bluuebunny/crossref_metadata_2025_split huggingface dataset:
Text Message–Based Breastfeeding Support Compared With Usual Care
Authors: Bender Whitney , Levine Lisa , Durnwald Celeste 
Published: October 2022

OBJECTIVE:
To evaluate whether a postpartum text message–based communication platform improves breastfeeding rates.

METHODS:
In a randomized controlled trial, a control group receiving weekly text messages inquiring about infant feeding method was compared with an intervention group receiving educational text messages and personalized, text message–based breastfeeding support. The primary outcome was breastfeeding exclusivity at 6 weeks postpartum. Secondary outcomes included any breastfeeding and formula supplementation at 6 weeks postpartum. A sample size of 190 was planned to achieve 80% power to detect a 50% change in breastfeeding exclusivity from 40% baseline, with a two-sided alpha of 5%. Race was noted to be an effect modifier; therefore, results are presented overall and stratified by self-reported Black race compared with non-Black race.

RESULTS:
From January 2020 to January 2021, 300 patients were enrolled and 216 were randomized as follows: 110 to control and 106 to intervention. In the cohort, 52.8% were Black, 45.4% had public insurance, and 46.3% were nulliparous. There were no differences in demographic, delivery, or postpartum characteristics between groups. Among the 185 patients (85.6%) with data available for the primary outcome, there was no difference in breastfeeding exclusivity by treatment group (intervention 48.4% vs usual care 41.3%, P=.33). When stratified by race, Black patients in the intervention arm had 2.6 times higher odds of exclusively breastfeeding at 6 weeks postpartum compared with Black patients in the control arm (39.5% vs 20.0%, odds ratio 2.62, 95% CI 1.04–6.59). Enrollment in the intervention arm decreased the Black–non-Black disparity in the primary outcome (20.0% vs 66.7%, P<.001in usual care arm vs 39.5% vs 56.0%, P=.11 in intervention arm). There were no differences in other secondary outcomes.

CONCLUSION:
A text message–based communication platform was not associated with breastfeeding exclusivity at 6 weeks postpartum compared with usual care.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04108533.
Fetal Autopsy Rates in the United States
Authors: Oliver Emily A. , Finneran Matthew M. , Rood Kara M. , Ma'ayeh Marwan , Berghella Vincenzo , Silver Robert M. 
Published: October 2022

OBJECTIVE:
To identify rates of fetal autopsy in the United States as well as demographic and clinical characteristics related to consent to autopsy after stillbirth.

METHODS:
This is a population-based retrospective cohort study using U.S. fetal death certificates for stillborn fetuses (20 weeks of gestation or more) delivered between January 2014 and December 2016. Multiple gestations were excluded. Fetal autopsy rates were calculated by gestational age, maternal age, self-reported race and ethnicity, education, and having at least one living child. Multivariate logistic regression to adjust for potential confounders was performed.

RESULTS:
There were 60,328 stillbirths meeting inclusion criteria. Overall, fetal autopsy was performed in 20.9% of stillbirths. Non-Hispanic Black women had the highest rate of fetal autopsy (22.9%, 95% CI 22.3–23.6%), compared with non-Hispanic White women (20.4%, 95% CI 20.0–20.9%) and Hispanic women (19.6%, 95% CI 19.0–20.3%) (P<.001). After adjusting for potential confounders, maternal non-Hispanic Black race (adjusted odds ratio [aOR] 1.22, 95% CI 1.16–1.29), higher education (graduate degree: aOR 1.62, 95% CI 1.47–1.79), and higher gestational age (term: aOR 2.08, 95% CI 1.95–2.23) were associated with increased aORs for fetal autopsy. Maternal age 40 years or older (aOR 0.77 95% CI 0.63–0.92) and having at least one living child (aOR 0.74, 95% CI 0.71–0.78) were associated with a decreased aOR of having a fetal autopsy. Women of American Indian or Alaska Native decent had decreased uptake of fetal autopsy compared with non-Hispanic White women (aOR 0.72, 95% CI 0.58–0.90).

CONCLUSION:
Fetal autopsy rates are low throughout the United States. The reasons for low autopsy rates warrant further exploration to inform strategies to increase availability and uptake.
Incidence and Outcome of Pneumomediastinum in Non-ICU Hospitalized COVID-19 Patients*
Authors: Muley Moises , Finamore Panaiotis , Pedone Claudio , Margiotta Domenico Paolo Emanuele , Gilardi Emanuele , Sambuco Federica , De Vincentis Antonio , Vespasiani-Gentilucci Umberto , Travaglino Francesco , Antonelli-Incalzi Raffaele 
Published: October 2022

OBJECTIVES:
Pneumomediastinum (PNM) is a rare complication of mechanical ventilation, but its reported occurrence in patients with acute respiratory distress syndrome secondary to COVID-19 is significant. The objective is to determine the incidence, risk factors, and outcome of PNM in non-ICU hospitalized patients with severe-to-critical COVID-19 pneumonia.

DESIGN:
Retrospective observational study.

SETTING:
Population-based, single-setting, tertiary-care level COVID treatment center.

PATIENTS:
Individuals hospitalized with a diagnosis of COVID-19 pneumonia and severe to critical illness were included. Those hospitalized without respiratory failure, observed for less than 24 hours, or admitted from an ICU were excluded.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
All patients underwent a complete clinical assessment and chest CT scan, and were followed up from hospitalization to discharge or death. The outcome was the number of cases of PNM, defined as the presence of free air in the mediastinal tissues diagnosed by chest CT scan, in non-ICU hospitalized patients and the subsequent risk of intubation and mortality. PNM occurred in 48 out of 331 participants. The incidence was 14.5% (95% CI, 10.9–18.8%). A CT-Scan Severity score greater than 15 was positively associated with PNM (odds ratio [OR], 4.09; p = 0.002) and was observed in 35.2% of the participants (95% CI, 26.2–44.9%). Noninvasive ventilation was also positively associated with PNM (OR, 4.46; p = 0.005), but there was no positive association with airway pressures. Fifty patients (15%) were intubated, and 88 (27%) died. Both the risk for intubation and mortality were higher in patients with PNM, with a hazard ratio of 3.72 (p < 0.001) and 3.27 (p < 0.001), respectively.

CONCLUSIONS:
Non-ICU hospitalized patients with COVID-19 have a high incidence of PNM, increasing the risk for intubation and mortality three- to four-fold, particularly in those with extensive lung damage. These findings help define the risk and outcome of PNM in severe-to-critical COVID-19 pneumonia in a non-ICU setting.
Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge*
Authors: Stripari Schujmann Debora , Claudia Lunardi Adriana , Neri Peso Claudia , Pompeu José Eduardo , Annoni Raquel , Miura Mieko Claudia , Maschio de Censo Caroline , Noriko Takahashi Taniguchi Luzia , de Moraes Regenga Marisa , Cristina de Campos Elaine , Fraga Righetti Renato , Pereira Yamaguti Wellington , May Moran de Brito Christina , Lourenço Adriana , Castaldi Aguera Sabrina , Tanaka Clarice , Fu Carolina 
Published: October 2022

OBJECTIVES:
To analyze functional recovery groups of critically ill COVID-19 survivors during their hospital stay and to identify the associated factors.

DESIGN:
Prospective observational multicenter study.

SETTING:
Demographic, clinical, and therapeutic variables were collected, and physical and functional status were evaluated. The Barthel index was evaluated at three time points: 15 days before hospitalization, at ICU discharge, and at hospital discharge from the ward.

PATIENTS:
Patients with functional independence before COVID-19 diagnosis were recruited from four hospitals and followed up until hospital discharge.

MEASUREMENTS AND MAIN RESULTS:
Three groups of functional recovery were described for 328 patients: functional independence (n = 144; 44%), which included patients who preserved their functional status during hospitalization; recovered functionality (n = 109; 33.2%), which included patients who showed dependence at ICU discharge but recovered their independence by hospital discharge; and functional dependency (n = 75; 22.8%), which included patients who were dependent at ICU discharge and had not recovered their functional status at hospital discharge. The factors associated with becoming functionally dependent at ICU discharge were time to out-of-bed patient mobilization (odds ratio [OR], 1.20; 95% CI, 1.11–1.29), age (OR, 1.02; 95% CI, 1.01–1.04), hyperglycemia (OR, 2.52; 95% CI, 1.56–4.07), and Simplified Acute Physiology Score (OR, 1.022; 95% CI, 1.01–1.04). Recovery to baseline independence during ward stays was associated with ICU length of stay (OR, 0.97; 95% CI, 0.94–0.99) and muscle strength (Medical Research Council test) at ICU discharge (OR, 1.13; 95% CI, 1.08–1.18).

CONCLUSIONS:
Age, hyperglycemia, and time for patient mobilization out of bed were independent factors associated with becoming physically dependent after their ICU stay. Recovery of physical function at hospital discharge was associated with muscle strength at ICU discharge and length of ICU stay.
Selective Endothelialectomy in Peters Anomaly: A Novel Surgical Technique and Its Clinical Outcomes in Children
Authors: Ramappa Muralidhar , Chaurasia Sunita , Mohamed Ashik , Ramya Achanta Divya Sree , Mandal Anil Kumar , Edward Deepak Paul , Gokhale Nikhil , Swarup Rishi , Nischal Ken K. 
Published: October 2022

Purpose:
This study describes the surgical outcomes of selective endothelialectomy in Peters anomaly (SEPA), a relatively new technique to manage Peters anomaly (PA).

Methods:
This study included 34 eyes of 28 children who had a visually significant posterior corneal defect due to PA and underwent SEPA between 2012 and 2019. A selective endothelialectomy from the posterior corneal defect was performed while preserving Descemet membrane. The primary outcome measure was the resolution of corneal opacification. The secondary outcome measures were functional vision, complications, and risk factors for failure.

Results:
At a mean postoperative follow-up of 0.96 ± 0.20 years, 29 eyes (85.3%) maintained a successful outcome. Mean preoperative and postoperative best-corrected visual acuities were 2.55 ± 0.13 and 1.78 ± 0.13 (P < 0.0001), respectively. Ambulatory functional visual improvement was seen in 97%, and 23% attained vision ranging between 20/190 and 20/50. Corneal opacification failed to clear in 5 eyes (15%). Risk factors associated with surgical failure were female sex (P = 0.006), disease severity (P < 0.0001), glaucoma (P = 0.001), and additional interventions after SEPA (P = 0.002). In multivariate analysis, only disease severity (ie, a type 2 PA) was a significant risk factor for the failure of SEPA. There were no sight-threatening complications.

Conclusions:
SEPA is a safe and effective technique in select cases of posterior corneal defect due to PA. SEPA could be a potential surgical alternative to pediatric keratoplasty or optical iridectomy in children with central corneal opacification smaller than 7 mm due to PA.
Mortality Associated With Occupational Exposure in Helsinki, Finland—A 24-Year Follow-up
Authors: Jalasto Juuso , Luukkonen Ritva , Lindqvist Ari , Langhammer Arnulf , Kankaanranta Hannu , Backman Helena , Rönmark Eva , Sovijärvi Anssi , Kauppi Paula , Piirilä Päivi 
Published: October 2022

Objectives
Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort.

Methods
We divided the participants based on the answers to asthma and chronic obstructive pulmonary disease (COPD) diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure.

Results
High exposure had a hazards ratio (HR) of 1.34 (1.11–1.62) and asthma and COPD coexistence of 1.58 (1.10–2.27). The combined effects of intermediate exposure and coexistence had an HR of 2.20 (1.18–4.09), high exposure with coexistence of 1.94 (1.10–3.42) for overall mortality, and sub-HR for respiratory-related mortality of 3.21 (1.87–5.50).

Conclusions
High occupational exposure increased overall but not respiratory-related mortality hazards, while coexisting asthma and COPD overall and respiratory-related hazards of mortality.
Visuospatial Cognitive Dysfunction in Patients with Vestibular Loss
Authors: Ahmad Maimuna , Bola Lukasz , Boutabla Anissa , King Susan , Lewis Richard F. , Chari Divya A. 
Published: October 2022

Objective
To characterize visuospatial and nonvisuospatial cognitive domains affected by vestibular loss and determine whether patient-reported outcomes measures (PROMs) correlate with performance on neuropsychological tests.

Study Design
Cross-sectional study.

Setting
University-based tertiary medical center.

Patients
Sixty-nine age-matched subjects: 25 patients with bilateral vestibular loss (BVL), 14 patients with unilateral vestibular loss (UVL), and 30 normal controls (NC).

Interventions
Neuropsychological tests used to assess visuospatial and auditory short-term and working memory, number magnitude representation, executive function, and attention. Validated PROMs used to evaluate quality of life and subjective cognitive impairment.

Main Outcome Measures
Performance on neuropsychological tests and scores on PROM surveys.

Results
BVL and UVL patients performed significantly worse than NC subjects on tasks requiring visuospatial representation compared with NC subjects (p < 0.01). BVL patients demonstrated decreased performance on spatial representation tasks compared with UVL and NC subjects (p < 0.05 and p < 0.05, respectively). All subject groups performed similarly on tasks assessing nonvisuospatial cognitive domains, such as auditory short-term and working memory, executive function, and attention. PROMs did not seem to correlate with performance on neuropsychological tasks.

Conclusion
Patients with vestibular loss exhibit impairments in tasks requiring visuospatial representation but perform similarly to NC subjects in tasks of auditory working memory, executive function, or attention. Currently available questionnaires may be insufficient to screen patients for cognitive deficits.
Vestibular Function and Clinical Presentation of Dizziness: Are They Similar in Patients With Different Types of Migraine?
Authors: Faim Aline Emer , Carvalho Gabriela Ferreira , Grossi Debora Bevilaqua , Dach Fabiola , Oliveira Andreia Ardevino , Carneiro Camila de Giacomo 
Published: October 2022

Objective
To compare the vestibular function and clinical aspects (vestibular and migraine symptoms) of patients divided into three groups—migraine without aura, migraine with aura, and chronic migraine—and a control group by using electronystagmography and a design questionnaire.

Study design
Case-control study.

Setting
Tertiary referral center.

Patients
Women aged between 18 and 55 years diagnosed with migraine with aura, migraine without aura, or chronic migraine according to the International Classification of Headache Disorders ICHD—third edition; diagnosis was made by a headache specialist. The control group consisted of patients' family members and hospital employees without a personal history of headache.

Main Outcome Measures
Application of a questionnaire regarding vestibular symptoms and their relation to migraine aspects. Assessment of the vestibular function by electronystagmography.

Results
This study evaluated 120 female patients. Dizziness was the most prevalent vestibular symptom in all the migraine groups, with higher prevalence in the episodic migraine with aura and chronic migraine groups. Phonophobia and photophobia during vestibular symptoms also had greater prevalence in the latter groups. Electronystagmography tests did not reveal differences among the groups, but clinical stratification showed that tests with mixed etiology abnormalities were more prevalent in the episodic migraine with aura and chronic migraine groups.

Conclusion
The prevalence of vestibular symptoms in the migraine groups and the etiology of vestibular impairment highlight that migraine affects the vestibular system. Our findings suggest that symptom progression and vestibular impact are related to migraine chronicity and presence of aura.
Cochlear Implantation in Patients With Known Cognitive Impairment: What Are the Benefits?
Authors: Babajanian Eric E. , Carmichael Erin C. , Gordon Steven A. , Patel Neil S. , Gurgel Richard K. 
Published: October 2022

Objective
To evaluate the outcomes of cochlear implantation (CI) in adults with preoperatively diagnosed cognitive impairment.

Study Design
Retrospective cohort study.

Setting
Tertiary-care academic center.

Patients
Adults undergoing CI with preexisting cognitive impairment.

Interventions
Cochlear implantation.

Main Outcome Measures
1) Hearing improvement after CI; 2) morbidity and mortality associated with surgery.

Results
Eight patients met inclusion criteria with mean age 77.8 years (SD, 9.6 y) at time of implantation; 7 were included in subsequent analysis as one did not have speech recognition scores. Average preoperative MoCA cognitive score of 22.6 (SD, 3.9, ≤25 demonstrates cognitive impairment). Average follow-up was 29.0 months (SD, 33.3 mo). Two patients passed away at an average 58.0 months (SD, 31.1 mo) after surgery. Median preoperative pure tone average was 86.3 dB HL ( interquartile range 31.3 dB HL) compared with 33.8 dB HL (IQR 5.0 dB HL) postoperatively (p = <0.001). Median preoperative speech testing score (AzBio/HINT) was 21% (IQR, 24%) compared with 44% (IQR, 21%) postoperatively (p = <0.001). There were no observed surgical complications during the follow-up period.

Conclusions
This study demonstrates that patients with cognitive impairment before CI can experience improved hearing, no increased risk of complications, and good longevity after CI. Further prospective studies are needed to further define the utility of CI in patients with impaired cognition.
Dizziness After Traumatic Brain Injury: A Prospective TRACK-TBI Analysis of Risk Factors, Quality of Life, and Neurocognitive Effects
Authors: Chae Ricky , Barber Jason , Temkin Nancy R. , Sharon Jeffrey D. ,   the TRACK-TBI Investigators
Published: October 2022

Objective
To determine the longitudinal incidence of dizziness and its association with demographic factors, neurocognitive effects, functionality, and quality of life.

Study Design
Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) is a prospective, longitudinal cohort study in which TBI patients were assessed at the emergency department and 2-week, 3-month, 6-month, and 12-month follow-up via telephone and/or in-person visits.

Setting
Multicenter study in emergency departments of 18 academic medical centers in the United States.

Patients
A total of 1,514 patients 17 years or older with a diagnosis of TBI, injury occurrence within 24 hours of admission, fluency in English or Spanish, and completed Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 12 months were enrolled between February 2014 and August 2018.

Main Outcome Measure
RPQ, Short Form-12 Version 2, Wechsler Adult Intelligence Scale IV, Trail Making Test, Patient Health Questionnaire-9, PROMIS-PAIN, and Glasgow Outcome Scale–Extended Revised. The primary outcome measure was a self-report of “feelings of dizziness” on RPQ at 12 months post-TBI.

Results
Of the 1,514 participants, 1,002 (66%) were male and 512 (34%) were female. The mean age was 41.6 (SD, 17.4) years. At 12 months, 26% experienced dizziness, with 9% experiencing moderate or severe dizziness. Dizziness was strongly associated with headache (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.92–4.07; p < 0.001), nausea (OR, 4.43; 95% CI, 3.45–5.69; p < 0.001), worse hearing (OR, 3.57; 95% CI, 2.64–4.82; p < 0.001), noise sensitivity (OR, 3.02; 95% CI, 2.54–3.59; p < 0.001), and light sensitivity (OR, 3.51; 95% CI, 2.91–4.23; p < 0.001). In multivariable regression models, participants with severe dizziness demonstrated lower performance compared with those without new or worse dizziness on the Wechsler Adult Intelligence Scale IV (−6.64; p < 0.001), Trail Making Test part A (7.90; p = 0.003) and part B (19.77; p = 0.028), and Short Form-12 physical (−13.60; p < 0.001) and mental health (−11.17; p < 0.001), after controlling for age, sex, education, and TBI severity.

Conclusion
Dizziness is common among TBI patients and relates to quality of life and neurocognitive performance.
Guidelines for Cystic Fibrosis Carrier Screening in the Prenatal/Preconception Period
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A. 
Published: October 2022

Importance
Cystic fibrosis (CF) is one of the most common autosomal recessive disorders. Carrier screening for CF should be offered to all women considering becoming pregnant or who are pregnant. Understanding the available screening tests, their limitations, and the benefits of screening is of paramount importance to the obstetrician-gynecologist.

Objective
The objective is to review the current guidelines for CF carrier screening including the options for carrier screening, the potential complexities associated with carrier screening for CF, and indications for referral to certified genetic counselors or maternal-fetal medicine specialists.

Evidence Acquisition
A MEDLINE search of “cystic fibrosis,” “cystic fibrosis carrier screening pregnancy,” and “inheritance of cystic fibrosis” in the review was performed.

Results
The evidence cited in this review includes 2 medical society committee opinions and 15 additional peer-reviewed journal articles that were original research or expert opinion summaries.

Conclusions and Relevance
The American College of Obstetricians and Gynecologists recommends that obstetricians offer CF carrier screening to all pregnant women or women considering becoming pregnant. Based on recent guidelines from ACMG, additional expanded carrier screening can be recommended to patients in the future, with additional CF variants and other autosomal or X-linked recessive conditions. It is important for the prenatal care provider to understand the guidelines for carrier screening as well as the potential complexities associated with carrier screening due to the multiple pathogenic variants in the CFTR gene that may be associated with varying phenotypes. With the options for CF carrier screening, screening performance in different populations, a basic understanding of the disease and interpretation of carrier screening results is of paramount importance to the prenatal care provider.

Target Audience
Obstetrician-gynecologist, family medicine, or other practitioner(s) providing prenatal care

Learning Objectives
After participating in this activity, physicians should be better able to define indications and the current guidelines for carrier testing for CF; compare types of CF carrier screening and describe potential results of the screening; propose patient counseling strategies regarding residual risk after negative CF carrier screening; and explain appropriate referral measures for patients with positive CF carrier screening results.
Accuracy of Surgeon Self-Reflection on Hysterectomy Quality Metrics
Authors: Milman Tal , Murji Ally , Matelski John , Shirreff Lindsay 
Published: October 2022

(Abstracted from Obstet Gynecol 2022;140:39–47)
Assessing surgical performance and tracking quality metrics has the potential to improve patient care and safety, reducing perioperative morbidity and mortality. A number of studies have suggested that surgeons inaccurately judge their own performance, especially with respect to self-reflection on surgical proficiency.