bluuebunny/crossref_metadata_2025 huggingface dataset:
INFLIXIMAB AND VEDOLIZUMAB HAVE SIMILAR CLINICAL AND SAFETY OUTCOMES AMONG BIOLOGIC-NAÏVE PATIENTS WITH MILD TO MODERATE PEDIATRIC INFLAMMATORY BOWEL DISEASE
Authors: Elknawy Essam , Rosen Michael , Colman Ruben , Goyal Alka
Published: January 2024

BACKGROUND

Infliximab (IFX) is the only FDA-approved intravenous therapy for the treatment of pediatric inflammatory bowel disease (IBD). The gut-selective anti-integrin vedolizumab (VDZ) has been increasingly used as second-line therapy. However, the comparative effectiveness of IFX vs. VDZ to treat biologic-naïve children with IBD is currently unknown.

AIMS

1. Compare the real-world effectiveness of IFX vs. VDZ in bio-naïve pediatric patients with IBD at 12 months. 2. Study the safety of IFX and VDZ in the pediatric population.

METHODS

A single-center retrospective cohort study was conducted at an academic children’s hospital between February 2015 and August 2023. We included bio-naive mild-moderate IBD patients, <23 years old, who started IFX or VDZ as their first advanced therapy. Patients with a confirmed diagnosis of IBD based on Porto criteria with baseline and at least 6-month follow-up data were included. Exclusion criteria were designed to limit the study population to patients who would typically be eligible for vedolizumab treatment according to the current standard of care, including: prior biologic use; steroid-refractory acute-severe colitis; stricturing or penetrating Crohn’s disease (CD); or perianal disease; and extraintestinal manifestations. The primary outcome was steroid-free clinical remission (SFCR) at 12 months, defined by the PUCAI <10 or ShPCDAI <10 and off corticosteroids. Biochemical remission (BR) was defined as fecal calprotectin (FCP) <250 μg/g. Descriptive statistics included the Chi-square and the Mann-Whitney U test.

RESULTS

Among the 100 included patients, 73 in IFX group vs. 27 in VDZ group, the mean age was 13 ± 4 years old, males were 68% (IFX) vs. 41% (VDZ) (P = 0.01). 49% had CD, 48% had UC, and 3% had unclassified IBD (IBDU). IFX- and VDZ-treated patients had similar Paris classifications. Baseline albumin levels (3.7 vs. 4.2 g/L, P<0.01) and steroid use (58% vs. 74%, P = 0.13) were lower in IFX vs. VDZ-treated patients. 12-month SFCR was 72% (49/68) and 71% (15/21) in IFX- and VDZ-treated patients, respectively (NS). Among SFCR at 12 months, BR was 59.62% (IFX) vs. 76.47% (VDZ), P = 0.21. Adverse events were rated as mild to moderate and occurred rarely in 8.22% (6/73) of IFX patients and in 7.41% (2/27) of VDZ patients (P = 0.89). These included an infusion reaction (1 in each group), elevated liver enzymes (1 in each group), infection (1), folliculitis (1), eczema (1), , and psoriasis (1).

CONCLUSION

We found both IFX and VDZ to have similar effectiveness in achieving SFCR and BR at 12 months when used as first-line agents for patients with uncomplicated mild-moderately active IBD. Prospective, larger head-to-head studies are needed for further validation.

IFX group vs. VDZ group at the baseline.

IFX group vs. VDZ group for Steroid Free Clinical Remission Patients at 12 months.
THE DEVELOPMENT OF HUMAN PRIMARY CULTURE MODELS TO MODEL INFLAMMATORY SIGNALING IN CROHN’S DISEASE AND ULCERATIVE COLITIS
Authors: Thelin William
Published: January 2024

Intestinal inflammation is a major pathological feature associated with gastrointestinal disorders such as Crohn’s disease and ulcerative colitis (UC). To unravel the complex mechanisms underlying these conditions and to develop effective therapeutic strategies, it is crucial to recapitulate intestinal inflammatory signaling using accurate and biologically relevant experimental systems. To establish primary cell-based models that reprise the inflammatory signaling in Crohn’s and UC, we developed the RepliGut platform. Briefly, we established a biobank of primary intestinal stem cells, derived from healthy full-length intestines from a range of donors of different sexes, ages, and ethnicities. From each donor, intestinal epithelial stem cells were isolated from each region of the small intestine and colon (duodenum, jejunum, ileum, ascending colon, transverse colon, and descending colon). The intestinal stem cells were passed to generate large and quality-controlled cell lots of “ready-to-use” vials which are cryopreserved and can be thawed directly onto 12- or 96-well Transwell inserts, generating the RepliGut platform. The RepliGut culture conditions allow for investigation into the physiology of intestinal epithelial cells as either proliferative stem or differentiated cell types and enable studies on focused regional differences in the intestinal tract, while the Transwell platform allows apical and basal media access that facilitates barrier function measures and convenient bi-lateral media sampling. Using this system, Crohn’s and UC-like inflammation can be produced via treatment with the most clinically and therapeutically validated cytokines associated with disease pathophysiology, TNF-α and IFN-γ. Circulating concentrations of both TNF-α and IFN-γ are observed to be elevated in patients with inflammatory bowel diseases and therapeutic antagonists including adalimumab (TNF-α) and JAK inhibitors such as tofacitinib (IFN-γ) represent the current standard of care. On the RepliGut platform, both TNF-α and IFN-γ produced a dose-dependent loss in epithelial barrier function, increased cytokine secretion, and caused cellular death, all of which were mitigated by adalimumab and tofacitinib, respectively. Moreover, at clinically relevant concentrations, combinations of TNF-α and IFN-γ produced synergistic inflammatory response on the intestinal epithelial cultures. In summary, the RepliGut platform provides a convenient and high-throughput platform that reproduces cytokine-induced intestinal inflammation for mechanistic studies and drug screening.
Monodromy Kernels for Strata of Translation Surfaces
Authors: Giannini Riccardo
Published: January 2024

The non-hyperelliptic connected components of the strata of translation surfaces are conjectured to be orbifold classifying spaces for some groups commensurable to some mapping class groups. The topological monodromy map of the non-hyperelliptic components projects naturally to the mapping class group of the underlying punctured surface and is an obvious candidate to test commensurability. In the present article, we prove that for the components $\mathcal {H}(3,1)$ and $\mathcal {H}^{nh}(4)$ in genus 3 the monodromy map fails to demonstrate the conjectured commensurability. In particular, building on the work of Wajnryb, we prove that the kernels of the monodromy maps for $\mathcal {H}(3,1)$ and $\mathcal {H}^{nh}(4)$ are large, as they contain a non-abelian free group of rank $2$.
Gardnerella Species and Their Association With Bacterial Vaginosis
Authors: Munch Matthew M , Strenk Susan M , Srinivasan Sujatha , Fiedler Tina L , Proll Sean , Fredricks David N
Published: January 2024

Background

Bacterial vaginosis (BV) is a condition marked by high vaginal bacterial diversity. Gardnerella vaginalis has been implicated in BV but is also detected in healthy women. The Gardnerella genus has been expanded to encompass 6 validly named species and several genomospecies. We hypothesized that particular Gardnerella species may be more associated with BV.

Methods

Quantitative polymerase chain reaction (PCR) assays were developed targeting the cpn60 gene of species groups including G. vaginalis, G. piotii/pickettii, G. swidsinskii/greenwoodii, and G. leopoldii. These assays were applied to vaginal swabs from individuals with (n = 101) and without BV (n = 150) attending a sexual health clinic in Seattle, Washington. Weekly swabs were collected from 42 participants for up to 12 weeks.

Results

Concentrations and prevalence of each Gardnerella species group were significantly higher in participants with BV; 91.1% of BV-positive participants had 3 or more Gardnerella species groups detected compared to 32.0% of BV-negative participants (P < .0001). BV-negative participants with 3 or more species groups detected were more likely to develop BV within 100 days versus those with fewer (60.5% vs 3.7%, P < .0001).

Conclusions

These results suggest that BV reflects a state of high Gardnerella species diversity. No Gardnerella species group was a specific marker for BV.
Harnessing the potential of large language models in medical education: promise and pitfalls
Authors: Benítez Trista M , Xu Yueyuan , Boudreau J Donald , Kow Alfred Wei Chieh , Bello Fernando , Van Phuoc Le , Wang Xiaofei , Sun Xiaodong , Leung Gilberto Ka-Kit , Lan Yanyan , Wang Yaxing , Cheng Davy , Tham Yih-Chung , Wong Tien Yin , Chung Kevin C
Published: January 2024

Objectives

To provide balanced consideration of the opportunities and challenges associated with integrating Large Language Models (LLMs) throughout the medical school continuum.

Process

Narrative review of published literature contextualized by current reports of LLM application in medical education.

Conclusions

LLMs like OpenAI’s ChatGPT can potentially revolutionize traditional teaching methodologies. LLMs offer several potential advantages to students, including direct access to vast information, facilitation of personalized learning experiences, and enhancement of clinical skills development. For faculty and instructors, LLMs can facilitate innovative approaches to teaching complex medical concepts and fostering student engagement. Notable challenges of LLMs integration include the risk of fostering academic misconduct, inadvertent overreliance on AI, potential dilution of critical thinking skills, concerns regarding the accuracy and reliability of LLM-generated content, and the possible implications on teaching staff.
Dietary glycine supplementation enhances glutathione availability in tissues of pigs with intrauterine growth restriction
Authors: He Wenliang , Posey Erin A , Steele Chandler C , Savell Jeffrey W , Bazer Fuller W , Wu Guoyao
Published: January 2024

This study tested the hypothesis that dietary supplementation with glycine enhances the synthesis and concentrations of glutathione (GSH, a major antioxidant) in tissues of pigs with intrauterine growth restriction (IUGR). At weaning (21 d of age), IUGR pigs and litter mates with normal birth weights (NBW) were assigned randomly to one of two groups, representing supplementation with 1% glycine or 1.19% l-alanine (isonitrogenous control) to a corn- and soybean meal-based diet. Blood and other tissues were obtained from the pigs within 1 wk after the feeding trial ended at 188 d of age to determine GSH, oxidized GSH (GSSG), and activities of GSH-metabolic enzymes. Results indicated that concentrations of GSH + GSSG or GSH in plasma, liver, and jejunum (P < 0.001) and concentrations of GSH in longissimus lumborum and gastrocnemius muscles (P < 0.05) were lower in IUGR pigs than in NBW pigs. In contrast, IUGR increased GSSG/GSH ratios (an indicator of oxidative stress) in plasma (P < 0.001), jejunum (P < 0.001), both muscles (P < 0.05), and pancreas (P = 0.001), while decreasing activities of γ-glutamylcysteine synthetase and GSH synthetase in liver (P < 0.001) and jejunum (P < 0.01); and GSH reductase in jejunum (P < 0.01), longissimus lumborum muscle (P < 0.01), gastrocnemius muscle (P < 0.05), and pancreas (P < 0.01). In addition, IUGR pigs had greater (P < 0.001) concentrations of thiobarbituric acid reactive substances (TBARS; an indicator of lipid peroxidation) in plasma, jejunum, muscles, and pancreas than NBW pigs. Compared with isonitrogenous controls, dietary glycine supplementation increased concentrations of GSH plus GSSG and GSH in plasma (P < 0.01), liver (P < 0.001), jejunum (P < 0.001), longissimus lumborum muscle (P = 0.001), and gastrocnemius muscle (P < 0.05); activities of GSH-synthetic enzymes in liver (P < 0.01) and jejunum (P < 0.05), while reducing GSSG/GSH ratios in plasma (P < 0.001), jejunum (P < 0.001), longissimus lumborum muscle (P < 0.001), gastrocnemius muscle (P = 0.01), pancreas (P < 0.05), and kidneys (P < 0.01). Concentrations of GSH plus GSSG, GSH, and GSSG/GSH ratios in kidneys were not affected (P > 0.05) by IUGR. Furthermore, glycine supplementation reduced (P < 0.001) TBARS concentrations in plasma, jejunum, muscles, and pancreas. Collectively, IUGR reduced GSH availability and induced oxidative stress in pig tissues, and these abnormalities were prevented by dietary glycine supplementation in a tissue-specific manner.
Inter-organizational governance and innovation under different local institutional contexts
Authors: Belso-Martinez Jose Antonio , Díez-Vial Isabel , Rodríguez-Pose Andrés
Published: January 2024

This article examines the effect of formal and informal institutional settings and of the governance of inter-organizational relationships on innovation at the cluster level. The research primarily relies on quantitative methods, utilizing data obtained from a survey involving 115 firms and 12 in-depth interviews. Supplementary qualitative information from the interviews has also been incorporated into the analysis. The results support the hypothesis that innovative firms should consider not only the impact of different governance modes but also how these modes align with the existing local contexts. Failure to do so may result in firms becoming entrenched in the prevailing practices and products of a specific location.
One-pot chemoenzymatic syntheses of non-canonical amino acids
Authors: Chao Tsung-Han , Wu Xiangyu , Renata Hans
Published: January 2024

Despite their prevalent use in drug discovery and protein biochemistry, non-canonical amino acids are still challenging to synthesize through purely chemical means. In recent years, biocatalysis has emerged as a transformative paradigm for small-molecule synthesis. One strategy to further empower biocatalysis is to use it in combination with modern chemical reactions and take advantage of the strengths of each method to enable access to challenging structural motifs that were previously unattainable using each method alone. In this Mini-Review, we highlight several recent case studies that feature the synergistic use of chemical and enzymatic transformations in one pot to synthesize novel non-canonical amino acids.

One-Sentence Summary

This Mini-Review highlights several recent case studies that feature the synergistic use of chemical and enzymatic transformations in one pot to synthesize novel non-canonical amino acids.
How dual-message nature documentaries that portray nature as amazing and threatened affect entertainment experiences and pro-environmental intentions
Authors: Freytag Anna , Possler Daniel
Published: January 2024

Nature documentaries are an entertaining and informative genre that appears well-suited to environmental communication. However, producers of nature documentaries face a dilemma: Although they aim to inspire their audiences to act pro-environmentally, they fear ruining viewers’ entertainment experience if they address environmental destruction. Hence, conventional nature documentaries solely portray pristine nature. In contrast, recent nature documentaries have adopted a dual-message strategy by showing beautiful nature footage while also addressing conservation issues. We investigated how these dual-message nature documentaries affect viewers’ hedonic and eudaimonic entertainment experiences and their pro-environmental behavior intentions compared with conventional nature documentaries. We integrated theoretical accounts from entertainment research and environmental psychology and tested our assumptions in three online experiments (total N = 1,362). Our findings suggest that dual-message nature documentaries evoke weaker hedonic experiences than conventional documentaries but stronger eudaimonic experiences (i.e., mixed affect and reflection) that mediate the effect of dual-message documentaries on pro-environmental intentions.
The mobilization and transport of newly fixed carbon are driven by plant water use in an experimental rainforest under drought
Authors: Huang Jianbei , Ladd S Nemiah , Ingrisch Johannes , Kübert Angelika , Meredith Laura K , van Haren Joost , Bamberger Ines , Daber L Erik , Kühnhammer Kathrin , Bailey Kinzie , Hu Jia , Fudyma Jane , Shi Lingling , Dippold Michaela A , Meeran Kathiravan , Miller Luke , O’Brien Michael J , Yang Hui , Herrera-Ramírez David , Hartmann Henrik , Trumbore Susan , Bahn Michael , Werner Christiane , Lehmann Marco M
Published: January 2024

Non-structural carbohydrates (NSCs) are building blocks for biomass and fuel metabolic processes. However, it remains unclear how tropical forests mobilize, export, and transport NSCs to cope with extreme droughts. We combined drought manipulation and ecosystem 13CO2 pulse-labeling in an enclosed rainforest at Biosphere 2, assessed changes in NSCs, and traced newly assimilated carbohydrates in plant species with diverse hydraulic traits and canopy positions. We show that drought caused a depletion of leaf starch reserves and slowed export and transport of newly assimilated carbohydrates below ground. Drought effects were more pronounced in conservative canopy trees with limited supply of new photosynthates and relatively constant water status than in those with continual photosynthetic supply and deteriorated water status. We provide experimental evidence that local utilization, export, and transport of newly assimilated carbon are closely coupled with plant water use in canopy trees. We highlight that these processes are critical for understanding and predicting tree resistance and ecosystem fluxes in tropical forest under drought.
Examination of prognostic factors in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis
Authors: Sugi Suzuna , Tominaga Masaki , Kaieda Shinjiro , Fujimoto Kiminori , Chikasue Tomonori , Koga Takuma , Hasuo Yuri , Iwanaga Erina , Murotani Kenta , Lim Jamie Kristen T , Ida Hiroaki , Kawayama Tomotaka , Hoshino Tomoaki
Published: January 2024

Objective

This study investigated the prognostic factors of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5-DM).

Methods

This study analysed 34 MDA5-DM cases (20 and 14 in the survival and death groups, respectively) encountered at Kurume University between 2008 and 2021. The clinical, physiological, and computed tomography findings, pulmonary function, and serological results were retrospectively evaluated for each MDA5-DM case during the first visit and throughout the next 12 weeks.

Results

In the death group, the mean age of patients was higher (47.6 vs. 61.8 years), while the duration from symptom onset to consultation was shorter (110 vs. 34.9 days). During the first visit, the death group demonstrated a significantly higher serum C-reactive protein level (0.52 vs. 1.99) and a significantly lower albumin level (3.23 vs. 2.63) than the survival group; this persisted throughout the next 12 weeks. Poor prognosis was associated with C-reactive protein and albumin levels >0.19 mg/dl and <2.3 g/dl, respectively, 4 weeks after starting the treatment.

Conclusion

Four weeks after starting the treatment, serum C-reactive protein and albumin levels of patients with MDA5-DM can be used to evaluate treatment response and predict prognosis.
eHealth, family-based interventions, and multilevel approaches to pediatric weight management: a scoping review
Authors: Henes Sarah T , Stotz Sarah A , Riggs Sandra E , Yang Hsuan-Mein
Published: January 2024

Objective

This scoping review examines the current literature on technology-based, eHealth interventions that integrate community and clinical approaches for family-based pediatric weight management.

Background

Telehealth and eHealth interventions for weight management are increasingly commonplace; however, it is unclear in the current literature how family-based, pediatric, healthy-weight interventions integrate technology. Additionally, multilevel approaches to address childhood obesity, including working with clinical and community partners, are currently considered best practice and within the socioecological framework for sustainability of outcomes. Little is known how current family based pediatric healthy weight interventions integrate eHealth and multi-level approaches.

Methods

Guided by Arksey and O’Malley’s scoping review framework, a scoping literature review was conducted. Four databases were searched to identify studies conducted between 2010 and 2022 that addressed multilevel, family-based, pediatric weight management interventions that also integrated technology. Studies were excluded that did not include at least 2 of the 4 components and that did not include technology to some degree.

Results

A total of 15 articles were included in the scoping review. All articles included some type of technology in the intervention. Twelve articles included a family-based approach, and only 1 article fully used a holistic approach to family-based, pediatric weight management that included technology and integrated clinical and community approaches to address the complexity of childhood obesity.

Conclusions

There are several family-based, pediatric weight management interventions that incorporate an eHealth component. There is a gap in the literature about programs that use both technology and integrate multilevel clinical and community approaches for treatment. Additionally, gaps exist in information about adolescent, family-based, weight management interventions, and there are opportunities for nutrition and dietetic professionals to become more involved with technological and multilevel approaches in family-based pediatric weight management.
Challenges Facing Antimicrobial Stewardship Programs in the Endemic Region for Coccidioidomycosis
Authors: Hayes Justin F , Nix David E
Published: January 2024

Coccidioidomycosis poses a significant cost and morbidity burden in the United States. Additionally, coccidioidomycosis requires constant decision-making related to prevention, diagnosis, and management. Delays in diagnosis lead to significant consequences, including unnecessary diagnostic workup and antibacterial therapy. Antifungal stewardship considerations regarding empiric, prophylactic, and targeted management of coccidioidomycosis are also complex. In this review, the problems facing antimicrobial stewardship programs (ASPs) in the endemic region for coccidioidomycosis, consequences due to delayed or missed diagnoses of coccidioidomycosis on antibacterial prescribing, and excess antifungal prescribing for prevention and treatment of coccidioidomycosis are elucidated. Finally, our recommendations and research priorities for ASPs in the endemic region for coccidioidomycosis are outlined.
Towards Affective-Evaluativism: the Intentional Structure of Unpleasant Pain Experience
Authors: Mitchell Jonathan
Published: January 2024

Evaluativism about unpleasant pains offers one way to think about unpleasant pain experience. However, extant Evaluativist views do not pay enough attention to the affective dimension of pain experience and the complex relations between the affective, evaluative and sensory dimensions. This paper clarifies these relations and provides a view which more closely reflects the phenomenology of unpleasant pains. It argues that the intentional structure of paradigmatic unpleasant pain is as follows: unpleasant pains essentially involve a proprietary intentional mode—what I call affective-interoception—and a distinctive kind of evaluatively qualified sensory content. The resulting view is Affective-Evaluativism.
Loss Sharing in Central Clearinghouses: Winners and Losers
Authors: Kubitza Christian , Pelizzon Loriana , Sherman Mila Getmansky
Published: January 2024

Central clearing counterparties (CCPs) were established to mitigate default losses resulting from counterparty risk in derivatives markets. In a parsimonious model, we show that clearing benefits are unevenly distributed across market participants. Loss sharing rules determine who wins or loses from clearing. Current rules disproportionately benefit market participants with flat portfolios. Instead, those with directional portfolios are relatively worse off, consistent with their reluctance to voluntarily use central clearing. Alternative loss sharing rules can address cross-sectional disparities in clearing benefits. However, we show that CCPs may favor current rules to maximize fee income, with externalities on clearing participation. (JEL G18, G23, G28, G12)
What do you do when your career script runs out? How older workers decide whether and how to sustain their careers
Authors: Hallpike Helen , Van der Heijden Beatrice I J M , Vallée-Tourangeau Gaëlle
Published: January 2024

This article explores executive career decision-making at the later career stages, against a background of precarious employment and increasing longevity, and the consequent need, and difficulty, for older workers to sustain their careers for longer. We address a gap in the literature on the careers of later stage workers by exploring older executives’ career options and demonstrating how a decision-making unit (DMU) of stakeholders actively participate in choosing between options, and which factors influence their choices. We furthermore highlight the key factors that can determine whether a career is sustainable, and the strategies that can optimize a career that is becoming unsustainable. We interviewed later stage executives and analyzed our interview data from the perspective of distributed decision-making for sustainable careers. We identified a range of decision-makers who contributed to the DMU at different levels for each decision, from proactively to reactively. Furthermore, we identified interacting strategies which could optimize the sustainability of a later stage career: personal, when individuals re-engaged actively with their careers; and contextual, when careers were reinvented by individuals and organizations. We synthesized these findings in a career sustainability matrix, designed to enable later stage workers to identify whether a career is sustainable, and how to extend career sustainability.
South Africa celebrates 15 years of clinical associates
Authors: Smalley Scott , Mgobozi Aviwe
Published: January 2024

Clinical associates (ClinAs) in South Africa are modeled after physician associates in the United States and the Netherlands and clinical officers elsewhere in Africa. The first ClinAs began their education in 2008 and started working in 2011. Three universities offer a 3-year bachelor of clinical medical practice degree. This article documents the nascent healthcare profession's origins, development, current status, and future. In the next decade, South Africa needs to address the challenges of ClinA supervision with tiered practice regulations, combat unemployment, and increase graduate retention by developing career paths.
Empowering NPs to Treat Opioid Use Disorder
Authors: Queen Angela
Published: January 2024

It's time for full practice authority across all U.S. states.
Americans Are Struggling to Pay for Health Care
Authors: Roush Karen
Published: January 2024

Survey respondents said care was unaffordable even with insurance.
New CMS Rule Helps Bring Care to People Living on the Streets
Authors: Roush Karen
Published: January 2024

Billing codes for services apply to government and private insurers.
Burn Nursing
Authors: Carrougher Gretchen J.
Published: January 2024

Burn nurses care for patients throughout the recovery continuum.
The Role of Clinical Nurses in Supporting DEIB Initiatives
Authors: Gilles Selena Ann , Crespo-Fierro Michele , Johnson-Campbell Tanisha
Published: January 2024

Five steps nurses can take to lead change
Misoprostol Alone Is Safe and Effective for Abortion
Authors: Rosenberg Karen
Published: January 2024

According to this study:
Trusting the Wisdom of Elders
Authors: Yimmee Suchawadee
Published: January 2024

Empirical evidence shouldn't be the only guide in difficult treatment decisions.
Stress management strategies for NP practice
Authors: Felsenstein Denise R.
Published: January 2024

Knowledge of stress management strategies is helpful to NPs in clinical practice, as they frequently encounter patients or patients' family members who require assistance in managing acute stress. Patients or patients' family members may experience a high level of stress due to health factors such as pain, life-changing diagnoses, treatment options viewed as undesirable, and/or poor medical prognoses. In addition, healthcare visits, hospitalization, diagnostic tests, surgical procedures, and other treatments can cause stress for some patients. NPs should therefore be well informed about stress management strategies to be able to effectively educate and provide compassionate care for their patients. This article reviews four strategies designed to assist patients and/or their family members in reducing stress to allow for a more positive experience during a healthcare visit or hospitalization.
Food intolerances
Authors: Day Mercedes , Kuzin Julia , Spencer Michelle , Hilliard Tara , Phillips Priscila , Moore Amy
Published: January 2024

Food intolerances are prevalent and often confused with food allergies. This article reviews the complex landscape of adverse reactions to food, distinguishing between immune-mediated responses (food allergies) and nonimmune reactions (food intolerances). It also explores specific food intolerances such as lactose intolerance, nonceliac gluten sensitivity, fructose intolerance, and salicylate sensitivity.
Reproductive Outcomes of Oocyte Donation in Patients With Uterine Mullerian Anomalies
Authors: Muñoz Elkin , Fernandez Iria , Pellicer Nuria , Mariani Giulia , Pellicer Antonio , Garrido Nicolas
Published: January 2024

(Abstracted from Fertil Steril 2023;120(4):850–859)

Uterine müllerian anomalies (UMAs) are anatomic malformations of the female genital tract found in 5.5% of the general population but 24.5% of women with a history of miscarriage and infertility. Studies identifying the relationships between UMAs and reproductive outcomes suggest a higher rate of adverse outcomes but have largely been conducted in women using their own oocytes and have focused on a single anomaly category.
The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System
Authors: Sinkler Margaret A. , Furdock Ryan J. , Halloran Sean , Liu Raymond W.
Published: January 2024

Background:

The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals.

Methods:

Forty-three new anteroposterior (AP) hand radiographic parameters were identified from the Fels and Greulich and Pyle (GP) skeletal maturity systems. Twelve parameters were eliminated from further evaluation for poor correlation with skeletal maturity, poor reliability, and lack of relevance in the peripubertal years. In addition to the 8 previously described Modified Fels Wrist parameters, 31 hand radiographic parameters were evaluated on serial peripubertal AP hand radiographs to identify the ones most important for accurately estimating skeletal age. This process produced a “Modified Fels hand-wrist” model; its performance was compared with (1) GP only; (2) Sanders Hand (SH) only; (3) age, sex, and GP; (4) age, sex, and SH; and (5) Modified Fels Wrist system.

Results:

Three hundred seventy-two radiographs from 42 girls and 38 boys were included. Of the 39 radiographic parameters that underwent full evaluation, 9 remained in the combined Modified Fels Hand-Wrist system in addition to chronological age and sex. Four parameters are wrist specific, and the remaining 5 are hand specific. The Hand-Wrist system outperformed both GP and SH in estimating skeletal maturity (P<0.001). When compared with the Modified Fels Wrist system, the Modified Fels Hand-Wrist system performed similarly regarding skeletal maturity estimation (0.36±0.32 vs. 0.34±0.26, P=0.59) but had an increased (worse) rate of outlier predictions >1 year discrepant from true skeletal maturity (4.9% vs. 1.9%, P=0.01).

Conclusions:

The addition of hand parameters to the existing Modified Fels Wrist system did not improve skeletal maturity estimation accuracy and worsened the rate of outlier estimations. When an AP hand-wrist radiograph is available, the existing Modified Fels wrist system is best for skeletal maturity estimation.

Level of Evidence:

Level III.
Screening for hepatitis C as part of an opioid stewardship quality improvement initiative: Identifying infected patients and analyzing linkage to care
Authors: DeCamillis Rebekah B. , Hekman Aliza L. , Priest David H.
Published: January 2024

Screening patients with opioid use disorder (OUD) for HCV can potentially decrease morbidity and mortality if HCV-infected individuals are linked to care. We describe a quality improvement initiative focused on patients with OUD, incorporating an electronic health record decision-support tool for HCV screening across multiple health care venues, and examining the linkage to HCV care. Of 5829 patients with OUD, 4631 were tested for HCV (79.4%), (compared to a baseline of 8%) and 1614 (27.7%) tested positive. Two hundred and thirty patients had died at the study onset. Patients tested in the acute care and emergency department settings were more likely to test positive than those in the ambulatory setting (OR = 2.21 and 2.49, p < 0.001). Before patient outreach, 279 (18.2%) HCV-positive patients were linked to care. After patient outreach, 326 (23.0%) total patients were linked to care. Secondary end points included mortality and the number of patients who were HCV-positive who achieved a cure. The mortality rate in patients who were HCV-positive (12.2%) was higher than that in patients who were HCV-negative (7.4%) (OR = 1.72, p < 0.001) or untested patients (6.2%) (OR = 2.10, p<0.001). Of the 326 with successful linkage to care, 113 (34.7%) had a documented cure. An additional 55 (16.9%) patients had a possible cure, defined as direct acting antiviral ordered but no follow-up documented, known treatment in the absence of documented sustained viral response lab draw, or documentation of cure noted in outside medical records but unavailable laboratory results. A strategy utilizing electronic health record decision-support tools for testing patients with OUD for HCV was highly effective; however, linking patients with HCV to care was less successful.
Causes and outcomes of implantable collamer lens explantation in patients with corneal endothelial cell loss
Authors: Yoon Hye Yeon , Byun Yong-soo , Kim Hyun Seung , Chung So-Hyang
Published: January 2024

Purpose:

To investigate the correlated factors of corneal endothelial cell density (ECD) loss and ECD change in implantable collamer lens (ICL) explantation patients.

Setting:

Seoul St. Mary's Hospital, Seoul, South Korea.

Design:

Retrospective analysis.

Methods:

The study cohort consisted of 93 eyes from 50 patients who underwent ICL explantation. Correlation analysis was performed to assess the ocular parameters associated with ECD loss, while percentage of ECD change (ΔECD%) was monitored up to 6 months postoperatively. Receiver operating characteristic (ROC) curve was used to set cutoff values of ocular parameters to prevent ECD loss after explantation.

Results:

In multiple regression analysis, high vaulting, high vaulting/anterior chamber depth (ACD), low anterior chamber angle (ACA), and high iris pigmentations are the significant factors of ECD loss. At postoperative 6 months, 14 eyes (15.1%) had decrease (10.5% loss), 47 eyes (51.0%) were stationary, and 32 eyes (34.4%) had increase (12.7% gain) of ECD. The ROC curve analysis showed that vaulting had the highest area under the curve (AUC = 0.822), followed by vaulting/ACD (AUC = 0.821), ECD (AUC = 0.753), and ACA (AUC = 0.723) (all P < .01). Preoperative ECD showed a sensitivity of 77.6% and specificity of 86.7% in preventing ECD loss after explantation, with a cutoff value of 1722 cells/mm2, as determined by ROC curve analysis.

Conclusions:

Our study demonstrated that high vaulting is a significant factor in ECD loss among ICL-inserted patients. To prevent continuous ECD loss in ICL patients, close monitoring of ECD and making appropriate decisions regarding explantation may be necessary.
Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery
Authors: Huang Feng , Tong Wentao , Wang Dandan , Guan Weichen , Zhang Zhewen , Zhao Yun-e
Published: January 2024

Purpose:

To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length.

Setting:

Eye Hospital of Wenzhou Medical University at Hangzhou.

Design:

Prospective self-controlled trial.

Methods:

Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination.

Results:

21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively (P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively (P < .05); at 12 months postoperatively, there was a significant difference in ACOA (P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint (P > .05).

Conclusions:

For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.
Clinical outcomes of epithelial basement membrane dystrophy after keratorefractive lenticule extraction
Authors: Kim Bu Ki , Chung Young Taek
Published: January 2024

Purpose:

To determine the clinical outcomes of keratorefractive lenticule extraction (KLEx) in eyes with epithelial basement membrane dystrophy (EBMD) that developed after surgery.

Setting:

Onnuri Smile Eye Clinic, Seoul, South Korea.

Design:

Retrospective single-center study.

Methods:

This study reviewed the medical records of 26 eyes of 16 patients who exhibited signs of EBMD after KLEx. Postoperatively, corneal findings and visual outcomes were evaluated. Statistical analyses were also performed on eyes without corneal complications after KLEx.

Results:

Signs of EBMD were first observed within 1 week postoperatively in 22 eyes (84.6%): 6 eyes (23.1%) showed epithelial defects, 10 eyes (38.5%) showed subepithelial corneal opacity, 5 eyes (19.2%) showed diffuse lamellar keratitis, and 1 eye (3.9%) showed epithelial ingrowth. Symptoms such as pain, while corneal lesions were present, occurred in 21 eyes (80.8%). At 3 months postoperatively, 21 eyes (80.8%) showed no specific findings on slitlamp microscopy after medical treatment, 2 eyes (7.7%) showed subepithelial corneal opacity, 2 eyes (7.7%) showed corneal scar, and 1 eye (3.9%) showed epithelial ingrowth. Uncorrected distance visual acuity was 20/25 or better in 24 eyes (92.3%), and spherical equivalent was within ±1.0 D in 20 eyes (76.9%). The efficacy index of the EBMD group did not significantly differ from the control group, while the safety index was significantly lower.

Conclusions:

Manifestations of EBMD can occur after KLEx and can affect clinical outcomes. Most cases showed favorable results with appropriate nonsurgical treatment; however, some cases had long-term complications such as corneal scarring.
Predicting operative time for metabolic and bariatric surgery using machine learning models: a retrospective observational study
Authors: Kang Dong-Won , Zhou Shouhao , Niranjan Suman , Rogers Ann , Shen Chan
Published: January 2024

Background:

Predicting operative time is essential for scheduling surgery and managing the operating room. This study aimed to develop machine learning (ML) models to predict the operative time for metabolic and bariatric surgery (MBS) and to compare each model.

Methods:

The authors used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2016 and 2020 to develop ML models, including linear regression, random forest, support vector machine, gradient-boosted tree, and XGBoost model. Patient characteristics and surgical features were included as variables in the model. The authors used the mean absolute error, root mean square error, and R2 score to evaluate model performance. The authors identified the 10 most important variables in the best-performing model using the Shapley Additive exPlanations algorithm.

Results:

In total, 668 723 patients were included in the study. The XGBoost model outperformed the other ML models, with the lowest root mean square error and highest R2 score. Random forest performed better than linear regression. The relative performance of the ML algorithms remained consistent across the models, regardless of the surgery type. The surgery type and surgical approach were the most important features to predict the operative time; specifically, sleeve gastrectomy (vs. Roux-en-Y gastric bypass) and the laparoscopic approach (vs. robotic-assisted approach) were associated with a shorter operative time.

Conclusions:

The XGBoost model best predicted the operative time for MBS among the ML models examined. Our findings can be useful in managing the operating room scheduling and in developing software tools to predict the operative times of MBS in clinical settings.
Predictive factors for alteration of diastolic function in patients with ST-elevation myocardial infarction
Authors: Miri Chaymae , Bouchlarhem Amine , Bouazzaoui Mohammed-Amine , Hbali Anass , Abda Naima , Bazid Zakaria , Ismaili Nabila , El Ouafi Noha
Published: January 2024

Introduction:

Diastolic dysfunction is common in patients with myocardial infarction and is associated with a poor prognosis. Our aim in this study is to describe diastolic function and identify factors predictive of worsening diastolic function in patients admitted in the acute phase of ST-segment elevation myocardial infarction

Materials and methods:

This was a retrospective descriptive and analytical cohort study performed at the Cardiology Department of the University Hospital of Oujda between November 1, 2018 and October 31, 2019 including patients who presented with STEMI. Echocardiographic results were recorded to assess diastolic function within 48 hours of STEMI. The study population was divided into two groups: Group I (normal diastolic function n=49) and Group II (diastolic dysfunction n=141).

Results:

Our study included 204 patients, 155 (76%) of whom were men. The mean age was 63 years (SD=11), 69% of patients had diastolic dysfunction, 24.5% of whom had elevated left ventricular filling pressure. Data analysis showed that diabetes (P=0.011), previous anterior myocardial infarction location (P=0.05), impaired left ventricular ejection fraction (P<0.001), left ventricular hypertrophy (P=0.002), high blood glucose on admission (P=0.02) and anemia (P=0.017) were independent predictors of diastolic dysfunction.

Conclusion:

Knowledge of these predictive factors is important for early detection of those at risk of developing heart failure and requiring strict clinical and echocardiographic monitoring.
Evidence Based Management of Labor
Authors: Zambrano Guevara Linda M. , Buckheit Caledonia , Kuller Jeffrey A. , Gray Beverly , Dotters-Katz Sarah
Published: January 2024

Importance

Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery.

Objective

To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques.

Evidence acquisition

Review of recent original research, review articles, and guidelines on IOL using PubMed (2000–2022).

Results

Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma.

Conclusion and relevance

Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

Discuss the current evidence and best practices regarding prelabor interventions to improve delivery outcomes; describe evidence-based methods of cervical ripening; outline data-driven practices to progress induction; and explain methods to improve birth outcomes and reduce risks in the second stage of labor.