bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of pathological staging and grading of renal clear cell carcinoma based on deep learning algorithms
Authors: Wen-zhi Gao , Tai Tian , Zhixin Fu , Huanyu Liang , Yanqing Gong , Yuexian Guo , Xuesong Li 
Published: November 2022

Objective Deep learning algorithms were used to develop a model for predicting the staging and grading of renal clear cell carcinoma to inform clinicians’ treatment plans. Methods Clinical and pathological information was collected from 878 patients diagnosed with renal clear cell carcinoma in the Department of Urology, Peking University First Hospital. The patients were randomly assigned to the test set (n = 702) or the verification set (n = 176). Pathological staging and grading of renal clear cell carcinoma were predicted by preoperative clinical variables using deep learning algorithms. Receiver operating characteristic curves were used to evaluate the predictive accuracy as measured by the area under the receiver operating characteristic curve (AUC). Results For tumor pathological staging, AUC values of 0.933, 0.947, and 0.948 were obtained using the BiLSTM, CNN-BiLSTM, and CNN-BiGRU models, respectively. For tumor pathological grading, the AUC values were 0.754, 0.720, and 0.770, respectively. Conclusions The proposed model for predicting renal clear cell carcinoma allows for accurate projection of the staging and grading of renal clear cell carcinoma and helps clinicians optimize individual treatment plans.
Patient-reported outcome measures (PROMs) in stone surgery: A multi-centre study of patient experience of flexible ureteroscopy (fURS) versus extracorporeal shockwave lithotripsy (SWL)
Authors: Thompson William R , Tolofari Sotonye K , Starmer Ben , Broome James , Garrod Huw , Agarwal Ketan , Wong Kee , Panayi Zoe , Hughes Kaylie , Iskander Morkos , Javed Saqib , Kelly Pat , Lazarowicz Henry , Calvert Rob C 
Published: November 2022

Objectives: To compare patient-reported outcome measures (PROMs) for patients with symptomatic renal stone disease treated by flexible ureterorenoscopy (fURS) and shockwave lithotripsy (SWL) Introduction: Historically, surgical outcomes are measured by surgeon-specific outcomes such as ‘stone-free rates’. More recently, there is increasing emphasis on PROMs to ascertain a patient’s perspective of their own surgical outcome. Despite this, the literature in reference to renal stone-specific PROMs following stone treatment remains limited. Methods: Data were collected in a prospective multi-centre study. Patients undergoing fURS or SWL were asked to complete the validated Cambridge Renal Stone Patient Reported Outcome Measure ( CReSP) on the day of initial treatment and at weeks 1, 6 and 12 post-operatively. Results: Data were collected for 119 patients. Three were excluded as stone metric and demographic details were incomplete. Sixty underwent SWL and 56 underwent fURS. Median stone size was 7.52 mm. There were no significant differences in baseline PROM scores between the treatment groups. At 1 week, the PROM scores were significantly higher in the fURS group compared to SWL (27.40 ± 0.85sd versus 22.51 ± 1.07sd; p < 0.05). However, at 6 and 12 weeks, the PROM scores were significantly lower in the fURS group (18.51 ± 2.27sd versus 23.67 ± 1.30sd; p < 0.05) and (17.01 ± 2.29sd versus 22.49 ± 1.49sd; p < 0.05), respectively. By week 12, overall scores for anxiety and social factors were more favourable in the fURS cohort. Conclusion: Our study suggests that fURS is associated with a short-lived increase in morbidity in comparison with SWL, which may be due to ureteric stenting in the majority of patients post-operatively. However, fURS patients appear to report significantly better PROM scores in the longer term. This appears to be associated with more favourable anxiety and social factor scoring over the treatment period. Level of evidence: Not applicable.
Is the infrapubic approach a safe option for patients with poorly controlled diabetes mellitus and obesity undergoing inflatable penile prosthesis surgery?
Authors: Micallef Dariush , Wightman Stuart , Naqi Muhammad , Modgil Vaibhav , Pearce Ian 
Published: November 2022

Objective: Inflatable penile prosthesis (IPP) surgery is an effective treatment for patients with erectile dysfunction (ED). The two most used surgical approaches are infrapubic (IP) and penoscrotal (PS). Concerns exist whether raised Body Mass Index (BMI) or poor glycaemic control negatively affect outcome. We conducted a retrospective review of 50 consecutive virgin IP IPP cases investigating the effect of BMI and glycaemic control on post-operative complications and implant utilisation. Patients and Methods: Data collected included demographics, ED aetiology and risk factors, diabetic status, HbA1c and post-operative complications focusing on infection and re-operation. Telephone survey provided implant usage at 3, 6, 12 and 24 months post-operatively. All patients followed the same pre-, peri- and post-operative pathway, including antibiotic prophylaxis and implant preparation. Results: Complication rates of patients with BMI ⩾ 30 (2/20; 10%) and BMI < 30 (0/28, 0%) ( p = 0.169) and of patients with poorly controlled diabetes mellitus (DM), HbA1c > 69 mmol/mol (0/6, 0%) versus HbA1c ⩽ 69 (2/21, 9.52%) ( p = 1) were not significantly different. Two patients reported complications. Implant utilisation did not differ significantly between low or high BMI and HbA1c cohorts. Conclusion: Our study shows pre-operative HbA1c and BMI do not significantly impact complication rates or implant utilisation in patients undergoing IP IPP insertion. Level of Evidence: 2b
Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study
Authors: Smith Kelly M. , Scerpella Danny , Guo Amy , Hussain Naaz , Colburn Jessica L. , Cotter Valerie T. , Aufill Jennifer , Dy Sydney M. , Wolff Jennifer L. 
Published: November 2022

Introduction: Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care. Methods: Semi-structured interviews or focus groups with patient/family dyads (family, friends, unpaid caregivers) and primary care stakeholders (clinicians, staff, administrators) elicited perceived barriers and facilitators of SHARING Choices implementation. Field notes and interview transcripts were coded using template analysis along the Consolidated Framework for Implementation Research (CFIR) constructs. Content analysis identified themes not readily categorized within CFIR. Results: About 22 dyads, including 14 with cognitive impairment, and 30 stakeholders participated in the study. Participants were receptive to the SHARING Choices components. Enablers of SHARING Choices included adaptability of the intervention, purposive engagement of family (particularly for patients with dementia), consistency with organizational priorities, and the relative advantage of SHARING Choices compared to current practices. Perceived barriers to implementation included intervention complexity, space constraints, workflow, and ACP hesitancy. The ACP facilitator was perceived as supportive in addressing individual and organizational implementation barriers including patient health and technology literacy and clinician time for ACP discussions. Conclusions: Patients, family, and primary care clinicians endorsed the objectives and individual components of SHARING Choices. Strategies to enhance adoption were to simplify materials, streamline processes, leverage existing workflows, and embed ACP facilitators within the primary care team.
Perioperative Management and Outcomes of Hip Fracture Patients with Advanced Chronic Kidney Disease
Authors: Ongzalima Chris , Dasborough Kimberly , Narula Siddarth , Boardman Glenn , Kumarasinghe Panchi , Seymour Hannah 
Published: November 2022

Aims To explore clinical characteristics, perioperative management and outcomes of Hip Fracture patients with advanced Chronic Kidney Disease (HF-aCKD) compared to the general Hip Fracture population without aCKD (HF-G) within a large volume tertiary hospital in Western Australia. Methods Retrospective chart review of patients admitted with hip fracture (HF) to a single large volume tertiary hospital registered on Australian and New Zealand Hip Fracture Registry (ANZHFR). We compared baseline demographic and clinical frailty scale (CFS) of HF-aCKD (n = 74), defined as eGFR < 30 mls/min/1.73 m2, with HF-G (n = 452) and determined their outcomes at 120 days. Results We identified 74 (6.97%) HF patients with aCKD. General demographics were similar in HF-aCKD and HF-G populations. 120-days mortality for HF-aCKD was double that of HF-G population (34% vs 17%, P = .001). For dialysis patients, 120-days mortality was triple that of HF-G population (57%). Except for the fit category of HF-aCKD group, higher CFS was associated with higher 120-days mortality in both groups.  Of all HF-aCKD patients, 96% had operative intervention and 48% received blood transfusion. There were no new starts to dialysis peri-operatively. Each point reduction in eGFR below 12 mL/min/1.73 m2 was associated with 3% increased probability of death in hospital. Conclusions 120-days mortality was double in HF-aCKD and triple in HF-dialysis that of the HF-G within our institution. Clinical frailty scale can be useful in predicting mortality after HF in frail aCKD patients. High rate of blood transfusions was observed in HF-aCKD group. Further studies with larger HF-aCKD numbers are required to explore these associations in detail.
Anatomy of Flexor Hallucis Longus and Its Relationship with Hallux Valgus: A Cadaveric Study
Authors: Ortiz Cristian A. , Butteri Ana I. , Espinoza Carolina Avilés , Mombello Franco L. , Redlich Alex , Chaparro Felipe R. , Carcuro Giovanni M. , Pellegrini Manuel J. 
Published: November 2022

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: The first ray is an inherently unstable structure that relies on a fine balance between its static and dynamic stabilizers to maintain its alignment. Multiple risk factors have been associated with hallux valgus development. The dynamic stabilizers, particularly the flexor hallucis longus (FHL), has been mentioned as a potential deforming force that could contribute and accentuate hallux valgus deformity due to its spatial situation and insertion morphology. The aim of this study is to describe FHL distal insertion morphology and it spatial relationship with interphalangeal (IP) and metatarso-phalangeal (MTTP) joint. Methods: 10 fresh frozen cadaver hallux were dissected up to the MTT-F joint, exposing FHL and bony structures, leaving in situ ligamentous attachments. We evaluated FHL distal insertion morphology in terms of width of insertion and distance between insertion borders of the FHL and medial-lateral phalangeal borders. The spatial relationship of the FHL with IP and MTTP joint was measured by the position of the FHL long axis width midpoint in relation to the phalangeal and metatarsal width 1cm proximal to the joint. Results: The FHL mean width of insertion was 12,1mm (range 10-15) SD (+-1,5). All specimens showed a lateral tendon fascicle that was inserted more lateral and distal than the tendon main insertion. Mean lateral distance of insertion to phalangeal border was 3mm (range3-4) SD (+-0,7), mean medial distance of insertion to phalangeal border 5,2mm (range 4-7) SD (+-1,1). FHL long axis width midpoint was on average 12.36% laterally deviated from the osseous midpoint at MTTP joint and 14.07% lateral deviated at IP joint. Conclusion: The FHL has a closer insertion to the lateral phalanx border and it long axis midpoint is laterally located in relation to IP and MTTP joint, creating a laterally directed force vector over both joints that could be involved in the pathogenesis of hallux valgus.
Behavior of the Subtalar Joint after Arthroereisis in Adult Acquired Flatfoot, Evaluation with WBCT
Authors: Ortiz Cristian A. , Chaparro Felipe R. , Redlich Alex , Pellegrini Manuel J. , Carcuro Giovanni M. , Espinoza Carolina Avilés , Mombellos Franco L. 
Published: November 2022

Category: Hindfoot Introduction/Purpose: Flatfoot is a common deformity in adult and pediatric populations, with a 5% incidence. It corresponds to a complex three-dimensional pathology characterized by peritalar subluxation (PTS) of the hindfoot, with a dynamic behavior during weight-bearing. This is how weight-bearing computed tomography (WBCT) has become a fundamental tool for optimizing staging in flatfoot deformities. The indication for arthroereisis is a symptomatic flexible flat foot or hindfoot valgus in the pediatric or adolescent population in most publications. There are no studies that evaluate the behavior of the subtalar joint and degree of three-dimensional correction achieved in adult patients who underwent arthroereisis for symtomatic flexible flatfoot. Methods: After obtaining IRB approval, our prospectively collected surgical database was queried for patients undergoing arthroereisis for symptomatic flexible flatfoot. Patients were included if they had preoperative weight-bearing CT (WBCT). Patients were excluded if they had less than four months postoperative, had revision surgery, or declined to participate. Nine patients (15 feet) met the inclusion/exclusion criteria. All patients were brought back to the clinic for weight-bearing CT scan and to sign informed consent for the specific needs of this study. All measurements were performed by one of the authors in two time-frames (alignment of the hindfoot and talonavicular joint), separated for one month each. Results: Median age of 39 years. 14 feet showed a significant correction of the evaluated parameters. The preoperative median Talonavicular Coverage angle and Posterior and Middle Facet Subluxation of the subtalar joint were 33°, 19° and 39° respectively in preoperative WBCT, and 18°, 10° and 27° respectively in postoperative WBCT. The t test showed p < 0.01 for the change between preoperative and postoperative angles. The incidence of sinus tarsi pain was 20%, 2 patients required removal of the implant, 1 of them bilateral, without loss of correction in control with WBCT at the final follow-up (6 months after extraction). Conclusion: The application of subtalar arthroereisis is a minimally invasive alternative and effective therapy for adult acquired flatfoot, which achieves an adequate three-dimensional correction observed with WBCT after surgery. No loss of correction was observed in patients who required implant removal.
Emergency Department Visits Within 90 Days of Total Ankle Arthroplasty
Authors: Ratnasamy Philip P. , Kammien Alexander J. , Gouzoulis Michael J. , Grauer Jonathan N. 
Published: November 2022

Category: Arthroscopy; Ankle Introduction/Purpose: Emergency department (ED) visits following total ankle arthroplasty (TAA) may impact patient satisfaction and healthcare cost. Elucidating the timing of and risk factors for ED visits in this patient population might help facilitate targeted risk reduction strategies. Methods: This retrospective cohort study utilized data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset to identify patients who underwent TAA with at least 90 days of follow-up. Patient factors were extracted including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which their procedure was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, frequency, and primary diagnoses for 90-day postoperative ED visits were identified and interpreted in the context of one-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for such ED visits. Results: Of 7,600 TAA patients identified, 743 (9.8%) visited the ED within 90 days of their procedure. Of those who visited the ED, one ED visit was reported for 571 patients, two for 117 patients, three for 26 patients, and four or more visits for 29 patients. 37.2% of all ED visits occurred within two weeks following surgery; weekly visits returned to within 0.5% of the population baseline by three weeks after surgery. 90-day readmissions were identified for 289 patients (3.80%) of the cohort. Multivariate analysis revealed several predictors of ED utilization following TAA: younger age (odds ratio (OR) 1.40 per decade decrease), female sex (OR 1.18), higher ECI (OR 1.36 per 2-point increase), and Medicaid coverage (OR 2.74; 1.92-3.90 relative to Medicare) (p < 0.05 each). Regarding reasons for ED visits, surgical site issues were identified for 74.4%, with the most common reason being surgical site pain (60.4%). Conclusion: Of 7,600 TAA patients, 9.8% returned to the ED within 90 days of surgery, with predisposing demographic actors identified. The highest incidence for these ED visits was in the first two postoperative weeks, with surgical site pain being the most common reason. By identifying the timing, predisposing factors, and reasons for ED visits following TAA, targeted care pathways should be able to be adjusted to minimize their occurrence, improve patient experience, and minimize health care utilization/costs.
Physical Therapy Utilization Within 90 Days of Total Ankle Arthroplasty
Authors: Ratnasamy Philip P. , Gouzoulis Michael J. , Kammien Alexander J. , Grauer Jonathan N. 
Published: November 2022

Category: Ankle; Arthroscopy; Other Introduction/Purpose: Physical therapy (PT) following total ankle arthroplasty (TAA) is often considered, but guidelines for its use are not standardized. While there may be patient factors that dictate recommendations, establishing a baseline of utilization practices may set the stage for establishing generalizable recommendations. Methods: This retrospective cohort study employed data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset. Those undergoing TAA were identified based on coding, and patient factors were extracted, including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of PT utilization in the 90-days following TAA were identified as occurring at home or in an outpatient setting. Univariate and multivariate logistic regression analyses allowed the identification of predictive factors for PT utilization. Results: Of 6,563 TAA patients identified, 2788 (42.5%) utilized postoperative PT services. Most services were done as an outpatient (63.4%), compared to at home (6.1%). Weekly utilization of PT was greatest in the first week following surgery (17.7% of those who utilized PT) and thereafter followed a roughly bell-shaped curve of utilization with the greatest incidence at seven weeks following surgery (14.9% of those who utilized PT). Multivariate analysis identified multiple predictors of PT utilization following TAA, including: older age (odds ratio [OR] 1.23 per decade increase, p < 0.0001), higher ECI (OR 1.03 per 2-point increase, p = 0.0383), having surgery performed in the midwest, northeast, or western US (relative to the South OR 1.43, p < 0.0001; 1.20, p = 0.0109; and 1.32, p < 0.0001, respectively), and having commercial or Medicaid insurance coverage (relative to Medicare OR 1.96, p < 0.0001 and 1.62, p = 0.0006, respectively). Conclusion: Of 6,563 TAA patients, 42.5% utilized PT within 90 days of surgery. PT utilization was highest in the first- and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAA, algorithms for PT usage may be better defined and consistently employed.
Development and Validation of a Patient Decision Aid for the Treatment of Ankle Arthritis
Authors: Raymond Oluseye , Cordery Kyla , Hsu Nigel , Humbyrd Casey J. 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Choosing a treatment course can be challenging for patients with ankle osteoarthritis given the multiple operative and nonoperative options. We developed and validated the Ankle Arthritis Patient Decision Aid as a tool to improve shared decision-making for such patients. Methods: Eighty patients of 2 surgeons at a US academic foot and ankle practice were recruited from October 2020 to June 2021 using an electronic medical record messaging system. Participants reviewed the tool and answered survey questions evaluating its quality and factors affecting treatment choice in a hypothetical patient scenario. We evaluated the tool using decisional conflict scores (maximum, 40 points, with higher scores indicating greater uncertainty), pre- and post-knowledge test scores (maximum, 8 points), and helpfulness scores (maximum, 7 points). We compared pre- and post-test knowledge scores using paired Student t- tests. Alpha=.05. Results: Mean (+- standard deviation) knowledge scores improved from 4.8 +- 1.2 (pre-test) to 6.7 +- 1.3 (post-test), for a mean improvement of 1.9 +- 1.4 (p<.001). The mean decisional conflict score was 4.1 +- 5.7, reflecting minimal uncertainty. Factors greatly affecting participants' treatment choices were desire to maintain a high level of physical activity (n=58), risk of complications (n=35), recovery time (n=33), and risk of increased rate of arthritis in adjacent joints (n=32). The mean reported helpfulness score was 5.9 +- 1.2, reflecting substantial benefit. Conclusion: The Ankle Arthritis Patient Decision Aid is a comprehensible tool that significantly improves patient knowledge regarding treatment options for ankle arthritis.