bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intensive, telemedicine-based, self-management program for rural, underserved patients with diabetes mellitus: Re-entry of retired endocrinologists into practice
Authors: Santen Richard J , Nass Ralf , Cunningham Cindy , Horton Carla , Yue Wei 
Published: June 2022

Introduction Endocrinology workforce data demonstrate a substantial gap in the number of practicing endocrinologists, a phenomenon particularly affecting patients with diabetes in rural, financially challenged, underserved areas. We evaluated the concept that retired endocrinologists could re-enter practice part time and utilize telemedicine in collaboration with personnel in Federally Qualified Community Health Center clinics to conduct an intensive self-management program and provide 6-month concurrent care for patients with diabetes. Methods The program involved intensive glucose control measures and education in diabetes, nutrition, and lifestyle changes over a 6-month period. Key elements included comprehensive initial telehealth evaluations, frequent phone calls, and collaboration with certified diabetes care and education specialists, referring providers, referring-clinic staff, and the University of Virginia Telehealth Center. Results The mean A1C in the 139 patients completing the 6-month self-management program decreased from 10.3 ± 1.94% to 7.78 ± 1.51% p < 0.0001. The number of treatment modalities per patient ranged from one to five with several different regimens utilized. The majority of patients maintained the reduction in A1C levels without recidivism over a mean follow-up of 16 months after discharge. Strategies using meal replacements are being implemented to facilitate weight loss. Discussion This program resulted in improved A1C levels of patients with diabetes in rural, financially challenged, underserved areas; met recidivism goals; and provided a practical template to reduce the workforce gap of endocrinologists in those areas.
Risk factors and prediction algorithm for advanced neoplasia on screening colonoscopy for average-risk individuals
Authors: Ukashi Offir , Pflantzer Barak , Barash Yiftach , Klang Eyal , Segev Shlomo , Yablecovitch Doron , Kopylov Uri , Ben-Horin Shomron , Laish Ido 
Published: June 2022

Background: Screening with colonoscopy for all average-risk population is probably not cost-effective due to the limited sources and over-generalization of the risk, and risk stratification can be used to optimize colorectal cancer screening. Objectives: We aimed to assess risk factors for advanced neoplasia (AN) and a classification tree algorithm to predict the risk. Design: This is a retrospective cross-sectional study. Methods: This study was composed of consecutive asymptomatic average-risk individuals undergoing first screening colonoscopy between 2008 and 2019. Detailed characteristics including background diseases, habits, and medications were collected. We used multivariable logistic regression to investigate the associations between clinical variables and the presence of AN and built a classification algorithm to predict AN. Results: A total of 3856 patients were included (73.2% male, median age 55). Adenoma and AN detection rate were 15.8% and 3.4%, respectively. On multivariable analysis, predictors of AN [odds ratio (OR), 95% confidence interval (CI)] were age (1.04, 1.01–1.06, p = 0.003), male sex (2.69, 1.56–4.64, p < 0.001), and smoking (1.97, 1.38–2.81, p  < 0.001). A classification tree algorithm showed that smoking was the most important risk factor for prediction of AN (4.9% versus 2.4%, p < 0.001), followed by age with a cutoff value of 60 in the smokers (8.4% versus 3.8%, p = 0.001) and 50 in the non-smokers (2.9% versus 0.9%, p = 0.004). Conclusion: Smoking habits, old age, and male gender are highly associated with an increased risk for AN and should be incorporated in the individualized risk-assessment to adapt a screening program.
Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion
Authors: Shao Yanqi , Zhang Zheyu , Jin Bo , Xu Jingsi , Peng Deqing , Geng Yu , Zhang Jungen , Zhang Sheng 
Published: June 2022

Background: Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment. Objective: This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population. Methods: This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis. Results: A total of 400 patients were included in this analysis. In the training group ( n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group ( n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 ( p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778). Conclusion: The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.
Racial and ethnic differences in the pharmacologic management of osteoarthritis: rapid systematic review
Authors: Vina Ernest R. , Tsoukas Philip H. , Abdollahi Shahrzad , Mody Nidhi , Roth Stephanie C. , Redford Albert H. , Kwoh C. Kent 
Published: June 2022

Background: Racial and ethnic disparities in osteoarthritis (OA) patients’ disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments. Objectives: The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA. Data sources and methods: A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results: The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations. Conclusion: This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.
Remote Research: Resources, Intervention Needs, and Methods in People with Diabetes and Peripheral Neuropathy
Authors: Bohnert Kathryn L. , Zellers Jennifer A. , Jeong Hyo Jung , Chen Ling , York Alexa , Hastings Mary K. 
Published: June 2022

Background: Stay-at-home orders associated with the SARS-CoV-2 (COVID-19) pandemic were particularly important for older adults with type 2 diabetes, at risk for severe COVID-19 complications. In response, research shifted to remote telehealth methodology. Study participant interests, equipment needs, and ability to adapt methods to the remote/telehealth environment were unknown. Study purposes to assess (1) resource needs (internet/devices accessibility), (2) future telehealth interests, and (3) ability to adapt common research and clinical measures of glycemic control, physical function, activity measures, and quality of life outcomes to a telehealth setting. Method: Twenty-one participants with type 2 diabetes and peripheral neuropathy were recruited from a longitudinal study (11 female; age: 66.3 ± 8.3 years; DM: 15.1 ± 8.7 years). Technology needs and future telehealth interests were assessed. A glycemic measure (HbA1c), a five-times chair rise, a one-week activity monitor, and surveys (self-efficacy, depression, and balance) were collected. All aspects of the study were completed remotely over email and video/phone call. Results: Twelve participants used computers; nine used phones for study completion. Participants had the following resource needs: connectivity (n = 3), devices (n = 6), and technical support (n = 12). Twenty people expressed interest in participating in future telehealth studies related to balance, exercise, and diabetes management. Methodological considerations were primarily the need for assistance for participants to complete the home HbA1c test, five-time chair rise, wearable activity monitoring, and surveys. Conclusions: Older adults with type 2 diabetes and peripheral neuropathy would need technological and personal assistance (connection, device, guidance) to complete a long-term telehealth intervention. Despite technology needs, participants were interested in telehealth interventions. Clinical Trial: Parent study, “Metatarsal Phalangeal Joint Deformity Progression—R01 (NCT02616263) is registered at https://clinicaltrials.gov/ .
Insulin Requirements for Basal and Auto-Correction Insulin Delivery in Advanced Hybrid Closed-Loop System: 4193 Days’ Real-World Data of Children in Two Different Age Groups
Authors: Karakuş Kağan Ege , Yeşiltepe Mutlu Gül , Gökçe Tuğba , Eviz Elif , Can Ecem , Muradoğlu Serra , Hatun Şükrü 
Published: June 2022

Background: The insulin requirements of people with type 1 diabetes (T1D) can vary throughout the day due to factors such as biorhythm, exercise, and food intake. The MiniMed 780G system delivers micro boluses to adjust basal insulin and delivers auto-correction boluses to meet insulin needs when micro bolus increases are insufficient. Through analysis of MiniMed 780G data, this study investigates the variations in insulin requirements throughout the day. Methods: 4193 days’ pump and continuous glucose monitoring (CGM) data of 34 children using MiniMed 780G were collected from Medtronic CareLink. Micro and auto-correction boluses were analyzed on an hourly basis for two age groups: below nine years old and above nine years old. Glycemic metrics were analyzed based on International CGM consensus. Results: The mean age was 12.3 years and mean duration of diabetes was 6.1 years. The mean time in range (TIR) and glucose management indicator (GMI) were 80.5% and 6.6%, respectively. The micro bolus (basal) ratio between 05.00 and 07.00 was significantly higher than the ratio between 10.00 and 03.00 ( P < .01), whereas micro bolus was significantly lower between 19.00 and 21.00 than those between 00.00 and 10.00 ( P < .001). The auto-correction ratio between 21.00 and 00.00 was significantly higher than those between 03.00-17.00 ( P < .001) and 19.00-21.00 ( P = .008), whereas auto-correction was significantly lower between 07.00 and 10.00 than those between 10.00 and 03.00 ( P < .001). The micro bolus ratio was significantly higher in children below nine years old than in children above nine years old between 21.00-00.00 ( P = .026) and 00.00-03.00 ( P = .003). Conclusion: The basal insulin need follows a diurnal pattern with two significantly different periods—high between 00.00 and 10.00 and low between 10.00 and 00.00. The auto-correction rates are low between 05.00 and 10.00 and show an increasing pattern peaking between 21.00 and 00.00. These findings are compatible with the dawn and reverse dawn phenomena.
Management of Open Ankle Fractures in Elderly Patients With a Fibula Nail is a Safe and Reliable Technique
Authors: Odeh Abdulrahman , Archer James , Budair Basil , Marsh Alastair , Fenton Paul 
Published: June 2022

Background: Ankle fractures are becoming more common in the elderly and their management is frequently challenging. There is increasing evidence of good outcomes following fibula nail fixation in the management of ankle fractures. The use of a fibula nail in open fractures comes with potential advantages such as minimal soft tissue dissection, early rehabilitation, and decreased wound complications. We aimed to assess their use in the management of open ankle fractures in the elderly. Methods: A review of patients aged 60 years or older with an open ankle fracture treated with a fibular nail at a major trauma center was conducted. All patients were managed with joint Orthopaedic and Plastic Surgical input to determine their optimal management. Functional outcome scores, postoperative complications, and re-operation rates were determined. Results: Fifteen patients were identified with a mean age of 76 years. Patient-reported outcomes (Olerud and Molander Score) were calculated in 73% of patients. Our results demonstrated excellent outcome scores (>91) in 1 patient, good outcome scores (61-90) in 7 patients, and fair outcome scores (31-60) in 3 patients. There were no postoperative complications or re-operations within our study group. Conclusion: This article is the largest series presenting the outcomes of fibula nails in the management of open ankle fractures in elderly patients. We conclude that it can be used as a treatment option to safely manage open ankle fractures in the elderly. It provides a stable fixation, early weight-bearing, low risk of postoperative complications while maintaining good patient-reported functional outcomes. Level of Evidence: Level 4
Concurrent facial nerve palsy and uvula deviation after paediatric dental rehabilitation–A case report
Authors: Long Melody Huiyi , Khor Melissa Mei-Yi , Challa Satish Kumar Reddy 
Published: June 2022

Introduction Facial nerve palsy is a rare, but known complication resulting from local anaesthesia (LA) infiltration during dental surgery. Its incidence is reported to be 1–1.1%, with short or long-term effects. Case Report A 6 years old well child underwent elective dental rehabilitation under general anaesthesia. For extractions, he received LA infiltration to the anterior part of the hard palate. In the immediate post-operative period, he presented with left sided facial droop and uvula deviation to the left with no hoarseness of voice or ptosis. His neurological symptoms resolved within 3 h of the administration of LA. He was reviewed on the same day by the paediatric neurologist. No further investigations were required. He was discharged well the next day. Conclusion Transient facial nerve palsy and uvula deviation, while rare, can occur after a dental procedure. For paediatric patients, the neurologist’s input helps with parental assurance.
The prevalence of concurrent pulmonary and extrapulmonary tuberculosis in Uganda: a retrospective study
Authors: Kyagulanyi Eddy , Mirembe Joy , Nantaayi Brandy , Nalukenge Sonita , Mukasa David , Tamale Jaffar , Oriekot Anthony , Kamya Moses R. , Baluku Joseph Baruch 
Published: June 2022

Background: Concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) is associated with poor treatment outcomes yet its epidemiology in Uganda is unknown. The purpose of this study was to determine the prevalence, associated factors, and treatment outcomes of concurrent PTB and EPTB among patients at a national tuberculosis (TB) treatment center located at Mulago National Referral Hospital in Kampala, Uganda. Methods: We conducted a retrospective review of charts for people with TB who were enrolled in care between January 2015 and December 2019. Eligible charts were for people with pulmonary bacteriologically confirmed TB enrolled into care in the period under study. Concurrent PTB and EPTB was defined as PTB and bacteriological, histopathological, and/or radiological features of TB at another noncontiguous sites. Results: Overall, 400 patient charts were eligible, of whom 240 (60.0%) were aged 15–34 years and 205 (51.3%) were female. The prevalence of concurrent PTB and EPTB was 8.5% (34/400) [95% confidence interval (CI): 6.0–11.7%]. People with concurrent PTB and EPTB were more likely to have at least one comorbidity (82.4% versus 37.2%, p < 0.001), of which HIV was the most frequent. Furthermore, people with concurrent PTB and EPTB were more likely to have empyema (15% versus 2.6%, p = 0.028) but less likely to have bronchopneumonic opacification (0.0% versus 15.3%, p = 0.043) on chest x-ray imaging. People with concurrent PTB and EPTB had higher mortality (26.5% versus 6.37%) and a lower cure rate (41.2% versus 64.8%), p = 0.002. Conclusion: Our findings highlight the need for early detection of TB before dissemination particularly among people who use alcohol and people with HIV.
Magnitude of central obesity and associated factors among adults working in government offices in Bedele town, Buno Bedele zone, Southwest Ethiopia
Authors: Tefera Workineh , Shuremu Muluneh , Tadelle Amanuel , Abdissa Daba , Banjaw Zelalem 
Published: June 2022

Objective: Central obesity is an emerging public health problem globally and an independent risk factor for heart, blood vessels, and metabolic disorder. This study aimed to assess the central obesity and associated factors among adults working in government offices in Bedele town, Southwest Ethiopia, 2021. Methods: An institutional survey was conducted among randomly selected government offices. Anthropometric measurements were carried out. Face-to-face interview using standard questionnaires were also used to collect data. A total of 403 respondents were selected from the list of public office workers employed in Bedele Town. Data were entered into Epi data 3.1 then exported to SPSS version 20 for analysis. Each variable with a p value less than 0.25 in the bivariate analysis was entered into logistic regression and p value 0.05 was considered as statistically significant. Results: The response rate was 373 respondents (92.6%). The overall prevalence of central obesity among public office workers of Bedele town was 54.7%. Sitting for more than 5 h at workplace adjusted odds ratio = 2.911 (95% confidence interval = 1.644, 5.156), being a female adjusted odds ratio = 3.258 (95% confidence interval = 1.744, 6.047), age range of 40–49 (adjusted odds ratio = 4.520, 95% confidence interval = 1.798, 11.363), age ⩾ 50 years (adjusted odds ratio = 5.907, 95% confidence interval = 1.808, 19.297), being physically inactive (adjusted odds ratio = 4.594, 95% confidence interval = 2.313, 9.125), consumption of snack (adjusted odds ratio = 4.521, 95% confidence interval = 2.583, 7.913), and alcohol consumption (adjusted odds ratio = 2.324 95% confidence interval = 1.210, 4.463) were factors significantly associated with central obesity among office workers in Bedele town. Conclusion: The magnitude of central obesity was high among office workers in Bedele town and being female gender, older age, physical inactivity, consumption of snacks, and alcohol were associated with it. Physical exercise and a healthy lifestyle should be promoted to minimize the problem.
The Impact of the Fascia Iliaca Block Beyond Perioperative Pain Control in Hip Fractures: A Retrospective Review
Authors: Houserman David J. , Raszewski Jesse A. , Palmer Brandi , Chavan Bhakti , Sferrella Abby , Campbell Melody , Santanello Steven 
Published: June 2022

Background Geriatric hip fractures are common injuries that are associated with high morbidity and mortality. Adequate pain control remains a challenge as the altered physiology in elderly patients makes use of traditional analgesics challenging. The use of regional anesthetics, specifically the fascia iliaca compartment block (FICB), in the perioperative period has been shown to decrease opioid use in this population. This study aimed to investigate the effect the FICB had on pain control, length of stay, readmissions, and complications in a 30-day postoperative period. Methods This was a retrospective cohort study comparing patients who sustained hip fractures; one cohort (110 patients) received a preoperative fascia iliaca block with continuous infusion (FICB), whereas the other cohort (110 patients) did not receive a block (NO-FICB). Both cohorts were from level II trauma centers. Data were collected between 2016 and 2019. Descriptive statistics was performed to describe and summarize the data. Bivariate analysis was performed using chi-square test, with 2 tailed P-values ≤ .05 were considered statistically significant. Results The FICB group had a lower length of stay (3.9 days vs 4.8 days; P < .001), and lower pain scores on post-operative days 2 and 3 ( P = .019). There was no difference in time from admission to surgery ( P = .112) or narcotic use between cohorts ( P = .304). However, the FICB group was more likely to discharge to a skilled nursing facility (P=.002), and more likely to be readmitted within 30 days ( P = .047). There were no differences in medical complications or mortality between the 2 groups. Conclusions The primary study endpoint, length of stay, was found to be significantly shorter in the patients who underwent the FICB vs the group who did not undergo the FICB. Pain scores on POD2 and POD3 were lower in patients who received a FICB. This study adds to the body of evidence that the FICB is an effective addition to a multimodal pain pathway. Level of Evidence Level III Evidence – Retrospective Cohort Study