bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review and meta-analysis of morbidity and pancreatic fistula after distal pancreatectomy with versus without prophylactic intra-abdominal drainage
Authors: Klaiber Ulla , Collins Philip M. , Trinkler Simon , Gustorff Charlotte , Schindl Martin , Sahora Klaus , Leonhardt Carl-Stephan , Strobel Oliver
Published: July 2024

Background:

The omission of a prophylactic intra-abdominal drainage has been under debate in pancreatic surgery due to the high-risk of complications and especially of postoperative pancreatic fistula (POPF). Recently, the second randomized controlled trial (RCT) and two propensity score-matched comparative studies assessing risks and benefits of a no-drainage policy versus prophylactic drainage after distal pancreatectomy (DP) have been published. This systematic review with meta-analysis provides an updated summary of the available evidence on this topic.

Methods:

RCTs and nonrandomized comparative studies (NCS) investigating outcomes of no drainage versus drainage after DP were searched systematically in MEDLINE, Embase, and CENTRAL. Random effects meta-analyses were performed, and the results presented as weighted odds ratios (OR) or mean differences with their corresponding 95% CI. Subgroup analyses were performed to account for interstudy heterogeneity between RCTs and NCS.

Results:

Two RCTs and six NCS with a total of 3610 patients undergoing DP were included of whom 1038 (28.8%) patients did not receive prophylactic drainage. A no-drainage policy was associated with significantly lower risks of POPF (OR 0.38, 95% CI: 0.25–0.56; P<0.00001), reduced major morbidity (OR 0.64, 95% CI: 0.47–0.89; P=0.008), less reinterventions (OR 0.70, 95% CI: 0.52–0.95; P=0.02), and fewer readmissions (OR 0.69, 95% CI: 0.54–0.88; P=0.003) as well as shorter length of hospital stay (mean differences −1.74, 95% CI: −2.70 to −0.78; P=0.0004). Subgroup analyses including only RCTs confirmed benefits of the no-drainage policy.

Conclusion:

A no-drainage policy is associated with reduced POPF and morbidity and can therefore be recommended as standard procedure in patients undergoing DP.
Efficacy and safety of robotic surgery versus open surgery for hilar cholangiocarcinoma: a systematic review and meta-analysis
Authors: Hu Manqin , Xu Dingwei , Zhang Yan , Li Ao , Li Xincheng , Huang Jie
Published: July 2024

Objective:

The aim is to assess and contrast the effectiveness and safety of employing robotic surgery versus traditional open surgery in managing cases of hilar cholangiocarcinoma.

Methods:

Computer searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database to identify case–control studies comparing robotic surgery with traditional open surgery in the treatment of hilar cholangiocarcinoma from inception until July 2023. References from retrieved articles were reviewed to broaden the search. This review was prospectively registered in the PROSPERO database (PROSPERO ID: CRD42024527511) and reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. The primary outcome measures included operation time, intraoperative blood transfusion rate, R0 resection rate, lymph node metastasis rate, incidence of postoperative complications, and postoperative hospital stay. Data analysis was performed using RevMan 5.4 software, calculating combined odds ratios (OR), mean differences (MD), and 95% CI.

Results:

A total of 4 studies encompassing 267 patients diagnosed with hilar cholangiocarcinoma (177 males and 90 females, mean age of (58.8±5.7) years) were included in this analysis. Among these, 165 patients underwent open surgery, while 102 patients underwent robotic surgery. The results of the meta-analysis demonstrated comparable outcomes between the two groups. Specifically, the operation time between the robotic surgery and open surgery cohorts did not significantly differ (MD=−103.96, 95% CI: −216.90 to 8.98, P=0.070). Additionally, the intraoperative blood transfusion rate (OR=1.32, 95% CI: 0.43–4.07, P=0.630), R0 resection rate (OR=1.41, 95% CI: 0.71–2.81, P=0.330), and lymph node metastasis rate (OR=1.62, 95% CI: 0.46–5.63, P=0.450) showed no significant differences between the groups. Similarly, there were no statistically significant disparities observed in the incidence of postoperative complications (OR=0.60, 95% CI: 0.28–1.31, P=0.200) and postoperative hospital stay (MD=2.17, 95% CI: −11.56 to 15.90, P=0.760).

Conclusion:

In the treatment of hilar cholangiocarcinoma, robotic surgery demonstrates comparable safety and feasibility to traditional open surgery. However, due to the limited quantity and quality of the included studies, these conclusions warrant validation through additional high-quality investigations.
Shared Decision-Making About Returning to Sport After Recovery From Pediatric Concussion: Clinician Perspectives
Authors: Kroshus-Havril Emily , Opel Douglas J. , Jinguji Thomas M. , Steiner Mary Kathleen , Senturia Kirsten , MacDonald James P. , Master Christina L. , Giza Christopher C. , Burton Monique S. , Quitiquit Celeste , Krabak Brian J. , Kotch Jeanette P. , Rivara Frederick P.
Published: July 2024

Objective:

Describe how sports medicine clinicians support decision making about sport participation after concussion recovery with adolescent patients and their parents. Specific areas of inquiry related to how clinicians framed the decision, what factors they considered in how they approached the decision process, and how they navigated discordance within families.

Design:

Qualitative study.

Setting:

Tertiary care sports medicine clinics at 4 children's hospitals in the United States.

Participants:

Individual interviews were conducted with 17 clinicians practicing in sports medicine settings.

Interventions:

N/A.

Main Outcome Measures:

Semi-structured interviews explored clinician approaches to supporting decision making, with the question guide informed by components of the Ottawa Decision Support Framework.

Results:

Clinicians routinely incorporated aspects of shared decision making (SDM) into their conversations with families. This included ensuring all parties were informed about risk and aligned behind a shared value of adolescent well-being. Mediation strategies were used to manage discordance between adolescents and their parents, and between parents. These strategies aimed to facilitate a decision that was adolescent centered. When clinicians believed that there was a medical benefit to modifying the adolescent's sport participation practices, or when they did not believe the athlete was psychologically ready to return to the sport in which they were injured, they initiated conversations about alternative activities. In such situations, they used persuasive communication practices to encourage families to strongly consider this option.

Conclusion:

The strengths and strategies used by sports medicine clinicians in this study provide a foundation for guidance or intervention development aimed at supporting SDM after concussion with adolescents and their families.
Nephrology rapid response team in the intensive care unit
Authors: Gomez-Villarreal Juan P. , Borbolla Paola , Garza-Treviño Ricardo A. , Kashani Kianoush B. , Romero-González Gregorio A. , Rizo-Topete Lilia M.
Published: July 2024

Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU), and it is known as an independent factor for adverse outcomes like increased length of hospital stay, the development of chronic kidney disease (CKD), and increased mortality with the associated high cost to healthcare systems. The use of AKI biomarkers and new tools such as point-of-care ultrasonography (POCUS) to perform a hemodynamic and volume status assessment has made it more feasible to detect or predict kidney damage in a very accurate way, thereby avoiding the progression of AKI. The design and implementation of a nephrology rapid response team (NRRT) should be considered to improve patient outcomes and healthcare costs. In this paper, we provide an overview of the implementation of an NRRT.
Chlamydia and Gonorrhea Testing in Pregnancy: Time to Improve Adherence and Update Recommendations
Authors: Kaufman Harvey W. , Alagia Damian P. , Van Ky , Van Der Pol Barbara
Published: July 2024

Objective

The aim of the study is to evaluate adherence to national recommendations for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhea) testing during pregnancy including tests for cure/clearance and for persistence/potential reinfection at time of delivery.

Materials and Method

We evaluated results of chlamydia and gonorrhea nucleic acid amplification tests (NAAT) performed by major national reference laboratory from January 2010 through July 2022.

Results

Of 3,519,781 uniquely identified pregnant individuals, we identified 4,077,212 pregnancies. Among pregnancies that had chlamydia or gonorrhea testing, 3.7% (149,422/4,055,016) and 0.4% (15,858/ 4,063,948) were initially positive, respectively. Initial tests occurred in the first trimester for approximately 88%. Of those initially chlamydia test positive, 71% were retested; 15.8% in <4 weeks and 37.3% >8 weeks (similarly for gonorrhea). Among patients initially test positive in early/mid pregnancy, more than one-third had no evidence of late pregnancy retesting. Individuals who were initially test negative and subsequently retested positive were approximately 50% likely to have the last available result be positive. Among all whom initially tested positive and were retested, 6.8% and 4.0%, were positive for chlamydia and gonorrhea, respectively on their last test before estimated delivery. There was no subsequent negative test before estimated delivery for 35.1% and 36.9% chlamydia or gonorrhea infected patients, respectively.

Conclusions

Adherence to current recommendations is suboptimal and may not be adequate to reduce disease burden. Professional societies and practice plans should work to encourage better adherence to existing guidelines to protect the health of women and their newborns. We propose recommendations that may be helpful in reducing disease burden.
Pulmonary vascular diseases at high altitude – is it safe to live in the mountains?
Authors: Titz Anna , Hoyos Rodrigo , Ulrich Silvia
Published: July 2024

Purpose of review

This review addresses the concern of the health effects associated with high-altitude living and chronic hypoxia with a focus on pulmonary hypertension. With an increasing global population residing at high altitudes, understanding these effects is crucial for public health interventions and clinical management.

Recent findings

Recent literature on the long-term effects of high-altitude residence and chronic hypoxia is comprehensively summarized. Key themes include the mechanisms of hypoxic pulmonary vasoconstriction, the development of pulmonary hypertension, and challenges in distinguishing altitude-related pulmonary hypertension and classical pulmonary vascular diseases, as found at a low altitude.

The findings emphasize the need for research in high-altitude communities to unravel the risks of pulmonary hypertension and pulmonary vascular diseases. Clinically, early and tailored management for symptomatic individuals residing at high altitudes are crucial, as well as access to advanced therapies as proposed by guidelines for pulmonary vascular disease. Moreover, identifying gaps in knowledge underscores the necessity for continued research to improve understanding and clinical outcomes in high-altitude pulmonary vascular diseases.
Concise review: breast cancer stems cells and their role in metastases
Authors: Kamalabadi Farahani Mohammad , Farjadmehr Mohammad , Atashi Amir , Momeni Alireza , Behzadifard Mahin
Published: July 2024

Background:

Breast cancer stem cells (BCSCs) have been suggested to be responsible for the development of Breast cancer (BC). The aim of this study was to evaluate BCSCs and the target organs microenvironment immunophenotyping markers in common BC metastases, and therapeutic targets regarding to the mentioned criteria.

Material and methods:

This narrative review involved searching international databases; PubMed, Google Scholar using predetermined keywords including breast cancer, breast cancer stem cells, breast cancer metastases, immunophenotyping, immunohistochemistry and metastases. The search results were assessed based on the title, abstract, and full text of the articles, and relevant findings were included in the review.

Results:

BCSCs express high amounts of aldehyde dehydrogenase 1 (ALDH1), Ganglioside 2 (GD2), CD44 and CD133 but are negative for CD24 marker. CXCR4 and OPN have high expression in the cells and may contribute in BC metastasis to the bone. Nestin, CK5, prominin-1 (CD133) markers in BCSCs have been reported to correlate with brain metastasis. High expression of CD44 in BCSCs and CXCL12 expression in the liver microenvironment may contribute to BC metastasis to the liver. Aberrantly expressed vascular cell adhesion molecule-1 (VCAM-1) that binds to collagen and elastin fibers on pulmonary parenchyma, and CXCR4 of BCSCs and CXCL12 in lung microenvironment may promote the cells homing and metastasis to lung.

Conclusion:

As in various types of BC metastases different markers that expressed by the cells and target organ microenvironment are responsible, BCSCs immunophenotyping can be used as target markers to predict the disease prognosis and treatment.
Artificial intelligence-driven transformations in diabetes care: a comprehensive literature review
Authors: Iftikhar Muhammad , Saqib Muhammad , Qayyum Sardar Noman , Asmat Rehana , Mumtaz Hassan , Rehan Muhammad , Ullah Irfan , Ud-din Iftikhar , Noori Samim , Khan Maleeka , Rehman Ehtisham , Ejaz Zain
Published: July 2024

Artificial intelligence (AI) has been applied in healthcare for diagnosis, treatments, disease management, and for studying underlying mechanisms and disease complications in diseases like diabetes and metabolic disorders. This review is a comprehensive overview of various applications of AI in the healthcare system for managing diabetes. A literature search was conducted on PubMed to locate studies integrating AI in the diagnosis, treatment, management and prevention of diabetes. As diabetes is now considered a pandemic now so employing AI and machine learning approaches can be applied to limit diabetes in areas with higher prevalence. Machine learning algorithms can visualize big datasets, and make predictions. AI-powered mobile apps and the closed-loop system automated glucose monitoring and insulin delivery can lower the burden on insulin. AI can help identify disease markers and potential risk factors as well. While promising, AI’s integration in the medical field is still challenging due to privacy, data security, bias, and transparency. Overall, AI’s potential can be harnessed for better patient outcomes through personalized treatment.
National trends of malpractice-related cardiovascular mortality within the United States, 1999–2020
Authors: Ashraf Hamza , Ashfaq Haider , Paryani Neha Saleem , Malik Shanza , Shaikh Ali Tariq , Saleh Aalaa , Khan Jehanzeb Ahmed , Hameed Ishaque
Published: July 2024

Cardiovascular disease (CVD) stands as the leading cause of mortality in the USA, claiming a life every 33 seconds, while cardiology ranks among the top three specialties with malpractice-related claims. The authors’ study aims to scrutinize sex disparities in CVD-related mortality linked with malpractice among the elderly population (≥65 years) in the USA. Data pertaining to malpractice incidents in CVD treatment spanning from 1999 to 2020 were sourced from the CDC Wonder database. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals were computed. Joinpoint regression analysis was used to determine the annual percent changes (APCs) with a 95% CI, stratified across variables such as age, race/ethnicity, census region, and urban or rural settings. Over the investigated period, 2432 deaths in the US were attributed to CVD-related malpractice, with an AAMR of 2.7. Initially stable (1999–2004), mortality rates experienced a significant decline until 2020. Females consistently exhibited a higher AAMR (2.7) than males (2.6). Notably, NH Black females recorded the highest AAMR (3.1), while NH Black males and NH Asian females reported the lowest (2.5). Furthermore, NH White males demonstrated a higher AAMR (2.7) than NH Black males (2.5); conversely, NH Black females exhibited a higher AAMR (3.1) than NH White females (2.7). Mortality rates were notably elevated in the West compared to the South, with both urban and rural areas indicating higher AAMRs in females. The authors’ findings underscore the necessity for targeted interventions to address the pronounced disparities, particularly among NH Black women, individuals in the West, males, and urban locales.
Unusual presentations in systemic lupus erythematosus with concurrent IgA nephropathy lesion: a rare case report from Eastern Nepal
Authors: Pokhrel Popular , Neupane Nitesh , Karna Nitesh Kumar , Pokhrel Gopal , Chapagain Niraj , Niraula Abhas , Yadav Ajay Kumar
Published: July 2024

Introduction:

Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organs. While lupus nephritis (LN) is seen in SLE, concurrent IgA nephropathy lesion is rare. Uncommon manifestations like cutaneous ulcers and orbital involvement present diagnostic challenges, and this case from Nepal emphasizes careful diagnostic approach in such cases.

Case presentation:

A 42-year-old female presented with bilateral lower limb swelling, gum bleeding, and epistaxis. Initial evaluation revealed pancytopenia and suspected renal involvement. Renal biopsy showed IgA nephropathy lesions, but clinical and laboratory findings favored lupus nephritis. Treatment with immunosuppressive agents was initiated. Despite therapy, the patient developed cutaneous ulcers and orbital cellulitis. Decreasing anti-ds DNA levels were noted during the course of treatment.

Discussion:

The diagnosis of lupus nephritis in the presence of IgA nephropathy lesions emphasizes the complexity of SLE diagnosis. Treatment with immunosuppressive agents targeting the underlying autoimmune process, yet the development of cutaneous ulcers and orbital cellulitis highlights the importance of timely intervention in managing SLE complications. In resource-limited settings, clinicians should initiate interventions based on clinical and lab findings while awaiting detailed biopsy results.

Conclusion:

This case highlights diagnostic challenges in SLE and emphasizes the necessity for careful monitoring and timely intervention in managing complications. The interplay between SLE and IgA Nephropathy (IgAN) suggests that SLE may trigger or exacerbate it, complicating disease management. Further exploration is needed to enhance the understanding and management of complex autoimmune disorders like SLE.
A comparative study on effects of defect closure versus non-closure in laparoscopic totally extraperitoneal repair of direct inguinal hernia
Authors: Sah Vijay Pratap , Sah Bikash Kumar , Sah Nishant , Khanal Bhawani , Kumar Abhijeet , Gupta Rakesh Kumar
Published: July 2024

Introduction:

Totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repair are the principal techniques in laparoscopic hernia repair. Seroma formation and pain are frequent complications of moderate-large size laparoscopic direct inguinal hernia mesh repair. This study was conducted to evaluate the feasibility of defect closure in moderate-large direct inguinal hernias and its effect on various outcomes.

Method:

This is a prospective cohort study from September 2020 to August 2021, where a total of 88 patients with uncomplicated direct inguinal hernia (M3 or more) were enrolled in the study and divided into two equal groups of TEP defect closure and non-closure, and various outcome measures were noted.

Results:

The majority of patients were male (94.31%), with a mean age range of 18–85 years, and had right-sided inguinal hernia (46.5%). Seroma formation at 10th POD in the defect closure and non-closure were 24% and 33% (p value: 0.225), which reduced to 11% and 18%, respectively, at 1 month (p value: 1.000). All seromas resolved within 6 months. Pain in VAS at 10th POD in the defect closure and non-closure were 1.55±0.571 and 1.38±0.527, respectively (p value: 0.121), which gradually decreased to 1.20±0.524 and 1.16±0.420 at a 6-month interval (p value: 0.689). The mean operative time in the bilateral and unilateral defect closure groups was 72.3±4.1 and 56.5±4.3 min, respectively, whereas that in the bilateral and unilateral defect non-closure groups was 62.3±3.7 and 45.7±3.6 min, respectively.

Conclusion:

The defect closure was found to have higher pain and less seroma formation at various intervals of time following TEP for moderate-large direct inguinal hernia. Although these findings were statistically insignificant, they may be clinically significant, and further studies with a larger sample size are suggested.
Symptom Clusters in Children With Leukemia Receiving Chemotherapy
Authors: Li Rongrong , Zhang Lin , Shen Xinyi , Ma Jinling , Chan Yuying , Li Huiling
Published: July 2024

Background

Leukemia represents the most prevalent childhood malignancy. Understanding the symptom clusters (SCs) associated with leukemia may help develop an effective care plan for affected children.

Objectives

The aims of this study were to summarize the methods of identifying SCs; ascertain the types, attributes, and changing patterns of SCs during different chemotherapy phases; and provide a point of reference for the subsequent improvement of symptom management in pediatric leukemia.

Methods

The methodological framework employed was the Joanna Briggs Institute Scoping Review Guide. A comprehensive search was conducted across various databases, including PubMed, EMBASE, CINAHL, Web of Science, MEDLINE, Scopus, and China National Knowledge Infrastructure from inception until July 15, 2023.

Results

A total of 14 articles were included in this review, 6 in English and 8 in Chinese. The Memorial Symptom Assessment Scale 10–18 is the most commonly used instrument, whereas factor analysis is the most common statistical method for SC identification. The SCs were classified into 12 categories. The most severe SCs varied across different phases. Specifically, the emotional cluster dominated the prechemotherapy phase, the gastrointestinal cluster surfaced during postinduction therapy, and the consolidation and maintenance therapy phases revealed the self-image disorder cluster.

Conclusion

Various consistent and dynamic SCs manifest among pediatric patients with leukemia undergoing chemotherapy.

Implications for Practice

Future research endeavors should formulate clear criteria to determine the stability and consistency of SCs, validate SC composition and characteristics, and devise precise symptom management protocols based on SC characteristics in the distinct chemotherapy phases.
Test time affects Farnsworth D15 outcomes in practiced, but not unpracticed, subjects with color vision deficiency
Authors: Cho Anne Arah , Ng Jason S.
Published: July 2024

SIGNIFICANCE

Imposing a time limit on the Farnsworth D15 test may prevent patients from compromising the test.

PURPOSE

This study aimed to investigate the effect of test time on the Farnsworth D15 color vision test in unpracticed and practiced subjects and determine an optimal test time.

METHODS

Twenty-one subjects (mean/standard deviation age, 33.1/9.3 years) with a range of congenital color vision deficiency participated in the study. Pseudoisochromatic plate screening, Farnsworth D15, and anomaloscope testing were performed for classification purposes. At each of 2 visits, 10 trials of the Farnsworth D15 were performed with a range in test times from 30 seconds to 10 minutes. Between visits, subjects practiced the test. Major crossovers were used as the outcome measure. A repeated-measures analysis of variance compared the scores across trials. Post hoc Dunnett's testing analyzed the pairwise data.

RESULTS

Although no significant difference in the mean number of major crossovers was found across the 10 trials for the first visit (F(9, 180) = 1.30, p=0.24), a significant difference was found for the second visit (F(9, 180) = 4.77, p<0.001). The range of mean number of major crossovers for the second visit was 1.71 to 5.1, with the 30-second trial resulting in the largest number of major crossovers and the longest trial resulting in the smallest number of major crossovers. Analysis showed that a 2-minute time limit resulted in a Farnsworth D15 outcome that would be expected based on the anomaloscope for a majority of subjects.

CONCLUSIONS

In this study, test time was found to affect performance in practiced subjects but not in unpracticed subjects. Based on this study, we recommend enforcing a time limit of 2 minutes to discourage those who try to pass the Farnsworth D15 through practice. Additional measures, such as recording patient behavior, can also be taken.
Implementation of Intrahospital Transfer Strategy During COVID-19 and Identification of Success Factors Based on DEMATEL Technique
Authors: Ahmadinejad Bahareh , Jalali Alireza , Bahramian Fatemeh , Shabani Amir , Sherafati Mohammadali
Published: July 2024

Background and Objectives:

The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID.

Methods:

Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors’ success.

Results:

The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria.

Conclusion:

The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.
Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi
Authors: Puchi Carolina , Paravic-Klijn Tatiana , Salazar Alide
Published: July 2024

Background and Objectives:

The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique.

Methods:

The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts.

Results:

Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care.

Conclusions:

The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.
Clinical Validation of a Deep Learning Algorithm for Automated Coronary Artery Disease Detection and Classification Using a Heterogeneous Multivendor Coronary Computed Tomography Angiography Data Set
Authors: Muscogiuri Emanuele , van Assen Marly , Tessarin Giovanni , Razavi Alexander C. , Schoebinger Max , Wels Michael , Gulsun Mehmet Akif , Sharma Puneet , Fung George S. K. , De Cecco Carlo N.
Published: July 2024

Purpose:

We sought to clinically validate a fully automated deep learning (DL) algorithm for coronary artery disease (CAD) detection and classification in a heterogeneous multivendor cardiac computed tomography angiography data set.

Materials and Methods:

In this single-centre retrospective study, we included patients who underwent cardiac computed tomography angiography scans between 2010 and 2020 with scanners from 4 vendors (Siemens Healthineers, Philips, General Electrics, and Canon). Coronary Artery Disease–Reporting and Data System (CAD-RADS) classification was performed by a DL algorithm and by an expert reader (reader 1, R1), the gold standard. Variability analysis was performed with a second reader (reader 2, R2) and the radiologic reports on a subset of cases. Statistical analysis was performed stratifying patients according to the presence of CAD (CAD-RADS >0) and obstructive CAD (CAD-RADS ≥3).

Results:

Two hundred ninety-six patients (average age: 53.66 ± 13.65, 169 males) were enrolled. For the detection of CAD only, the DL algorithm showed sensitivity, specificity, accuracy, and area under the curve of 95.3%, 79.7%, 87.5%, and 87.5%, respectively. For the detection of obstructive CAD, the DL algorithm showed sensitivity, specificity, accuracy, and area under the curve of 89.4%, 92.8%, 92.2%, and 91.1%, respectively. The variability analysis for the detection of obstructive CAD showed an accuracy of 92.5% comparing the DL algorithm with R1, and 96.2% comparing R1 with R2 and radiology reports. The time of analysis was lower using the DL algorithm compared with R1 (P < 0.001).

Conclusions:

The DL algorithm demonstrated robust performance and excellent agreement with the expert readers' analysis for the evaluation of CAD, which also corresponded with significantly reduced image analysis time.
Surgical Technique Selection in the Management of Pediatric Gynecomastia
Authors: Ragsdale Louisa B. , Pyon Rachel , Plikaitis Christina M.
Published: July 2024

Introduction:

Although the majority of pubertal onset gynecomastia is self-resolving in nature, persistent deformity may require surgical intervention. This study aims to identify patient factors associated with surgical technique selection and proposes an algorithm for the surgical management of pediatric gynecomastia.

Methods:

A retrospective analysis was performed of all surgically managed pediatric gynecomastia patients operated on at a single institution from 2012 to 2022. Charts and patient photos were analyzed for patient and operative demographics, endocrinologic comorbidities, complications, and outcomes. Data were analyzed using bivariate and logistic regression analysis.

Results:

Fifty-six surgically managed gynecomastia patients less than 18 years of age were included. The average age at surgery was 16.1 years old, with a mean BMI of 26.9. Most patients were overweight or obese (54.8%) and had Simon grade IIb or greater gynecomastia (55.4%) at presentation. All patients underwent 1 of 4 mastectomy techniques with or without liposuction: inferior periareolar (n=25, 44.6%), circumareolar (n=13, 23.1%), transverse with pedicled nipple (n=4, 7.1%), or free nipple graft (n=14, 25.0%). Bivariate and logistic regression analysis revealed significant differences in sternal notch-to-nipple distance, nipple-to-inframammary fold distance, breast resection weight, and gynecomastia grade between the 4 surgical techniques used in this study. An algorithm incorporating these factors was devised to guide surgical decision-making.

Conclusions:

The proposed algorithm guides surgical technique selection for pediatric gynecomastia and is contingent upon the degree of ptosis and skin excess, anticipated resection weight, and skin quality.
Nasal Deformity Correction in Cleft Lip and Palate Patients by Secondary Rhinoplasty: Patients Satisfactions
Authors: Ghanim Khalid , Alsabee Waleed M.B. , Al-Rawee Rawaa Y. , Tawfeeq Bashar Abdul-Ghani
Published: July 2024

Aim of the Study:

To evaluate the degree of patient satisfaction postsecondary rhinoplasty, specifically in cleft patients in Mosul city.

Methodology:

A retrospective comparison questionnaire study was conducted between March and April 2024 among cleft patients who underwent surgical secondary rhinoplasty in Mosul City of Nineveh Province. All cleft patients aged 18 to 40 who underwent secondary rhinoplasty are included in the study. Forty participants respond to a specific questionnaire in 3 time periods (before surgery 3 and 6 months after). Basic demographic information (age, gender, cause of visit, diagnosis, and treatment) is recorded. Questionnaire which conflict the patient’s perception presurgery and postsurgery also. The improvement rate and reduction rate of improvement are calculated according to a special equation.

Thanks for such comment. The sentences changed as requested with (Six standard questions applied to evaluate the patients’ satisfaction postsurgery. Responses are assessed statistically by special equation to detect the improvement rate).

Results:

According to age groups, the age between 26 and 30 years have the highest incidence between the cases with 37.5%. Females are highest with (55%). Esthetics are the most common cause. Effective or improvement rate shows positive except for question 6 ( median: 4%). The reduction rate shows positive results.

Conclusions:

Despite being a complicated surgical operation, cleft rhinoplasty can yield symmetry, improved esthetics, and enhanced functioning, including improved breathing, which can be life-changing for patients and fulfilling for the surgeon. Its difficulty stems from the fact that it has required several surgical phases throughout the years, each of which calls for a comprehensive surgical team with a variety of specializations to be addressed for optimal outcomes.
Aerobic Fitness of Elderly Community and Non-Community Individuals After Chronic Stroke
Authors: Ferreira de Oliveira Maria Clara , Joviano Galvão Ana Carolina , Moura Dario Daniella , Tavares Aguiar Larissa , Cunha Polese Janaine
Published: July 2024

Introduction:

Stroke commonly causes low aerobic fitness and walking speed.

Objective:

To compare the estimated aerobic fitness of the community and non-community elderly individuals after chronic stroke. Investigate the association between walking speed and aerobic fitness.

Methods:

Elderly people after stroke classified as community walkers or limited community walkers, according to their walking speed (10-m walk test), in m/s, were assessed with The Human Activity Profile (HAP). The Lifestyle Energy Consumption (LEC) score of the HAP was used to estimate aerobic fitness through the peak oxygen uptake (V̇o2peak).

Results:

Aerobic fitness of elderly individuals after stroke classified as community walkers was on average 17.3 (6.0) mL kg−1 min−1, while for non-community walkers, it was on average 10.2 (5.6) mL kg−1 min−1. There was a significant difference between groups (−7.05, 95% CI −10.98 to −3.12; P < .001). A statistically significant (P < .001) association with moderate magnitude (r = 0.587) was observed between the LEC and the habitual walking speed.

Conclusions:

Individuals with lower walking speed have lower aerobic fitness.
A Randomized Controlled Clinical Trial of Xingnao Kaiqiao Acupuncture Combined With Modern Rehabilitation Therapy in the Treatment of Cognitive Dysfunction After Acute Ischemic Stroke
Authors: Mu Xin , Guo Lan , Yang Ying , Qin Yu-xi , Jing Xing-wen , Mao Min
Published: July 2024

Objective:

To investigate the therapeutic effect of Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy on cognitive dysfunction after acute ischemic stroke (AIS).

Methods:

Totally 140 patients with cognitive impairment after AIS admitted to Sichuan Provincial Rehabilitation Hospital from September 2016 to May 2021 were included in this prospective randomized controlled trial. After admission, patients were randomly divided into the trial group and the control group based on a computer-generated random number table. Patients in the trial group were treated with Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy, and those in the control group were treated with modern rehabilitation therapy alone. Before and after treatment, Mini-Mental State Examination (MMSE) and Barthel index (BI) were used to evaluate the cognitive function and daily living activities, and event-related potentials (ERP) were also measured in both groups. Statistical analyses were performed to compare the results between the two groups.

Results:

Finally 135 patients were included, 67 in the trial group and 68 in the control group. After treatment, the MMSE score and BI were significantly improved in both groups as compared with those before treatment (both P < .001). In the trial group, the BI and the MMSE subscores in the domains of orientation, registration, recall, and language were significantly higher than those in the control group (all P < 0.05). The global MMSE score of the trial group was higher than that of the control group both after 2 and 4 weeks of treatment, and the differences were statistically significant (P = 0.000/0.001). In the analysis of time effect alone, time had significant effects on the MMSE score in both groups (P < 0.001). After treatment, the latencies of P3 waves were significantly shorter and the amplitudes of P3 waves were significantly higher in the trial group as compared with the control group (both P < 0.05).

Conclusion:

Xingnao Kaiqiao acupuncture combined with modern rehabilitation therapy may be associated with a better efficacy in treating cognitive dysfunction after AIS. The effect of Xingnao Kaiqiao acupuncture on ERP may play a role in the mechanism underlying such a therapeutic effect.
Handheld Dynamometry Agrees With One-Repetition Maximum Testing With Cuff Weights for Knee Extension, Hip Abduction, and Hip Extension in Older Adults
Authors: Anemaet Wendy K. , Hammerich Amy S.
Published: July 2024

This study compared handheld dynamometry (HHD) at the weakest point of the strength curve for hip extensors, hip abductors, and knee extensors in older adults and one-repetition maximum (1RM) of that same muscle groups with cuff weights. Fifty participants (62-94 years) were tested. Paired t tests indicated no significant differences between the 2 measures. Reliability testing for absolute agreement between 1RM and HHD yielded intraclass correlations of good to excellent. This demonstrates HHD at or near the weakest point of a muscle group provides an accurate measure of older individual’s 1RM for knee extension, hip extension, and hip abduction.
The Age Factor in Cardiac Rehabilitation
Authors: Biben Vitriana , Tanuwidjaja Deta , Zamir Arief , Nurarifah Sitti Ayu Hemas
Published: July 2024

Coronary artery disease (CAD) is a major global cause of death, and its risk increases with age. This study investigates the relationship between age, patient characteristics, and rehabilitation outcomes in the cardiac rehabilitation (CR) of CAD. A cross-sectional study analyzed 60 medical records of post-coronary artery bypass graft (CABG) or post-percutaneous coronary intervention (PCI) patients who underwent a 6-week CR program after a graded exercise test using the Modified Bruce Protocol. The CR consists of 90% male participants, with an average age of 59.25 ± 6.69 years and an overweight body mass index. CR increases metabolic equivalents in all subjects, while age has a weakly significant negative correlation with the result of CR, so it can be concluded that CR is advantageous for older post-CABG or post-PCI patients.
Repositioning Guidelines to Decrease Pressure Injury in the Pediatric Intensive Care Unit
Authors: Birdsong Margaret T. , Ascenzi Judy , Aquino Carla , Kudchadkar Sapna R.
Published: July 2024

PURPOSE:

The purpose of this quality improvement (QI) project was to develop and implement repositioning guidelines that reduce pressure injury (PI) in hemodynamically unstable pediatric intensive care unit (PICU) patients.

PARTICIPANTS AND SETTING:

All PICU patient ages 0 to 36 months who required sedation for invasive mechanical ventilation and had a Braden Q score ≤ 18 were eligible for inclusion. The project was implemented in 116 patients preimplementation and 100 postimplementation. Their median t age was 5 months (interquartile range 2-13 months). The QI project setting was an academic hospital PICU with a Level I trauma center located in the Mid-Atlantic Region of the United States.

APPROACH:

A pre-post observational design was used to compare the at-risk population for 21 weeks before (August-December 2018) and after (August-December 2019) implementing repositioning guidelines. Turn attempts were undertaken every 2 hours. Repositioning attempts were defined as (1) full (30°); (2) partial (15°); (3) unable to turn owing to hemodynamic instability; or (4) noncompliance. The primary outcome was incidence of Stage II or higher PI.

OUTCOMES:

We found a significant reduction in the incidence of PI before and after implementation of the repositioning intervention (16.4% vs 2.0%, P = .0003).

IMPLICATIONS FOR PRACTICE:

A structured intervention for repositioning hemodynamically unstable PICU patients has the potential to significantly lower PI incidence in a group of hemodynamically unstable children.
Connected interactions: enriching food web research by spatial and social interactions
Authors: Valdovinos Fernanda S. , Bodini Antonio , Jordán Ferenc
Published: July 2024

This theme issue features 18 papers exploring ecological interactions, encompassing metabolic, social, and spatial connections alongside traditional trophic networks. This integration enriches food web research, offering insights into ecological dynamics. By examining links across organisms, populations, and ecosystems, a hierarchical approach emerges, connecting horizontal effects within organizational levels vertically across biological organization levels. The inclusion of interactions involving humans is a key focus, highlighting the need for their integration into ecology given the complex interactions between human activities and ecological systems in the Anthropocene. The comprehensive exploration in this theme issue sheds light on the interconnectedness of ecological systems and the importance of considering diverse interactions in understanding ecosystem dynamics.

This article is part of the theme issue ‘Connected interactions: enriching food web research by spatial and social interactions’.
Limited function of road verges as habitat for species connecting plant–bee networks in remnant semi-natural grasslands
Authors: Henriksen Marie V. , Bär Annette , Garratt Michael P. D. , Nielsen Anders , Johansen Line
Published: July 2024

Species-rich natural and semi-natural ecosystems are under threat owing to land use change. To conserve the biodiversity associated with these ecosystems, we must identify and target conservation efforts towards functionally important species and supporting habitats that create connections between remnant patches in the landscape. Here, we use a multi-layer network approach to identify species that connect a metanetwork of plant–bee interactions in remnant semi-natural grasslands which are biodiversity hotspots in European landscapes. We investigate how these landscape connecting species, and their interactions, persist in their proposed supporting habitat, road verges, across a landscape with high human impact. We identify 11 plant taxa and nine bee species that connect semi-natural grassland patches. We find the beta diversity of these connector species to be low across road verges, indicating a poor contribution of these habitats to the landscape-scale diversity in semi-natural grasslands. We also find a significant influence of the surrounding landscape on the beta diversity of connector species and their interactions with implications for landscape-scale management. Conservation actions targeted toward species with key functional roles as connectors of fragmented ecosystems can provide cost-effective management of the diversity and functioning of threatened ecosystems.

This article is part of the theme issue ‘Connected interactions: enriching food web research by spatial and social interactions’.
Ecological associations distribution modelling of marine plankton at a global scale
Authors: Gaudin Marinna , Eveillard Damien , Chaffron Samuel
Published: July 2024

Marine plankton communities form intricate networks of interacting organisms at the base of the food chain, and play a central role in regulating ocean biogeochemical cycles and climate. However, predicting plankton community shifts in response to climate change remains challenging. While species distribution models are valuable tools for predicting changes in species biogeography under climate change scenarios, they generally overlook the key role of biotic interactions, which can significantly shape ecological processes and ecosystem responses. Here, we introduce a novel statistical framework, association distribution modelling (ADM), designed to model and predict ecological associations distribution in space and time. Applied on a
Tara
Oceans genome-resolved metagenomics dataset, the present-day biogeography of ADM-inferred marine plankton associations revealed four major biogeographic biomes organized along a latitudinal gradient. We predicted the evolution of these biome-specific communities in response to a climate change scenario, highlighting differential responses to environmental change. Finally, we explored the functional potential of impacted plankton communities, focusing on carbon fixation, outlining the predicted evolution of its geographical distribution and implications for ecosystem function.

This article is part of the theme issue ‘Connected interactions: enriching food web research by spatial and social interactions’.