bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse events are not increased with trainee participation in transcarotid revascularization
Authors: Husman Regina , Tanaka Akiko , Saqib Naveed U , Mirza Aleem , George Mitchell J , Keyhani Arash , Keyhani Kourosh , Wang S Keisin 
Published: November 2022

Objective To determine whether a vascular surgery trainee’s participation in transcarotid revascularization (TCAR), a new technology, affects patient safety and outcomes. Design Retrospective, institutional review of our carotid database was performed. Patients who underwent TCAR were stratified based on whether a vascular trainee was present during the procedure. Relevant demographics, comorbidities, anatomical indication, perioperative courses, and adverse events in the postoperative period were captured for statistical analysis. Setting Data were obtained from affiliated Memorial Hermann Hospitals in Houston, Texas. Participants All patients who underwent TCAR from September 2017 to January 2022 were included. Results Of 486 patients who underwent TCAR, 173 (35.6%) were performed in the presence of a trainee, and 313 (64.4%) were performed without a trainee. Subjects in the trainee cohort had more challenging anatomy, defined as a higher rate of carotid bifurcation above C2, restenotic disease, previous ipsilateral neck dissection, and neck radiation. The trainee cohort had higher rates of estimated blood loss (61.1 ± 66 vs. 35.5 ± 39 mL, p < 0.01), longer operative time (64.8 ± 30.3 vs. 57.9 ± 20.4 min, p < .01), longer cerebral blood flow reversal time (8.9 ± 6.1 vs. 7.9 ± 6.6 min, p = .01), and higher contrast administration (25.7 ± 12.0 vs. 21.1 ± 9.4 mL, p < .01). The ability to achieve technical success was similar between the two cohorts. There was no difference in the rates of cranial nerve palsy, ipsilateral stroke, hematoma, and stent thrombosis. Hospital length of stay, death (0% vs. 1.6%, p = .10), and stroke (1.1% vs. 2.8%, p = .22) were also similar between the two cohorts. Conclusion Vascular surgery trainee’s involvement during TCAR did not increase adverse outcomes, such as stroke and death, in the perioperative period. The results presented herein should encourage other teaching institutions to provide surgical trainees with supervised, hands-on experience during TCAR.
Operationalising a modified Delphi study to progress quality care process nursing metrics for acute care
Authors: O’Connor Laserina , McAuliffe Eilish , Casey Mary , Rogers Lisa , Gallen Anne , Finnegan Leonie , Glasgow Mary Ellen , White Mark , White Ciara , Kavanagh Paula , Bell Miriam , Killeen Angela , Barnard Marlize 
Published: November 2022

Background Despite representing the largest occupational group within the healthcare workforce, evidence suggests that due to the complexity of nursing practice, nurses’ contribution remains ‘invisible’. Quality Care Metrics aligned to standards can offer valuable numerical information that quantify input, output and dimensions of nursing care processes in complex clinical and interprofessional milieus. Aims and objectives Progress an evidence-based metric system to measure the quality and clinical safety of nursing care within acute care in Ireland. The objectives were to: classify quality care process nursing metrics and corresponding indicators pertinent to acute care; reach agreement on a selected set of robust metrics and corresponding indicators; and implement the findings of the study. Design A modified four-round Delphi study. Methods The modified Delphi study integrated a four-round survey of 422 nurses, face-to-face meetings with a patient representative and key stakeholders within acute services with a final consensus meeting inclusive of a panel of 26 expert nurse clinicians. Results There was consensus on 11 quality care process nursing metrics and 53 corresponding indicators for the acute care setting. Despite the rating of ‘critical’ in the Delphi rounds, a concern was reported by participants on the subjective nature of three of the developed metrics: ‘patient experience’, ‘patient engagement’ and ‘professional and ethical approach to care’ based on the absence of objective measurement tools that include patient input. Conversely, this led to the conundrum for the panel of experts at the final consensus meeting who were divided in their views on objectively observing, recording and subsequent auditing of those three developed metrics in real-time clinical practice. Conclusion This paper describes the operationalisation of a modified Delphi technique that progressed a set of 11 quality care process metrics and 53 corresponding indicators. The challenge now is the implementation of these quality care process metrics so that nurses’ contribution to patient-centred care is tangible in acute care.
Clip-assisted endoloop ligation of the mucosal defect after resection of colorectal polyps decreased postprocedural delayed bleeding
Authors: Xu Jian-hua , Gao Peng , Zhou Min , Gao Shuang , Dong Zhi-qi , Shen Yu-cui , Zhang Qi-sheng 
Published: November 2022

Background: Postprocedural delayed bleeding (PDB) remains the most common major complication of colorectal polypectomy. Incomplete clip closure of mucosal defect and unclosed injured blood vessels in gaps between clips may be the risk factors for PDB. Objectives: To observe whether completely no-gap closure of mucosal defect after polypectomy can reduce PDB occurrence. Design: Single-center, retrospective case-control study. Methods: In this study based on historical comparisons of patients in 2 time periods, only the patients with polyps sized between 6 and 15 mm were included. A new clip-assisted endoloop ligation (CAEL, treatment group) method was used between January 2019 and December 2020, and a traditional simple clip closure (SCC, control) was used Between January 2017 and December 2018 to prevent PDB after polypectomy. The rate of PDB of two groups and risk factors for PDB were evaluated. Results: Totally 4560 patients were included in the study; 2418 patients belong to CAEL group, and 2142 patients belong to SCC group. The overall rate of PDB was significantly lower in CAEL group compared to SCC group (0.6% versus 1.5%, p < 0.00). On multivariate logistic analysis, CAEL was a significant independent preventive factor for PDB (odds ratio (OR), 0.092; 95% confidence interval (CI), 0.029–0.3335; p = 0.000). Polyps located at rectum (colon versus rectum) represented a significant independent risk factor for PDB (OR, 11.888; 95% CI, 3.343–42.269; p = 0.001). Conclusion: Completely no-gap closure of mucosal defect after polypectomy further reduced the rate of PDB for polyps sized between 6 and 15 mm. CAEL may be a significant independent preventive factor for PDB. Polyps located at the rectum may be a significant independent risk factor for PDB.
Adjunctive PD-1 inhibitor versus standard chemotherapy in recurrent or metastatic nasopharyngeal carcinoma: a systematic review and meta-analysis
Authors: Polintan Edgar Theodore , Canicula Stephanie Krystel , Catahay Jesus Alfonso , Lo Kevin Bryan , Villalona-Calero Miguel , Loong Herbert Ho-fung 
Published: November 2022

Objective: To investigate whether Adjunctive PD-1 inhibitors have improved clinical outcomes compared to chemotherapy alone in platinum-pretreated and platinum-naive recurrent or metastatic nasopharyngeal carcinoma (R/M NPCA). Methods: The study involved a literature search from PubMed, Cochrane CENTRAL, and Google Scholar for randomized clinical trials (RCTs) on the use of PD-1 inhibitors versus chemotherapy alone in patients with R/M NPCA. Bias was assessed using Cochrane collaboration’s risk of bias tool. Overall Survival (OS) was examined as the primary endpoint. Secondary endpoints were Progression-Free Survival (PFS), Objective Response Rate, Disease Control Rate (DCR), Duration of Response, and Serious/Grade ⩾3 Adverse Events. Outcomes were measured with either Mean Difference, Risk ratio (RR), or Hazard ratios (HRs) at 95% confidence interval. Results: Four RCTs were included in the meta-analysis and systematic review. OS for the monotherapy subgroup was a HR of 0.87 [0.67, 1.13] ( p = 0.30) while the combination subgroup had 0.64 [0.45, 0.90] ( p = 0.01). The monotherapy subgroup exhibited significantly worse outcomes in PFS (HR 1.31 [1.01, 1.68]) ( p = 0.04) and DCR (RR 1.52 [1.12, 2.05]) ( p = 0.007) but no significant difference in other outcomes. For combination therapy, a statistically significant benefit can be seen in all outcomes except DCR (RR 0.62 [0.38, 1.01]) ( p = 0.06) which was a non-significant benefit favoring PD-1 inhibitors. Conclusion: Combination PD-1 inhibitor + chemotherapy followed by maintenance PD-1 inhibitor therapy is superior to chemotherapy alone in the first-line treatment of R/M NPCA, implying a potential benefit with the use of PD-1 inhibitors + chemotherapy with maintenance PD-1 inhibitors as first-line in R/M NPCA compared to standard chemotherapy alone.
Comparison of comorbidities of stroke collected in administrative data, surveys, clinical trials and cohort studies
Authors: Kilkenny Monique F , Dalli Lachlan L , Sanders Ailie , Olaiya Muideen T , Kim Joosup , Ung David , Andrew Nadine E 
Published: November 2022

Background Administrative data are used extensively for research purposes, but there remains limited information on the quality of these data for identifying comorbidities related to stroke. Objective To compare the prevalence of comorbidities of stroke identified using International Classification Diseases, Australian Modification (ICD-10-AM) or Anatomical Therapeutic Chemical codes, with those from (i) self-reported data and (ii) published studies. Method The cohort included patients with stroke or transient ischaemic attack admitted to hospitals (2012–2016; Victoria and Queensland) in the Australian Stroke Clinical Registry (N = 26,111). Data were linked with hospital and pharmaceutical datasets to ascertain comorbidities using published algorithms. The sensitivity, specificity, and positive predictive value of these comorbidities were compared with survey responses from 623 patients (reference standard). An indirect comparison was also performed with clinical data from published stroke studies. Results The sensitivity of hospital ICD-10-AM data was poor for most comorbidities, except for diabetes (93.0%). Specificity was excellent for all comorbidities (87–96%), except for hypertension (70.5%). Compared to published stroke studies (3 clinical trials and 1 incidence study), the prevalence of diabetes and atrial fibrillation in our cohort was similar using ICD-10-AM codes, but lower for dyslipidaemia and anxiety/depression. Whereas in the pharmaceutical dispensing data, the sensitivity was excellent for dyslipidaemia (94%) and modest for anxiety/depression (77%). In the pharmaceutical data, specificity was modest for hypertension (78%) and anxiety or depression (76%), but specificity was poor for dyslipidaemia (19%) and heart disease (46%). Conclusion Variation was observed in the reporting of comorbidities of stroke in administrative data, and consideration of multiple sources of data may be necessary for research. Further work is needed to improve coding and clinical documentation for reporting of comorbidities in administrative data.
Effects of NGF and Photobiomodulation Therapy on Crush Nerve Injury and Fracture Healing: A Stereological and Histopathological Study in an Animal Model
Authors: Şen Esengül , Özkan Nilüfer , Önger Mehmet Emin , Kaplan Süleyman 
Published: November 2022

Study Design A stereological and histopathological study in an animal model Objective This study explores the effects of the nerve growth factor and photobiomodulation therapy on the damaged nerve tissue and fracture healing. Methods A total of 24 rabbits were divided into 4 groups: control group (n = 5), nerve growth factor (NGF) group (n = 7), photobiomodulation (PBMT) group (n = 6), and nerve growth factor and photobiomodulation therapy (NGF+PBMT) group (n = 6). The vertical fracture was performed between the mental foramen and the first premolar, and the mental nerve was crushed for 30 seconds with a standard serrated clamp with a force of approximately 50 N in all groups. The control group received an isotonic solution (.02 mL, .09% NaCl) to the operation site locally. The NGF group received 1 μg human NGF-β/.9% .2 mL NaCl solution for 7 days locally. The PBMT group received PBMT treatment (GaAlAs laser, 810 nm, .3 W, 18 J/cm2) every 48 hours for 14 sessions following the surgery. The NGF+PBMT group received both NGF and PBMT treatment as described above. After 28 days, the bone tissues and mental nerves from all groups were harvested and histologically and stereologically analyzed. Results According to the stereological results, the volume of the new vessel and the volume of the new bone were significantly higher in the PBMT group than in other groups (P < .001). According to the histopathological examinations, higher myelinated axons were observed in experimental groups than in the control group. Conclusions As a result, PBMT has beneficial effects on bone regeneration. Based on the light microscopic evaluation, more regenerated axon populations were observed in the NGF group than in the PBMT and PBMT + NGF groups in terms of myelinated axon content.
Determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age attending health facilities in Ethiopia, 2019
Authors: Dirirsa Dejene Edosa , Awol Salo Mukemil , Gudeta Mogos Beya , kelbessa Merga Eticha , Lammi Mengistu Bekele 
Published: November 2022

Objective: This study aimed to identify the determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age in Ethiopia, 2019. Methods: The institutional-based case–control study design was implemented from June to August 2019. Eligible study participants were sampled using systematic random sampling technique. Data were collected using structured and pre-tested questionnaire and entered into Epi Info and exported to SPSS version 20 for further analysis. All variables with a p value of <0.05 at odds ratio of 95% confidence interval in multivariable logistic regression analysis were considered as determinants of early discontinuation of long-acting and reversible contraceptive methods. Results: A total of 825 study participants (206 cases and 619 controls) were included in the study. Decision-making on the use of contraception (adjusted odds ratio: 4.8, 95% confidence interval: 1.4–16.8 and adjusted odds ratio: 5.6, 95% confidence interval: 1.7–18.8), the women who got counseled about side effects of contraceptive methods being 84% less likely to discontinue long-acting and reversible contraceptive methods compared to the women of their counterpart (adjusted odds ratio: 0.16, 95% confidence interval: 0.15–0.4), having two or more children (adjusted odds ratio: 10, 95% confidence interval: 3.7–28), and desire to be pregnant (adjusted odds ratio = 0.15 95% confidence interval: 0.06–0.4) were determinants of early discontinuation of long-acting and reversible contraceptive methods. Conclusion: According to the findings of this study, decision-maker on utilization of contraceptive methods, being counseled on side effects of contraception, number of children, and desire of woman to be pregnant were found to be determinants of discontinuation of long-acting and reversible contraceptive methods. Health care providers should strengthen providing pre-insertion counseling in accordance with the national guideline for family planning services, with an emphasis on potential contraceptive side effects and consideration of counseling on decision-making.
Effects of Competition Level on the Prevalence and Incidence of Lumbar Disk Degeneration in Japanese Collegiate Gymnasts
Authors: Koyama Koji , Nakazato Koichi , Kubo Yoshiaki , Gushiken Koji , Hatakeda Yoshiaki , Seo Kyoko , Nakase Takuya , Hiranuma Kenji 
Published: November 2022

Background: Lumbar disk degeneration (LDD) occurs frequently in athletes. Researchers have found that LDD occurs mainly in the lower disks (L4/L5 and L5/S1) in the general and athletic populations. However, a retrospective study showed a high prevalence of LDD in the upper lumbar disks (L1/L2), especially in elite gymnasts. Purpose: To investigate the effect of competition level on the prevalence and incidence of LDD in the upper lumbar disks (L1/L2). Study Design: Cross-sectional study; Level of evidence, 3; and cohort study; Level of evidence, 2. Methods: We conducted 2 studies to evaluate the effect of competition level on the prevalence and incidence of LDD in Japanese collegiate gymnasts. In study 1, a cross-sectional study of 298 collegiate gymnasts was conducted between 2011 and 2015. Competition levels were categorized as regional, national, and international, and T2-weighted magnetic resonance imaging (MRI) was used to evaluate LDD. Chi-square testing was applied to assess differences in the prevalence of LDD and spinal levels among the 3 competition levels. In study 2–-a prospective cohort study–-LDD progression and its related risk factors were investigated in 51 collegiate gymnasts. Baseline lumbar MRI scans and measurements of physical function (generalized joint laxity and finger-floor distance test) were performed in March 2014. Follow-up lumbar MRI scans were obtained 2 years later, in February 2016. Logistic regression analyses were performed to investigate the relationship between competition level and LDD progression. Results: In study 1, the prevalence of at least 1 degenerated disk in the regional, national, and international groups was 44.2% (19/43), 44.7% (98/219), and 52.8% (19/36), respectively ( P = .655). The prevalence of LDD at L1/L2 in the international group was significantly higher than that in the other 2 groups ( P = .018). In study 2, the presence of LDD at L1/L2 was associated significantly with international-level competition (adjusted odds ratio, 47.8; 95% CI, 2.75-830.50). Conclusion: In Japanese collegiate gymnasts, competing at the international level was found to be a risk factor for LDD at L1/L2.
Risk Factors for Increase in Posterior Slope After Medial Open-Wedge High Tibial Osteotomy
Authors: Song Ju-Ho , Bin Seong-Il , Kim Jong-Min , Lee Bum-Sik , Park Jun-Gu , Lee Sang-Min 
Published: November 2022

Background: Whether lateral hinge fracture (LHF) after open-wedge high tibial osteotomy (OWHTO) is associated with the change in tibial posterior slope (PS) has not been determined. Risk factors for PS increase are still unknown. Hypothesis: There will be no difference in patient characteristics and radiographic factors when stratified by change in tibial PS (ΔPS). Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of 148 patients who underwent OWHTO with locking-plate fixation from 2010 to 2016. Included were those with a minimum 2-year follow-up and true lateral radiographs before and at 1 year after surgery. ΔPS was defined as a difference between preoperative and 1-year postoperative PS, with positive values indicating PS increase. ΔPS was classified into <3°, 3° to <6°, and ≥6°. Any LHFs were grouped by Takeuchi classification as stable (type 1) or unstable (types 2 and 3). Risk factors for PS increase were evaluated using ordinal logistic regression analyses. Clinical outcomes according to ΔPS were evaluated using the Hospital for Special Surgery score. Results: There were 79 (53.4%) patients with ΔPS <3°, 44 (29.7%) with 3° ≤ ΔPS < 6°, and 25 (16.9%) with ΔPS ≥6°. LHFs were observed in 41 (27.7%) patients: 32 with type 1 and 7 and 2 with types 2 and 3, respectively. Results of the multivariate ordinal logistic regression analysis indicated that ΔPS was associated with unstable LHF ( P = .005, exp[β] = 6.34), preoperative PS ( P = .028, exp[β] = 0.90), and correction angle ( P = .037, exp[β] = 1.09). ΔPS ≥6° was seen in 4 of 9 (44.4%) patients with unstable LHF, 9 of 32 (28.1%) with stable LHF, and 12 of 107 (11.2%) with no LHF ( P = .017). The mean correction angle was 11.3° ± 3.6° in patients with ΔPS ≥6°, 9.4° ± 4.6° in cases of 3° ≤ ΔPS < 6°, and 8.8° ± 3.6° in cases of ΔPS <3° ( P = .019). Hospital for Special Surgery scores did not differ according to ΔPS. Conclusion: LHF type and correction angle were associated with ΔPS after OWHTO, and unstable LHF and large correction angle were risk factors for PS increase. There was no significant difference in clinical outcomes according to ΔPS.
Success Rate of Non-Operative Treatment of Insertional Achilles Tendinopathy
Authors: Kunkle Bryce F. , Baxter Nicholas A. , Hoch Caroline P. , Caughman Alexander , Barcel John , Scott Daniel J. , Gross Christopher E. 
Published: November 2022

Category: Other Introduction/Purpose: Non-operative treatment of Insertional Achilles tendinopathy (IAT) is historically thought to be effective in 50-70% of cases, the success rate of modern non-operative treatment is not well defined in the current literature. The purpose of this study is to define the success rate of modern non-operative treatment of IAT. Methods: A retrospective chart review was performed to identify 133 patients (137 ankles) who received either surgical or non- surgical treatment of IAT at an academic medical center between September 2015 and June 2019. The success rates of various non-operative treatment strategies were recorded in order to determine which, if any, had the highest success rate. Patient factors including demographic factors, comorbidities, modifiable risk factors, patient-reported outcome measures (PROMs), physical exam findings, and radiographic parameters were recorded to determine those that are associated with the failure of conservative management of IAT. Results: The overall success rate of non-operative treatment was 82.5% and the average time from initial diagnosis to surgery was 198.83 (range, 28-486) days. There was no difference in treatment method between those successfully treated conservatively and those who went on to require surgery. At first encounter, patients who later received surgery were significantly more likely to be female (91.7% vs. 66.4%; p=.013) and have higher VAS pain scores (6.54 vs. 5.10; p=.045), lower SF-12 physical scores (25.16 vs. 35.61; p<.001), hypertension (79.2% vs. 52.2%; p=.015), Haglund's Deformity on physical exam (95.7% vs. 71.3%; p=.014), and greater cross-sectional tendon disease involvement on MRI (43.5% vs. 28.0%; p=.001). (Table 1) Conclusion: The success rates of non-operative treatment for IAT may be higher than historical reports, at just over 80%. Several patient factors were shown to be associated with the failure of conservative management of IAT. Orthopaedic surgeons should use this information to provide more accurate patient-specific counseling on the most appropriate treatment strategies for IAT.