bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain treatment and prophylaxis on pain
Authors: Raeder Johan 
Published: September 2022

Purpose of review
Also in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment.

Recent findings
Postoperative pain should be addressed both pre, intra- and postoperatively. The management should be with a multimodal nonopioid-based procedure specific guideline for the routine cases. In 10–20% of cases, there will be a need to adjust and supplement the basic guideline with extra analgesic measures. This may be because there are contraindications for a drug in the guideline, the procedure is more extensive than usual or the patient has extra risk factors for strong postoperative pain. Opioids should only be used when needed on top of multimodal nonopioid prophylaxis. Opioids should be with nondepot formulations, titrated to effect in the postoperative care unit and eventually continued only when needed for a few days at maximum.

Summary
Multimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.
Feasibility Pilot Study of an Opioid Helpline for Individuals at High Risk for Opioid Use Disorder
Authors: Ait-Daoud Tiouririne Nassima , Coley Justin , Kalelioglu Tevfik , Schorling Kelly 
Published: September 2022

Background
Evidence suggests that educational interventions delivered by healthcare providers can be effective in altering patients’ attitudes toward pain management and in referral to addiction treatment when appropriate. Time constraints during visits limit the delivery of such important interventions.

Objective
This study aims to explore the feasibility and perceived value of an opioid helpline that provides resources to individuals suffering from or at risk for opioid use disorder.

Methods
We developed a helpline with a toll-free number “1-877 OPIOIDS (6437)” established through the University of Virginia, which runs Monday through Friday from 8:30 am to 5 pm and is answered by a live answering service after hours. The helpline offered a range of resources including opioid pain medication education, signs of overdose or withdrawal, addiction treatment options, and connection to treatment services. The helpline was supported by outreach efforts to surrounding counties in Virginia. Questionnaires on perceived usefulness were sent to callers and providers who used or offered the helpline in their clinics. Survey data were analyzed to identify trends.

Results
Thirty-one consented individuals of 166 contacts were included in the study. Although participants were referred to the helpline through a variety of sources, most were referred by a physician (38.7%). Most participants rated the helpline’s helpfulness with the highest satisfaction score (81.5%). Most individuals seeking addiction treatment found the helpline to be useful, whereas those referred by their respective physician to gain more information about their opioid use and prevent escalation to addiction felt it was an unnecessary step.

Conclusions
Our pilot study demonstrated that a helpline could be an additional tool to combat the opioid crisis. Individual callers rated the intervention favorably. Our study shows that the most substantial area of satisfaction for our participants is being able to reach a live person when in need.
CLINICAL IMPLICATION OF RETINAL NERVE FIBER LAYER SCHISIS AND MACULAR FLUORESCEIN LEAKAGE IN PRIMARY IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Kim Jonghyun , Kim Seong-Woo , Choi Mihyun , Yun Cheolmin , Oh Jaeryung 
Published: September 2022

Purpose:
We evaluated the relationship between macular fluorescein leakage and retinal nerve fiber layer (RNFL) schisis and investigated the visual prognostic values after pars plana vitrectomy (PPV) and idiopathic epiretinal membrane removal.

Methods:
We analyzed the correlations between preoperative optical coherence tomography (OCT) parameters and macular leakage. The final best-corrected visual acuity and central macular thickness were compared according to the presence or absence of macular leakage and RNFL schisis.

Results:
In 80 eyes with idiopathic epiretinal membrane treated with PPV and membrane peeling, preoperative macular leakage was associated with the presence of preoperative RNFL schisis and inner nuclear layer microcysts. Eyes with both macular leakage and RNFL schisis showed worse postoperative best-corrected visual acuity than those without both factors.

Conclusion:
In the presence of macular fluorescein leakage and RNFL schisis, postoperative best-corrected visual acuity is worse, and improvements in the central macular thickness are greater than those in the absence of both factors.
FOCAL CHOROIDAL THICKNESS HEMODYNAMICS AS a SIGN OF MACULAR NEOVASCULARIZATION ACTIVITY IN PATHOLOGIC MYOPIA
Authors: Amoroso Francesca , Miere Alexandra , El Matri Khaled , Cohen Salomon Yves , Jung Camille , Pallone Carlotta , Bruyere Elsa , El Matri Leila , Souied Eric H. 
Published: September 2022

Purpose:
To analyze the relationship between a focal increase of choroidal thickness (ChT) and exudative activity of macular neovascularization (MNV) secondary to pathologic myopia.

Methods:
Retrospective analysis including eyes with pathologic myopia presenting with a focally increased ChT underneath active MNV. All patients included were treated, and ChT was measured before and after each intravitreal injection by two experienced ophthalmologists.

Results:
Fifty-two eyes of 52 patients with myopic MNV (19 men and 33 women) were included in this analysis. ChT at T-1 averaged 51.09 ± 33.56 μm, whereas at the time of MNV activation (T0), ChT was significantly thicker: 85.11 ± 43.99 μm (P < 0.001). After a single intravitreal injection, the ChT significantly decreased to 53.23 ± 34.15 μm (P < 0.001).

Conclusion:
This study showed that focal ChT variations may be considered an interesting corollary sign of MNV in high myopic patients, indicating the activity of myopic neovascularization.
Peoples' beliefs about their chronic hip pain and its care: a systematic review of qualitative studies. “I'm just getting old and breaking down”
Authors: Haber Travis , Hinman Rana S. , Dobson Fiona , Bunzli Samantha , Hilton Adam , Hall Michelle 
Published: September 2022

Abstract
To enhance patient-centred care of people with hip pain, we need a comprehensive understanding of peoples' beliefs about their hip pain. This systematic review explored the beliefs and expectations of middle-aged and older adults about chronic hip pain and its care across different healthcare settings and contexts. This review was a synthesis of qualitative studies using a framework synthesis approach. We searched 5 databases: MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO. Two reviewers independently screened the studies for eligibility. We included qualitative studies that included people with a mean age of older than 45 years and 80% or more of the participants had chronic hip pain, or if they reported the data about participants with chronic hip pain who were 45 years or older separately. We excluded studies of people with systemic conditions and studies not published in English. We included 28 studies involving 352 participants with chronic hip pain. We generated 5 themes: (1) biomedical causes (subtheme 1: scary pathoanatomical labels, subtheme 2: information needs); (2) negative impacts on physical, social, and mental health; (3) activity avoidance or modification and rest; (4) treatment failures (subtheme: information and support were helpful); (5) surgery is inevitable. Middle-aged and older adults labelled their hip joint damaged and attributed their hip pain to age, and wear and tear. People coped with their hip pain by avoiding or modifying activity. People were not educated about treatments or used treatments that failed to improve their hip pain. People believed that surgery for their hip was inevitable.
Early Insights From a Pharmacogenomic-Enriched Comprehensive Medication Management Program Implementation in an Adult Employee Population
Authors: Keogh Murray , Fragala Maren S. , Peter Arul Prakasam , Lorenz Raymond A. , Goldberg Steven E. , Shaman Jeffrey A. 
Published: September 2022

Objectives
The aims of the study are to assess adoption of a pharmacogenomic-enriched comprehensive medication management program in a self-insured employer setting and to better understand medication risks that affect employees.

Methods
Employees were identified to be at high risk of medication mismanagement and were subsequently provided with a program and process to improve their health. DNA testing, a clinical decision support system, and pharmacists were used to identify medication safety and effectiveness issues and to recommend appropriate changes.

Results
A total of 10.6% of the invited employees enrolled in the program. Actionable recommendations were suggested by pharmacists for 85.8% of employees who completed the program, averaging 5.2 recommendations per person.

Conclusions
Implementation of a PGx + CMM program in a self-insured employer setting is feasible, detects risks in prescription regimens, and offers opportunities to improve medication management and reduce the burden of healthcare expenses.
Ruxolitinib in a Child With JAK2 Exon 12 Mutant Polycythemia Vera
Authors: Stoops Katie , Kuril Sandeepkumar 
Published: September 2022

Background:
Polycythemia Vera (PV) is a well-defined disorder of erythroid hyperproliferation that can result in life-threatening thromboembolic and hemorrhagic events. It is most prevalent in adults and is caused by mutations in Janus Kinase 2 (JAK2). Predominantly, PV is caused by a JAK2V617F mutation on exon 14.

Observations:
A rare case of PV in a 9-year-old, driven by an uncommon, p.Glu543_Asp544del, JAK2 exon 12 mutation. Despite management with phlebotomy, aspirin and hydroxyurea, the patient suffered a dural sinus venous thrombosis, prompting a change in therapy to Ruxolitinib.

Conclusions:
This is the first description of the successful use of ruxolitnib to treat a pediatric patient with PV caused by a JAK2 exon 12 mutation.
STING Agonists in Head and Neck Squamous Cell Carcinoma
Authors: Wallington David G. , Contessa Joseph N. , Hayman Thomas J. 
Published: September 2022

Abstract
Despite the development of new treatment paradigms and improved biologic understanding of head and neck squamous cell carcinoma (HNSCC), therapeutic resistance remains a substantial problem, and novel treatment approaches are needed. Stimulator of interferon genes (STING) is a critical regulator of the antitumor response through regulation of both immune-dependent and tumor-intrinsic mechanisms. As such, the STING pathway has emerged as a rational pharmacologic target leading to the development of multiple STING agonists. These compounds have impressive preclinical efficacy as single agents and with PD-1 (programmed death-1) axis agents. However, clinical evaluation in this context has yet to show substantial efficacy. In contrast to monotherapy approaches, activation of STING in combination with DNA-damaging agents has been shown to enhance the effect of these agents in preclinical models and represents a promising approach to improve outcomes in patients with HNSCC. In this review, we will discuss the preclinical and clinical data supporting the use of STING agonists and highlight potential avenues of exploration to unlock the potential of these agents in HNSCC.
Human Papillomavirus–Directed Therapeutics for Human Papillomavirus–Associated Oropharyngeal Cancer
Authors: Campbell Jean S. , Pai Sara I. 
Published: September 2022

Abstract
Despite the availability of prophylactic human papillomavirus (HPV) vaccines, there is a growing incidence of HPV-associated head and neck squamous cell carcinomas (HPV-HNSCC) worldwide. The viral etiology of HPV-HNSCC provides an opportunity to develop personalized immune-based therapies, which target the unique viral- or tumor-specific proteins. Novel HPV-targeted immunotherapeutic approaches in clinical development are reviewed. Early results from these trials highlight new opportunities and potential challenges ahead. Immunotherapies for HPV-associated HNSCCs will require a tailored combinatorial approach based on preexisting mechanisms of host immune resistance. As the field continues to identify the relevant HPV types 16 and 18 immunogenic epitopes that are presented by diverse HLA class I alleles, improved HPV-targeted biologics and clinical monitoring tools can be developed and applied to a broader cancer patient population.
Migraine Headaches in Patients with Upper Extremity Compressive Neuropathy
Authors: Gfrerer Lisa , Lans Jonathan , Chartier Christian , Wenzinger Eric , Austen William G. , Eberlin Kyle R. 
Published: September 2022

Background:
Upper extremity nerve compression syndromes and migraines caused by nerve entrapment have many similarities including patient presentation, anatomic findings, and treatment by surgical decompression of affected nerves. Parallels between the two conditions point towards the possibility of shared predisposition. The aim of this study was to evaluate the relationship between migraine and upper extremity nerve compression.

Methods:
9,558 patients that underwent nerve decompression surgery of the upper extremity (median, ulnar, radial and thoracic outlet) as identified by Current Procedural Terminology and International Classification of Diseases (ICD) codes were included in the analysis. ICD codes for migraine and comorbidities included as part of the Elixhauser comorbiditiy index were identified. Bivariate and multivariable logistic regression was performed.

Results:
Median nerve decompression (OR: 1.3, 95% CI: 1.0-1.8, p=0.046) and multiple nerve decompressions (OR: 1.7, 95% CI: 1.2-2.5, p=0.008) were independently associated with higher rates of migraine compared to ulnar nerve decompression and thoracic outlet syndrome. Older age and male gender had a negative association with migraine. History of psychiatric disease, rheumatoid arthritis/collagen vascular diseases, hypothyroidism, hypertension, and chronic pulmonary disease were independently associated with migraine headache.

Conclusion:
Patients who undergo median and multiple nerve decompression are more likely to suffer from migraine headache. It is important to recognize this overlap and provide comprehensive patient screening for both conditions. This shared predisposition and better understanding of a common disease mechanism and genetics, may provide greater insight into the pathogenesis, and therefore treatment of these clinical problems.
Utilization of a Guideline-recommended Imaging Paradigm for Pregnant Patients With Suspicion of Pulmonary Embolism
Authors: McCandlish John A. , Naidich Jason J. , Feizullayeva Chinara , Makhnevich Alexander , Barish Matthew A. , Sanelli Pina C. , Cohen Stuart L. 
Published: September 2022

Purpose:
A dose reduction imaging paradigm utilizing chest x-ray (CXR) to triage between computed tomography pulmonary angiography (CTPA) and lung scintigraphy (LS) was introduced in 2001 and adopted in 2012 by the American Thoracic Society/Society of Thoracic Radiology (ATS) guideline for the evaluation of pulmonary embolism in pregnancy. We aimed to assess the utilization of this imaging paradigm preadoption and postadoption by the ATS guideline, and identify factors associated with its utilization.

Materials and Methods:
This retrospective cohort study evaluated consecutive pregnant patients who received CTPA or LS for the evaluation of pulmonary embolism in pregnancy at 2 tertiary hospitals between September 2008 and March 2017, excluding 2012 for guideline release washout. Utilization of the imaging paradigm was defined per patient by the use of CXR before advanced imaging, with CTPA performed following positive CXR and LS performed following negative CXR. Multivariate analyses were performed to assess factors associated with utilization of the imaging paradigm. P<0.05 is considered significant.

Results:
Overall, 9.8% (63/643) of studies utilized the dose reduction imaging paradigm, 13.3% (34/256) before the guidelines, and 7.5% (29/387) after. Multivariable analysis showed that the dose reduction imaging paradigm utilization was higher for inpatients (odds ratio [OR]: 4.5) and outpatients (OR: 3.1) relative to the emergency department patients, and lower for second (OR: 0.3) and third (OR: 0.2) trimester patients, without significant differences by study priority, patient age, or patient race.

Conclusions:
Guideline-recommended dose reduction imaging paradigm utilization was low, and decreased after guideline publication. Utilization varied by patient setting and trimester, which are potential targets for interventions to improve guideline compliance.
Luminal Preservation Protects the Small Intestine in a Brain-dead Rat Model
Authors: Trentadue Guido , Vecchio Leandro , Kats-Ugurlu Gursah , Vernengo Julieta , Haveman Jan Willem , Ivanoff Ivana , Faber Klaas Nico , Rumbo Martín , Dijkstra Gerard 
Published: September 2022

Background.
Intestinal transplantation depends on donation after brain death (DBD). Luminal preservation (LP) has been beneficial against preservation injury in previous studies in animal models, but none include DBD. This study aims to investigate whether these benefits occur also with DBD.

Methods.
Wistar rats (male, N = 9) underwent brain death for 2 h. Thereafter, vascular perfusion was done with University of Wisconsin solution (UW). The small intestine was then explanted and randomized into 3 groups: control (empty segment), LP+PEG (with polyethylene glycol 3350 solution), or LP+UW (with UW), treated and tied shut. Ice-cold UW was used for cold storage. Samples were taken at procurement and after 4 (t = 4) and 8 h (t = 8) of preservation. Histopathological scorings were performed for intestinal preservation injury, subepithelial space, absence of epithelial lining, and hemeoxygenase-1 expression.

Results.
There was low-level mucosal injury (median intestinal preservation injury score 2) at procurement. At t = 4, bowels treated without LP had more damage than LP-treated samples (control score 4, LP+PEG 2 and LP+UW 2, P < 0.001 control versus LP+UW). At t = 8, no benefit of LP was observed (control 2, LP+PEG 3, LP+UW 2). Subepithelial space increased with time and the presence of LP; epithelial lining was better conserved in LP-treated samples. Hemeoxygenase-1 staining showed increased intensity with increased damage, irrespective of treatment.

Conclusions.
Luminal perfusion of the small intestine with UW or PEG protects the mucosa in brain-dead rats for up to 4 h. Fewer benefits of LP were found than previously described in non-DBD models. To mimic the clinical situation, DBD should be included in future animal studies on intestinal preservation.
Cilostazol Administration for Subarachnoid Hemorrhage: A Meta-analysis of Randomized Controlled Trials
Authors: Chen Hongshen , Luo Wenqing , Cai Xianfu , Cai Jing 
Published: September 2022

Introduction
The efficacy of cilostazol administration to treat subarachnoid hemorrhage remains controversial. We conduct a systematic review and meta-analysis to explore the influence of cilostazol administration on treatment efficacy for subarachnoid hemorrhage.

Methods
We have searched PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through July 2020 for randomized controlled trials assessing the effect of cilostazol administration in patients with subarachnoid hemorrhage. This meta-analysis is performed using the random-effect model.

Results
Four randomized controlled trials involving 405 patients were included in the meta-analysis. Overall, compared with control group for subarachnoid hemorrhage, cilostazol intervention can significantly reduce symptomatic vasospasm (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.21–0.60; P = 0.0001) and cerebral infarction (OR, 0.40; 95% CI, 0.22–0.73; P = 0.003) and improve no or mild angiographic vasospasm (OR, 2.01; 95% CI, 1.19–3.42; P = 0.01) and an mRS score of 2 or less (OR, 2.70; 95% CI, 1.09–6.71; P = 0.03), but revealed no obvious influence on severe angiographic vasospasm (OR, 0.53; 95% CI, 0.27–1.02; P = 0.06). There were no increase in adverse events (OR, 1.17; 95% CI, 0.54–2.52; P = 0.69), hemorrhagic events (OR, 0.62; 95% CI, 0.06–6.27; P = 0.69), and cardiac events (OR, 2.14; 95% CI, 0.44–10.27; P = 0.34) after the cilostazol intervention than control intervention.

Conclusions
Cilostazol treatment may be effective to treat subarachnoid hemorrhage in the terms of symptomatic vasospasm, cerebral infarction, no or mild angiographic vasospasm, and an mRS score of 2 or less.
Pneumonia in Sudan; Systematic Scoping Review of Literature and Meta Analysis
Authors: Mohamed D M , SalahEldin M A , Idris A B , Idris E B , Mohamed S G , Badawi M M 
Published: September 2022

AbstractIn addition to excessive burden of non-communicable diseases, natural and manmade disasters and internal conflicts, Sudan is predominantly susceptible to communicable diseases such as Malaria, Tuberculosis, and Pneumonia, which bring about a burden of infectious diseases and demand for high quality health care. According to the WHO as well as the Sudan Health Observatory, Pneumonia is one of the leading causes of death in Sudan. This study therefore aimed to determine pneumonia infection prevalence among Sudanese as well as its related risk factors. A systematic review of the literature was conducted in the 1stof December 2020. The review was regulated in accordance with PRISMA. After abstract and full text screening only seventeen articles met our inclusion criteria and passed the quality assessment procedure. Seven included studies determined prevalence of pneumonia; the overall pooled prevalence was around 30%. Furthermore, twelve research articles investigated risk factors related to pneumonia among Sudanese population. Further research with larger sample sizes targeting risk factors of pneumonia among Sudanese population is needed to be conducted.