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Article ; Online: A validity study of COMLEX-USA Level 3 with the new test design.

Mao, Xia / Boulet, John R / Sandella, Jeanne M / Oliverio, Michael F / Smith, Larissa

Journal of osteopathic medicine

2024

Abstract: Context: The National Board of Osteopathic Medical Examiners (NBOME) administers the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), a three-level examination designed for licensure for the practice of ... ...

Abstract	Context: The National Board of Osteopathic Medical Examiners (NBOME) administers the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA), a three-level examination designed for licensure for the practice of osteopathic medicine. The examination design for COMLEX-USA Level 3 (L3) was changed in September 2018 to a two-day computer-based examination with two components: a multiple-choice question (MCQ) component with single best answer and a clinical decision-making (CDM) case component with extended multiple-choice (EMC) and short answer (SA) questions. Continued validation of the L3 examination, especially with the new design, is essential for the appropriate interpretation and use of the test scores. Objectives: The purpose of this study is to gather evidence to support the validity of the L3 examination scores under the new design utilizing sources of evidence based on Kane's validity framework. Methods: Kane's validity framework contains four components of evidence to support the validity argument: Scoring, Generalization, Extrapolation, and Implication/Decision. In this study, we gathered data from various sources and conducted analyses to provide evidence that the L3 examination is validly measuring what it is supposed to measure. These include reviewing content coverage of the L3 examination, documenting scoring and reporting processes, estimating the reliability and decision accuracy/consistency of the scores, quantifying associations between the scores from the MCQ and CDM components and between scores from different competency domains of the L3 examination, exploring the relationships between L3 scores and scores from a performance-based assessment that measures related constructs, performing subgroup comparisons, and describing and justifying the criterion-referenced standard setting process. The analysis data contains first-attempt test scores for 8,366 candidates who took the L3 examination between September 2018 and December 2019. The performance-based assessment utilized as a criterion measure in this study is COMLEX-USA Level 2 Performance Evaluation (L2-PE). Results: All assessment forms were built through the automated test assembly (ATA) procedure to maximize parallelism in terms of content coverage and statistical properties across the forms. Scoring and reporting follows industry-standard quality-control procedures. The inter-rater reliability of SA rating, decision accuracy, and decision consistency for pass/fail classifications are all very high. There is a statistically significant positive association between the MCQ and the CDM components of the L3 examination. The patterns of associations, both within the L3 subscores and with L2-PE domain scores, fit with what is being measured. The subgroup comparisons by gender, race, and first language showed expected small differences in mean scores between the subgroups within each category and yielded findings that are consistent with those described in the literature. The L3 pass/fail standard was established through implementation of a defensible criterion-referenced procedure. Conclusions: This study provides some additional validity evidence for the L3 examination based on Kane's validity framework. The validity of any measurement must be established through ongoing evaluation of the related evidence. The NBOME will continue to collect evidence to support validity arguments for the COMLEX-USA examination series.
Language	English
Publishing date	2024-03-19
Publishing country	Germany
Document type	Journal Article
ISSN	2702-3648
ISSN (online)	2702-3648
DOI	10.1515/jom-2023-0011
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Article ; Online: Consequences of group III/IV afferent feedback and respiratory muscle work on exercise tolerance in heart failure with reduced ejection fraction.

Smith, Joshua R / Senefeld, Jonathon W / Larson, Kathryn F / Joyner, Michael J

Experimental physiology

2023 Volume 108, Issue 11, Page(s) 1351–1365

Abstract: Exercise intolerance and exertional dyspnoea are the cardinal symptoms of heart failure with reduced ejection fraction (HFrEF). In HFrEF, abnormal autonomic and cardiopulmonary responses arising from locomotor muscle group III/IV afferent feedback is one ...

Abstract	Exercise intolerance and exertional dyspnoea are the cardinal symptoms of heart failure with reduced ejection fraction (HFrEF). In HFrEF, abnormal autonomic and cardiopulmonary responses arising from locomotor muscle group III/IV afferent feedback is one of the primary mechanisms contributing to exercise intolerance. HFrEF patients also have pulmonary system and respiratory muscle abnormalities that impair exercise tolerance. Thus, the primary impetus for this review was to describe the mechanistic consequences of locomotor muscle group III/IV afferent feedback and respiratory muscle work in HFrEF. To address this, we first discuss the abnormal autonomic and cardiopulmonary responses mediated by locomotor muscle afferent feedback in HFrEF. Next, we outline how respiratory muscle work impairs exercise tolerance in HFrEF through its effects on locomotor muscle O
MeSH term(s)	Humans ; Heart Failure ; Muscle, Skeletal ; Exercise Tolerance ; Stroke Volume/physiology ; Feedback ; Respiratory Muscles ; Dyspnea
Language	English
Publishing date	2023-09-21
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1016295-1
ISSN	1469-445X ; 0958-0670
ISSN (online)	1469-445X
ISSN	0958-0670
DOI	10.1113/EP090755
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Article ; Online: Informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders: Systematic review and report from a CCCDTD5 Working Group.

Choudhury, Samira / Ghodasara, Sheena / Stiffel, Michael / Fischer, Corinne E / Tang-Wai, David F / Smith, Eric Edward / Massoud, Fadi / Robin Hsiung, Ging-Yuek / Lee, Linda / Bruneau, Marie-Andrée / Laforce, Robert Jr / Ismail, Zahinoor / Burhan, Amer M / Kumar, Sanjeev

International journal of geriatric psychiatry

2022 Volume 37, Issue 2

Abstract: Objective: As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders ( ...

Abstract	Objective: As part of the fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, we assessed the literature on informant-based tools for assessment and monitoring of cognition, behavior, and function in neurocognitive disorders (NCDs) to provide evidence-based recommendations for clinicians and researchers. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards guidelines. Publications that validated the informant-based tools or described their key properties were reviewed. Quality of the studies was assessed using the modified Quality Assessment tool for Diagnostic Accuracy Studies. Results: Out of 386 publications identified through systematic search, 34 that described 19 informant-based tools were included in the final review. Most of these tools are backed by good-quality studies and are appropriate to use in clinical care or research. The tools vary in their psychometric properties, domains covered, comprehensiveness, completion time, and ability to detect longitudinal change. Based on these properties, we identify different tools that may be appropriate for primary care, specialized memory clinic, or research settings. We also identify barriers to use of these tools in routine clinical practice. Conclusion: There are several good-quality tools available to collect informant-report for assessment and monitoring of cognition, behavior, or function in patients with NCDs. Clinicians and researchers may choose a particular tool based on their specific needs such as domains of interest, desired psychometric properties, and feasibility. Further work is needed to make the tools more user-friendly and to adopt them into routine clinical care.
MeSH term(s)	Canada ; Cognition ; Dementia/diagnosis ; Humans ; Neurocognitive Disorders ; Sensitivity and Specificity
Language	English
Publishing date	2022-01-18
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	806736-3
ISSN	1099-1166 ; 0885-6230
ISSN (online)	1099-1166
ISSN	0885-6230
DOI	10.1002/gps.5678
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Article ; Online: Water‐dispersible nanocolloids and higher temperatures promote the release of carbon from riparian soil

Kenton A. Rod / A. Peyton Smith / Weinan Leng / Sean Colby / Ravi K. Kukkadapu / Mark Bowden / Odeta Qafoku / Wooyong Um / Michael F. Hochella Jr. / Vanessa L. Bailey / Ryan S. Renslow

Vadose Zone Journal, Vol 19, Iss 1, Pp n/a-n/a (2020)

2020

Abstract: Abstract Increasing temperatures in alpine regions accompanied by glacial retreat is occurring rapidly due to climate change. This may affect riparian soils by increasing weathering rates, resulting in greater organic carbon (OC) release to rivers via ... ...

Abstract	Abstract Increasing temperatures in alpine regions accompanied by glacial retreat is occurring rapidly due to climate change. This may affect riparian soils by increasing weathering rates, resulting in greater organic carbon (OC) release to rivers via movement of iron‐containing colloids and nanominerals. Increased concentrations of iron‐ or silcate‐nanominerals would result in higher surface area for OC adsorption. To test the influence of temperature on OC leaching, we examined mineral weathering and nanocolloid facilitated release of OC through a series of controlled laboratory batch and column experiments using sediment from the banks of the Nisqually River, Mount Rainier in Washington State (USA). Additional experiments were conducted using the same sediments, but with an illite amendment added to test the influence of additional surface area and nanominerals that many sediments along the Nisqually River contain. These higher‐ and lower‐surface‐area sediments (i.e., sediments with and without the illite amendment) were incubated for 90 d at 4 or 20 °C, followed by batch and column OC leaching tests. Results show that OC leaching rates for 20 °C were two to three times greater than for 4 °C. Further, our results suggest that nanocolloids are responsible for moving this increased OC load from these sediments. When hydrologically connected, OC is released from bank sediments to rivers faster than presently anticipated in fluvial environments experiencing climate change‐induced glacial retreat. Further, a one‐dimensional, finite‐element computational model developed for this study estimates that a 1 °C increase in temperature over a 90‐d summer runoff period increases the OC release rate from sediments by 79%.
Keywords	Environmental sciences ; GE1-350 ; Geology ; QE1-996.5
Subject code	550
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
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Article ; Online: Targeting SARS-CoV-2 papain-like protease in the postvaccine era.

Ton, Anh-Tien / Pandey, Mohit / Smith, Jason R / Ban, Fuqiang / Fernandez, Michael / Cherkasov, Artem

Trends in pharmacological sciences

2022 Volume 43, Issue 11, Page(s) 906–919

Abstract: While vaccines remain at the forefront of global healthcare responses, pioneering therapeutics against SARS-CoV-2 are expected to fill the gaps for waning immunity. Rapid development and approval of orally available direct-acting antivirals targeting ... ...

Abstract	While vaccines remain at the forefront of global healthcare responses, pioneering therapeutics against SARS-CoV-2 are expected to fill the gaps for waning immunity. Rapid development and approval of orally available direct-acting antivirals targeting crucial SARS-CoV-2 proteins marked the beginning of the era of small-molecule drugs for COVID-19. In that regard, the papain-like protease (PLpro) can be considered a major SARS-CoV-2 therapeutic target due to its dual biological role in suppressing host innate immune responses and in ensuring viral replication. Here, we summarize the challenges of targeting PLpro and innovative early-stage PLpro-specific small molecules. We propose that state-of-the-art computer-aided drug design (CADD) methodologies will play a critical role in the discovery of PLpro compounds as a novel class of COVID-19 drugs.
MeSH term(s)	Antiviral Agents/pharmacology ; Antiviral Agents/therapeutic use ; Coronavirus Papain-Like Proteases/antagonists & inhibitors ; Humans ; SARS-CoV-2 ; COVID-19 Drug Treatment
Chemical Substances	Antiviral Agents ; Coronavirus Papain-Like Proteases (EC 3.4.22.2) ; papain-like protease, SARS-CoV-2 (EC 3.4.22.2)
Language	English
Publishing date	2022-08-24
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	282846-7
ISSN	1873-3735 ; 0165-6147
ISSN (online)	1873-3735
ISSN	0165-6147
DOI	10.1016/j.tips.2022.08.008
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Article ; Online: Coastal inundation regime moderates the short-term effects of sediment and soil additions on seawater oxygen and greenhouse gas dynamics

Peter Regier / Nicholas D. Ward / Alex Izquierdo / Andrew H. Baldwin / Donnie Day / Julia McElhinny / Kaizad Patel / Rodrigo Vargas / Jianqiu Zheng / Exchange Consortium / Allison Myers-Pigg / Silver Alford / Michael P. Back / Vanessa Bailey / Jade Bolinger / Madison Bowe / Maxim I. Boyanov / Jacob A. Cianci-Gaskill / Nathan A. Conroy /

Matthew J. Cooper / Alex Demeo / Kyle Derby / Derek Detweiler / Suzanne Devres-Zimmerman / Erin Eberhard / Keryn Gedan / LeeAnn Haaf / Khadijah K. Homolka / Erin Johnson / Kenneth M. Kemner / Aliya Khan / Matthew Kirwan / Payton Kittaka / Erika Koontz / Adam Langley / Riley Leff / Scott Lerberg / Allison M. Lewis / Sairah Malkin / Amy M. Marcarelli / Steven E. McMurray / Tyler Messerschmidt / Taylor C. Michael / Holly A. Michael / Elizabeth C. Minor / Brian Moye / Thomas J. Mozdzer / Allison N. Myers-Pigg / Neubauer Scott / Cooper G. Norris / Edward J. O'Loughlin / Opal Otenburg / Andrea Pain / Kaizad F. Patel / Stephanie C. Pennington / Michael Philben / Evan Phillips / Dannielle Pratt / J. Alan Roebuck Jr. / Lauren Sage / Daniel Sandborn / Stacy Smith / Alex Smith / Samina Soin-Voshell / Bongkeun Song / Amanda Sprague-Getsy / Kari St Laurent / Lorie Staver / Alice Stearns / Lucie Stetten / Rebecca Swerida / Ethan J. Theuerkauf / Katherine Tully / Elizabeth Watson / Coreen Weilminster

Frontiers in Marine Science, Vol

a microcosm experiment

2023 Volume 10

Abstract: The frequency and persistence of tidal inundation varies along the coastal terrestrial-aquatic interface, from frequently inundated wetlands to rarely inundated upland forests. This inundation gradient controls soil and sediment biogeochemistry and ... ...

Abstract	The frequency and persistence of tidal inundation varies along the coastal terrestrial-aquatic interface, from frequently inundated wetlands to rarely inundated upland forests. This inundation gradient controls soil and sediment biogeochemistry and influence the exchange of soils and sediments from terrestrial to aquatic domains. Although a rich literature exist on studies of the influence of tidal waters on the biogeochemistry of coastal ecosystem soils, few studies have experimentally addressed the reverse question: How do soils (or sediments) from different coastal ecosystems influence the biogeochemistry of the tidal waters that inundate them? To better understand initial responses of coastal waters that flood coastal wetlands and uplands, we conducted short-term laboratory experiments where seawater was amended with sediments and soils collected across regional gradients of inundation exposure (i.e., frequently to rarely inundated) for 14 sites across the Mid-Atlantic, USA. Measured changes in dissolved oxygen and greenhouse gas concentrations were used to calculate gas consumption or production rates occurring during seawater exposure to terrestrial materials. We also measured soil and water physical and chemical properties to explore potential drivers. We observed higher oxygen consumption rates for seawater incubated with soils/sediments from frequently inundated locations and higher carbon dioxide production for seawater incubated with soils from rarely inundated transect locations. Incubations with soil from rarely inundated sites produced the highest global warming potential, primarily driven by carbon dioxide and secondarily by nitrous oxide. We also found environmental drivers of gas rates varied notably between transect locations. Our findings indicate that seawater responses to soil and sediment inputs across coastal terrestrial-aquatic interfaces exhibit some consistent patterns and high intra- and inter-site variability, suggesting potential biogeochemical feedback loops as inundation regimes ...
Keywords	greenhouse gases ; dissolved oxygen ; aquatic carbon cycle ; terrestrial-aquatic interface ; coastal inundation ; Science ; Q ; General. Including nature conservation ; geographical distribution ; QH1-199.5
Subject code	550
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The Safe Cholecystectomy: Evaluating the Use of Laparoscopic Subtotal Cholecystectomy Between Junior and Senior Faculty.

Smith, Michael C / Nordness, Mina F / Fogel, Jessa / Streams, Jill R / Dennis, Bradley M / Gunter, Oliver L

The American surgeon

2023 Volume 89, Issue 7, Page(s) 3339–3342

Abstract: Background: Laparoscopic Subtotal Cholecystectomy (SC) is a technique for performing safe cholecystectomy when excessive inflammation prevents exposure of the Critical View of Safety. Studies have evaluated outcomes and complications of laparoscopic ... ...

Abstract	Background: Laparoscopic Subtotal Cholecystectomy (SC) is a technique for performing safe cholecystectomy when excessive inflammation prevents exposure of the Critical View of Safety. Studies have evaluated outcomes and complications of laparoscopic cholecystectomy (LC), with mixed results in terms of surgeon experience. It is unclear if the rate of SC is associated with experience. We hypothesized that the rate of SC would decrease as surgical experience increased. Methods: We performed a retrospective review of LC performed at an academic medical center. Demographics were analyzed using descriptive statistics. We performed a multivariable logistic regression to examine the relationship between years in practice and performance of SC. We performed a sensitivity analysis comparing those in their first year on faculty with all others. Results: Between November 1, 2017, and November 1, 2021, there were 1222 LC performed. 771 patients (63%) were female. 89 patients (7.3%) underwent SC. There were no bile duct injuries requiring reconstruction. Controlling for age, sex, and ASA class, there was no difference in the rate of SC by years of experience (OR .98, 95% CI .94-1.01). In a sensitivity analysis comparing first-year faculty to those beyond their first year, there was also no difference (OR .76, 95% CI 0.42-1.39). Discussion: We find no difference in the rate of performance of SC between junior and senior faculty. This reflects consistency, in keeping with best practice guidelines. This could be confounded by junior faculty requesting assistance during difficult operations. Further investigation into factors affecting decision-making may clarify this.
MeSH term(s)	Humans ; Female ; Male ; Cholecystectomy, Laparoscopic/methods ; Cholecystectomy/methods ; Retrospective Studies ; Bile Duct Diseases ; Inflammation
Language	English
Publishing date	2023-02-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348231157859
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Article: Water‐dispersible nanocolloids and higher temperatures promote the release of carbon from riparian soil

Rod, Kenton A. / Smith, A. Peyton / Leng, Weinan / Colby, Sean / Kukkadapu, Ravi K. / Bowden, Mark / Qafoku, Odeta / Um, Wooyong / Hochella, Michael F., Jr / Bailey, Vanessa L. / Renslow, Ryan S.

Vadose zone journal. 2020, v. 19, no. 1

2020

Abstract: Increasing temperatures in alpine regions accompanied by glacial retreat is occurring rapidly due to climate change. This may affect riparian soils by increasing weathering rates, resulting in greater organic carbon (OC) release to rivers via movement of ...

Abstract	Increasing temperatures in alpine regions accompanied by glacial retreat is occurring rapidly due to climate change. This may affect riparian soils by increasing weathering rates, resulting in greater organic carbon (OC) release to rivers via movement of iron‐containing colloids and nanominerals. Increased concentrations of iron‐ or silcate‐nanominerals would result in higher surface area for OC adsorption. To test the influence of temperature on OC leaching, we examined mineral weathering and nanocolloid facilitated release of OC through a series of controlled laboratory batch and column experiments using sediment from the banks of the Nisqually River, Mount Rainier in Washington State (USA). Additional experiments were conducted using the same sediments, but with an illite amendment added to test the influence of additional surface area and nanominerals that many sediments along the Nisqually River contain. These higher‐ and lower‐surface‐area sediments (i.e., sediments with and without the illite amendment) were incubated for 90 d at 4 or 20 °C, followed by batch and column OC leaching tests. Results show that OC leaching rates for 20 °C were two to three times greater than for 4 °C. Further, our results suggest that nanocolloids are responsible for moving this increased OC load from these sediments. When hydrologically connected, OC is released from bank sediments to rivers faster than presently anticipated in fluvial environments experiencing climate change‐induced glacial retreat. Further, a one‐dimensional, finite‐element computational model developed for this study estimates that a 1 °C increase in temperature over a 90‐d summer runoff period increases the OC release rate from sediments by 79%.
Keywords	Washington (state) ; adsorption ; bioinformatics ; climate ; climate change ; colloids ; glaciation ; illite ; organic carbon ; riparian soils ; rivers ; runoff ; sediments ; summer ; surface area ; temperature ; vadose zone
Language	English
Publishing place	John Wiley & Sons, Ltd
Document type	Article
Note	JOURNAL ARTICLE
ZDB-ID	2088189-7
ISSN	1539-1663
ISSN	1539-1663
DOI	10.1002/vzj2.20077
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Assessment of Lab4P Probiotic Effects on Cognition in 3xTg-AD Alzheimer's Disease Model Mice and the SH-SY5Y Neuronal Cell Line.

Webberley, Thomas S / Bevan, Ryan J / Kerry-Smith, Joshua / Dally, Jordanna / Michael, Daryn R / Thomas, Sophie / Rees, Meg / Morgan, James E / Marchesi, Julian R / Good, Mark A / Plummer, Sue F / Wang, Duolao / Hughes, Timothy R

International journal of molecular sciences

2023 Volume 24, Issue 5

Abstract: Aging and metabolic syndrome are associated with neurodegenerative pathologies including Alzheimer's disease (AD) and there is growing interest in the prophylactic potential of probiotic bacteria in this area. In this study, we assessed the ... ...

Abstract	Aging and metabolic syndrome are associated with neurodegenerative pathologies including Alzheimer's disease (AD) and there is growing interest in the prophylactic potential of probiotic bacteria in this area. In this study, we assessed the neuroprotective potential of the Lab4P probiotic consortium in both age and metabolically challenged 3xTg-AD mice and in human SH-SY5Y cell culture models of neurodegeneration. In mice, supplementation prevented disease-associated deteriorations in novel object recognition, hippocampal neurone spine density (particularly thin spines) and mRNA expression in hippocampal tissue implying an anti-inflammatory impact of the probiotic, more notably in the metabolically challenged setting. In differentiated human SH-SY5Y neurones challenged with β-Amyloid, probiotic metabolites elicited a neuroprotective capability. Taken together, the results highlight Lab4P as a potential neuroprotective agent and provide compelling support for additional studies in animal models of other neurodegenerative conditions and human studies.
MeSH term(s)	Mice ; Humans ; Animals ; Alzheimer Disease/metabolism ; tau Proteins/metabolism ; Mice, Transgenic ; Neuroblastoma/pathology ; Amyloid beta-Peptides/metabolism ; Cell Line ; Cognition ; Disease Models, Animal
Chemical Substances	tau Proteins ; Amyloid beta-Peptides
Language	English
Publishing date	2023-02-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms24054683
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Article ; Online: Multicenter retrospective cohort study of the association between surgery for odontoid fractures in the elderly and in-hospital outcomes.

Merali, Zamir / Zhang, Peng F / Jaffe, Rachael H / Jaja, Blessing N R / Harrington, Erin M / Malhotra, Armaan K / Smith, Christopher W / He, Yingshi / Balas, Michael / Jack, Andrew S / Fehlings, Michael G / Wilson, Jefferson R / Witiw, Christopher D

Scientific reports

2023 Volume 13, Issue 1, Page(s) 6276

Abstract: Odontoid fractures are increasingly prevalent in older adults and associated with high morbidity and mortality. Optimal management remains controversial. Our study aims to investigate the association between surgical management of odontoid fractures and ... ...

Abstract	Odontoid fractures are increasingly prevalent in older adults and associated with high morbidity and mortality. Optimal management remains controversial. Our study aims to investigate the association between surgical management of odontoid fractures and in-hospital mortality in a multi-center geriatric cohort. We identified patients 65 years or older with C2 odontoid fractures from the Trauma Quality Improvement Program database. The primary study outcome was in-hospital mortality. Secondary outcomes were in-hospital complications and hospital length of stay. Generalized estimating equation models were used to compare outcomes between operative and non-operative cohorts. Among the 13,218 eligible patients, 1100 (8.3%) were treated surgically. The risk of in-hospital mortality did not differ between surgical and non-surgical groups, after patient and hospital-level adjustment (OR: 0.94, 95%CI: 0.55-1.60). The risks of major complications and immobility-related complications were higher in the operative cohort (adjusted OR: 2.12, 95%CI: 1.53-2.94; and OR: 2.24, 95%CI: 1.38-3.63, respectively). Patients undergoing surgery had extended in-hospital length of stay compared to the non-operative group (9 days, IQR: 6-12 days vs. 4 days, IQR: 3-7 days). These findings were supported by secondary analyses that considered between-center differences in rates of surgery. Among geriatric patients with odontoid fractures surgical management was associated with similar in-hospital mortality, but higher in-hospital complication rates compared to non-operative management. Surgical management of geriatric patients with odontoid fractures requires careful patient selection and consideration of pre-existing comorbidities.
MeSH term(s)	Humans ; Aged ; Retrospective Studies ; Spinal Fractures/surgery ; Treatment Outcome ; Odontoid Process/surgery ; Fractures, Bone
Language	English
Publishing date	2023-04-18
Publishing country	England
Document type	Multicenter Study ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-33158-3
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