bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Time to Aneurysm Repair and Mortality in Aneurysmal Subarachnoid Hemorrhage
Authors: Sheehan Tiffany O. , Davis Nicolle W. , Guo Yi , Kelly Debra Lynch , Yoon Saunjoo L. , Horgas Ann L. 
Published: July 2022

ABSTRACT

BACKGROUND: Prompt aneurysm repair is essential to prevent rebleeding after aneurysmal subarachnoid hemorrhage. To date, most studies on this topic have focused on 1 set of predictors (eg, hospital or patient characteristics) and on 1 outcome (either time to aneurysm repair or mortality). The purpose of this study was to test a model that includes hospital and patient characteristics as predictors of time to aneurysm repair and mortality, controlling for disease severity and comorbidity, and considering time to aneurysm repair as a potential influence in these relationships. METHODS: A sample of aneurysmal subarachnoid hemorrhage patients with a principal procedure of clipping or coiling was selected (n = 387) from a statewide administrative database for cross-sectional retrospective analysis. The primary study outcome was in-hospital mortality. Independent variables were level of stroke center, age, race, sex, and type of aneurysm repair. Hierarchical logistic regression was used to estimate the probability of in-hospital death. RESULTS: Patients who underwent a coiling procedure were more likely to be treated within the first 24 hours of admission compared with those undergoing clipping (odds ratio, 0.54; 95% CI, 0.35–0.84; P = .01). Patients treated at a certified comprehensive stroke center (CSC) had a 72% reduction in odds of death compared with those treated at primary stroke centers (odds ratio, 0.28; 95% CI, 0.10–0.77; P = .01), after controlling for disease severity and comorbid conditions. Time to aneurysm repair was not significantly associated with mortality and did not influence the relationship between hospital and patient characteristics and mortality. CONCLUSION: Our results indicate that treatment at a CSC was associated with a lower risk of in-hospital mortality. Time to aneurysm repair did not influence mortality and did not explain the mortality benefit observed in CSCs. Research is needed to explore interdisciplinary hospital factors including nursing and nurse-sensitive interventions that may explain the relationship between CSCs and mortality outcomes.
Membership matters! A toolkit strategy
Authors: Wilson Kathleen P. 
Published: July 2022

ABSTRACT
Professional organizations often have a symbiotic relationship with their members. Not only is there dependency on membership to thrive but also there is availability of professional resources for members, thus dually meeting the organization's goals and objectives. Since 2020 with the Covid -19 pandemic, some professional organizations may have experienced challenges affecting membership. Nurse Practitioner (NP) organization leaders, including Fellows of the American Association of Nurse Practitioners (FAANP), must be attentive to finding ways to create new member state and local councils that will increase overall membership across the tri-level tier of local, state, and national membership. Increasing NP membership enhances NP voices in those matters that most affect NP practice, policy, and legislation. A toolkit for initiating a new local professional organization is shared to support this effort.
Methods recently used for the assessment of physical activity in children and adolescents
Authors: Jurado-Castro Jose Manuel , Gil-Campos Mercedes , Llorente-Cantarero Francisco Jesus 
Published: July 2022

Purpose of review
The aim of this review is to summarize recent evidences and advances on the implementation and the use of new tools to assessing physical activity (PA) in children.

Recent findings
Technological advances provide, increasingly, new objective methods for the evaluation of PA in children. In addition to accelerometry, there are other objective methods for assessing PA in children such as new wearable monitoring and activity bracelets, smartphone and recording software applications, Global Positioning System or Inertial Sensors Devices.

Summary
Doubly labeled water and calorimetry are reference methods to assessing PA but with limitations of use. Accelerometry is an accurate method for measuring sedentary behavior and PA levels in children. In fact, it is a real alternative reference method for the validation of methods and tools of assessing PA. However, there is still no consensus about the most appropriate approach to analyze the duration and intensity of PA in children. Therefore, the implementation of other alternative objective methods, as well as complementation with PA questionnaires, can provide a more precise evaluation of different patterns and behaviors related with sedentarism and PA.
High protein diet in digestive cancers
Authors: Laviano Alessandro 
Published: July 2022

Purpose of review
Recent advances in the nutritional management of patients with digestive cancers suggest that modulation of protein intake may significantly contribute to achieve nutritional and clinical benefits. By reviewing the available evidence, a quantitatively and qualitatively optimal protein intake could be derived.

Recent findings
High protein diets (i.e., 1–1.5 g/kg body weight/day) appear key to maintain the adequate nutritional status, and may also contribute to achieve clinical benefits. This target appears particularly relevant in patients with digestive cancers at risk or already malnourished, or in older patients. During active cancer treatments, protein intake should be closer to the upper limit of the recommended intake. Also, high protein intake should be maintained also beyond the periods of catabolic crisis associated with active treatments. In contrast with general reasoning, animal proteins should represent the majority of the recommended intake. Based on the available evidence, the intake of no specific amino acid can be strongly recommended to enhance anabolic potentials or the immune modulating effects of high protein diets.

Summary
High protein intake, mostly based on animal proteins, should be recommended to patients with digestive cancers. However, this target should be translated into clinical prescription after considering the clinical and metabolic needs of the patients. The quest for the optimal protein intake of patients with cancer at different time points of their clinical journey is still open.
Outcome differences between PARAMEDIC2 and the German Resuscitation Registry: a secondary analysis of a randomized controlled trial compared with registry data
Authors: Knapp Jürgen , Huber Markus , Gräsner Jan-Thorsten , Bernhard Michael , Fischer Matthias 
Published: July 2022

Background and importance
There has been much discussion of the results of the PARAMEDIC2 trial, as resuscitation outcome rates are considerably lower in this trial than in country-level registries on out-of-hospital cardiac arrest (OHCA). Here, we developed a statistical framework to investigate this gap and to examine possible sources for observed discrepancies in outcome rates.

Design
Summary data from the PARAMEDIC2 trial were used as available in the publication of this study. We developed a modelling framework based on logistic regression to compare data from this randomized controlled trial and registry data from the German Resuscitation Registry (GRR), where we considered 26 019 patients treated with epinephrine for OHCA in the GRR. To account and adjust for differences in patient characteristics and baseline variables predictive for outcomes after OHCA between the GRR cohort and the PARAMEDIC2 study sample, we included all available variables determined at the arrival of EMS personnel in the modelling framework: age, sex, initial cardiac rhythm, cause of cardiac arrest, witness of cardiac arrest, CPR performed by a bystander, and the interval between emergency call and arrival of the ambulance at the scene (baseline model). In order to find possible explanations for the discrepancies in outcome between PARAMEDIC2 and GRR, in a second (baseline plus treatment) model, we additionally included all available variables related to the interventions of the EMS personnel (type of airway management, type of vascular access, and time to administration of epinephrine).

Main results
A patient cohort with baseline variables as in the PARAMEDIC2 trial would have survived to hospital discharge in 7.7% and survived with favourable neurological outcome in 5.0% in an EMS and health care system as in Germany, compared with 3.2 and 2.2%, respectively, in the Epinephrine group of the trial. Adding treatment-related variables to our logistic regression model, the rate of survival to discharge would decrease from 7.7 (for baseline variables only) to 5.6% and the rate of survival with favourable neurological outcome from 5.0 to 3.4%.

Conclusion
Our framework helps in the medical interpretation of the PARAMEDIC2 trial and the transferability of the trial’s results for other EMS systems. Significantly higher rates of survival and favourable neurological outcome than reported in this trial could be possible in other EMS and health care systems.
Bone Morphogenic Protein 2 Use for the Surgical Treatment of Acute Scaphoid Fractures and Scaphoid Non-unions
Authors: Clark DesRaj M. , Piscoya Andres S. , Dunn John C. , Nesti Leon J. 
Published: July 2022

Background:
Bone morphogenic protein 2 (BMP-2) has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. Questions/purpose: This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive BMP-2 to further characterize BMP-2 use in the hand and wrist.

Methods:
Retrospective review of scaphoid fractures treated surgically in one region of the military health system from 2009 to 2019 was conducted to identify cases employing BMP-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior non-unions, union rates at 4 & 6 weeks, and functional outcomes.

Results:
Fourteen patients met inclusion criteria. Non-unions accounted for 50% of included fractures. The total union rate was 93%. Mean time to union was 6.2 weeks. All acute fractures healed with mean time to union of 4.8 weeks. Non-unions had a union rate of 86% with mean time to union of 7.7 weeks. Four patients (29%) developed radiographic heterotopic ossification (HO); however, there was no significant decrease in motion was appreciated. Thirteen patients (93%) resumed the push-ups portion of the military fitness test. No major complications were identified during follow up.

Conclusions:
Adjunctive use of BMP-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess if adjunctive BMP-2 use in scaphoid fractures provides significant benefit versus other treatments.
Efficacy of Post-Surgical Nostril Retainer (PSNR) in patients with UCLP Treated with Pre-Surgical NasoAlveolar Molding (NAM) and Primary Cheiloplasty-Rhinoplasty
Authors: Al-Qatami Fawzi , Avinoam Shayna P , Cutting Court B , Grayson Barry H , Shetye Pradip R 
Published: July 2022

Objective:
The aim of this investigation is to determine if the nasal form of patients with unilateral cleft lip and palate (UCLP) treated with pre-surgical nasoalveolar molding (NAM) therapy, primary lip-nose surgery, and post-surgical Nostril Retainer (PSNR) is different from patients treated with pre-surgical NAM and primary lip and nose surgery alone.

Design:
A cross-sectional, retrospective review of 50 consecutive non-syndromic patients with UCLP: 24 treated with NAM and primary lip-nose surgery followed by PSNR (Group I) compared to 26 patients treated with NAM and primary lip-nose surgery without PSNR (Group II). Polyvinyl siloxane nasal impressions were performed at the average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparison of cleft versus non-cleft side nasal measurements were performed within Group I and Group II, as well as comparison of the difference between the two groups.

Results:
Cleft side nasal dimension was statistically significantly better in Group I than Group II across all measures except nasal projection (P<0.05). Group I showed less difference between the cleft and non-cleft side in all six measurements than Group II (p<0.05).

Conclusion:
There is a significant difference in the nasal shape of patients who underwent PSNR compared to those that did not. The patients who used PSNR showed better nasal shape at the average age of 12 months than the control group.
Primary Targeted Muscle Reinnervation after Below Knee Amputation is Not Associated with An Increased Risk of Major or Minor Surgical Complications: A Multi-Institutional, Propensity Score-Matched Analysis
Authors: Shammas Ronnie L. , Azoury Said C. , Sergesketter Amanda R. , Lee Hui-Jie , Poehlein Emily , Othman Sammy E. , Cason Roger W. , Levinson Howard , Kovach Stephen J. , Mithani Suhail K. 
Published: July 2022

BACKGROUND:
Targeted muscle reinnervation (TMR) has emerged as a technique to reduce neuroma and phantom limb pain after below knee amputation (BKA); however, the incidence of post-operative complications remains unknown. This multi-institutional study assessed the risk of post-operative complications among patients who underwent TMR at the time of BKA (BKA+TMR).

STUDY DESIGN:
Patients who underwent BKA+TMR were propensity score-matched 1:3 to patients who underwent BKA only. Study outcomes included the incidence of major or minor complications within 60 days. Regression models were utilized to estimate the relative risk (RR) of major and minor complications.

RESULTS:
Overall, 96 patients were matched including 31 BKA+TMR and 65 BKA only. In the matched sample, a higher incidence of major complications (29% vs. 24.6%), readmission (25.8% vs. 18.5%) and reoperation (19.4% vs. 10.8%) was seen after BKA+TMR compared to BKA only. Furthermore, patients who underwent BKA+TMR displayed a higher incidence of minor complications (25.8% versus 20.0%), blood transfusion (22.6% vs. 18.5%), wound healing complications (45.2% vs. 33.8%), and longer operative time (mean [standard deviation] 188.5 [63.6] vs. 88 [28.2] minutes). However, there was no statistically significant difference in the risk of major (RR:1.20, 90% confidence interval (CI):0.68, 2.11) or minor (RR:1.21, 90% CI:0.61, 2.41) complications between the two cohorts.

CONCLUSION:
Despite an increased incidence of post-operative complications, undergoing BKA+TMR does not confer a statistically significant increased risk of major or minor complications. Future studies are needed to delineate patient selection criteria when assessing the suitability of TMR at the time of major limb amputation.
“Negative Pressure Wound Therapy (NPWT) Yields Lower Wound Complication and Surgical Site Infection Rates Compared to Standard Surgical Dressings (SSDs) after Resection of a Malignancy: A Systematic Review and Meta-Analysis”
Authors: Hays Thomas R. , Singh Gurtej , Saragossi Jamie , Park Jason , Shekar Shruthi , Marquez Jocellie E. , Dagum Alexander B. , Khan Sami U. , Khan Fazel A. , Bui Duc T. 
Published: July 2022

Background–
Negative Pressure Wound Therapy (NPWT) offers many advantages over Standard Surgical Dressings (SSDs) in the treatment of open wounds including accelerated wound healing (72.3% vs 30.8%), cost savings (up to $1,607), and reduced complication rates (35% vs 53%).2-4 Contraindicated by device manufacturers in malignancy-resected wounds for hypothesized risk of tumor recurrence, NPWT is still applied post-operatively due to limited clinical support. A systematic review with meta-analysis was performed to compare NPWT outcomes with SSDs on open wounds with our null hypotheses stating there would be no outcome differences.

Methods–
A systematic review of the literature on NPWT and SSDs on malignancy-resected wounds was conducted following PRISMA guidelines using PubMed, EMBASE, CINAHL, and Cochrane Central databases. Meta-analysis compared group outcomes, including malignancy recurrence, wound complication, and surgical site infection (SSI) rates, with random effects model.

Results–
1,634 studies were identified and 27 met eligibility criteria, including 4 randomized control trials (RCTs), 4 prospective cohort studies, and 19 retrospective reviews. Eighty-one percent of papers (n = 22) recommended NPWT use in malignancy-resected wounds. Meta-analysis determined NPWT yielded significantly lower overall SSI (P = 0.004) and wound complication rates (P = 0.01) than SSDs; however, there were no statistically significant differences found for other outcomes between the two groups.

Conclusions–
This review demonstrates favorable outcomes of NPWT over SSDs for malignancy-resected wounds without an increased risk of malignancy recurrence. However, with limited RCTs (detailing only incisional wounds for limited malignancies and anatomic regions), additional high-power RCTs are recommended.
OLDER PATIENTS AND PATIENTS WITH SEVERE ARTERIOSCLEROSIS ARE LESS LIKELY TO DEVELOP KELOIDS AND HYPERTROPHIC SCARS AFTER THORACIC MIDLINE INCISION: A SURVEY-BASED ANALYSIS OF 328 CASES
Authors: Sugimoto Atsuko , Ono Shinpei , Usami Satoshi , Nitta Takashi , Ogawa Rei 
Published: July 2022

BACKGROUND:
Surgery is a well-known trigger of keloid and hypertrophic scarring. Sternotomy scars are subject to high skin tension, which is also known to promote pathological scarring. This suggests that sternotomies in adults associate with high pathological-scarring rates, which is also our anecdotal experience. However, this notion has never been formally examined. Therefore, we conducted a survey-based cohort study of patients who had undergone a sternotomy.

STUDY DESIGN:
All consecutive Japanese adults (≥18 years) who underwent cardiovascular surgery with sternotomy in 2014–2017 were identified in 2019 by chart review and sent a questionnaire. Respondents formed the study cohort. The questionnaire presented randomly-ordered photos of representative mature, keloid, and hypertrophic scars and asked the patients to choose the image that best resembled their midline scar when it was particularly noticeable. The incidence of self-reported pathological scarring (keloids and hypertrophic scars were grouped together) and the patient demographic (age and sex) and clinical characteristics (e.g. intima media thickness of the left and right common and internal carotid arteries) that associated with pathological scarring were determined.

RESULTS:
Of the 548 sternotomy patients, 328 (mean age, 67 years; 68.0% male) responded (60% response rate). Of these, 195 (59.5%) reported they had a pathological scar. Compared to mature-scar patients, pathological-scar patients had lower mean age (65 vs. 69 years, p=0.0002) and intima-media thickness (0.92 vs. 1.05 mm, p=0.028).

CONCLUSION:
Sternotomy was associated with a high rate of pathological scarring. An older age and arteriosclerosis were associated with less pathological scarring.
“An Algorithm for Reconstruction of Electrical Injuries of the Scalp”
Authors: Khalid Farrukh A. , Ahmed Omar A. , Rabbani Muhammad Jibran , Saleem Muhammad , Amin Muhammad , Mujahid Abdul Malik , Mehrose Muhammad Younas , Tarar Moazzam N , Shahzad Farooq 
Published: July 2022

Background:
Electrical Injuries of the scalp are a frequent occurrence in underdeveloped countries. Burns can be contact or conductive and result in extensive tissue damage. We present our experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm.

Methods:
This is a retrospective cohort study comprising of all patients with electrical injuries of the scalp treated at our center between January 2010 and December 2016. Non-contrast computed tomography scan was obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single stage debridement and reconstruction was performed. All non-viable soft tissue and bone was removed. Soft tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts.

Results:
Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high voltage (44 patients) and low voltage (8 patients) electrical injury All patients underwent successful soft tissue reconstruction. Osteomyelitis with draining sinuses developed in 3 patients; these patients underwent flap re-elevation and bone debridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in 2 patients and split rib grafts in 4 patients. One patient underwent scalp tissue expansion for hair restoration.

Conclusions:
We propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough debridement of the calvarium is the most important determinant of a successful outcome.
Refined concept of motor supply to the medial periorbital area relevant to periorbital surgery
Authors: Choi Yeop , Kim In-Beom 
Published: July 2022

Background:
Mimetic muscles in the medial periorbital area were thought to be innervated solely by the angular nerve. Recently however, the upper medial palpebral branch and lower palpebral branch were reported as additional motor suppliers in this area. This study aimed to define all the motor nerve systems passing through the medial canthal area.

Methods:
Motor nerve branches that passed through the medial canthal region were identified and traced thoroughly from the parotid gland to their destinations under a surgical microscopic field in 74 hemifaces. The courses, anatomical positions of, and anatomical relationships between the angular nerve and the upper medial palpebral branch were observed.

Results:
The upper medial palpebral branch and the angular nerve were found in all samples within a 3-6 mm area lateral to the intersecting point of the medial orbital rim and medial canthal ligament. The upper medial palpebral branch supplied the upper eyelid, whereas the angular nerve supplied the extra-orbicularis muscles in the medial periorbital area. The medial pretarsal area of the upper eyelid was supplied solely by the pretarsal branches of the upper medial palpebral branch, which was formed by uniting three or four minor branches that traveled throughout the anterior cheek.

Conclusion:
wo separate motor nerve systems, the upper medial palpebral branch and the angular nerve, exist in the medial canthal area. The upper medial palpebral branch course along the medial orbital rim is considered as a facial nerve danger zone.