bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Concept Development for the Symptom Science Model 2.0
Authors: Kurnat-Thoma Emma L. , Graves Letitia Y. , Billones Ruel R. 
Published: May 2022

Background
The National Institute of Nursing Research developed the National Institutes of Health symptom science model (SSM) in 2015 as a parsimonious conceptual model to guide symptom science research.

Objectives
This concept development paper synthesizes justifications to strengthen the original model.

Methods
A literature review was performed, discussions with symptom science content expert stakeholders were held, and opportunities for expanding the current model were identified. Concept elements for a revised conceptual model—the SSM 2.0—were developed.

Results
In addition to the four original concept elements (complex symptom presentation, phenotypic characterization, biobehavioral factors [previously biomarker discovery], and clinical applications), three new concept elements are proposed, including social determinants of health, patient-centered experience, and policy/population health.

Discussion
There have been several calls to revise the original SSM from the nursing scientific community to expand its utility to other healthcare settings. Incorporating three additional concept elements can facilitate a broader variety of translational nursing research symptom science collaborations and applications, support additional scientific domains for symptom science activities, and produce more translatable symptom science to a wider audience of nursing research scholars and stakeholders during recovery from the COVID-19 pandemic. The revised SSM 2.0 with newly incorporated social determinants of health, patient-centered experience, and policy/population health components now empowers nursing scientists and scholars to address specific symptom science public health challenges particularly faced by vulnerable and underserved populations.
Rehabilitation definition for research purposes. A global stakeholders’ initiative by Cochrane Rehabilitation
Authors: Negrini Stefano , Selb Melissa , Kiekens Carlotte , Todhunter-Brown Alex , Arienti Chiara , Stucki Gerold , Meyer Thorsten 
Published: May 2022

ABSTRACT

Objective
Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes.

Design
We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers.

Results
We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that “In a health care context,” rehabilitation is defined as a “multimodal, person-centered, collaborative process” (Intervention-general), including interventions targeting a person’s “capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance” (Intervention-specific) with the goal of “optimizing” the “functioning” (Outcome) of “persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability” (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a “rehabilitation intervention” as “any intervention provided within the rehabilitation process.”

Conclusion
We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation.
External and internal work load during a mountain time trial in trained handcyclists vs. a world class handcyclist and determinants of performance
Authors: de Groot Sonja , Kouwijzer Ingrid , Hoekstra Sven P. , Vroemen Guido , Valent Linda J.M. ,   HandbikeBattle group, van der Woude Lucas H.V. 
Published: May 2022

ABSTRACT

Objective
To evaluate the external and internal work load of trained handcyclists during a mountain time trial, to compare the results with a world class (WC) handcyclist, and to identify time trial performance determinants.

Design
Ten trained and one WC handcyclists performed a graded exercise test to determine power output (PO) and heart rate (HR) at the ventilatory thresholds (VT1 and VT2) and exhaustion. PO and HR were continuously measured during the race.

Results
Absolute POmeanrace (119 ± 21 vs. 203 W, p < 0.001) was lower in the trained handcyclists compared to the WC handcyclist. Absolute and relative HRrace (86 ± 7% vs. 88%, p = 0.40) and relative POrace (66 ± 10% vs. 62%, p = 0.24) were similar. Trained handcyclists cycled significantly less time at a PO between VT1-VT2 (48% vs. 64%, p = 0.02) and more at a PO > VT2 (34% vs. 11%, p = 0.005). POVT2 showed the strongest correlation with finish time (r = -0.78) and POpeak with POmeanrace (r = 0.90).

Conclusion
Lab outcomes POpeak and POVT2 are important performance determinants for longer time trials in handcyclists and it is, therefore, important to improve these outcomes with training. Since the trained handcyclists cycled most of the race in intensity zones 2 and 3, it is recommended to incorporate these zones also in the training.
Temporal trend of opioid and nonopioid pain medications: results from a national in-home survey, 2001 to 2018
Authors: Wang Yun , Wu Dan , Chan Alexandre , Chang Chih-Hung , Lee Vivian W.Y. , Nichol Michael B. 
Published: May 2022

Abstract

Introduction:
The opioid epidemic persists in the United States. The use of opioid medications is often assessed by claims data but potentially underestimated.

Objectives:
We evaluated the temporal trend in the use of opioid and nonopioid pain medications from a national survey.

Methods:
Using data from the 2001 to 2018 National Health and Nutrition Examination Survey (NHANES), we examined the current use of prescription analgesics in the past 30 days among 50,201 respondents aged 20 years or older. Joinpoint regressions were used to test statistically meaningful trends of opioid vs nonopioid analgesics.

Results:
The mean percentage of people who had pain medications in the past 30 days was 6.4% (5.3%-7.1%) for opioid and 11.3% (9.0%-14.8%) for nonopioid analgesics. The availability of opioid and nonopioid prescriptions at home has remained stable, except for the slight decline of opioids among cancer-free patients in 2005 to 2018. The most frequently used opioid analgesic medications included hydrocodone/acetaminophen, tramadol, and hydrocodone.

Conclusion:
We uniquely measured the proportion of people who had opioid and nonopioid pain medications at home in the United States and supplemented the previous knowledge of prescription rates mainly obtained from claims data.
Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model
Authors: Uhelski Megan L. , Gorur Aysegul , Shi Ted , Corrales German , Du Kim N. , Li Yan , Amit Moran , Tatsui Claudio E. , Rhines Laurence D. , Dougherty Patrick M. , Cata Juan P. 
Published: May 2022

Abstract

Introduction:
Currently, cancer pain is viewed as a process orchestrated by the release of pronociceptive molecules and the invasion of neural structures, referred to as perineural invasion (PNI). Cancer pain resulting from PNI is well-documented, but the mechanisms leading to peripheral sensitization because of tumor growth are not fully known.

Methods:
A retrospective study was used to examine how the use of anti-inflammatory medications affected preoperative pain in patients with oral squamous cell carcinoma cancer. We then used an in vitro coculture model in which dorsal root ganglion (DRG) neurons were incubated together with Fadu human head and neck squamous cell carcinoma cancer cells to explore how cancer cells affect the electrical membrane properties of sensory neurons.

Results:
We found that inflammation contributes to preoperative pain in patients with oral squamous cell carcinoma. After coculture with Fadu human head and neck squamous cell carcinoma cancer cells, we identified markers of inflammation in coculture media and found evidence of neuronal sensitization, including spontaneous activity, reduced current thresholds, depolarized resting membrane potential, and enhanced responses to current stimulation in human and rat DRG neurons. In rats, these effects were influenced by sex and age: neurons from young adult female rats were resistant to changes in neuronal activity, in contrast to neurons from older adult female rats or male rats of either age group.

Conclusions:
Pro-inflammatory substances released in cancer cell–DRG coculture promoted neuronal hyperexcitability and may contribute to cancer pain after PNI, and these effects may differ across age groups and sexes.
The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis
Authors: Timmer Allard S. , Zwanenburg Pieter R. , Eskes Anne M. , Hompes Roel , Boermeester Marja A. 
Published: May 2022

Background:
Infected wounds extend healing time and are associated with higher treatment costs than noninfected wounds. Several observational studies indicate that negative-pressure wound therapy with instillation can effectively reduce bacterial bioburden and improve wound healing. Only a few randomized trials with small sample sizes have been published, and a meta-analysis directly comparing negative-pressure wound therapy with instillation to current standard care is lacking. It is therefore uncertain whether negative-pressure wound therapy with instillation actually improves wound healing. The authors performed a systematic review and hypothesized that negative-pressure wound therapy with instillation reduces wound closure time.

Methods:
The PubMed, Embase, and CENTRAL databases were searched up to December of 2020 for English studies that compare negative-pressure wound therapy with instillation—to either negative-pressure wound therapy without instillation or to other types of wound care—for the treatment of acute or chronically infected wounds. Time to wound closure was analyzed using a random effects meta-analysis in predefined subgroups according to study design and comparative wound care.

Results:
The authors identified 14 studies describing 1053 patients. Meta-analysis of three randomized trials shows no significant difference in time to wound closure between negative-pressure wound therapy with instillation and that without (mean difference, 0.48 day; 95 percent CI, −0.70 to 1.65; I² = 0 percent). Data from eleven observational studies indicate that negative-pressure wound therapy with instillation reduces wound closure time (from 1.6 to 16.8 days; no pooled data). Because of imprecision and risk of bias, the available evidence provides only low-level certainty.

Conclusions:
There is currently insufficient evidence to support or discard the use of negative-pressure wound therapy with instillation for infected wounds. More randomized trials are needed to determine whether a beneficial effect can be substantiated.
Reducing Complications and Expanding Use of Robotic Rectus Abdominis Muscle Harvest for Pelvic Reconstruction
Authors: Davila Armando A. , Goldman Joshua , Kleban Shawna , Lyons Mitchell , Brosious John , Bardakcioglu Ovunc , Baynosa Richard C. 
Published: May 2022

Summary:
The rectus abdominis flap has long been a workhorse in perineal reconstruction. Although traditionally approached though an external incision, the morbid nature of the incision and subsequent violation of the anterior rectus sheath has encouraged innovation of minimally invasive approaches for harvest. In this study, we present our experience, evolution, and comparative outcomes of robotic rectus abdominis muscle harvest. A retrospective review of perineal reconstruction was performed for a 6-year period (2014 to 2019). Robotic rectus abdominis muscle flaps were compared to nonrobotic techniques performed during this time. Descriptive statistics and complication profiles were computed. The details of our surgical technique are also described. Thirty-six patients underwent perineal reconstruction. Sixteen were performed using the robotic rectus abdominis muscle and 20 with traditional repairs (12 vertical rectus abdominis myocutaneous flaps and eight gracilis flaps). Demographic profiles were similar between cohorts, including age, body mass index, smoking, diabetes, neoadjuvant radiation therapy, and need for vaginal wall repair. Six robotic patients underwent abdominal wall reinforcement with biological mesh. Length of stay, surgical times, and incidence of major complications were similar between cohorts with a trend toward increased minor complications in traditional reconstructions (55 percent versus 31 percent; p = 0.15). Robotic rectus abdominis muscle harvest is a powerful tool that continues to evolve the potential to mitigate common morbidities and complications of traditional repair and further enhance cosmetic outcomes. This study suggests that greater flexibility for reconstruction can be afforded with harvest of the posterior rectus sheath and complications avoided with prophylactic mesh reinforcement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Validity of Using the Scratch Collapse Test in the Lower Extremities
Authors: Pisquiy John J. , Carter Jordan T. , Gonzalez Gilberto A. 
Published: May 2022

Background:
The scratch collapse test is a provocative test that has been successfully used for peripheral neuropathies. The elbow is the main testing site, but there may be times when use of the upper extremities is contraindicated. This study sought to determine the sensitivity of using the scratch collapse test on the lower extremity for upper extremity neuropathies.

Methods:
One hundred patients with an electromyographically confirmed diagnosis of carpal tunnel or cubital tunnel syndrome were prospectively enrolled. As a control, the scratch collapse test was conducted normally using the elbow as a testing site. After a baseline was established, the test was repeated using eversion of the foot and ankle against an inversion force.

Results:
Of the 100 study patients, 89 had a positive scratch collapse test on the upper extremity and 84 had a positive test on the lower extremity. In the 51 patients with carpal tunnel syndrome, 45 had a positive test on the upper extremity (sensitivity, 88.2 percent; 95 percent CI, 76.13 to 95.56 percent), and 42 had a positive test of the lower extremity (sensitivity, 82.35 percent; 95 percent CI, 69.13 to 91.60 percent). In the 49 patients with cubital tunnel syndrome, 44 had a positive test on the upper extremity (sensitivity, 89.8 percent; 95 percent CI, 77.77 to 96.6 percent), and 42 had a positive test on the lower extremity (sensitivity, 85.7 percent; 95 percent CI, 72.76 to 94.06 percent).

Conclusion:
There were no statistically significant differences in the sensitivities of the scratch collapse test on the upper or lower extremities, suggesting that the lower extremity could serve as an alternative site for the scratch collapse test.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, II.
Physical and Functional Outcomes of Simultaneous Vascularized Lymph Node Transplant and Lymphovenous Bypass in the Treatment of Lymphedema
Authors: Garza Rebecca M. , Beederman Maureen , Chang David W. 
Published: May 2022

Background:
The authors analyze the outcomes of simultaneous vascularized lymph node transplant and lymphovenous bypass for treatment of primary and secondary lymphedema. To the best of their knowledge, this is the largest study to date with long-term outcome data of this novel approach.

Methods:
Three hundred twenty-eight patients who underwent physiologic surgical treatment over a 5.5-year period were evaluated using a prospective database and chart review. Preoperative characteristics, operative details, and postoperative outcomes (volume difference change, Lymphedema Life Impact Scale score) were assessed. Statistical analysis including multivariate regression was performed.

Results:
Two hundred twenty patients (67.1 percent) underwent simultaneous vascularized lymph node transplant and lymphovenous bypass. Mean body mass index was 26.9 ± 4.7 kg/m2. Ninety-two patients (41.8 percent) had lymphedema of the lower extremity, 121 (55.0 percent) had upper extremity involvement, and seven had lymphedema of upper and lower extremities (3.2 percent). Average duration of lymphedema was 95.4 ± 103.6 months. Thirty patients (13.6 percent) had primary lymphedema and 190 patients (86.4 percent) had secondary lymphedema. The majority improved and experienced volume reduction of an average 21.4 percent at 1 year (p < 0.0001), 36.2 percent at 2 years (p < 0.0001), 25.5 percent at 3 years (p = 0.1), and 19.6 percent at 4 years. Median Lymphedema Life Impact Scale scores were 7.0 points lower (p < 0.0001) at 3 months and improved progressively over time to 27.5 points lower at 3 years postoperatively (p < 0.005).

Conclusions:
Simultaneous vascularized lymph node transplant and lymphovenous bypass is an appropriate and effective approach for both early and advanced stages of primary and secondary lymphedema, with significant objective and subjective improvements. Volume reduction in the affected limb was observed at all time points postoperatively, with significant improvement in Lymphedema Life Impact Scale scores.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Do Preoperative Depressor Anguli Oris Muscle Blocks Predict Myectomy Outcomes? A Single-Cohort Comparison in Postparetic Facial Synkinesis
Authors: Hembd Austin S. , Sanchez Cristina V. , Halani Sameer H. , Mohanty Ahneesh J. , Krag Andreas E. , Rozen Shai M. 
Published: May 2022

Summary:
The complexity of facial synkinesis will likely benefit from an individualized approach to intervene on discrete synkinetic facial subunits. This overarching treatment algorithm requires understanding each synkinetic mimetic subunit. The depressor anguli oris muscle, because of its antagonistic relationship to the zygomaticus major, is of particular interest. This study aims to provide outcomes of depressor anguli oris muscle myectomies and the predictive value of preoperative lidocaine blocks. Preoperative depressor anguli oris muscle lidocaine blocks were administered to patients with postparetic facial synkinesis, and subsequent isolated depressor anguli oris muscle myectomies were performed on those who showed improvement and elected to proceed. Twenty synkinetic patients underwent isolated depressor anguli oris myectomies after lidocaine blockade, with an average follow-up of 9 months. Facial mimetic parameters and measurements were recorded and analyzed by Massachusetts Eye and Ear Infirmary Emotrics and National Institutes of Health ImageJ software to compare results from both blocks and myectomies. Both lidocaine block and depressor anguli oris myectomy improved dental show by 14.42 mm2 and 23.012 mm2, respectively, and open mouth smile angles above a horizontal plane by 4.66 and 3.32 degrees, respectively. There was no statistical difference between the groups in terms of improvements noted in closed and open mouth smile angles above a horizontal plane, or in dental show (p = 0.695, p = 0.351, and p = 0.242, respectively). Preoperative lidocaine blockade accurately predicts the improvement in dental show and modiolus smile angle that is provided by isolated depressor anguli oris muscle myectomy. This furthers our understanding of depressor anguli oris muscle abnormality in the overall spectrum of facial synkinesis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Modified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemia
Authors: Salih Abdulwahid M. , Baba Hiwa O. , Ahmed Mohsin M. , Kakamad Fahmi H. , Hassan Hunar A. , Hassan Marwan N. , Abdulla Berwn A. , Muhialdeen Aso S. , Mohammed Shvan H. 
Published: May 2022

Objective:
To share 4 techniques that decrease the rate of postoperative hypocalcaemia and save recurrent laryngeal nerve with a good cosmetic outcome.

Method:
The research included all consecutive patients of thyroidectomy (hemi and total thyroidectomy) during 4-year practice. The techniques included (1) elevation of a circular flap after 4 cm collar incision. (2) Ligation of the pedicles (middle first-vein, inferior last-artery). (3) Sharp dissection of the parathyroid glands. (4) Sharp and blunt dissection and exposing the nerve in all of the patients.

Result:
The total numbers of patients were 2399. At least 1 symptom of hyperthyroidism was found in 1271 patients (53%). The main indication for operation was multinodular goiter and compression symptoms in 1331 (55.5%) patients, followed by thyrotoxicosis in 598 (25%) patients and malignancy in 402 (16.8%) patients. The most common operations were total thyroidectomy in 1880 (78.4%) patients, followed by thyroid lobectomy in 495 (20.6%) patients and completion thyroidectomy in 24 (1%) patients. Among all patients, 4 (0.16%) patients developed permanent voice change. Seven (0.3%) patients developed permanent hypocalcemia.

Conclusion:
This study offers a set of surgical techniques that reduced the risks of complications of thyroidectomy to a minimal range.