4), and median admission GCS of 13 (interquartile range: 7 to 15). Overall, 406 (84.6%) patients received an external ventricular drain, 469 (97.7%) underwent aneurysm repair, and 60 died (12.5%). Compared with admission HH score, GCS 24 hours after admission (area under the curve: 0.84, 95% confidence interval [CI]: 0.79-0.88) and 24 hours after aneurysm repair (area under the curve: 0.87, 95% CI: 0.82-0.90) were more likely to be associated with in-hospital mortality. Among those who died, the greatest decline in GCS was noted between 24 hours after aneurysm repair and discharge (−3.38 points, 95% CI: –4.17, −2.58).

Conclusions:
Compared with admission HH score, GCS 24 hours after admission (or 24 h after aneurysm repair) is more likely to be associated with in-hospital mortality after aSAH.
Increasing Prevalence and High Risk of Associated Anomalies in Congenital Vertebral Defects: A Population-based Study
Authors: Heiskanen Susanna , Syvänen Johanna , Helenius Ilkka , Kemppainen Teemu , Löyttyniemi Eliisa , Gissler Mika , Raitio Arimatias 
Published: March 2022

Background:
Congenital vertebral anomalies are a heterogeneous group of diagnoses, and studies on their epidemiology are sparse. Our aim was to investigate the national prevalence and mortality of these anomalies, and to identify associated anomalies.

Methods:
We conducted a population-based nationwide register study and identified all cases with congenital vertebral anomalies in the Finnish Register of Congenital Malformations from 1997 to 2016 including live births, stillbirths, and elective terminations of pregnancy because of major fetal anomalies. Cases were categorized based on the recorded diagnoses, associated major anomalies were analyzed, and prevalence and infant mortality were calculated.

Results:
We identified 255 cases of congenital vertebral anomalies. Of these, 92 (36%) were diagnosed with formation defects, 18 (7.1%) with segmentation defects, and 145 (57%) had mixed vertebral anomalies. Live birth prevalence was 1.89 per 10,000, and total prevalence was 2.20/10,000, with a significantly increasing trend over time (P<0.001). Overall infant mortality was 8.2% (18/219); 3.5% (3/86) in patients with formation defects, 5.6% (1/18) in segmentation defects, and 12.2% (14/115) in mixed vertebral anomalies (P=0.06). Co-occurring anomalies and syndromes were associated with increased mortality, P=0.006. Majority of the cases (82%) were associated with other major anomalies affecting most often the heart, limbs, and digestive system.

Conclusions:
In conclusion, the prevalence of congenital vertebral anomalies is increasing significantly in Finnish registers. Detailed and systematic examination is warranted in this patient population to identify underlying comorbidities as the majority of cases are associated with congenital major anomalies.

Level of Evidence:
Level III.
Establishing Clinically Significant Outcomes After Anterior Cruciate Ligament Reconstruction in Pediatric Patients
Authors: Maheshwer Bhargavi , Polce Evan M. , Parvaresh Kevin C. , Paul Katlynn , Yanke Adam B. , Forsythe Brian , Bush-Joseph Charles A. , Bach Bernard R. , Cole Brian J. , Verma Nikhil N. , Kogan Monica , Chahla Jorge 
Published: March 2022

Purpose:
The purpose of this study was to establish clinically significant outcome values for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after anterior cruciate ligament reconstruction (ACLR) in the pediatric and adolescent populations and to assess factors that were associated with achieving these outcomes.

Methods:
Patients between the age of 10 to 21 who underwent ACLR between 2016 and 2018 were identified and patient-reported outcomes (PROs) were collected preoperatively and postoperatively. Intraoperative variables collected included graft choice, graft size (diameter), graft fixation method, and concomitant procedures. PROs collected for analysis were the International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). MCID and PASS were calculated using receiver operating characteristic with area under the curve analyses for delta (ie, baseline-to-postoperative change) and absolute postoperative PRO scores, respectively.

Results:
A total of 59 patients were included in the analysis. Of the entire study population, 53 (89.8%) reported satisfaction with their surgical outcome. The established MCID threshold values based on the study population were 33.3 for IKDC, 28.6 for (KOOS) Symptoms, 19.4 for Pain, 2.9 for activities of daily living (ADL), 45.0 for Sport, and 25.0 for Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 80.5 for IKDC, 75.0 (KOOS) Symptoms, 88.9 for Pain, 98.5 for ADL, 75.0 for Sport, and 68.8 for QoL.

Conclusion:
Clinically meaningful outcomes including MCID and PASS were established for pediatric ACLR surgery using selected PRO measures, IKDC, and KOOS. Patient age, sex, graft type, and graft size were not associated with greater achievement of these outcomes. In contrast, collision sports, fixed-object high-impact rotational landing sports, and concomitant meniscectomy surgery were associated with a decreased likelihood of achieving clinically significant improvement. However, findings must be interpreted with caution due to limitations in follow-up and sample size.

Level of Evidence:
Level IV: case series.
A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center
Authors: Bailey Ryan S. , Klein Robert , de Los Cobos Daniel , Geraud Simone , Puryear Aki 
Published: March 2022

Background:
Adult studies have demonstrated the efficacy of written protocols for clearance of the cervical spine. However, less than half of recently surveyed pediatric trauma centers report using a documented protocol. Little data exists on such protocols in pediatric populations, but interest remains because of potential reductions in radiation exposure, time to clearance, hospital stay, and specialist referral. However, missed injury can have devastating consequences. The purpose of this study is to examine the efficacy in detecting injury of an implemented cervical spine clearance protocol at a level-1 pediatric trauma hospital.

Methods:
A retrospective review was performed on pediatric patients presenting as activated traumas to the emergency department of a single level-1 pediatric trauma hospital between May 2010 and October 2018. This institution has utilized a written cervical spine clearance protocol throughout this time. Presence of cervical spine injury, documented clearance, cervical spine imaging, and follow-up documentation were reviewed for any missed injuries.

Results:
There were no missed cervical spine injuries. Five-hundred sixty-three clinically significant cervical spine injuries were identified, representing 16.5% of patients. Of these, 96 were fractures, dislocations, or ligamentous injuries, representing 2.8% of all patients. Most cervical spine clearances were performed by trauma surgery. Advanced imaging of the cervical spine was ordered for 43.2% of patients overall and trended down over time.

Conclusion:
Documented cervical spine clearance protocols are effective for detection of significant injury in pediatric trauma patients. This study suggests these protocols minimize risk of missed injury and may prevent unnecessary radiation exposure, delayed clearance, prolonged hospitalization, or unnecessary specialist referral.

Clinical Relevance:
Utilization of a standard written protocol for cervical spine clearance likely prevents missed injury and helps to minimize radiation exposure in pediatric populations. Further research is needed on evaluation and management of pediatric cervical spine trauma.
Importance of Physical Therapy Interventions for Medically Complex Patient With Severe COVID-19: A Case Report
Authors: Thomas Bini , Tabisz Joanna , Collins Kelly , Kim Ok Kyung , Gupte Sharmila 
Published: March 2022

Introduction and Purpose:
The 2019 emergence of the coronavirus disease (COVID-19), and associated medical complications of pneumonia and acute respiratory distress syndrome, necessitated the development of safe and effective physical therapy (PT) interventions to treat this new patient population. The acuity of patients with COVID-19 resulted in intensive care unit (ICU)–acquired weakness and deconditioning. The purpose of this case study was to discuss the physical therapy contributions in treating a complex patient with COVID-19 who required venovenous extracorporeal membrane oxygenation (ECMO) support.

Case Presentation:
This case report discusses a patient who was 34 years old with morbid obesity, in her third trimester of pregnancy, who tested positive for SARS-CoV-2. The deteriorating respiratory status required the patient to have an emergent caesarean section, intubation, and ventilatory support.

Methods:
Worsening hypoxic respiratory failure and medical deterioration resulted in the initiation of ECMO. After 18 days, the patient was weaned off ECMO and medically cleared to initiate PT. Physical therapy interventions included positioning for airway clearance, bed mobility, transfer training, strengthening, mechanically assisted gait training, and patient education.

Results:
After 30 days, the patient was transferred back to the referring community hospital where she was subsequently weaned off oxygen support and discharged directly home.

Conclusion:
This case study outlines how initiating physical therapy interventions in the ICU in collaboration with other disciplines may have contributed to the functional recovery of a medically complex patient with COVID-19. Further research is recommended regarding early and collaborative interventions in the ICU for medically complex patients with COVID-19.
Outcomes and prognostic factors of cataract surgery in cytomegalovirus related anterior uveitis
Authors: Wan Kelvin H. , Liu Ke , Lam Nai Man , Chow Vanissa W.S. 
Published: March 2022

Abstract

Purpose:
To evaluate the outcomes of cataract surgery in patients with cytomegalovirus (CMV) anterior uveitis and factors associated with final visual outcome.

Setting:
A single tertiary academic hospital.

Design:
Retrospective case series.

Methods:
History, clinical characteristics, corrected distance visual acuity (CDVA), medications, and complications of CMV anterior uveitic eyes undergoing cataract surgery between 2010 to 2020 were reviewed.

Results:
This study included 26 eyes of 26 patients undergoing phacoemulsification. The median duration of disease was 4.8 years and the median quiescent period before surgery was 2.3 years. None required pupil manipulation or had significant intraoperative complications. The median CDVA improved from 20/100 (IQR 20/200-20/50) before surgery to 20/30 (IQR 20/40-20/25) at 1 year and 20/35 (IQR 20/50-20/30) at the last follow-up at a median of 4.9 years after surgery, respectively (p < 0.001). CDVA improved in 19 eyes (73.1%) and was ≥20/40 in 18 eyes (69.2 %). In the multivariate regression model, preoperative use of topical 0.15% ganciclovir (β 0.33, 95% CI 0.17-0.48, p < 0.001) and adjunctive intraoperative intracameral dexamethasone 0.4mg (β 0.19, 95% CI 0.01-0.36, p = 0.043) were associated with a better final CDVA. Loss of CDVA and poor postoperative CDVA visual acuity were mostly attributed to uveitic glaucoma, but preoperative glaucoma or the number of anti-glaucoma medications did not affect final CDVA.

Conclusion:
Cataract surgery in eyes with CMV anterior uveitis was safe and CDVA significantly improved and remained sustained after surgery. Topical ganciclovir 0.15% preoperatively and intracameral corticosteroid intraoperatively appear to maximize the final visual outcome.
Predictability of pseudophakic refraction using patient-customized paraxial eye models
Authors: Chang Yu-Cherng , Cabot Florence , Heilman Bianca Maceo , Meza Larissa , Ruggeri Marco , Ho Arthur , Yoo Sonia H. , Parel Jean-Marie , Manns Fabrice 
Published: March 2022

Purpose:
To determine whether patient-customized paraxial eye models that do not rely on exact ray tracing and do not consider aberrations can accurately predict pseudophakic refraction.

Setting:
Bascom Palmer Eye Institute, Miami, Florida.

Design:
Prospective study.

Methods:
Cataract surgery patients with and without a history of refractive surgery were included. Manifest refraction, corneal biometry, and extended-depth optical coherence tomography (OCT) imaging were performed at least 1 month postoperatively. Corneal and OCT biometry were used to create paraxial eye models. The pseudophakic refraction simulated using the eye model was compared with measured refraction to calculate prediction error.

Results:
49 eyes of 33 patients were analyzed, of which 12 eyes from 9 patients had previous refractive surgery. In eyes without a history of refractive surgery, the mean prediction error was 0.08 ± 0.33 diopters (D), ranging from −0.56 to 0.79 D, and the mean absolute error was 0.27 ± 0.21 D. 31 eyes were within ±0.5 D, and 36 eyes were within ±0.75 D. In eyes with previous refractive surgery, the mean prediction error was −0.44 ± 0.58 D, ranging from −1.42 to 0.32 D, and the mean absolute error was 0.56 ± 0.46 D. 7 of 12 eyes were within ±0.5 D, 8 within ±0.75 D, and 10 within ±1 D. All eyes were within ±1.5 D.

Conclusions:
Accurate calculation of refraction in postcataract surgery patients can be performed using paraxial optics. Measurement uncertainties in ocular biometry are a primary source of residual prediction error.
Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis
Authors: Claus Benedikt B. , Stahlschmidt Lorin , Dunford Emma , Major János , Harbeck-Weber Cynthia , Bhandari Rashmi Parekh , Baerveldt Ardith , Neß Verena , Grochowska Kamila , Hübner-Möhler Bettina , Zernikow Boris , Wager Julia 
Published: March 2022

Abstract
Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched 5 literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies used a pre–post design, assessed patients younger than 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity (g = −1.28), disability (g = −1.91), and number of missed school days at the 12-month follow-up (g = −0.99), as well as moderate improvements in anxiety (g = −0.77) and depression (g = −0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.
Effect of a delayed admission to the intensive care unit on survival after emergency department visit in patients with cancer: a retrospective observational study
Authors: Lucet Aude , Franchitti Jessica , Legay Léa , Milacic Hélène , Fontaine Jean-Paul , Ellouze Sami , Peyrony Olivier 
Published: March 2022

Background and importance
Delayed admission to the ICU is reported to be associated with worse outcomes in cancer patients.

Objective
The main objective of this study was to compare the 180-day survival of cancer patients whether they were directly admitted to the ICU from the emergency department (ED) or secondarily from the wards after the ED visit.

Design, settings and participants
This was a retrospective observational study including all adult cancer patients that visited the ED in 2018 and that were admitted to the ICU at some point within 7 days from the ED visit.

Exposure
Delayed ICU admission.

Outcome measure and analysis
Survival at day 180 was plotted using Kaplan–Meier curves, and hazard ratio (HR) from Cox proportional-hazard models was used to quantify the association between admission modality (directly from the ED or later from wards) and survival at day 180, after adjustment to baseline characteristics.

Results
During the study period, 4560 patients were admitted to the hospital following an ED visit, among whom 136 (3%) patients had cancer and were admitted to the ICU, either directly from the ED in 101 (74%) cases or secondarily from the wards in 35 (26%) cases. Patients admitted to the ICU from the ED had a better 180-day survival than those admitted secondarily from wards (log-rank P = 0.006). After adjustment to disease status (remission or uncontrolled malignancy), survival at day 180 was significantly improved in the case of admission to the ICU directly from the ED with an adjusted HR of 0.50 (95% confidence interval, 0.26–0.95), P = 0.03.

Conclusion
In ED patients with cancer, a direct admission to the ICU was associated with better 180-day survival compared with patients with a delayed ICU admission secondary from the wards. However, several confounders were not taken into account, which limits the validity of this result.
Similar But Different: Integrated Phylogenetic Analysis of Austrian and Swiss HIV-1 Sequences Reveal Differences in Transmission Patterns of the Local HIV-1 Epidemics
Authors: Kusejko Katharina , Tschumi Nadine , Chaudron Sandra E. , Nguyen Huyen , Battegay Manuel , Bernasconi Enos , Böni Jürg , Huber Michael , Calmy Alexandra , Cavassini Matthias , Egle Alexander , Grabmeier-Pfistershammer Katharina , Haas Bernhard , Hirsch Hans , Klimkait Thomas , Öllinger Angela , Perreau Matthieu , Ramette Alban , Flury Baharak Babouee , Sarcletti Mario , Scherrer Alexandra , Schmid Patrick , Yerly Sabine , Zangerle Robert , Günthard Huldrych F. , Kouyos Roger D. ,   the Swiss HIV Cohort Study and the Austrian HIV Cohort Study
Published: March 2022

Objectives:
Phylogenetic analyses of 2 or more countries allow to detect differences in transmission dynamics of local HIV-1 epidemics beyond differences in demographic characteristics.

Methods:
A maximum-likelihood phylogenetic tree was built using pol-sequences of the Swiss HIV Cohort Study (SHCS) and the Austrian HIV Cohort Study (AHIVCOS), with international background sequences. Three types of phylogenetic cherries (clusters of size 2) were analyzed further: (1) domestic cherries; (2) international cherries; and (3) SHCS/AHIVCOS-cherries. Transmission group and ethnicities observed within the cherries were compared with the respective distribution expected from a random distribution of patients on the phylogeny.

Results:
The demographic characteristics of the AHIVCOS (included patients: 3′141) and the SHCS (included patients: 12′902) are very similar. In the AHIVCOS, 36.5% of the patients were in domestic cherries, 8.3% in international cherries, and 7.0% in SHCS/AHIVCOS cherries. Similarly, in the SHCS, 43.0% of the patients were in domestic cherries, 8.2% in international cherries, and 1.7% in SHCS/AHIVCOS cherries. Although international cherries in the SHCS were dominated by heterosexuals with men who have sex with men being underrepresented, the opposite was the case for the AHIVCOS. In both cohorts, cherries with one patient belonging to the transmission group intravenous drug user and the other one non–intravenous drug user were underrepresented.

Conclusions:
In both cohorts, international HIV transmission plays a major role in the local epidemics, mostly driven by men who have sex with men in the AHIVOS, and by heterosexuals in the SHCS, highlighting the importance of international collaborations to understand global HIV transmission links on the way to eliminate HIV.
Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy
Authors: Chacko Joel , Leeds Steven G. , Aladegbami Bola G. , Ogola Gerald O. , Ward Marc A. 
Published: March 2022

Background:
The use of robotics in foregut surgery has become more prevalent in the United States over the last 10 years. We sought to find the differences in the clinical outcomes of robotic surgery compared with traditional laparoscopy in patients undergoing Heller myotomy.

Materials and Methods:
A retrospective population-based analysis was performed using the National Inpatient Sample (NIS) database for the span of 2010 to 2015. All patients who underwent laparoscopic or robotic Heller myotomy were included. Weighted multivariable random intercept linear and logistic regression models were used to assess the impact of robotic surgery on patient outcomes compared with laparoscopy.

Results:
There was a total of 11,562 patients with a median age of 54.2 years. Robotic Heller myotomy has a significantly decreased risk of overall complications for all centers (odds ratio=0.46; 95% confidence interval=0.29, 0.74). A subset analysis was performed looking specifically at high-volume centers (>20 operations per year), and overall complications remained lower in the robotic group. However, in high-volume centers, the robotic cohort did have a higher rate of esophageal perforation (2.7% vs. 0.8%, P<0.001). There was a higher length of stay in the laparoscopic Heller cohort (3.0 vs. 2.6 d, P=0.06) but higher overall charges in the robotic Heller cohort ($42,900 vs. $34,300, P=0.03).

Conclusions:
Robotic Heller myotomy is associated with lower overall complications and improved outcomes compared with laparoscopic Heller myotomy, even in high-volume centers. Robotic Heller myotomy is associated with a higher rate of esophageal perforations in high-volume centers despite the reduction in overall complications.