bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacokinetics and Pharmacodynamics of Inhaled Nicotine Salt and Free-Base Using an E-cigarette: A Randomized Crossover Study
Authors: Christen Samuel E , Hermann Laura , Bekka Elias , Vonwyl Celina , Hammann Felix , van der Velpen Vera , Eap Chin B , Benowitz Neal L , Haschke Manuel , Liakoni Evangelia
Published: April 2024

Introduction

Popular “pod-style” e-cigarettes commonly use nicotine salt-based e-liquids that cause less irritation when inhaled and can deliver higher nicotine concentrations than free-base nicotine. This study investigated the pharmacokinetic and pharmacodynamic effects of different nicotine formulations (salt vs. free-base) and concentrations that might influence systemic nicotine absorption and appeal of e-cigarettes.

Aims and Methods

In this randomized, double-blind, within-subject crossover study, 20 non-nicotine-naïve participants were switched among three e-liquids (free-base nicotine 20 mg/mL, nicotine salt 20 mg/mL, nicotine salt 40 mg/mL) using a refillable pod system and a standardized vaping protocol (one puff every 30 seconds, 10 puffs total). Serum nicotine concentrations and vital signs were assessed over 180 minutes; direct effects, craving, satisfaction, withdrawal, and respiratory symptoms were measured using questionnaires. CYP2A6 genotypes and the nicotine metabolite ratio were also assessed.

Results

Eleven (55%) participants were male and the median age was 23.5 years (range 18–67). All three formulations differed significantly in peak serum nicotine concentration (baseline adjusted Cmax, median (range): 12.0 ng/mL (1.6–27.3), 5.4 ng/mL (1.9–18.7), and 3.0 ng/mL (1.3–8.8) for nicotine salt 40 mg/mL, nicotine salt 20 mg/mL and free-base 20 mg/mL, respectively). All groups reached Cmax 2.0–2.5 minutes (median) after their last puff. Differences in subjective effects were not statistically significant. No serious adverse events were observed.

Conclusions

Free-base 20 mg/mL formulations achieved lower blood nicotine concentrations than nicotine salt 20 mg/mL, while 40 mg/mL nicotine salt yielded concentrations similar to cigarette smoking. The findings can inform regulatory policy regarding e-liquids and their potential use in smoking cessation.

Implications

Nicotine salt formulations inhaled by an e-cigarette led to higher nicotine delivery compared to nicotine-free-base formulations with the same nicotine concentration. These findings should be considered in future regulatory discussions. The 40 mg/mL nicotine salt formulation showed similar nicotine delivery as combustible cigarettes, albeit at concentrations over the maximum limit for e-liquids allowed in the European Union. Nicotine delivery resembling combustible cigarettes might be beneficial for smokers willing to quit to adequately alleviate withdrawal symptoms. However, increased nicotine delivery can also pose a public health risk, raising concerns about abuse liability, especially among youth and nonsmokers.
A direct comparison in diagnostic performance of CDUS, FDG-PET/CT and MRI in patients suspected of giant cell arteritis
Authors: van Nieuwland Marieke , Colin Edgar M , Vermeer Marloes , Wagenaar Nils R L , Vijlbrief Onno D , van Zandwijk Jordy K , Slart Riemer H J A , Koffijberg Hendrik , Jebbink Erik Groot , van der Geest Kornelis S M , Brouwer Elisabeth , Boumans Dennis , Alves Celina
Published: April 2024

Objectives

This study directly compares the diagnostic performance of colour duplex ultrasound (CDUS), fluor-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) in patients suspected of giant cell arteritis (GCA).

Methods

Patients with suspected GCA were included in a nested-case control pilot study. CDUS, whole body FDG-PET/CT and cranial MRI were performed within 5 working days after initial clinical evaluation. Clinical diagnosis after six months follow-up by experienced rheumatologists in the field of GCA, blinded for imaging, was used as reference standard. Diagnostic performance of the imaging modalities was determined. Stratification for GCA subtype was performed and imaging results were evaluated in different risk stratification groups.

Results

In total, 23 patients with GCA and 19 patients suspected of but not diagnosed with GCA were included. Sensitivity was 69.6% (95%CI 50.4%–88.8%) for CDUS, 52.2% (95%CI 31.4%–73.0%) for FDG-PET/CT and 56.5% (95%CI 35.8%–77.2%) for MRI. Specificity was 100% for CDUS, FDG-PET/CT and MRI. FDG-PET/CT was negative for GCA in all isolated cranial GCA patients (n = 8), while MRI was negative in all isolated extracranial GCA patients (n = 4). In four GCA patients with false-negative (n = 2; intermediate and high risk) or inconclusive (n = 2; low and intermediate risk) CDUS results, further imaging confirmed diagnosis.

Conclusions

Sensitivity of CDUS was highest, while specificity was excellent in all imaging modalities. Nevertheless, confidence intervals of all imaging modalities were overlapping. Following EULAR recommendations, CDUS can be used as a first test to diagnose GCA. With insufficient evidence for GCA, further testing considering GCA subtype is warranted.
Short-term effectiveness of guselkumab in psoriatic arthritis patients and axial involvement: results from a real-life multicentre cohort
Authors: Ruscitti Piero , Pantano Ilenia , Cataldi Giulia , Gentile Martina , Arrigoni Francesco , Riccio Luca , Marrone Sabrina , Mauro Daniele , Ursini Francesco , Esposito Maria , Barile Antonio , Fargnoli Maria Concetta , Giacomelli Roberto , Ciccia Francesco , Cipriani Paola
Published: April 2024

Objective

To evaluate the short-term effectiveness of guselkumab in patients with psoriatic arthritis (PsA) and suggestive features of axial involvement in a prospective ‘real-life’ multicentre cohort.

Methods

Between June 2022 and June 2023, PsA patients with axial involvement were evaluated if treated at least for 4 months with guselkumab. The effectiveness was evaluated by BASDAI, ASDAS, DAPSA, and achievement of BASDAI ≤ 4, also exploiting predictive factors. In a group of patients, MRI findings on sacroiliac joints were assessed before and after guselkumab administration.

Results

Sixty-seven patients with PsA and suggestive features of axial involvement (age 53.4 ± 11.2 years, male sex 26.9%) were treated with guselkumab. After 4 months, a significant reduction of BASDAI, ASDAS, and DAPSA was observed. A ΔBASDAI of −2.11 ± 0.43 was estimated assessing the mean difference values before and after guselkumab administration and 52.2% of patients reached a BASDAI ≤ 4. In 27 patients, MRI findings on sacroiliac joints were assessed before and after guselkumab administration. A reduction of 0.80 or larger in the sacroiliac joint lesion score was observed in the majority of patients (70.3%) based on MRI improvements, paralleling with the clinical response. No life-threatening side effects were recorded; 17.9% of patients reported minor adverse events mainly injection site reactions.

Conclusions

The short-term effectiveness of guselkumab in patients with PsA and suggestive features of axial involvement were shown. Although further studies are needed, our multicentre ‘real-life’ study may suggest the clinical usability of guselkumab in this context.
Modulating the mesenchymal stromal cell microenvironment alters exosome RNA content and ligament healing capacity
Authors: Chamberlain Connie S , Prabahar Archana , Kink John A , Mueller Erika , Li Yiyao , Yopp Stephanie , Capitini Christian M , Hematti Peiman , Murphy William L , Vanderby Ray , Jiang Peng
Published: April 2024

Although mesenchymal stromal cell (MSC) based therapies hold promise in regenerative medicine, their clinical application remains challenging due to issues such as immunocompatibility. MSC-derived exosomes are a promising off-the-shelf therapy for promoting wound healing in a cell-free manner. However, the potential to customize the content of MSC-exosomes, and understanding how such modifications influence exosome effects on tissue regeneration remain underexplored. In this study, we used an in vitro system to compare the priming of human MSCs by 2 inflammatory inducers TNF-α and CRX-527 (a highly potent synthetic TLR4 agonist that can be used as a vaccine adjuvant or to induce anti-tumor immunity) on exosome molecular cargo, as well as on an in vivo rat ligament injury model to validate exosome potency. Different microenvironmental stimuli used to prime MSCs in vitro affected their exosomal microRNAs and mRNAs, influencing ligament healing. Exosomes derived from untreated MSCs significantly enhance the mechanical properties of healing ligaments, in contrast to those obtained from MSCs primed with inflammation-inducers, which not only fail to provide any improvement but also potentially deteriorate the mechanical properties. Additionally, a link was identified between altered exosomal microRNA levels and expression changes in microRNA targets in ligaments. These findings elucidate the nuanced interplay between MSCs, their exosomes, and tissue regeneration.
Wet canopy photosynthesis in a temperate Japanese cypress forest
Authors: Jiao Linjie , Kosugi Yoshiko , Sakabe Ayaka , Sempuku Yuichi , Chang Ting-Wei , Chen Siyu
Published: April 2024

This study aimed to reveal the mechanism and significance of wet canopy photosynthesis during and after rainfall in temperate coniferous ecosystems by evaluating the influence of abaxial leaf interception on wet canopy photosynthesis. We used the eddy covariance method in conjunction with an enclosed-path gas analyser to conduct continuous ecosystem CO2 flux observations in a Japanese cypress forest within the temperate Asian monsoon area over 3 years. The observation shows that wet-canopy CO2 uptake predominantly occurred during the post-rainfall canopy-wet period rather than the during-rainfall period. Then, the measured canopy-wet net ecosystem exchange was compared with the soil–vegetation–atmosphere transfer multilayer model simulations under different parameter settings of the abaxial (lower) leaf surface wet area ratio. The multilayer model predicted net ecosystem exchange most accurately when it assumed the wet area ratio of the abaxial surface was 50% both during and after rainfall. For the wet canopy both during and after rainfall, the model overestimated CO2 uptake when it assumed no abaxial interception in the simulation, but underestimated CO2 uptake when it assumed that the entire abaxial leaf surface was wet. These results suggest that the abaxial surface of the Japanese cypress leaf is only partly wet to maintain stomatal openness and a low level of photosynthesis. These results allow for an evaluation of the effect of rainfall on forest carbon circulation under a changing climate, facilitating an improvement of ecosystem carbon exchange models.
Zinc and manganese homeostasis closely interact in mammalian cells
Authors: Nishito Yukina , Kamimura Yoshiki , Nagamatsu Shino , Yamamoto Nao , Yasui Hiroyuki , Kambe Taiho
Published: April 2024

Understanding the homeostatic interactions among essential trace metals is important for explaining their roles in cellular systems. Recent studies in vertebrates suggest that cellular Mn metabolism is related to Zn metabolism in multifarious cellular processes. However, the underlying mechanism remains unclear. In this study, we examined the changes in the expression of proteins involved in cellular Zn and/or Mn homeostatic control and measured the Mn as well as Zn contents and Zn enzyme activities to elucidate the effects of Mn and Zn homeostasis on each other. Mn treatment decreased the expression of the Zn homeostatic proteins metallothionein (MT) and ZNT1 and reduced Zn enzyme activities, which were attributed to the decreased Zn content. Moreover, loss of Mn efflux transport protein decreased MT and ZNT1 expression and Zn enzyme activity without changing extracellular Mn content. This reduction was not observed when supplementing with the same Cu concentrations and in cells lacking Cu efflux proteins. Furthermore, cellular Zn homeostasis was oppositely regulated in cells expressing Zn and Mn importer ZIP8, depending on whether Zn or Mn concentration was elevated in the extracellular milieu. Our results provide novel insights into the intricate interactions between Mn and Zn homeostasis in mammalian cells and facilitate our understanding of the physiopathology of Mn, which may lead to the development of treatment strategies for Mn‐related diseases in the future.
Acute liver failure
Authors: Beck James , Bolina Jasleen K. , Boyd Lisa H.
Published: April 2024

Acute liver failure, commonly caused by acetaminophen overdose, is associated with numerous systemic complications including cerebral edema, hypotension, acute kidney injury, and infection. Management is primarily supportive, with an emphasis on excellent neurocritical care. Although some antidotes and targeted treatments exist, the only definitive treatment remains orthotopic liver transplant.
Gendered racial microaggressions and stress in PAs who are Black women
Authors: Lotson Fallon , Gathers Quinetra S. , Gordon A'yana C. , Litton Allison G.
Published: April 2024

Objective:

This mixed-methods study explored whether physician associates/assistants (PAs) who are Black women (for brevity, called Black women PAs throughout this article) experience gendered racial microaggressions and whether these experiences correlated with psychologic distress. The phrase Black women encompasses those who identify with the sociocultural roles, behaviors, and expressions of being a Black woman.

Methods:

We conducted an online survey of Black women PAs using the Gendered Racial Microaggressions Scale during a 2-month period in 2019.

Results:

Black women PAs experienced gendered racial microaggressions in clinical settings. Gendered racial microaggressions were correlated with stress, being silenced and marginalized, and assumptions of beauty and sexual objectification. No correlations were found between stress and the angry Black woman and strong Black woman variables.

Conclusions:

This study revealed that Black women have interlocking forms of oppression related to their race and gender, which are associated with psychologic distress. Awareness of these occurrences can reduce the unknowing perpetuation of gendered racial microaggressions and create cultural awareness practices.
Career flexibility for PAs
Authors: Ward-Lev Eliana , Kuriakose Clair , Navoa Jesus (Jay) , Halley Meghan
Published: April 2024

Switching specialties is common among physician associates/assistants (PAs) and important in combating burnout. Despite this, little is known about the PA experience with switching specialties. This study sought to identify factors associated with successfully switching specialties using semistructured interviews with PAs and hiring managers. Participants reported that switching specialties was initially challenging for managers and PAs because of insufficient onboarding and unrealistic expectations, but they also reported that they were generally satisfied with long-term outcomes. Our findings suggest that PAs hoping to switch specialties may want to focus on building a professional network, identifying areas where they can highlight relevant experience, and demonstrating their intent to remain in that role. Hiring managers could benefit from considering their hiring practices and tailoring onboarding expectations for new hires.
Original Research: Exploring U.S. Nurses' Perceived Duty to Care During the COVID-19 Pandemic
Authors: Sutherland Jodi , Collier Rosemary , Si Bing , Alramadeen Wesam , Palmer Deborah
Published: April 2024

Background:

Duty to care is both an integral concept in health care and a fundamental nursing obligation. But nurses' perceptions of duty to care can be moderated by their experiences in the practice setting. Research examining nurses' perceptions of their duty to care during the COVID-19 pandemic could shed light on how the pandemic is affecting the nursing workforce.

Purpose:

This study aimed to examine nurses' sense of duty to care during the early months of the pandemic, using the Nash Duty to Care Scale (NDCS), and to compare the high-scoring nurses with the low-scoring nurses.

Methods:

This quantitative study used a descriptive, cross-sectional design. It was conducted among licensed RNs enrolled at two accredited nursing programs in the Northeast region of the United States. Data were collected via a demographics questionnaire and the NDCS. A two-step cluster procedure was used to categorize participants into two groups: those with high perceived duty to care (HPDC) and those with low perceived duty to care (LPDC). Independent t tests were performed to compare NDCS results between the two groups.

Results:

Nearly two-thirds (61%) of the participants had total NDCS scores indicating an HPDC, while 39% had scores indicating an LPDC. Of the NDCS's four subscales, perceived obligation and perceived risk were the most important in separating participants into the low- and high-scoring groups.

Conclusions:

This study adds to the literature about the components that affected nurses' perceived duty to care and willingness to report to work during the early months of the pandemic. Just as nurses have a duty to care, health care organizations have an obligation to provide a safe working environment so that nurses can fulfill that duty without sacrificing personal safety. The study findings may guide health care leaders, systems, and organizations regarding how to create safer work environments that support the nurse's duty to care during disasters.
Prevalence of Low or Very Low Food Security in Undergraduate Nursing Students
Authors: Rinaldi Kailey , Aul Karen , Phillips Amelia
Published: April 2024

Food insecurity occurs when there is a lack of resources to obtain food. This study sought to identify the prevalence of food insecurity in baccalaureate nursing students. Data on demographics, perceived stress, food security, and food access were collected using a survey from 201 baccalaureate nursing students. Nearly 43 percent of students reported food insecurity within the last year. Students reporting food insecurity reported higher levels of perceived stress (p < .01). Findings support that food insecurity is prevalent in nursing students. An increase in awareness, assessment, and efforts to provide early interventions should be considered.
Implementation of an Innovative Learning Experience to Address Vaccine Hesitancy
Authors: Townsend Haley , Kaylor Sara , Johnson Paige
Published: April 2024

The COVID-19 pandemic and subsequent vaccine hesitancy highlighted the need for additional learning experiences for nursing students to address person-centered care and communication. This project aimed to employ a three-step service-learning experience consisting of town hall meetings, motivational interviewing training, and rural health fairs to address vaccine hesitancy in communities surrounding the college. Evaluation of the project revealed satisfaction and increased confidence among participating nursing students.
Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study
Authors: McGillion Michael H. , Borges Flavia K. , Conen David , Sessler Daniel I. , Coleman Brenda L. , Marcucci Maura , Ouellette Carley , Bird Marissa , Whitmore Carly , Henry Shaunattonie , Ofori Sandra , Pettit Shirley M. , Bedini Deborah M. , Gauthier Leslie P. , Lounsbury Jennifer , Carter Nancy M. , Tandon Vikas , Patel Ameen , Cafaro Teresa , Simunovic Marko R. , Harlock John A. , Heels-Ansdell Diane , Elias Fadi , Rapanos Theodore , Forbes Shawn , Peter Elizabeth , Watt-Watson Judy , Metcalfe Kelly , Carroll Sandra L. , Devereaux Philip J.
Published: April 2024

Objective:

To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery.

Background:

Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability.

Methods:

We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109).

Results:

Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2–7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30–1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24–1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61–2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24–3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33–1.95) were associated with readmission.

Conclusions:

Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.
Security Comparison of Various Surgical Knots Using Nylon Suture
Authors: Lim SooA , Lee Dong Yun , Doh GyeongHyeon , Seo YeongKwon , Lim ChiYeon , Yoon JungSoo , Eo SuRak
Published: April 2024

OBJECTIVE

To evaluate the strengths of various surgical knot techniques, including square knot, surgeon’s knot, granny knot, and random knot with the same three throws.

METHODS

The authors tested each of the four knot techniques using four different gauges of nylon (polyamide [Ethicon]): 4-0, 5-0, 6-0, and 7-0. Each knot type was tested 20 times per nylon gauge, for a total of 320 knots tested. The authors used a static pull machine to measure elongation at yield and maximal force to break.

RESULTS

A comparison of elongation at yield revealed that the surgeon’s knot was superior to the square knot, granny knot, and random knots across all gauges of nylons. Further, a comparison of maximal force to break revealed that the surgeon’s knot was superior to the square knot, granny knot, and random knots when using 4-0, 5-0, and 6-0 nylon but not when using 7-0 nylon.

CONCLUSIONS

The surgeon’s knot was the strongest, and random knot was the weakest when the authors used nylon 4-0, 5-0, and 6-0. While handling fine suture materials such as 7-0 nylon, knot failure appears to be unrelated to the knot technique used. This study provides not only fundamental guidance for tying surgical knots using nylon, but also a rational basis for an adequately strong knot choice in various fields of surgery.
A Novel Bone-Screw-Fastener Demonstrates Greater Maximum Compression Force Prior to Failure Compared to a Traditional Buttress Screw.
Authors: Thorne Tyler , Featherall Joseph , O’Neill Dillon , Lisitano Leonard , Haller Justin
Published: April 2024

Objectives:

This study compared the maximal compression force prior to thread stripping of the novel bone-screw-fastener (BSF) compared to the traditional-buttress-screw (TBS) in synthetic osteoporotic and cadaveric bone models.

Methods:

Maximum compression force of the plate-bone interface prior to loss of screw purchase during screw tightening was measured between self-tapping 3.5mm BSF and 3.5mm TBS using calibrated load cells. Three synthetic biomechanical models were used: a synthetic osteoporotic diaphysis (model 1); a 3-layer biomechanical polyurethane foam with 50-10-50 pounds-per-cubic-foot (PCF) layering (model 2), and a 3-layer polyurethane foam with 50-15-50 PCF layering (model 3). For the cadaveric metaphyseal model, three sets of cadaveric tibial plafonds and three sets of cadaveric tibial plateaus were used. A plate with sensors between the bone-plate interface was used to measure compression force during screw tightening in the synthetic bone models, while an annular load cell that measured screw compression as it slid through a guide was used to measure compression in the cadaver models.

Results:

Across all synthetic osteoporotic bone models, the BSF demonstrated greater maximal compression force prior to stripping compared to the TBS (model 1, 155.51N(SD=7.77N) vs 138.78N(SD=12.74N), p=0.036; model 2, 218.14N (SD=14.15N) vs 110.23N(SD=8.00N), p<0.001; model 3, 382.72N(SD=20.15) vs 341.09N(SD=15.57N), p=0.003. The BSF had greater maximal compression force for the overall cadaver trials, the tibial plafond trials, and the tibial plateau trials (overall, 111.27N vs 97.54N(SD 32.32N), p=0.002; plafond, 149.6N vs 132.92N(SD 31.32N), p=0.006; plateau 81.33N vs 69.89N(SD 33.38N), p=0.03.

Conclusion:

The novel bone-screw-fastener generated 11-65% greater maximal compression force than the traditional-buttress-screw in synthetic osteoporotic and cadaveric metaphyseal bone models. A greater compression force may increase construct stability, facilitate early weight bearing, and reduce construct failure.
ChatGPT Responses to Common Questions About Slipped Capital Femoral Epiphysis: A Reliable Resource for Parents?
Authors: Adelstein Jeremy M. , Sinkler Margaret A. , Li Lambert T. , Mistovich R. Justin
Published: April 2024

Background:

We sought to evaluate the ability of ChatGPT, an AI-powered online chatbot, to answer frequently asked questions (FAQs) regarding slipped capital femoral epiphysis (SCFE).

Methods:

Seven FAQs regarding SCFE were presented to ChatGPT. Initial responses were recorded and compared with evidence-based literature and reputable online resources. Responses were subjectively rated as “excellent response requiring no further clarification,” “satisfactory response requiring minimal clarification,” “satisfactory response requiring moderate clarification,” or “unsatisfactory response requiring substantial clarification.”

Results:

ChatGPT was frequently able to provide satisfactory responses that required only minimal clarification. One response received an excellent rating and required no further clarification, while only 1 response from ChatGPT was rated unsatisfactory and required substantial clarification.

Conclusions:

ChatGPT is able to frequently provide satisfactory responses to FAQs regarding SCFE while appropriately reiterating the importance of always consulting a medical professional.
Comparison of Open Surgery Versus Minimally Invasive Surgery in Nonsevere Adult Degenerative Scoliosis
Authors: Shao Zhenxuan , Liang Haibo , Li Sunlong , Ye Zhaoming , Wang Xiangyang
Published: April 2024

Study Design.

A systematic review and meta-analysis.

Objective.

This study aimed to evaluate the clinical efficacy of minimally invasive surgery (MIS) and open surgery in correcting ADS.

Summary of Background Data.

Adult degenerative scoliosis (ADS) is a scoliosis secondary to degenerative changes in the intervertebral discs and facet joints in adults. Severe low back pain, radicular pain, and intermittent claudication are often present and require surgical treatment.

Methods.

PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI) Database, Wanfang Data, Weipu Database, and China Biomedical Document Service System (CBM) were systematically searched for studies that focused on the clinical efficacy of minimally invasive surgery and open surgery to correct ADS.

Results.

This meta-analysis included 11 studies, involving 1527 patients (581 in the MIS group and 946 in the open surgery group). Regarding surgery and outcome indicators, the operative time in the open surgery group was shorter, the MIS group had less intraoperative blood loss, shorter hospitalization time, and lower incidence of serious postoperative complications. In terms of imaging parameters, although there was no significant difference in Cobb angle improvement and sagittal balance, the open surgery group exhibited better lumbar lordosis improvement and pelvic tilt improvement. In terms of clinical scores, including changes in the ODI index and VAS scores for low back and leg pain, similar improvements were appreciated across both groups.

Conclusions.

In mild to moderate ADS, we found that the advantages of open surgery include greater improvement in lumbar lordosis and pelvic tilt angle and shorter operative time. The advantages of minimally invasive surgery are less intraoperative blood loss, shorter hospital stay, and fewer serious postoperative complications. There is no significant difference between the 2 surgical methods in terms of Cobb angle, clinical pain, and sagittal vertical axis improvement.
Perceptions on Specialist Palliative Care Involvement During and After Cardiopulmonary Resuscitation: A Qualitative Study
Authors: Tenge Theresa , Schallenburger Manuela , Batzler Yann-Nicolas , Roth Sebastian , M´Pembele René , Stroda Alexandra , Böhm Lennert , Bernhard Michael , Jung Christian , Meier Stefan , Kindgen-Milles Detlef , Kienbaum Peter , Schwartz Jacqueline , Neukirchen Martin
Published: April 2024

IMPORTANCE:

Cardiopulmonary resuscitation (CPR) is an exceptional physical situation and may lead to significant psychological, spiritual, and social distress in patients and their next of kin. Furthermore, clinicians might experience distress related to a CPR event. Specialist palliative care (sPC) integration could address these aspects but is not part of routine care.

OBJECTIVES:

This study aimed to explore perspectives on sPC integration during and after CPR. A needs assessment for sPC, possible triggers indicating need, and implementation strategies were addressed.

DESIGN, SETTING, AND PARTICIPANTS:

A multiprofessional qualitative semistructured focus group study was conducted in a German urban academic teaching hospital. Participants were clinicians (nursing staff, residents, and consultants) working in the emergency department and ICUs (internal medicine and surgical).

ANALYSIS:

The focus groups were recorded and subsequently transcribed. Data material was analyzed using the content-structuring content analysis according to Kuckartz.

RESULTS:

Seven focus groups with 18 participants in total were conducted online from July to November 2022. Six main categories (two to five subcategories) were identified: understanding (of palliative care and death), general CPR conditions (e.g., team, debriefing, and strains), prognosis (e.g., preexisting situation, use of extracorporeal support), next of kin (e.g., communication, presence during CPR), treatment plan (patient will and decision-making), and implementation of sPC (e.g., timing, trigger factors).

CONCLUSIONS:

Perceptions about the need for sPC to support during and after CPR depend on roles, areas of practice, and individual understanding of sPC. Although some participants perceive CPR itself as a trigger for sPC, others define, for example, pre-CPR-existing multimorbidity or complex family dynamics as possible triggers. Suggestions for implementation are multifaceted, especially communication by sPC is emphasized. Specific challenges of extracorporeal CPR need to be explored further. Overall, the focus groups show that the topic is considered relevant, and studies on outcomes are warranted.
Vaginal dysbiosis – the association with reproductive outcomes in IVF patients: a systematic review and meta-analysis
Authors: Maksimovic Celicanin Milica , Haahr Thor , Humaidan Peter , Skafte-Holm Axel
Published: April 2024

Purpose of review

To examine impact of vaginal dysbiosis (VD), including bacterial vaginosis (BV) and aerobic vaginitis (AV) on reproductive outcomes of in vitro fertilization (IVF) patients.

Recent findings

BV-bacteria (e.g. Gardnerella) and AV-bacteria (e.g. Streptococci and Enterococci) have been identified in the endometrium. However, there is inconclusive evidence whether IVF patients with VD have lower success rates.

The present systematic review and meta-analysis of PubMed/Medline, until December 2023 included 25 studies, involving 6835 IVF patients. Overall VD was defined as an approximation of community state type IV, including BV and AV-type dysbiosis based on either molecular or microscopy methods. Outcomes were live birth rate (LBR), early pregnancy loss (EPL), clinical pregnancy rate (CPR), and biochemical pregnancy rate (BPR).

Vaginal dysbiosis prevalence was 19% [1271/6835, 95% confidence interval (CI) 18–20%]. Six studies examined AV-type dysbiosis with a prevalence of 4% (26/628, 95% CI 3–6%). Vaginal dysbiosis correlates with a higher EPL [relative risk (RR) = 1.49, 95% CI 1.15–1.94] and lower CPR (RR = 0.82, 95% CI 0.70–0.95). No statistically significant impact of VD, BV, or AV was found on LBR and BPR.

Thus, the association between VD and reproductive outcome remains puzzling as it is difficult to explain how VD impacts CPR and EPL but not LBR and BPR.
Daily spiritual experiences and allostatic load trajectories: a longitudinal study of midlife African American women
Authors: Williams Elizabeth , Harris Latesha K. , Zhang Shuo , Cortés Yamnia I.
Published: April 2024

Objective

This study aimed to evaluate the association between daily spiritual experiences and allostatic load (AL) trajectories in midlife African American women.

Methods

A longitudinal analysis of public-use data from 727 African American women in the Study of Women's Health Across the Nation (SWAN) was performed. We included African American women who completed the Daily Spiritual Experiences Scale at SWAN visit 4 (2000-2001) and had AL data at three or more study visits over 7 years. AL was calculated at each visit using 10 biomarkers: systolic and diastolic blood pressure, body mass index, C-reactive protein, high-density lipoprotein cholesterol, total cholesterol, waist-to-hip ratio, fasting serum glucose, triglycerides, and dehydroepiandrosterone. Group-based trajectory modeling identified women with similar patterns of AL. We used multinomial logistic regression to estimate associations between daily spiritual experiences (some days or less, most days, daily, many times a day) and AL trajectories.

Findings

Our sample had a mean ± SD age of 49.9 ± 2.66 years, 47% were early perimenopausal, and 17% earned <$19,999 annually. The mean ± SD AL score was 2.52 ± 1.68. Three AL trajectories were identified: low (35.1%), moderate (44.7%), and high (20.2%). In age-adjusted models, women who reported daily comfort in religion and spirituality were less likely to follow a high AL trajectory (odds ratio, 0.41; 95% CI, 0.18-0.93); the association was attenuated when controlling for depressive symptoms (odds ratio, 0.48; 95% CI, 0.19-1.21).

Conclusions

Findings from this study do not support an independent association between spirituality in African American women and AL trajectories in midlife. Studies with a larger sample and additional measures of spirituality are warranted in this population.
“Hypertension in Pregnancy Intervention Trial At Term” and “Disproportionate Intrauterine Growth Intervention Trial At Term” Studies
Authors: van Pampus Marielle G. , van der Post Joris A.M. , Verhoeven Corine J. , Koopmans Corine M. , Langenveld Josje , Broekhuijsen Kim , de Sonnaville Catherine M.W. , van der Tuuk Karin , Boers Kim , Groen Henk , Vijgen Sylvia , Bijlenga Denise , Scherjon Sicco , Mol Ben W.
Published: April 2024

In 2003, in the context of a national research funding program in which obstetric research was prioritized, several perinatal centers took the initiative to jointly submit a number of applications to the subsidy programs of Effectiveness Research and Prevention of ZonMw. This has led to the funding of the Obstetric Consortium with several projects, including the “Hypertension in Pregnancy Intervention Trial At Term” and the “Disproportionate Intrauterine Growth Intervention Trial At Term” studies. The studies showed that induction of labor for hypertension and growth restriction at term was the appropriate management. Subsequent implementation improved maternal and perinatal outcomes.
Top-down attention does not modulate mechanical hypersensitivity consecutive to central sensitization: insights from an experimental analysis
Authors: Della Porta Delia , Scheirman Eléonore , Legrain Valéry
Published: April 2024

According to the neurocognitive model of attention to pain, when the attentional resources invested in a task unrelated to pain are high, limited cognitive resources can be directed toward the pain. This is supported by experimental studies showing that diverting people's attention away from acute pain leads to experiencing less pain. Theoretical work has suggested that this phenomenon may present a top-down modulatory mechanism for persistent pain as well. However, conclusive empirical evidence is lacking. To fill this gap, we used a preregistered, double-blind, between-subject study design to investigate whether performing a tailored, demanding, and engaging working memory task unrelated to pain (difficult) vs a task that requires less mental effort to be performed (easy), could lead to lower development of secondary hypersensitivity—a hallmark of central sensitization. Eighty-five healthy volunteers, randomly assigned to one of the 2 conditions, performed a visual task with a different cognitive load (difficult vs easy), while secondary hypersensitivity was induced on their nondominant forearm using high-frequency stimulation. To assess the development of secondary hypersensitivity, sensitivity to mechanical stimuli was measured 3 times: T0, for baseline and 20 (T1) and 40 (T2) minutes after the procedure. We did not observe any significant difference in the development of secondary hypersensitivity between the 2 groups, neither in terms of the intensity of mechanical sensitivity nor its spatial extent. Our results suggest that a top-down modulation through attention might not be sufficient to affect pain sensitization and the development of secondary hypersensitivity.
The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients
Authors: Alsaqer Hebah , Rababah Jehad A. , Al-Hammouri Mohammed Munther , Barbarawi Mohamed M. , Suliman Mohammad
Published: April 2024

BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect (P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.
Feasibility of a Capacity Building Organizational Intervention for Worker Safety and Well-being in the Transportation Industry
Authors: Peters Susan E. , López Gómez María-Andrée , Hendersen Gesele , Martínez Maldonado Marta , Dennerlein Jack
Published: April 2024

Objective

This study developed, implemented, and evaluated the feasibility of executing an organizational capacity building intervention to improve bus driver safety and well-being in a Chilean transportation company. Method: Through an implementation science lens and using a pre-experimental mixed methods study design, we assessed the feasibility of implementing a participatory organizational intervention designed to build organizational capacity. Result: We identified contextual factors that influenced the intervention mechanisms and intervention implementation and describe how the company adapted the approach for unexpected external factors during the COVID-19 pandemic and social and political unrest experienced in Chile. Conclusions: The intervention enabled the organization to create an agile organizational infrastructure that provided the organization’s leadership with new ways to be nimbler and more responsive to workers’ safety and well-being needs and was robust in responding to strong external forces that were undermining worker safety and well-being.
Leadership From a Different Lens: Shaping the Future of Healthcare Education
Authors: Jalaba Stephanie M. , Ruger Katherine M.
Published: April 2024

Physician assistant (PA) educators are responsible for preparing the next generation of PAs to be not only healthcare providers but also healthcare leaders. Regardless of whether advanced practice providers choose to pursue formal leadership roles in healthcare, they will undoubtedly be expected to possess and exhibit leadership skills. The PA profession indicates leadership as an important professional competency, yet leadership training is rare in current curricula. The PA community should consider the importance of leadership training for educators as they influence future PAs and the way PA students will affect their future patients and the healthcare systems for which they work. The aim of this article was to bring awareness to the need for leadership skill training in PA education, to review common leadership styles in healthcare, and to offer practical leadership tips to healthcare educators.
Rates, Predictors, and Outcomes of Ustekinumab Dose Escalation in Inflammatory Bowel Disease
Authors: Petrov Jessica C. , Al-Bawardy Badr , Alzahrani Raneem , Mohamed Gamal , Fine Sean
Published: April 2024

Objective:

Ustekinumab (UST) is effective for the induction and maintenance of remission in inflammatory bowel disease (IBD). However, a significant proportion of patients will require UST dose escalation. We sought to determine the rates, predictors, and outcomes of UST dose escalation in patients with IBD.

Patients and Methods:

This was a multicenter, retrospective study of all patients with IBD who received UST from January 1, 2014 to March 1, 2022. Primary outcomes were the rates and predictors of UST dose escalation. Secondary outcomes included steroid-free clinical remission, endoscopic healing, and normalization of serum c-reactive protein in patients who underwent UST dose escalation.

Results:

A total of 198 patients were included (58% females and 76.7% with Crohn's disease). UST dose was escalated by 55.5% (n = 110). Mean baseline albumin was lower in the UST dose escalation group at 3.86 ± 0.47 versus 4.03 ± 0.45 g/dL (P = 0.044). The mean hemoglobin was lower in the UST dose escalation group at 12.1 ± 1.83 versus 12.7 ± 1.42 (P = 0.049). On multivariate analysis, male sex alone was associated with the need for dose escalation (odds ratio: 4.08, 95% CI: 1.20 – 13.90; P = 0.025). In the UST dose escalation group, 66.1% achieved steroid-free clinical remission, 55.8% had normalization of c-reactive protein, and 35.8% achieved endoscopic healing.

Conclusions:

UST dose escalation was needed in more than half of patients with IBD in this real-world cohort. UST dose escalation resulted in clinical remission in more than half of the cohort and endoscopic healing in one-third of patients.
An Analysis of Orientation and Preceptorship Influence on Nurse Job Satisfaction Across Two States
Authors: Robinson Kathryn , Cavanaugh Robert , Dias Rebecca , Peary Alexandra , Johnson Ryan , Rao Vikram , Baker Breac , Strout Kelley , Board Rhonda , Olivieri-Mui Brianne
Published: April 2024

A large public nursing data set was used to determine whether orientation and/or preceptor programs impact job satisfaction among registered nurses in Maine and Massachusetts. There was no association between orientation and preceptor programs and satisfaction, nor evidence that new nurse status modified the relationship. There is a need for evaluation of orientation and preceptor programs’ structure and effectiveness, and innovation is needed in promoting job satisfaction, thereby increasing nurse retention.
“Nobody Wants to Have Conversation About HIV.” A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention
Authors: Hill Samantha V. , Pratt Madeline C. , Elopre Latesha , Simpson Tina , Gaines Lanzi Robin , Matthews Lynn T.
Published: April 2024

Background

Black adolescent girls and young women (AGYW) in the US Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low preexposure prophylaxis uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including preexposure prophylaxis.

Methods

In-depth interviews (IDIs) were conducted with Black AGYW aged 14 to 24 years and health care providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. In-depth interviews were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings.

Results

Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21 years, representing 9 Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included the following: (1) improve sexual health education for providers and adolescents, (2) normalize conversations in clinical settings, and (3) engage communities to continue these conversations outside of clinical settings.

Conclusions

Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.