bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Different Techniques for Measuring Posterior Tibial Slope
Authors: MW Guesser , RE De Paula , PG Cruz , LZ Vasquez , AP Mozella , A Cordeiro
Published: November 2024

Objectives:

The posterior tibial slope assessment is crucial in preoperative planning for various surgeries. Different measurement methods exist, but no study has compared them. This study aims to verify the equivalence of four techniques for measuring the posterior tibial slope in lateral knee radiographs and assess inter-observer reliability among evaluators with different academic training levels.

Methods:

Forty-three lateral knee radiographs from patients with osteoarthritis and ligament injuries who had indications for tibial osteotomy were evaluated. Three evaluators with varying levels of academic training performed measurements using four parameters: anterior cortex, posterior cortex, anatomical axis of the proximal tibia, and anatomical axis of the proximal fibula. Results were expressed as mean values ± standard deviation, and a p-value < 0.05 was considered statistically significant.

Results:

The average degree values were 12.6±4.4 for the anterior cortex, 10.1±3.8 for the tibial axis, 7.8±4.1 for the posterior cortex, and 11.6±4.6 for the fibular axis. There was a significant difference between all these measurements, except for the comparison between the anterior cortex and the fibular axis. In terms of the tibial axis, the evaluator with the lowest level of training showed significant variation compared to the other two evaluators.

Conclusion:

The four methods for measuring the posterior tibial slope are not equivalent, except for the anterior cortex and fibular axis measurements. Lower-level trained professionals had difficulty performing tibial axis measurements. Further studies are needed to determine the most accurate technique for assessing posterior tibial slope angulation
Comparison of Patellar Position After Mobile-Bearing and Fixed-Bearing TKA: A Prospective Randomized Study
Authors: FGA Abreu
Published: November 2024

Objectives:

Total knee arthroplasty (TKA) is the treatment of choice for severe knee osteoarthritis. While many studies compare mobile- and fixed-bearing designs, data on patellar position between these systems remains insufficient. This study aimed to measure and compare patellar position in mobile- and fixed-bearing TKA systems.

Methods:

This prospective randomized study assessed 160 TKA patients, with 79 receiving a mobile-bearing tibial insert and 81 receiving a fixed-bearing system, between 2007 and 2009. The mean ages were 72 and 70 years, with a mean follow-up of 7.4 years (range 5-11 years). Both groups were comparable pre- and post-operatively using the International Knee Society (IKS) score. Patellar tilt and translation were measured using the technique described by Gomes et al.

Results:

There were no significant differences between the two groups in the Knee Society knee scores (94 vs 92; p=0.45), pain score (45.8 vs 45.8; p=0.97), function scores (83.2 vs 83.9; p=0.78), or maximum knee flexion (116 vs 112; p=0.07) at the 7-year follow-up. Patellar translation and tilt were also not statistically different between the mobile-bearing and fixed-bearing TKAs. However, a significant difference was found in the subgroup with patellar translation greater than 5mm (OR=2.3; p=0.048) in favor of the mobile-bearing design, although this had no impact on clinical outcomes.

Conclusion:

No advantages were found for mobile-bearing TKA regarding pain, function, maximum knee flexion, or radiographic outcomes, such as patellar tilt or translation. Longer-term follow-up is required to determine any potential benefits of mobile-bearing over fixed-bearing TKA.
Continuous Vertical Inside-Out Versus Traditional Vertical Inside-Out Meniscal Repair: A Biomechanical Comparison
Authors: Faria JLR , Santos APG , Ocampo More AD , LaPrade RF , Roesler CRM , Salim R
Published: November 2024

Objectives:

To evaluate the displacement, stiffness after cyclical loading, and load to failure for a continuous vertical inside-out meniscal suture compared to a traditional vertical inside-out meniscal suture in a porcine medial meniscus.

Methods:

Twenty-eight porcine knees were divided into 2 groups of 14 medial menisci each. A 2.0-cm longitudinal cut was made in the red-white zone of the medial meniscus in each knee. The continuous suture (CS) group received 4 vertical stitches using a continuous vertical suture technique, while the inside-out suture (IO) group received a traditional vertical suture with 4 stitches. The specimens underwent load-to-failure testing at 5 mm/s, and displacement, system stiffness, and maximum load to failure were compared between the groups.

Results:

Displacement after the cyclic test was 0.53 ± 0.12 mm for the CS group and 0.48 ± 0.07 mm for the IO group, with no significant difference (P = .2792). Stiffness at ultimate load testing was 36.3 ± 1.9 N/mm for the CS group and 35.3 ± 2.4 N/mm for the IO group (P = .2557). In the load-to-failure test, the ultimate load was 218.2 ± 63.9 N for the CS group and 238.3 ± 71.3 N for the IO group (P = .3062), showing no significant differences between the groups.

Conclusion:

The continuous vertical meniscal suture provided biomechanical results similar to the traditional vertical suture technique for the treatment of longitudinal meniscal lesions, offering a viable alternative for meniscal repair.
Correlation Between Catastrophizing and Pain in Knee Osteoarthritis Patients Awaiting Total Knee Replacement
Authors: Campos GC , Pietrobon MS , Moratelli L , Piedade SR , Miranda JB , Zorzi AR
Published: November 2024

Objectives:

Osteoarthritis is a leading cause of pain and disability, particularly in the elderly population. Total knee replacement is the primary treatment for advanced knee osteoarthritis, but not all individuals who undergo total knee arthroplasty are satisfied with the outcome. Psychological factors, such as pain catastrophizing, have been identified as significant contributors to the development of chronic pain after knee replacement. This study aims to correlate catastrophizing thoughts with knee pain, function, and quality of life in patients with knee osteoarthritis awaiting total knee replacement.

Methods:

Patients awaiting total knee replacement completed questionnaires assessing pain, function, and quality of life, along with the Pain-Related Self-Statements Scale (pain catastrophizing scale).

Results:

Fifty-three patients were included in the final analysis (64.2% female). The mean PRSS score was 2.6 on a 0-5 scale. The mean VAS and WOMAC scores were 68.0 and 57.34, respectively. A strong positive correlation was found between PRSS and VAS (ρ=0.615; p=0.000) and between PRSS and WOMAC (ρ=0.682; p=0.000). There was also a negative correlation between PRSS and almost all SF-36 domains (-0.6 < ρ < 0.4; p < 0.01).

Conclusion:

This study found a high incidence of pain catastrophizing among patients awaiting knee replacement and a direct correlation between pain catastrophizing scores and worse pain, function, and quality of life outcomes.
Reinforced static spacer for periprosthetic knee joint infection: Surgical technique and review of literature
Authors: TEMPONI EDUARDO FROIS , DE CARVALHO JUNIOR LUCIO HONORIO , SOARES LUIZ FERNANDO MACHADO , GONCALVES MATHEUS BRAGA JACQUES , PIMENTA FREDERICO SILVA , TEIXEIRA LUAN BERTOLACINI
Published: November 2024

Objectives

This paper reports a simple technique to make a static spacer that can be used in two-stage procedures for periprosthetic knee joint infection with massive bone loss

Methods

This work, in addition to describing step by step the technique for creating the metallic reinforced static spacer used in revision TKA for periprosthetic joint infection with massive bone loss, makes an important review of the literature on the subject.

Results

Cement spacers to treat periprosthetic knee joint infection are classified as static or mobile and are used in two-stage procedures. A static knee spacer has been used to deliver high doses of antibiotics locally, to minimize contractures of collateral ligaments and to preserve joint space for subsequent prosthesis re implantation.

Conclusion

Reinforced static spacer is an option for massive bone loss during periprosthetic joint infection treatment in two-stage procedure. Patients with massive bone loss, lack of soft tissue or ligamentous integrity may be the ideal candidate for its use. Reinforced static spacer provides stable fixation across the knee, local antibiotic delivery, maintenance of the joint space, preservation of soft-tissue tension around the joint and length maintenance
Identifying the Barriers to Self-Wound Management in Singapore—A Preliminary Study in the Primary Healthcare Sector
Authors: Goh Ling Jia , Zhu Xiaoli
Published: November 2024

Singapore's growing elderly population faces a rising burden of chronic wounds. Studies have shown the beneficial effects of shared wound management where the patient actively manages their wound with guidance from their healthcare professionals. However, this concept faces challenges due to patient resistance. This study investigates barriers hindering patients’ participation in self-wound care. Addressing these barriers to aid the development of targeted strategies can increase the uptake of self-wound care. A locally validated survey was conducted among 328 patients in the polyclinics to assess their hesitancy toward self-wound care. A lower score on the scale indicated a high hesitation toward the concept of self-wound care. Forty-five percent of the participants expressed hesitation toward self-care. Strong family support emerged as a crucial factor in encouraging participation. Conversely, concerns about improper technique, missed diagnoses, and wound infection were prevalent. Logistic difficulties also influenced anxieties. Younger patients and those with higher education exhibited less apprehension. Educational interventions, tailored to address anxieties and empower patients with proper techniques, are critical. Fostering communication within families and examining the process of acquiring wound dressing materials are crucial in overcoming these barriers to self-wound care.
Acute kidney injury in patients with COVID-19 and cancer in intensive care: A clinical and retrospective study
Authors: Alves Joubert Araújo , de Brito Germana Alves , Fernandes Alexandre Ricardo da Silva , Gomes Elaine Alexandre , Baptista Aline Lourenço , Andrade Luis André Silvestre , Imanishe Marina Harume , Pereira Benedito Jorge
Published: November 2024

Introduction. As cancer patients are a high-risk group for COVID-19, it is important to understand the potential complications they may experience, such as acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and risk factors associated with AKI in cancer patients with COVID-19. Methods. The study was conducted retrospectively, using data from patients hospitalized with SARS-CoV2 infection. Demographic, clinical, and laboratory data were collected, and statistical analysis was performed using SPSS 20.0. Results. In total, 143 patients were evaluated, of which 59.4% were male and aged 65.5 ± 12.8 years. The majority (81.1%) had a solid tumor. During their hospital stay, 43.3% of patients developed AKI, with 25.8% requiring renal replacement therapy (RRT). Patients with AKI were more likely to have hypertension (64.5%) and cardiovascular diseases (32.3%). They also required more mechanical ventilation (71.7%), prone position (18.0%), and vasoactive drugs (75.8%). The mortality rate was significantly higher in patients with AKI (72.6%) compared to those without AKI (39.5%). After 12 months, 44 patients were followed up, of which 84% did not have AKI and 16% developed AKI due to COVID-19 while in the ICU. In conclusion, AKI in cancer patients with COVID-19 admitted to the ICU was more common in older patients with underlying hypertension or cardiovascular diseases. These patients required more invasive procedures such as mechanical ventilation, prone position, and vasoactive drugs. The mortality rate was high even after discharge from the ICU.
Hormonal Fluctuation and Ankle Instability in Women—Is There a Correlation?
Authors: Hartman Hayden , Fehr Shannon , Gianakos Arianna L.
Published: November 2024

Background:

With higher incidences of ankle sprains and chronic ankle instability in women, it has been postulated that hormonal modulation and ligamentous laxity influences injury propensity. The purpose of this study is to investigate the impact of hormonal fluctuation on ankle stability and ligamentous laxity and their potential contribution to injury propensity in the female athlete.

Methods:

In November 2023, a systematic review of the MEDLINE, Embase, and Cochrane Library databases was performed following PRISMA guidelines. Articles were included if they were published after the year 2000, evaluated outcomes related to the impact of hormones on ankle stability in healthy patients, and included menstrual tracking. The following search terms were used: “(sex or gender) AND (ankle stability)” and “(hormone) AND (ankle).”

Results:

Thirteen articles were included, with 253 (76.4%) women at a weighted mean age of 21.9 ± 2.0 years (range, 20.0-25.9). Five studies evaluated postural sway and balance noting greater sway rates during ovulation compared with the follicular phase. Greater muscle tone ( P < .001) was observed in the follicular phase than ovulation for the tibialis anterior, peroneus longus, and lateral gastrocnemius. Significantly higher ankle joint laxity was observed in ovulation ( P = .016).

Conclusion:

This review found that during ovulation, when estrogen peaks, subjects showed impaired balance with higher postural sway rates, greater ankle joint laxity, and decreased muscle and ligamentous tone and stiffness—an indicator of laxity. An underlying hormonally mediated etiology for the increased propensity to ankle instability in the female athlete is suggested. Syncing an athlete’s workout type and intensity around menstrual cycle phase may be an advantageous strategy for injury prevention.
Sarcopenia and Sarcopenic Obesity in Asian-Indian Patients with Type 2 Diabetes Mellitus and Established Cardiovascular Disease: A Pilot Study of Prevalence
Authors: Wasir Amanpreet Singh , Wasir Jasjeet Singh , Bansal Manish , Joshi Anuradha Rajiv
Published: November 2024

Purpose

To determine the prevalence of sarcopenia and sarcopenic obesity (SO) in patients with type-2 diabetes mellitus (T2DM) and established cardiovascular disease (CVD).

Methods

This cross-sectional study included 60 T2DM patients (30 with CVD and 30 without, aged 40-70 years, 80% males). Data collection included body composition analysis using bio-impedance, hand grip strength measurement and gait-speed assessment. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS-19) guidelines, while SO was defined using a body-mass index, waist circumference and percentage of body fat. SPSS software version 23.0 was used. P < .05 was significant.

Results

Overall sarcopenia (including possible sarcopenia or sarcopenia) was found to be significantly higher in patients with CVD as compared to those without CVD (70% vs. 40%; P = .020). Although numerically greater (in patients with CVD), no statistically significant difference was found in the prevalence of SO (30% vs. 16.7%; P = .222).

Conclusion

Our study found that the prevalence of overall sarcopenia was significantly higher in patients with T2DM and CVD compared to those without CVD. Sarcopenia appears to be a potential independent risk factor in predicting risk of CVD in patients with T2DM.
Empowering Trusted Messengers With Motivational Interviewing Skills: Improving Dissemination of Accurate Information to Communities
Authors: Ivantechenko Marie , Akhter Shubarna , Gutnick Damara
Published: November 2024

Background

Historical injustices, structural racism, and negative healthcare experiences contribute to Black and Brown communities’ distrust of science. Bridging Research, Accurate Information, and Dialogue (BRAID) is a community engagement model that leverages trusted messengers to share accurate, co-created health and science messages to their community through their social networks. In our prior research, trusted messengers reported encountering resistance or “discord” when conveying information about controversial topics such as COVID-19 vaccines and the importance of diversity in clinical trials. Motivational Interviewing (MI) is an evidence-based communication style widely practiced by healthcare providers to guide ambivalent patients toward behavior change. However, MI’s application by community members, particularly trusted messengers, as a strategy for enhancing health message dissemination remains unexplored.

Purpose

This study used mixed methods to explore the feasibility of training trusted messengers in MI to support the dissemination of public health messages through social networks. Specifically, we sought to understand perspectives on learning MI and use of MI in conversations about clinical trial diversity and research subject protection.

Research Design

13 trusted messengers completed a MI introductory training.

Results

Eighty-five percent found the training highly valuable, 54% reported high self-efficacy, and 69% expressed a desire for additional training. Qualitative analysis revealed trusted messenger endorsement of MI, recognition of MI’s applicability to various contexts, and a sense of empowerment to share accurate information to their communities.

Conclusions

Our findings suggest that empowering trusted messengers with communication skills can be a practical, feasible, and cost-effective public health strategy for effective dissemination of accurate public health messages.
Optimising the treatment of chronic ischemic heart disease by training general practitioners to deliver very brief advice on physical activity (OptiCor): protocol of the systematic development and evaluation of a complex intervention
Authors: Hoppe Sabrina , Prinz Alicia , Crutzen Rik , Donner-Banzhoff Norbert , Icks Andrea , Kotz Daniel , Kuß Oliver , Mons Ute , Vomhof Markus , Wilm Stefan , Kastaun Sabrina
Published: November 2024

Background

Chronic ischemic heart disease (IHD) is one of the leading causes of morbidity and mortality. Physical activity (PA) is an effective secondary preventive strategy in IHD management. The German treatment guideline recommends that general practitioners (GPs) deliver PA advice to patients. This recommendation seems inadequately implemented, often due to GP’s insufficient specific training. International guidelines recommend training GPs in how to deliver such advice effectively and efficiently. Evidence is lacking on whether such training can enhance the frequency and quality of PA advice in routine care. The OptiCor project aims to develop and evaluate a GP training in the delivery of very brief PA advice to optimise the treatment of patients with IHD in general practice.

Methods

OptiCor comprises three study phases according to the Medical Research Council recommendations for developing and evaluating complex interventions.

Phase 1 (needs analysis): A nationwide representative household survey will be conducted to collect data on the receipt of GP-delivered PA advice in people with IHD. Qualitative interviews and group discussions with GPs and people with IHD will help to explore, e.g., attitudes, experiences with, and barriers and facilitators of PA advice implementation or reception, respectively. Findings will inform the training development.

Phase 2 (pilot): A pragmatic cluster randomised controlled trial (cRCT) on the effectiveness of the developed training on proportions of GP-delivered PA advice during routine care of IHD patients will be piloted.

Phase 3 (evaluation): A full pragmatic cRCT will be conducted with patient-reported proportions of GP-delivered PA advice as primary endpoint. Collection of health economic and process-related data will facilitate a potential future broad implementation and health economic evaluation of the training.

Discussion

If the developed training successfully improves proportions and quality of GP delivered PA advice to patients with IHD, it could serve as a low-threshold and sustainable strategy for implementing PA recommendations in the secondary prevention of IHD in routine GP practice.

Trial registration

Work package (WP) 1, WP5, and WP6 have been prospectively registered at German Clinical Trials Register (WP1: DRKS00031304, 19/06/2023; WP5: DRKS00034641, 10/07/2024; WP6: DRKS00034642; 10/07/2024).
Risk of sarcopenia, frailty and malnutrition as predictors of postoperative delirium in surgery
Authors: Moellmann Henriette Louise , Alhammadi Eman , Boulghoudan Soufian , Kuhlmann Julian , Mevissen Anica , Olbrich Philipp , Rahm Louisa , Frohnhofen Helmut
Published: November 2024

Background

The risk factors for postoperative delirium are numerous and complex. One approach to identifying patients at risk is to evaluate their nutritional status. The aim of this prospective study is to better understand nutrition as a potential risk factor for postoperative delirium.

Methods

A comprehensive preoperative assessment (Clinical Frailty Scale (CFS), the SARC-F questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF)) were carried out as a prospective clinical study on 421 patients (70+) from 4 different surgical disciplines. Postoperatively, patients are examined daily for the presence of delirium using the 4AT screening tool (Arousal, Attention, Abbreviated Mental Test − 4, Acute change), the Nursing Delirium Screening Scale (NuDesc) and the Confusion Assessment Method (CAM) with its adaptation for the intensive care unit (CAM-ICU).

Results

If there were indications of frailty or sarcopenia in the CFS or SARC-F, the association with delirium was increased 5.34-fold (OR of 5.34 [95% CI: 2.57;11.1]) and 5.56-fold (OR of 5.56 [95% CI: 2.97;10.4]) respectively. Delirium also occurred significantly more frequently with the risk of malnutrition or manifest malnutrition (MNA-SF) than with a normal nutritional status.

Conclusions

Patients’ preoperative and nutritional status significantly impact the risk of developing postoperative delirium. Factors such as frailty, sarcopenia and possible malnutrition must be considered when implementing an effective and targeted preoperative assessment.

Trail registration

German Clinical Trials Registry at https://www.drks.de/DRKS00028614, Registered 25 March 2022.
MRI-based radiomic and machine learning for prediction of lymphovascular invasion status in breast cancer
Authors: Zhang Cici , Zhong Minzhi , Liang Zhiping , Zhou Jing , Wang Kejian , Bu Jun
Published: November 2024

Objective

Lymphovascular invasion (LVI) is critical for the effective treatment and prognosis of breast cancer (BC). This study aimed to investigate the value of eight machine learning models based on MRI radiomic features for the preoperative prediction of LVI status in BC.

Methods

A total of 454 patients with BC with known LVI status who underwent breast MRI were enrolled and randomly assigned to the training and validation sets at a ratio of 7:3. Radiomic features were extracted from T2WI and dynamic contrast-enhanced (DCE) of MRI sequences, the optimal feature filter and LASSO algorithm were used to obtain the optimal features, and eight machine learning algorithms, including LASSO, logistic regression, random forest, k-nearest neighbor (KNN), support vector machine, gradient boosting decision tree, extreme gradient boosting, and light gradient boosting machine, were used to construct models for predicating LVI status in BC. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were used to evaluate the performance of the models.

Results

Eighteen radiomic features were retained to construct the radiomic signature. Among the eight machine learning algorithms, the KNN model demonstrated superior performance to the other models in assessing the LVI status of patients with BC, with an accuracy of 0.696 and 0.642 in training and validation sets, respectively.

Conclusion

The eight machine learning models based on MRI radiomics serve as reliable indicators for identifying LVI status, and the KNN model demonstrated superior performance.This model offers substantial clinical utility, facilitating timely intervention in invasive BC and ultimately aiming to enhance patient survival rates.
A randomized trial of MONOFIX® vs. V-loc™ for resection bed suture during robotic partial nephrectomy
Authors: Han Jang Hee , Jung Gyoohwan , Kim Jung Kwon , Byun Seok-Soo , Seo Seong II , Hong Sung-Hoo , Kwak Cheol , Jeong Chang Wook
Published: November 2024

Background

To evaluate the clinical efficacy and safety of Monofix®-PDO compared to V-Loc™ for tumor bed suturing during robotic-assisted laparoscopic partial nephrectomy (RAPN).

Methods

A randomized, controlled, multicenter, single-blinded trial was conducted across four tertiary institutions. Patients with T1-2 stage renal masses scheduled for RAPN were enrolled. The exclusion criteria included patients not deemed in need of bed suturing, those with a history of prior chemotherapy or immunotherapy, and those with severe systemic diseases or high bleeding tendencies. A total of 174 patients participated and were subjected to permuted block randomization (T1a vs. others), resulting in 88 patients in the V-Loc™ group and 86 in the Monofix®-PDO group. The primary outcome was the resection bed suture time. The secondary outcomes were total suture use time, warm ischemia time, console time (for efficacy), estimated blood loss, hemoglobin change, and 90-day treatment-related adverse events (for safety). All patients were scheduled for follow-up visits for up to three months postoperatively.

Results

The primary outcome, resection bed suture time, did not significantly differ between the V-Loc™ and Monofix®-PDO groups (4.8 ± 2.6 vs. 4.5 ± 2.6 min, p = 0.531). Secondary outcomes, including total suture used time (5.3 ± 2.8 vs. 4.8 ± 2.6 min, p = 0.289) and warm ischemic time (15.6 ± 5.5 vs. 15.4 ± 5.4 min, p = 0.834), were comparable between the two groups. In terms of safety outcomes, changes in serum hemoglobin levels did not show significant differences on postoperative days 1, 3, and 14 (P = 0.537, 0.353, and 0.840, respectively). No device-related adverse events were observed during the 90-day follow-up period in either group.

Conclusions

Monofix®-PDO demonstrated non-inferior to V-Loc in terms of both safety and efficacy in patients undergoing RAPN. This trial is registered on cris.nih.go.kr as KCT0006809 (Registration date: 02/19/2021).
In vivo evaluation of the enamel wear of primary molar against four types of crowns using the intra-oral scanner
Authors: Amer Diana Mohamed , Abdellatif Abeer Mostafa
Published: November 2024

Background

Primary tooth wear is a common phenomenon that affects chewing ability, dental sensitivity, aesthetics, and occlusion. This study was conducted to compare the antagonistic enamel wear of primary molars opposed to four different crown materials.

Methods

Forty lower second primary molars of children aged 4–8 years were allocated into 4 groups: Group 1 (n = 10): received stainless steel crowns; Group 2 (n = 10): received prefabricated commercially available zirconia crowns (NuSmile®); Group 3 (n = 10): received locally manufactured zirconia crowns created via the CAD/CAM system; and Group 4 (n = 10): received locally manufactured hybrid ceramic (Vita Enamic®) crowns created via the CAD/CAM system. All the crowns were cemented with resin-modified glass ionomer cement. The upper arch was scanned with a 3D intraoral scanner immediately (baseline), 6 months, and 1 year after crown cementation to evaluate the wear of the natural enamel of the antagonistic primary molar. The resultant scans were compared via Exocad software to measure the amount of linear wear of the mesiopalatal cusp of the primary upper second molar.

Results

The analysed data revealed statistically significant differences between the studied groups. The highest mean wear was detected in the CAD/CAM zirconia crown group, followed by the NuSmile zirconia crown group and then the CAD/CAM hybrid crown group, and the lowest mean wear was detected for the stainless-steel crown group.

Conclusion

Compared with stainless steel crowns, aesthetic crowns cause more wear in the antagonistic primary molar enamel. CAD/CAM zirconia crowns induce the greatest amount of wear, followed by NuSmile zirconia crowns. The CAD/CAM hybrid crown is an aesthetic tooth-coloured crown that causes less wear of the opposing enamel than zirconia crowns do.

Trial registration

The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT06456879) on 07/06/2024.
Relationship between nursing students’ levels of liking children and self-efficacy in paediatric medication administration
Authors: Bulduk Mehmet , Can Veysel , Muhafiz Eda Nur
Published: November 2024

Background

Medication management is a critical aspect of nursing, in particular with respect to paediatric patients, in whom medication errors are prevalent. Enhancing competence in this area requires not only general nursing skills but also targeted educational interventions and emotional support. This study aims to examine the relationship between nursing students’ levels of liking children and their self-efficacy in paediatric medication administration, thereby exploring the impact of emotional factors on clinical competence.

Methods

This descriptive study was conducted with 308 nursing students in their second, third and fourth years of study at a state university in eastern Turkey between December 2022 and February 2023. Data were collected using the Student Descriptive Information Form, the Barnett Liking of Children Scale and the Medication Administration Self-Efficacy Scale. Statistical analysis included the Mann–Whitney U test, the Kruskal–Wallis H test, Dunn’s test for multiple comparisons and Spearman’s rho correlation coefficient.

Results

The mean age of the participants was 21.82 ± 1.94 years, and 68.8% were female. The mean Medication Administration Self-Efficacy Scale score was 52.97 ± 15.27, and the mean Liking of Children Scale score was 66.65 ± 15.8. No significant relationship was found between the total score on the Liking of Children Scale and the score on the drug preparation subdimension (p > 0.05). However, a positive but weak correlation was found between the total score on the Liking of Children Scale and the score on the drug administration subdimension (r = 0.137; p < 0.05). Similarly, a positive but weak relationship was identified between the total score on the Liking of Children Scale and the score on the Medication Administration Self-Efficacy Scale (r = 0.123; p < 0.05).

Conclusions

Nursing students’ liking of children is positively, although weakly, associated with their self-efficacy in paediatric medication administration. This result suggests that emotional factors, such as affinity for children, may be relevant when designing nursing education programmes, particularly in paediatric care settings .
Machine learning predicts pulmonary Long Covid sequelae using clinical data
Authors: Cordelli Ermanno , Soda Paolo , Citter Sara , Schiavon Elia , Salvatore Christian , Fazzini Deborah , Clementi Greta , Cellina Michaela , Cozzi Andrea , Bortolotto Chandra , Preda Lorenzo , Francini Luisa , Tortora Matteo , Castiglioni Isabella , Papa Sergio , Sona Diego , Alì Marco
Published: November 2024

Long COVID is a multi-systemic disease characterized by the persistence or occurrence of many symptoms that in many cases affect the pulmonary system. These, in turn, may deteriorate the patient’s quality of life making it easier to develop severe complications. Being able to predict this syndrome is therefore important as this enables early treatment. In this work, we investigated three machine learning approaches that use clinical data collected at the time of hospitalization to this goal. The first works with all the descriptors feeding a traditional shallow learner, the second exploits the benefits of an ensemble of classifiers, and the third is driven by the intrinsic multimodality of the data so that different models learn complementary information. The experiments on a new cohort of data from 152 patients show that it is possible to predict pulmonary Long Covid sequelae with an accuracy of up to

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. As a further contribution, this work also publicly discloses the related data repository to foster research in this field.
Australian general practice registrars’ billing patterns: a cross-sectional analysis from the Registrars Clinical Encounters in Training (ReCEnT) study
Authors: Fisher Katie , Tapley Amanda , Ralston Anna , Davey Andrew , Holliday Elizabeth , Dizon Jason , Wearne Susan , Fielding Alison , van Driel Mieke , Spike Neil , Clarke Lisa , Magin Parker
Published: November 2024

Background

In Australia, a government insurance scheme (Medicare) pays set rebates for a range of distinct general practitioner (GP) services. GPs may ‘bulk-bill’ and accept the Medicare rebate fee directly, or ‘privately-bill’ by charging the patient a higher fee that is partially reimbursed by Medicare. The billing behaviour of Australian GP registrars (trainees) and their decision to bulk- or privately-bill patients is an evidence gap. This study aimed to establish the prevalence and associations of registrars’ bulk-billing versus private-billing.

Methods

A cross-sectional analysis of data from the ReCEnT study, 2010–2021. The primary analysis used univariable and multivariable logistic regression, with the outcome factor being whether a consultation was bulk-billed versus privately-billed. The primary analysis excluded practices that universally bulk-bill or universally privately-bill all patients. A secondary analysis included all practices regardless of billing policy to provide an overall perspective of billing across the breadth of GP vocational training.

Results

For the primary analysis, 3,086 GP registrars recorded details of 316,141 consultations. Bulk-billing accounted for 61.8%, [95% CI:61.6%, 62.0%] of consultations. Significant positive associations of bulk-billing included: younger and older patient age (compared to patients aged 15–34 years, aOR 5.45; CI: [5.06, 5.87] for patients aged 0–14 years, aOR 2.36; 95% CI: [2.24, 2.49] for patients aged 65–74 years, and aOR 4.48; CI: [4.13, 4.85] for 75 years-and-older). Significant negative associations of bulk-billing included patients new to the practice (aOR 0.39; CI: [0.37, 0.41]) and patients new to the registrar (aOR 0.56; CI: [0.55, 0.58]), compared to existing patients of the registrar and practice; and practices with lesser socio-economic disadvantage (aOR 0.91; CI: [0.89, 0.93] per decile decrease in socioeconomic disadvantage). Bulk-billed consultations were positively associated with arranging patient follow-up (with the registrar aOR 1.06; CI: [1.03, 1.09]; or with another GP in the practice aOR 1.40; CI: [1.33, 1.46]).

Conclusions

Registrar billing decisions may, in part, reflect government bulk-billing incentives but our findings suggest other factors may contribute, including the provision of affordable care recognising patient need (children and elderly, and those living in areas of greater socioeconomic disadvantage) and continuity of care. Further research is needed to better understand how, and why, registrars make billing decisions.
Using a blend of oilseed meals in the diets of Nile tilapia (Oreochromis niloticus): effects on the growth performance, feed utilization, intestinal health, growth, and metabolic-related genes
Authors: Badran Ahmed A. , Magouz Fawzy I. , Zaineldin Amr I. , Abdo Safaa E. , Amer Asem A. , Gewaily Mahmoud S. , Dawood Mahmoud A.O.
Published: November 2024

In this study, Nile tilapia were fed a blend of oilseed meals (BOM) that includes cottonseed meal (CSM), linseed meal (LSM), sesame meal (SSM), and sunflower meal (SFM) at a ratio of 1 CSM: 1 LSM: 1 SSM: 1 SFM. Six diets were formulated where the first diet included FM and SBM as protein sources and considered the positive control diet (FM). Another five FM-free diets were formulated, where SBM was substituted with BOM and included at 0, 100, 200, 300, and 400 g/kg diet. After 90 days, the FBW, WG, and PER were markedly increased while FCR decreased by FM-based diet and BOM at 0, 100, or 200 g/kg compared to fish-fed BOM at 300, and 400 g/kg (P < 0.05). The groups treated with BOM at 100–200 g/kg demonstrated considerable impairments, followed by those treated with BOM at 300 g/kg. Furthermore, fish given BOM at 400 g/kg had significantly less intestinal histological characteristics than the other groups. The relative expression of the IGF-1, GHR1, FABP, and CCK genes were downregulated in tilapia-fed BOM at 200, 300, and 400 g/kg compared to fish-fed FM-based diet (P < 0.05). The relative cost of feed per kg fish gain showed 4.42, 7.11, 8.14, 10.32, and 8.10% reduction rates in fish-fed SBM, or BOM at 100, 200, 300, and 400 g/kg. In conclusion, dietary BOM can be incorporated in Nile tilapia diets at up to 200 g/kg without affecting growth performance or feed utilisation. High inclusion levels (300 and 400 g/kg) may impair growth performance and feed utilisation by disrupting intestinal histological characteristics and reducing expression of growth and metabolic genes (GHR1, IGF-1, FABP, and CCK) in the liver.
Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study
Authors: Shang Jingjing , Wang Liangliang , Gong Jinhong , Liu Xinru , Su Dan , Zhou Xindie , Wang Yuji
Published: November 2024

Background

Low molecular weight heparin (LMWH) has been the standard treatment for preventing venous thromboembolism after total joint arthroplasty. However, the evidence supporting specific LMWH dosing regimens is limited.

Objectives

This study assessed the efficacy and safety of three enoxaparin dosing regimens to prevent venous thromboembolism.

Methods

Participants undergoing hip or knee replacement were randomly assigned to receive 20 mg of enoxaparin 6 h postoperatively (Group A), 40 mg 6 h postoperatively (Group B), or 40 mg 12 h postoperatively (Group C). The primary outcomes included thromboembolic and major bleeding events within 3 months, while the secondary outcomes comprised ecchymosis, wound exudation, drainage volume, allogeneic red blood cell transfusion, and first postoperative day hemoglobin levels.

Results

A total of 536 patients were analyzed. The occurrence of thromboembolic events was comparably low across all groups. Group C exhibited the lowest postoperative ecchymosis rate at 19.3%, significantly less than Group A (32.8%, p = 0.004) and Group B (37.7%, p < 0.001). Ecchymosis rates were about double in Group A and 1.5 times higher in Group B compared to Group C. Significant differences were also observed in 24-hour and total postoperative drainage volumes, with Group B having higher volumes than the other groups.

Clinical trial registration

This trial was prospectively registered at the China Clinical Trials Registry (registration date: November 14, 2021; registration number: ChiCTR2100053191).

Conclusion

No significant differences in venous thromboembolism rates were seen between the tested enoxaparin dosing regimens after total joint arthroplasty. The 40 mg dose administered 12 h after surgery was associated with reduced postoperative ecchymosis and drainage volumes without an increased thrombosis risk, suggesting it is a safer and more effective option than earlier or lower dosages.

Graphical Abstract
Trauma team activation and triage of severely injured patients at one non-trauma-center hospital in Stockholm
Authors: Lapidus Oscar , Bäckström Denise , Hammarqvist Folke , Wladis Andreas , Rubenson Wahlin Rebecka
Published: November 2024

Background

In 2017 the Swedish public insurance company Löf published national guidelines for in-hospital trauma team activation (TTA), which are now widely adopted in Sweden. No studies have examined triage accuracy at non-trauma-center hospitals in the Stockholm trauma system since the implementation of the new TTA criteria.

Aim

To assess trauma triage accuracy at one non-trauma-center hospital in Stockholm.

Methods

3528 trauma patients treated at Södersjukhuset during 2019–2022 were acquired from the Swedish Trauma Registry (SweTrau) to calculate TTA triage accuracy. Undertriage was defined in accordance with national guidelines as patients with a New Injury Severity Score > 15 who did not prompt level 1 TTA on arrival to hospital.

Results

In total there were 849 severely injured patients during the study period, of which 2.2% (n = 19) prompted TTA level 1, corresponding to an undertriage of 98% (n = 830). Of the 849 severely injured patients, 41% (n = 348) prompted TTA level 2 whereas the remaining 57% (n = 482) prompted no TTA on arrival to hospital. There were a total of 3046 patients prompting TTA during the study period, but only 19% (n = 19) of level 1 and 12% (n = 348) of level 2 patients were severely injured, and 45% had a NISS ≤ 3.

Conclusion

Undertriage of severely injured trauma patients was 98% according to the definition specified by Swedish trauma triage guidelines, higher than reasonably acceptable. There is considerable overtriage with non-severely injured patients prompting TTA. However, the suitability of using NISS > 15 to retrospectively define the need for TTA is debatable as this does not always correlate with the fulfillment of the TTA criteria. Further investigation of adherence to trauma triage guidelines in clinical practice may be of value to improve triage accuracy in organized regional trauma systems.
Mortality in septic patients treated with short-acting betablockers: a comprehensive meta-analysis of randomized controlled trials
Authors: Alexandru Mihai-Gabriel , Niewald Patrick , Krüger Stefan , Borgstedt Rainer , Whitehouse Tony , Singer Mervyn , Rehberg Sebastian , Scholz Sean S.
Published: November 2024

Background

Treatment with short-acting betablockers in septic patients remains controversial. Two recent large multicenter trials have provided additional evidence on this therapeutic approach. We thus performed a meta-analysis, including the most recent data, to evaluate the potential impacts of treatment with short-acting betablockers on mortality in adult septic patients.

Methods

The data search included PubMed, Web of Science, ClinicalTrials.gov and the Cochrane Library. A meta-analysis of all eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only randomized, controlled studies with valid classifications of sepsis and intravenous treatment with short-acting betablockers (landiolol or esmolol) were included. Short-term mortality served as the primary endpoint. Secondary endpoints included effects on short-term mortality regarding patient age and cardiac rhythm.

Results

A total of seven studies summarizing 854 patients fulfilled the predefined criteria and were included. Short-term mortality as well as pooled mortality (longest period of data on mortality) was not significantly impacted by treatment with short-acting betablockers when compared to the reference treatment (Risk difference, − 0.10 [95% CI, − 0.22 to 0.02]; p = 0.11; p for Cochran’s Q test = 0.001; I2 = 73%). No difference was seen when comparing patients aged < 65 versus ≥ 65 years (p = 0.11) or sinus tachycardia with atrial fibrillation (p = 0.27). Despite statistical heterogeneity, no significant publication bias was observed.

Conclusion

Administration of short-acting betablockers did not reduce short-term mortality in septic patients with persistent tachycardia. Future studies should also provide extensive hemodynamic data to enable characterization of cardiac function before and during treatment.
Metastatic recurrence in women diagnosed with non-metastatic breast cancer: a systematic review and meta-analysis
Authors: Morgan Eileen , O’Neill Colette , Shah Richa , Langselius Oliver , Su Yaqi , Frick Clara , Fink Hanna , Bardot Aude , Walsh Paul M. , Woods Ryan R. , Gonsalves Lou , Nygård Jan F. , Negoita Serban , Ramirez-Pena Esmeralda , Gelmon Karen , Antone Nicoleta , Mutebi Miriam , Siesling Sabine , Cardoso Fatima , Gralow Julie , Soerjomataram Isabelle , Arnold Melina
Published: November 2024

Background

To assess proportions of metastatic recurrence in women initially diagnosed with non-metastatic breast cancer by stage at diagnosis, breast cancer subtype, calendar period and age.

Methods

A systematic search of MEDLINE and Web of Science databases (January 2010–12 May 2022) was conducted. Studies reporting the proportion of distant metastatic recurrence in women with non-metastatic breast cancer were identified and outcomes and characteristics were extracted. Risk of bias was assessed independently by two reviewers. Random-effects meta-analyses of proportions were used to calculate pooled estimates and 95% confidence intervals (CIs).

Results

193 studies covering over 280,000 patients were included in the main analysis. Pooled proportions of metastatic recurrence increased with longer median follow-up time from 12.2% (95% CI 10.5–14.0%) at 1–4 years post diagnosis, 14.3% (95% CI 12.9–15.7%) at 5–9 years to 23.3% (95% CI 20.1–26.8) at 10 years or more. Regional variation was observed with pooled estimates ranging from 11.0% (95% CI 8.5–13.7%) in Europe to 26.4% (95% CI 16.7–37.4%) in Africa (1–4 years follow-up). Proportions of recurrence were higher in studies with diagnosis before 2000 (22.2%, 95% CI 15.1–30.3) compared to studies with diagnosis from 2000 onwards (12.8%, 95% CI 11.7–14.0). At 1–4 years median follow-up, pooled proportions of metastatic recurrence were higher in women with hormone receptor negative (15.2%, 95% CI 12.0–18.7%) compared with receptor positive disease (9.6%, 95% CI 6.2–13.6%) and in women with locally advanced (33.2%, 95% CI 24.7–42.3%) relative to early disease at initial diagnosis (4.8%, 95% CI 2.5–7.8%). Proportions were higher in those under 50 years compared with 70+ years, 18.6% (95% CI 15.9–21.4%) versus 13.3% (95% CI 9.2, 18.0%), respectively. Heterogeneity was high in all meta-analyses and results should be interpreted with caution.

Conclusions

Higher proportions of metastatic recurrence in patients initially diagnosed at an advanced stage and in earlier calendar period emphasises the importance of early detection and treatment advancements. As the global number of breast cancer survivors increases, research and health policy efforts should be directed towards timely diagnosis and access to effective treatments and care.

Study registration: PROSPERO CRD42022314500.