bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures
Authors: Ezeokoli Ekene U. , Borici Neritan , Serrano Eduardo , Inneh Ifeoma , Shenava Vinitha , Smith Brian G. 
Published: May 2022

Background:
Supracondylar humerus fractures (SCHF) are the most common elbow fracture type in children, and one of the most common pediatric fracture types overall. Excellent outcomes are generally reported with closed reduction and pinning (CRPP), but the technique involves leaving the pins outside the skin. External pins can act as a nidus for infection. We characterize the infection complications from SCHF treatment at a single-centre tertiary children’s hospital over 10 years. This is the largest series on infectious outcomes after CRPP of SCHF reported to date.

Methods:
Pediatric patients undergoing CRPP for a type II or type III SCHF from 2011 to 2021 with postsurgical infections within 90 days were identified. Demographic and clinical data were retrieved from medical records. Descriptive statistics were estimated and reported as means or medians with range values or counts with percentages.

Results:
A total of 18 patients met inclusion criteria, 10 and 8 with type II and III SCHF, respectively. The average age at diagnosis of fracture was 4.7 (2 to 9) years. The average operating time for the index surgery was 29 minutes (12 to 42). The average number of postoperative days until pin removal was 29.8 (18 to 52), and the average number of postoperative days until readmission or visit with symptoms was 38.9 (18 to 77). There was a documented history of a wet cast in 6 patients (33%). Ten (56%) patients presented with fever, and the most common positive culture was methicillin-sensitive Staphylococcus aureus (9, 50%). Thirteen (72%) patients returned to the operating room for incision and drainage. There were no cases with continued complications after the original infection after a median follow-up of 63 days (8 to 559). Infection after CRPP of SCHF is a rare adverse event. In our series, it was most often associated with common pathogens and wet casts. The necessity of return to the operating room will vary with the presentation, but if efficaciously treated afterwards with oral antibiotics, there is a low chance of recurrence or subsequent complications. Patients should be carefully instructed in cast care and demonstrate understanding of risks and complications, and to contact their orthopaedist if their cast demonstrates lack of integrity.

Level of Evidence:
Prognostic level IV.
Preoperative Predictors for Acute Pain After Photorefractive Keratectomy
Authors: Toyota Adriana M. , Garcia Renato , Torricelli Andre A. M. , Silva Valquiria A. , Galhardoni Ricardo , Teixeira Manoel J. , de Andrade Daniel C. , Bechara Samir J. 
Published: May 2022

Purpose:
The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain.

Methods:
This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors.

Results:
This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05).

Conclusions:
Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.
Rapid Antigen Tests For Safe School Opening in the COVID-19 Pandemic Era
Authors: Goldenfeld Miki , Cohen Carmit , Gilboa Mayan , Pessach Itai M. , Mehnick Bella , Tal Ilana , Meltzer Lilac , Amit Sharon , Gonen Tal , Afek Arnon , Kreiss Yitshak , Regev-Yochay Gili 
Published: May 2022

Background:
Since the beginning of the Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, school closure as a mitigating measure was at the center of a public and professional debate. While the negative effects of school closure cannot be ignored, accumulating data suggested that it is necessary for reducing community transmission. Our study presents an optional strategy for safe school opening during a pandemic, implemented in selected Israeli high schools by a special task force constructed by the Sheba Medical Center (SMC).

Methods:
The study took place between November 2020 and April 2021. Three schools from different areas of Israel were enrolled. The participants were asked to undergo bi-weekly SARS-CoV-2 rapid diagnostic antigen tests (Ag-RDT). Those who tested positive were requested to self-isolate, whereas their school contacts were tested daily by Ag-RDT. Participants with a previously documented SARS-CoV-2 infection or who were found to be SARS-CoV-2 seropositive upon enrollment were exempted from screening.

Results:
Of a total of 361 participants who enrolled in the study, 12.3% were found to be seropositive. Fourteen SARS-CoV-2 cases were detected (3.5%), 12 of them in one single school located in an endemic area for SARS-CoV-2. The 14 cases resulted in 84 days of COVID-19-related absence from school, comparing with 1775 potential days of COVID-19-related absence under a strategy implementing self-isolation instead of testing.

Conclusions:
Safe continuation of academic routine during the pandemic is possible when using rapid Ag-RDT as a screening tool, while allowing swab collection by trained students and teachers.
Annual Trend in Lumbar Puncture for Infants Younger Than 3 Months Hospitalized With Suspected Serious Bacterial Infection: A Nationwide Inpatient Database Study
Authors: Fuseda Yasuyuki , Michihata Nobuaki , Kumazawa Ryosuke , Fushimi Kiyohide , Yasunaga Hideo 
Published: May 2022

Background:
A lumbar puncture is no longer necessary in febrile infants younger than 3 months when they are at low risk of serious bacterial infection because the risk factors for a severe bacterial infection have been identified. The purpose of this study was to identify the annual trend in the proportion of lumbar punctures in infants with suspected serious bacterial infections using a national inpatient database in Japan.

Methods:
Using the Diagnosis Procedure Combination database, we identified infants < 3 months of age who underwent blood and urine culture tests on admission from April 2011 to March 2020 in Japan.

Results:
In total, 44,910 eligible infants were included in the study. The proportion of lumbar punctures decreased gradually from 57.9% to 50.4% in infants 4–28 days old and from 54.5% to 37.3% in infants 29–89 days old between 2011 and 2019. Of the 18 hospitals, 15 (83.3%) recorded a lumbar puncture proportion of >50% in 2011 and 7 (38.9%) recorded >50% in 2019. In 3 hospitals, the proportion of lumbar punctures remained >75% in 2019.

Conclusion:
The proportion of lumbar punctures with hospitalized infants admitted with blood and urine culture tests decreased over the years, and this trend was greater in infants 29–89 days of age. The reduction in the proportion of lumbar punctures varied widely among the hospitals.
Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children
Authors: Dubois Melanie M. , Brooks Meredith B. , Malik Amyn A. , Siddiqui Sara , Ahmed Junaid F. , Jaswal Maria , Amanullah Farhana , Becerra Mercedes C. , Hussain Hamidah 
Published: May 2022

Background:
Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan.

Methods:
In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years.

Results:
A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB.

Conclusions:
This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.
Effect of femtosecond laser cutting parameters on the results of small-incision lenticule extraction
Authors: Enayati Sam , Zhou Wen , Stojanovic Aleksandar , Utheim Tor Paaske , Bian Zhiwen , Feng Yue , Chen Xiangjun 
Published: May 2022

Purpose:
To determine the effect of femtosecond laser cutting parameters on small-incision lenticule extraction (SMILE) results by evaluating cap thickness, interface light scattering, and visual and refractive outcomes.

Setting:
SynsLaser Clinic, Oslo, Norway.

Design:
Retrospective.

Methods:
58 right eyes treated with SMILE using a programmed cap thickness of 130 μm were divided into 2 groups according to laser settings: Group 1: 165 nJ pulse energy and 4.5 μm spot separation (n = 36); Group 2: 125 nJ pulse energy and 4.2 μm spot separation (n = 22). The cap thickness was measured within the central 5 mm of the horizontal meridian using spectral-domain optical coherence tomography. Postoperative interface light scattering was graded based on the percentage area showing light scattering: 0: no scattering; 1: ≤25%; 2: 26% to 50%; 3: 51% to 75%; and 4: >75%.

Results:
At 3 months postoperatively, cap thickness was 138.9 ± 6.2 μm in Group 1 and 149.4 ± 3.5 μm in Group 2 (P < .001). Interface scattering was 0.9 ± 1.0 in Group 1 and 0.3 ± 0.9 in Group 2 (P < .05), with no scattering in 33.3% and 86.4% of the eyes, respectively. The postoperative spherical equivalent refraction was −0.03 ± 0.44 diopters (D) in Group 1 and −0.04 ± 0.31 D in Group 2. In Group 1, 83.3% of the eyes were within ± 0.5 D of the desired outcome, and 69.4% achieved an uncorrected distance visual acuity of 20/20 or better. In Group 2, these values were 95.5% and 86.4%, respectively.

Conclusions:
Lower pulse energy with tighter spots seems to reduce interface light scattering and improve refractive outcomes while also significantly increasing cap thickness.
Hospital Cultural Competency Leadership and Training is Associated with Better Financial Performance
Authors: Upadhyay Soumya , Weech-Maldonado Robert , Opoku-Agyeman William 
Published: May 2022

SUMMARY

Goal:
An organization’s cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational cultural competency, which could affect organizational performance. Policies regarding health disparities point to the need for hospitals to become culturally competent. This study aimed to explore if CCLT practices are associated with better financial performance.

Methods:
Using secondary data from three sources—the American Hospital Association Annual Survey, the Health Care Cost Information System, and the Area Health Resource File—a longitudinal panel study design reviewed 3,594 hospital-year observations for acute care hospitals across the United States from 2011 to 2012. CCLT, the independent variable, was measured as a summated scale of strategy, execution, implementation, and training in diversity practices. For financial performance, the operating and total margins of hospitals were measured as dependent variables. Two random-effects regression models with year- and state-fixed effects were used to examine the relationship, with hospital being the unit of analysis.

Principal Findings:
The descriptive statistics showed that hospitals had an average CCLT score of approximately 2 (the range was 0–4). Regression analysis indicated that an increase in the CCLT score was associated with a 0.3% and 0.4% increase in total and operating margins, respectively (p < .05). Also, with each 10 additional staffed beds, hospitals on average experienced a 0.1% increase in both total and operating margins. Overall, for-profit hospitals experienced a 2.4% higher total margin and a 4.9% higher operating margin, as compared to not-for-profit hospitals. On the contrary, government hospitals showed 1% and 5.8% lower total and operating margins, respectively.

Applications to Practice:
Results of our study support a business case for CCLT practices. Cultural competency makes good economic sense by helping to improve cost savings, increase market share, and enhance the efficiency of care. Therefore, healthcare leaders should consider investing in CCLT. With the growing emphasis on value-based purchasing related to patient outcomes and experience, hospitals that develop a high degree of cultural competency through CCLT can benefit from the changes in reimbursement. CCLT also affects financial performance through avoidance of costs related to employee absenteeism and turnover and improves team cohesiveness by reducing cultural conflicts. Other mechanisms by which CCLT assists in saving costs and affecting financial performance include avoidance of unnecessary readmissions and expensive hospitalizations through the proper screening of patients from diverse backgrounds. CCLT improves cultural competency and diversity management, thus creating a unique competitive advantage for hospitals.
Analysis of a Resident Competence Self-Assessment Survey
Authors: Mullen Ashley , Horn Catherine 
Published: May 2022

ABSTRACT

Introduction
Orthotic and prosthetic clinicians need to self-assess their performance and make decisions about practice limitations and continuing education throughout their careers. The objectives of this study were to evaluate the internal consistency of a self-assessment survey, examine the latent common factors and responsiveness of the survey, and use the results of the analysis to develop a shortened self-assessment survey.

Methods
Residents completed a self-assessment 29-item survey based on the six domains of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics at multiple times during the clinical residency. Internal consistency was examined through Cronbach α. Confirmatory and exploratory factor analysis were used to examine latent common factors and inform item reduction. Responsiveness was examined through repeated-measures analysis of variance (ANOVA).

Results
Analysis revealed a Cronbach α of 0.927. Confirmatory factor analysis indicated a poor fit of the six-factor model. The final and best-fitting model suggested four latent common factors: patient centeredness, regulatory awareness, device evaluation, and professional responsibility. Review and revision of the items resulted in a 14-item instrument. The instrument was responsive to changes over time.

Conclusions
The results indicate a need to reexamine current clinical practice framework in orthotics and prosthetics, particularly as it relates to clinical competence. Future research should evaluate the performance of the shortened self-assessment survey and consider implications for educational standards.

Clinical Relevance
The use of validated educational tools can strengthen the efficacy of assessments in clinical education and residency. Improved clinical education assessments may result in standardization of competency and improved graduate preparedness.
Name the Diagnosis
Authors: Lao Robyn Huey , Theodorou Christina M. , Kohler Jonathan E. 
Published: May 2022

Abstract
A 9-year-old male presents to the emergency department with abdominal pain, emesis, fever, and generalized peritonitis. Computed tomography images are reviewed and reveal the diagnosis of foreign body magnet ingestion. Surgical and post-operative management are discussed, including readmission due to repeat foreign body ingestion. Pica, defined as compulsive ingestion of nonedible substances, is described. The case report illustrates the importance of a comprehensive history and being wary of potential repeat ingestions in patients with pica.
The Clinicopathologic Challenge of Nonneoplastic Vulvar Acanthosis
Authors: Day Tania , Scurry James , Haqshenas Gholamreza , Murray Gerald , Tran Hong , Dennerstein Graeme , Garland Suzanne M. 
Published: May 2022

Objective
The aim of the study was to evaluate clinicopathologic features of cases demonstrating an acanthotic tissue reaction not clearly consistent with psoriasis, lichen simplex chronicus, mycosis, or condyloma.

Materials and Methods
This is a retrospective pathologic case series of biopsies reported as “benign acanthotic lesion” and “acanthotic tissue reaction” that lacked a clear diagnosis on expert review. Cases with nuclear atypia were excluded. Clinical and histopathologic data were collected, immunohistochemistry for p16 and p53 were obtained, and molecular testing for 28 common anogenital human papillomavirus (HPV) genotypes was undertaken.

Results
There were 17 cases with a median age of 47 years. Unilaterality and medial location were clinical reasons for diagnostic difficulty. Histopathologic uncertainty often related to lack of papillary dermal fibrosis to support lichen simplex chronicus or psoriasiform lesions without parakeratosis, subcorneal pustules, and/or mycotic elements. Firm pathologic diagnoses were not possible, but 3 groups emerged: favoring chronic dermatitis, favoring psoriasis, and unusual morphologies. p16 results were negative or nonblock positive while p53 was normal or basal overexpressed. Human papillomavirus testing was negative in 12, low positive for HPV 16 in 1, unassessable in 3, and not requested in 1.

Conclusions
There is a group of acanthotic tissue reactions that cannot be classified with standard histopathologic assessment. Further clinicopathologic research into unilateral acanthotic lesions may provide insight into separation of psoriasis and mycosis when organisms are absent. Once nuclear atypia is excluded, immunohistochemistry for p16 and p53 and HPV molecular testing do not assist in diagnostic identification.
Temporary Left Ventricular Support Device as a Bridge to Heart-Liver or Heart-Kidney Transplant: Pushing the Boundaries of Temporary Support
Authors: Roach Amy , Emerson Dominic , Megna Dominick , Cole Robert , Catarino Pedro , Salabat Reza , Ramzy Danny , Moriguchi Jamie , Kobashigawa Jon , Trento Alfredo , Chikwe Joanna , Esmailian Fardad 
Published: May 2022

In patients with severe cardiogenic shock, temporary mechanical circulatory support has become a viable strategy to bridge patients to heart transplantation. However, end-stage heart failure is often associated with progressive organ dysfunction of the liver or kidney. This can require a dual organ transplant for definitive management (combined heart-liver [HL] or heart-kidney [HK] transplantation). We evaluated temporary mechanical support to bridge patients to HL or HK transplant at a single, high-volume center. All patients who underwent Impella 5.0 placement from January 2014 to October 2018 were identified. From this dataset, patients who underwent placement as a bridge to dual organ transplant were selected, as were those who underwent Impella as a bridge to isolated heart transplant.
Over the 5 years of evaluation, 104 patients underwent Impella 5.0 placement. Of these, 14.3% (n = 15) were identified as potential dual organ recipients (11 HK, 4 HL). In total, 80% (12/15) successfully underwent dual organ transplant (8 HK, 4 HL), with a 1-year survival of 100% in both transplanted groups. Among patients undergoing Impella 5.0 placement as a bridge to isolated heart transplant (n = 33), 78.8% (26) were successfully bridged, and 1-year survival was 92% after transplantation.
Impella 5.0 is a viable bridge to dual organ transplantation and should be considered as a management strategy in these complex patients at experienced institutions.
Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke
Authors: Sawtelle Michelle , Roddey Toni , Ellison Jennifer , Tseng Shih-Chiao 
Published: May 2022

Background and Purpose:
A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls.

Methods:
In this cross-sectional study, adults with chronic stroke (n = 12) and healthy controls (n = 12) completed 4 natural-speed chair-rise trials. Magnitude and onset of bilateral gluteus maximus activation were measured during the movement with secondary comparative data from biceps femoris and vastus lateralis muscles. Kinetic and kinematic measurements were used to quantify chair-rise phases and movement cycle duration.

Results:
Significant decreases in paretic (P = 0.002), and nonparetic (P = 0.001) gluteus maximus magnitudes were noted post-stroke compared with ipsilateral extremities of healthy adults. Significant gluteus maximus onset delays were noted in paretic extremities compared with nonparetic extremities post-stroke (P = 0.009) that were not apparent in comparative muscles. Similar onset times were noted when comparing the paretic extremity post-stroke to the ipsilateral extremity of healthy controls (P = 0.714) despite prolonged movement cycle durations in those with chronic stroke (P = 0.001). No onset delays were evident in the biceps femoris (P = 0.72) or vastus lateralis (P = 0.338) muscles.

Discussion and Conclusions:
Despite apparent unilateral muscle weakness post-stroke, bilateral decreases in gluteus maximus activation magnitudes and compounding onset deficits of the paretic extremity were observed during chair-rising. Further research is needed to determine whether interventions maximizing bilateral activation magnitudes and improving temporal activation congruency during chair-rising will carry over to functional gains

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A387).