bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing Public Health Modules as an Approach to Improve Knowledge and Attitudes of Medical Students: A Student-Led, Multiyear Study
Authors: Dunleavy Spencer , Edelman David S. , Wimer Gabrielle , Karelas Gregory , Hassan Amir , Clarke Cameron D. , Canfield Stephen M. , Lebwohl Benjamin , Lypson Monica L. , Moise Nathalie
Published: May 2024

Purpose

Public health is a necessary focus of modern medical education. However, while numerous studies demonstrate benefits of public health education during medical school among self-selected students (i.e., those interested in public health), there are few educational models shown to be effective across the general medical student population. This study examined the effect of a multiyear, case-based, longitudinal online public health curriculum required for all medical students at an urban, research-focused U.S. medical school.

Method

The authors created 11 short public health modules to supplement a year-long, organ-based preclerkship course at Columbia University Vagelos College of Physicians and Surgeons. Beginning in 2020, all students were required to complete these modules, with repeated surveys to assess changes in attitudes and knowledge of public health over time. The authors compared responses for these domains before and after each module, across multiple time points throughout the year, and cross-sectionally to a 2019 cohort of students who were not provided the modules.

Results

Across 3 cohorts, 405 of 420 (96.4%) students provided responses and were included in subsequent analyses. After completing the modules, students reported perceiving a greater importance of public health to nearly every medical specialty (P < .001), more positive attitudes toward public health broadly (P < .001), and increased knowledge of public health content (P < .001). These findings were consistent across longitudinal analysis of students throughout the year-long course and when compared to the cohort who did not complete the modules.

Conclusions

Case-based, interactive, and longitudinal public health content can be effectively integrated into the required undergraduate medical education curriculum to improve all medical students’ knowledge and perceptions of public health. Incorporating evidence-based public health education into medical training may help future physicians to better address the needs of the communities and populations in which they practice.
Development of a Hematology–General Medicine Hybrid Team to Improve Care of Patients With Sickle Cell Disease
Authors: Merz Lauren E. , Osei Miriam A. , Green Aliza , Story Charlotte M. , Schuering Kelly M. , Achebe Maureen Okam
Published: May 2024

Problem

Approximately 100,000 individuals in the United States have sickle cell disease (SCD). These individuals face multiple barriers to equitable care. At Brigham and Women’s Hospital, existing health inequities for these patients were compounded by admitting, rounding, and team structures that assigned patients with SCD to multiple medicine teams with a hematologist attending, leading to delays in patient care and gaps in residents’ hematology knowledge.

Approach

A hematology–general medicine hybrid team was created in September 2021 to enhance trainee knowledge, skill, and confidence in managing hematology conditions and improve the quality of care delivered to individuals with SCD. This allowed for regionalization of patients with classical hematology conditions to specific hospital floors under the care of one team with a hematologist as the attending of record.

Outcomes

From October 1, 2021, to January 11, 2022, the majority (745/824, 90%) of in-hospital days for patients with a primary hematology diagnosis were under the care of the hematology–general medicine hybrid team. Regionalization to the home floor of the hybrid team was achieved on 331 (40%) of these 824 hospital days, consistent with regionalization rates for other teams. From October 1, 2021, to September 30, 2022, there were 128 unique patients with SCD admitted over 511 encounters and cared for by approximately 78 residents and 12 medical students. Feedback from residents reported improved knowledge in the management of hematology conditions, especially SCD.

Next Steps

The authors are working on a comprehensive analysis of the hybrid team’s impact on trainee skill and confidence in managing SCD. The authors believe that this model can be replicated at other institutions to optimize trainee education, consolidate care, and address implicit bias against patients with SCD, even with the hematology attending as a consultant instead of as the attending of record.
Digital Twins of Acute Hypoxemic Respiratory Failure Patients Suggest a Mechanistic Basis for Success and Failure of Noninvasive Ventilation
Authors: Weaver Liam , Shamohammadi Hossein , Saffaran Sina , Tonelli Roberto , Laviola Marianna , Laffey John G. , Camporota Luigi , Scott Timothy E. , Hardman Jonathan G. , Clini Enrico , Bates Declan G.
Published: May 2024

OBJECTIVES:

To clarify the mechanistic basis for the success or failure of noninvasive ventilation (NIV) in acute hypoxemic respiratory failure (AHRF).

DESIGN:

We created digital twins based on mechanistic computational models of individual patients with AHRF.

SETTING:

Interdisciplinary Collaboration in Systems Medicine Research Network.

SUBJECTS:

We used individual patient data from 30 moderate-to-severe AHRF patients who had failed high-flow nasal cannula (HFNC) therapy and subsequently underwent a trial of NIV.

INTERVENTIONS:

Using the digital twins, we evaluated lung mechanics, quantified the separate contributions of external support and patient respiratory effort to lung injury indices, and investigated their relative impact on NIV success or failure.

MEASUREMENTS AND MAIN RESULTS:

In digital twins of patients who successfully completed/failed NIV, after 2 hours of the trial the mean (sd) of the change in total lung stress was –10.9 (6.2)/–0.35 (3.38) cm H2O, mechanical power –13.4 (12.2)/–1.0 (5.4) J/min, and total lung strain 0.02 (0.24)/0.16 (0.30). In the digital twins, positive end-expiratory pressure (PEEP) produced by HFNC was similar to that set during NIV. In digital twins of patients who failed NIV vs. those who succeeded, intrinsic PEEP was 3.5 (0.6) vs. 2.3 (0.8) cm H2O, inspiratory pressure support was 8.3 (5.9) vs. 22.3 (7.2) cm H2O, and tidal volume was 10.9 (1.2) vs. 9.4 (1.8) mL/kg. In digital twins, successful NIV increased respiratory system compliance +25.0 (16.4) mL/cm H2O, lowered inspiratory muscle pressure –9.7 (9.6) cm H2O, and reduced the contribution of patient spontaneous breathing to total driving pressure by 57.0%.

CONCLUSIONS:

In digital twins of AHRF patients, successful NIV improved lung mechanics, lowering respiratory effort and indices associated with lung injury. NIV failed in patients for whom only low levels of positive inspiratory pressure support could be applied without risking patient self-inflicted lung injury due to excessive tidal volumes.
Physical activity and exercise health benefits: cancer prevention, interception, and survival
Authors: Albini Adriana , La Vecchia Carlo , Magnoni Francesca , Garrone Ornella , Morelli Danilo , Janssens Jaak Ph. , Maskens Alain , Rennert Gad , Galimberti Viviana , Corso Giovanni
Published: May 2024

Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.
Oxygen reserve index versus conventional peripheral oxygen saturation for prevention of hypoxaemia
Authors: Kim Eun-Hee , Park Jung-Bin , Kang Pyoyoon , Ji Sang-Hwan , Jang Young-Eun , Lee Ji-Hyun , Kim Hee-Soo , Kim Jin-Tae
Published: May 2024

BACKGROUND

Hypoxaemia occurs frequently during paediatric laryngeal microsurgery.

OBJECTIVE

The oxygen reserve index is a noninvasive and continuous parameter to assess P
aO2 levels in the range of 100 to 200 mmHg. It ranges from 0.0 to 1.0. We investigated whether monitoring the oxygen reserve index can reduce the incidence of SpO2 90% or less.

DESIGN

Randomised controlled trial.

SETTING

A tertiary care paediatric hospital.

PARTICIPANTS

Paediatric patients aged 18 years or less scheduled to undergo laryngeal microsurgery.

INTERVENTION

The patients were randomly allocated to the oxygen reserve index or control groups, and stratified based on the presence of a tracheostomy tube. Rescue intervention was performed when the oxygen reserve index was 0.2 or less and the SpO2 was 94% or less in the oxygen reserve index and control groups, respectively.

MAIN OUTCOME MEASURE

The primary outcome was the incidence of SpO2 90% or less during the surgery.

RESULTS

Data from 88 patients were analysed. The incidence of SpO2 ≤ 90% did not differ between the oxygen reserve index and control groups [P = 0.114; 11/44, 25 vs. 18/44, 40.9%; relative risk: 1.27; and 95% confidence interval (CI): 0.94 to 1.72]. Among the 128 rescue interventions, SpO2 ≤ 90% event developed in 18 out of 75 events (24%) and 42 out of 53 events (79.2%) in the oxygen reserve index and control groups, respectively (P < 0.001; difference: 55.2%; and 95% CI 38.5 to 67.2%). The number of SpO2 ≤ 90% events per patient in the oxygen reserve index group (median 0, maximum 3) was less than that in the control group (median 0, maximum 8, P = 0.031).

CONCLUSION

Additional monitoring of the oxygen reserve index, with a target value of greater than 0.2 during paediatric airway surgery, alongside peripheral oxygen saturation, did not reduce the incidence of SpO2 ≥ 90%.
Coronavirus disease and assisted reproduction in South Africa: a qualitative study
Authors: Whittaker Andrea , Manderson Lenore
Published: May 2024

Objective:

Little has been written about the effects of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproduction services in low and middle-income countries. The purpose of this study was to investigate the immediate and long-term effects of assisted reproductive technology services in South Africa after 27 months of various lockdowns and restrictions associated with the pandemic.

Methods:

This article draws on data collected in 2020–2023 as part of a qualitative study of assisted reproduction within sub-Saharan Africa. Twenty-nine infertility specialists and other clinical staff including embryologists, clinic coordinators, ova donor coordinators, and nurses were interviewed and asked about the effects of the pandemic on their clinics and patients. A semistructured in-depth interview technique was used to collect the data. The analysis was conducted using the thematic analysis method.

Result:

Findings revealed that the immediate effects of the pandemic included the cancellations and deferral of assisted reproductive technology cycles and decreased numbers of cross-border patients. Challenges experienced by clinics in making decisions included whether to treat COVID-positive patients, increased costs of testing, and economic losses. Longer-term effects included the reconsideration of life priorities by both specialists and patients, and improved remote consultations and networking opportunities facilitated by the widespread dissemination of online platforms. There was also increased acceptability of the shipping and use of frozen gametes, leading to a perceived growth of the South African frozen oocyte trade. There was also decreased demand for add-ons, associated with the economic downturn post-pandemic in the region.

Conclusion:

COVID-19 carried costs (cancellation of cycles, a decrease in international patients, decrease in some procedures with the post-COVID economic downturn) but also unanticipated benefits for the practices and provision of services within infertility clinics in South Africa (increased gamete and embryo shipping; virtual patient consultations; improved virtual networking; greater use of local in vitro fertilization services). Further comparisons postpandemic in other low and middle-income countries are needed to understand the long-term implications.
Retinal dystrophy associated with Birt-Hogg-Dubé syndrome
Authors: Ma Jingyi , Sheri Narin , Carrell Nathan , Kalluri Meena , MacDonald Ian M
Published: May 2024

Purpose:

Birt-Hogg-Dubé syndrome (BHDS) is an autosomal dominant cancer syndrome characterized by skin fibrofolliculomas, lung cysts, spontaneous pneumothorax, and multifocal renal carcinomas. Ophthalmologic findings associated with BHDS include flecked chorioretinopathy, choroidal melanoma, iris melanocytosis, and eyelid fibrofolliculomas. We present the case of a retinal dystrophy associated with BHDS.

Methods:

Observational case report.

Results:

A 48-year-old woman was referred for poor night vision and peripheral visual field loss. She had a past medical history of Birt-Hogg-Dubé syndrome, manifesting as multiple pulmonary cysts and atelectasis of both lungs. Best corrected visual acuity was 20/25 OU. Posterior segment examination revealed significant vessel attenuation and peripheral retinopathy consistent with a retinal dystrophy.

Conclusion:

This case associates BHDS with retinal pigment epithelial changes and visual field defects. Patients with BHDS should undergo ophthalmological examination as part of their care.
Isoniazid-Induced Cerebellitis in a Chronic Kidney Disease Patient
Authors: Sarvepalli Tanushree , Alagappan S.P. , Nair Krishna S. , Dhas Clement Jenil , Partheeban Shamitha , Murali A
Published: May 2024

The bacterial disease tuberculosis (TB), when it affects organs of the body other than the lungs, is called extrapulmonary TB. The treatment regimen includes the drugs isoniazid, rifampicin, pyrazinamide, and ethambutol, of which isoniazid is known to be the most active drug. Adverse drug reactions commonly include immunological as well as drug toxicity effects, with the latter being particularly important in renally impaired patients because of high risk of drug accumulation. Cerebellitis, which is an inflammatory condition that results in cerebellar dysfunction, is a rare complication of isoniazid use. Diagnosis is made after excluding all other possibilities. In the case described here, the extrapulmonary TB patient was a known case of chronic kidney disease (G4). He presented with slurred speech and sedation; magnetic resonance imaging scan showed bilateral fluid-attenuated inversion recovery hyperintensities in the dentate nuclei, indicative of cerebellitis. Dramatic improvement was seen upon replacing Isoniazid with levofloxacin and administration of antioxidants and pyridoxine supplements, which confirmed the diagnosis of isoniazid-induced cerebellitis.
Web-based telemonitoring of visual function and self-reported postoperative outcomes in cataract care: international multicenter randomized controlled trial
Authors: Claessens Janneau L.J. , Wanten Joukje C. , Bauer Noël J.C. , Nuijts Rudy M.M.A. , Vrijman Violette , Selek Esen , Wouters Rob J. , Reus Nicolaas J. , van Dorst Fallon J.G.M. , Findl Oliver , Ruiss Manuel , Boden Karl , Januschowski Kai , Imhof Saskia M. , Wisse Robert P.L.
Published: May 2024

Purpose:

To compare web-based, self-administered follow-up after cataract surgery to conventional face-to-face follow-up.

Setting:

Eye clinics in the Netherlands, Austria, and Germany.

Design:

Randomized controlled trial with an embedded method comparison study (ClinicalTrials.gov: NCT04809402).

Methods:

Routine patients with cataract were randomized into 2 groups: The telemonitoring group undertook web-based vision self-assessments and questionnaires from home, while the usual care group received conventional care. All participants had a 4- to 6-week postoperative clinic visit for safety and validation purposes. Outcomes included, the web test's accuracy for assessing postoperative visual acuity (VA) and refractive error, adverse event rates, and patient-reported outcome measurements (PROMs).

Results:

94 participants (188 eyes) were enrolled. Web-based uncorrected distance VA testing demonstrated a negligible mean difference (−0.03 ± 0.14 logMAR) when compared with conventional Early Treatment Diabetic Retinopathy Study chart testing, with 95% limits of agreement ranging from −0.30 to 0.24 logMAR. The web-based refraction assessment overestimated the postoperative refractive error (mean difference in spherical equivalent 0.15 ± 0.67 diopters), resulting in a poorer corrected distance VA compared with subjective refraction (mean 0.1 vs −0.1 logMAR). Rates of adverse events and unscheduled consultations were minimal across both groups. Preoperative and postoperative PROM questionnaires had a 100% response rate. Visual functioning (Catquest-9SF and National Eye Institute Visual Function Questionnaire-25) improved postoperatively (mean improvement −0.80 and 16.70, respectively) and did not significantly differ between the 2 groups.

Conclusions:

The patients with cataract in this study effectively provided postoperative outcome data using a web interface. Both conventional and web-based follow-ups yielded similar PROMs and adverse event rates. Future developments should reduce the variability in the web-based VA test and yield representative refraction outcomes.
Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes
Authors: Hu Xiaoxin , Qi Jiao , Cheng Kaiwen , He Wenwen , Zhang Keke , Zhao Chen , Lu Yi , Zhu Xiangjia
Published: May 2024

Purpose:

To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes.

Setting:

Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Design:

Prospective cohort study.

Methods:

Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively.

Results:

A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm2 vs 21.85 ± 2.30 mm2, P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higher-order aberrations did not differ between the 2 groups (all P > .05).

Conclusions:

In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes.
Practical Applications and Observational Implications of Time-Based Coding for Workers’ Compensation Clinical Encounters—A Follow-up to Best Practices in Documenting and Coding High-Value Care in Workers’ Compensation Encounters—ACOEM Guidance Statement
Authors: Martin Douglas W.
Published: May 2024

Clinical practices that provide workers’ compensation care and other services related to managing work-related illnesses and injuries have long been challenged in receiving appropriate payment for their professional work. The American College of Occupational and Environmental Medicine (ACOEM) has provided excellent guidelines for coding and billing via its various documents that have been provided over the years. However, despite these guidelines, payors have been slow to adopt occupational specific coding guidelines to justify higher professional payment. With the move to a Centers for Medicare & Medicaid Services (CMS)-sponsored time-based coding option in 2011, the occupational and environmental medicine (OEM) clinics have been able to finally not only document but recoup the value of those services that go beyond the simple patient interface, being able to capture those activities that truly provide high value in the management of workers’ medical issues.
Physicians' Knowledge, Attitudes, and Practice of Occupational Diseases Diagnosis and Occupational History Taking
Authors: Sehsah Radwa , El-Gilany Abdel-Hady , El-Hadidy Samah S.
Published: May 2024

Objectives

This cross-sectional study assessed physicians' knowledge and attitudes toward occupational diseases, their practice of occupational history taking, and the associated factors and barriers.

Methods

From January 1 to June 30, 2023, Egyptian physicians from different specialties (n = 278) completed a questionnaire including sociodemographic and occupational data, questions measuring knowledge, attitudes, practice, and barriers.

Results

The significant predictor of low knowledge was the nonuse of a standard history form. The lack of undergraduate education/postgraduate training in occupational diseases was the predictor of unfavorable attitudes and poor practice. Unfavorable attitudes also predicted poor practice. The main barriers were insufficient knowledge and busy schedules.

Conclusions

Different specialties physicians are essential in recognizing occupational diseases. They need to be knowledgeable about occupational diseases within their specialties. Specialized undergraduate and postgraduate training in this topic can help achieve such needs.
Occupational and Health-Related Risk Factors for Incident and Recurrent Back Disorders in Danish Fishers—A Register-Based Study
Authors: Remmen Line Nørgaard , Halekoh Ulrich , Christiansen David Høyrup , Herttua Kimmo , Klakk Heidi , Berg-Beckhoff Gabriele
Published: May 2024

Background

Fishers are at risk of back disorders due to their physically demanding work. The aim was to investigate risk factors for back disorders in fishers in Denmark.

Methods

All male Danish registered fishers between 1994 and 2017 were included. ICD-10 codes classified back disorders (M40-M54* and DM99.1-4*). A multistate model on a cause-specific cox regression model was conducted.

Results

Of 13,165 fishers included, 16% had a hospital contact with an incident back disorder, and 52% at least had 1 recurrent episode. Having worked in another occupation (HR 1.14; 95% CI: 1.02, 1.27) and another musculoskeletal disorder (HR 1.84; 95% CI: 1.69, 2.01) were significant risk factors for the incident back disorder. No risk factors were seen for recurrent episodes.

Conclusions

Risk factors for incident and recurrent back disorders were different; thus, episode-specific initiatives are needed to reduce back disorders among fishers.
Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis
Authors: Rhim Hye Chang , Schon Jason M. , Xu Raylin , Schowalter Sean , Ha Jane , Hsu Connie , Andrew Michael , Robinson David M. , Tenforde Adam S. , Daneshvar Daniel H.
Published: May 2024

Objective:

To compare clinical outcomes following steroid injections using the anterior and posterior approaches.

Design:

Systematic review with meta-analysis.

Setting:

Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies.

Patients:

Patients with adhesive capsulitis.

Interventions:

Glenohumeral steroid injections using either anterior or posterior approach.

Main Outcome Measures:

Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs.

Results:

We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, −0.86; 95% CI, −1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, −0.52; 95% CI, −0.98 to −0.07). Overall, procedures were well tolerated without major complications.

Conclusions:

While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
Presence of Additional Pathology in Low-Grade Acromioclavicular Joint Injuries
Authors: Mulhall Drew , McRae Sheila , Koenig James , Matthewson Graeme , Nemeth Peter , MacDonald Peter
Published: May 2024

Objective:

To determine if additional pathology is present in low-grade acromioclavicular (AC) joint injuries.

Design:

Prospective case series.

Setting:

Patients were assessed by primary care sports medicine physicians at a single institution between 2019 and 2023.

Patients:

Patients aged 18 to 65 years diagnosed with a type I to III AC injury based on clinical and radiographic evaluation.

Intervention:

Consenting patients underwent magnetic resonance imaging (MRI) evaluation within 21 days of injury. All injuries were treated nonoperatively.

Main Outcome Measures:

Additional pathologies identified on MRI were reported in a standardized fashion by fellowship-trained musculoskeletal radiologists.

Results:

Twenty-nine patients (26 men/3 women) were consented with a mean (±SD) age of 28.6 ± 9.5 years. The mean time from injury to MRI was 8.1 ± 5.9 days. Twenty-three injuries were sport related, and 6 were accidental traumas. Based on MRI, injury type was reclassified in 16 of 29 patients, and 13 remained unchanged. Additional pathologies identified included 14 muscle injuries, 5 rotator cuff tears, 5 labral tears, 1 nondisplaced fracture, and 1 intra-articular body.

Conclusion:

MRI evidence suggests that most AC joint injuries are more severe than clinically diagnosed. Identifying additional pathology may alter diagnostic and treatment guidelines for type I to III AC joint injuries.
A simulation educational intervention to enhance preclinical family nurse practitioner student preparation
Authors: Link Tamara , Braswell April , Vaughn Jacqueline , Ford Shannon , Payne Jason , Wax Erin , Parker Diane , Waddill Colette , O'Brien Coleen , Stoffer Kassandra , Conde-Zuege Renata , Earp Crystal , Balogh Pamela , Hubbell Sara
Published: May 2024

Simulation has been shown to improve communication and psychometric skills in advanced practice nursing students. Little is known about the impact of a simulation educational intervention with a faculty-facilitated debriefing on the preparation of novice nurse practitioner students for their first clinical practicum. This article describes the development of an educational intervention to accomplish this. The simulation education intervention was implemented with preclinical nurse practitioner students designed to improve their preparation for their first precepted clinical experience. Students were surveyed preintervention and postintervention to explore their self-perception of confidence and preparation for clinicals looking at six domains: health history, physical examination, diagnostics, differentials, final diagnosis, and plan of care. Quantitative results were statistically significant for each domain. Qualitative findings gave deeper insight into the students' perceptions of how the intervention prepared them for clinicals. Advanced practice educators can use educational interventions such as this to prepare students for their first clinical practicums.
Risk Factors of Mortality and Long-Term Survival in Burn Patients With/Without Extracorporeal Membrane Oxygenation: A 16 Year Real-World Study
Authors: Hsu Po-Shun , Lin Jiun-Yu , Tsai Yi-Ting , Lin Chih-Yuan , Chen Jia-Lin , Chien Wu-Chien , Tsai Chien-Sung
Published: May 2024

Burn patients face cardiopulmonary failure risks, with recent observational studies suggesting promising outcomes for extracorporeal membrane oxygenation (ECMO). However, the effectiveness and long-term survival remain unclear. Our study aims to assess mortality risk factors and long-term survival in burn patients with and without ECMO. This study used Taiwan’s National Health Insurance Research Database and designed a case–control with onefold propensity score matching across variables including sex, age, total body surface area (TBSA) burned, and index date. We analyzed mortality and survival risk factors in each stratified group with/without ECMO. Finally, we analyze the mortality according to ECMO and TBSA burned, and the cause of death and long-term survival. From 2000 to 2015, 4,556 burn patients with ECMO compared to an equivalent number without ECMO. Primary mortality include male, age >65, TBSA ≥30%, escharotomy, hemodialysis, and bacteremia. The ECMO group showed lower survival across all stratified risk factors, with the primary cause of death being burn-related issues, followed by respiratory and heart failure. The overall mortality rate was 54.41% with ECMO and 40.94% without ECMO (p < 0.001). Additionally, long-term survival is lower in the group with ECMO. This research provides a valuable real-world gross report about ECMO efficacy and long-term survival among burn patients with/without ECMO.
Long-term cardiovascular outcomes after mini-crush or T and minimal protrusion techniques in complex bifurcation lesions: the EVOLUTE-CRUSH III study
Authors: Güner Ahmet , Uzun Fatih , Çizgici Ahmet Yaşar , Kahraman Serkan , Demirci Gökhan , Çiloğlu Koray , Gökçe Kaan , Doğan Abdullah , Akman Cemalettin , Uysal Hande , Gültekin Güner Ezgi , Aktürk İbrahim Faruk , Yildiz Mustafa , Serter Berkay , Yalçin Ahmet Arif , Keskin Berhan , Ertürk Mehmet
Published: May 2024

Background

Mini-crush (MC) and T-stenting and small protrusion (TAP) techniques are frequently used, but the long-term comparison of both techniques in patients with complex bifurcation lesions (CBLs) is still a debatable issue. This study sought to retrospectively evaluate the long-term outcomes of MC and TAP techniques in patients with CBLs.

Methods

A total of 271 patients [male: 202 (78.9%), mean age: 58.90 ± 10.11 years] patients in whom complex bifurcation intervention was performed between 2014 and 2023 were involved. The primary endpoint was major cardiovascular events (MACE) as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization. The Cox proportional hazard models were adjusted by the inverse probability weighting approach to reduce treatment selection bias.

Results

The initial management strategy was MC in 146 patients and TAP in 125 cases. MACE occurred in 52 patients (19.2%) during a mean follow-up period of 32.43 ± 16 months. The incidence of MACE (13 vs. 26.4%, P = 0.005) and major cardiovascular and cerebral events (15.1 vs. 28.8%, P = 0.006) were significantly lower in the MC group than in the TAP group. Additionally, the incidence of definite or probable stent thrombosis was numerically lower in the MC group compared with the TAP group but did not differ significantly (2.7 vs. 8%, P = 0.059). The long-term MACE was notably higher in the TAP group than the MC group [adjusted hazard ratio (inverse probability weighted): 1.936 (95% confidence interval: 1.053–3.561), P = 0.033].

Conclusion

In this study involving patients with CBLs, percutaneous coronary intervention with the MC technique had better long-term outcomes than the TAP technique.
Development and validation of risk prediction model for bacterial infections in acute liver failure patients
Authors: Liu Huimin , Xie Xiaoli , Wang Yan , Wang Xiaoting , Jin Xiaoxu , Zhang Xiaolin , Wang Yameng , Zhu Zongyi , Qi Wei , Jiang Huiqing
Published: May 2024

Infections significantly increase mortality in acute liver failure (ALF) patients, and there are no risk prediction models for early diagnosis and treatment of infections in ALF patients. This study aims to develop a risk prediction model for bacterial infections in ALF patients to guide rational antibiotic therapy. The data of ALF patients admitted to the Second Hospital of Hebei Medical University in China from January 2017 to January 2022 were retrospectively analyzed for training and internal validation. Patients were selected according to the updated 2011 American Association for the Study of Liver Diseases position paper on ALF. Serological indicators and model scores were collected within 24 h of admission. New models were developed using the multivariate logistic regression analysis. An optimal model was selected by receiver operating characteristic (ROC) analysis, Hosmer–Lemeshow test, the calibration curve, the Brier score, the bootstrap resampling, and the decision curve analysis. A nomogram was plotted to visualize the results. A total of 125 ALF patients were evaluated and 79 were included in the training set. The neutrophil-to-lymphocyte ratio and sequential organ failure assessment (SOFA) were integrated into the new model as independent predictive factors. The new SOFA-based model outperformed other models with an area under the ROC curve of 0.799 [95% confidence interval (CI): 0.652–0.926], the superior calibration and predictive performance in internal validation. High-risk individuals with a nomogram score ≥26 are recommended for antibiotic therapy. The new SOFA-based model demonstrates high accuracy and clinical utility in guiding antibiotic therapy in ALF patients.
Clinical effects of chemical drugs, fecal microbiota transplantation, probiotics, dietary fiber, and acupuncture in the treatment of chronic functional constipation: a systematic review and network meta-analysis
Authors: Tan Shufa , Zhang Wei , Zeng Pengfei , Yang Yunyi , Chen Shikai , Li Yuwei , Bian Yuhong , Xu Chen
Published: May 2024

Currently, there are increasingly diverse treatment modalities for chronic functional constipation (CFC). This study aims to compare the relative efficacy and safety of chemical drugs, fecal microbiota transplantation (FMT), probiotics, dietary fiber, and acupuncture in the treatment of patients with CFC. We searched relevant randomized controlled trials (RCTs) published in five databases up to November 2023. Network meta-analysis (NMA) was carried out using R Studio 4.2.1. Cumulative ranking probability plots, assessed through the surface under the cumulative ranking (SUCRA), were employed to rank the included drugs for various outcome measures. We included a total of 45 RCT studies with 17 118 patients with CFC. From the SUCRA values and NMA results FMT showed the best utility in terms of clinical efficacy, Bristol stool form scale scores, patient assessment of constipation quality of life scores, and the treatment modality with the lowest ranked incidence of adverse effects was electroacupuncture. Subgroup analysis of the chemotherapy group showed that sodium A subgroup analysis of the chemical group showed that sodium picosulfate 10 mg had the highest clinical efficacy. FMT is more promising in the treatment of CFC and may be more effective in combination with the relatively safe treatment of acupuncture.
Proton pump inhibitors are not associated with fundic gland polyps – a systematic review that takes into consideration all known confounders
Authors: Lam Shiu Kum , Lau George Ka Kit
Published: May 2024

Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I
2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10–20, 20–40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.
Virtual Reality–Based Simulated Hallucinations to Enhance Empathy Toward Individuals With Schizophrenia
Authors: Abrams Kenneth B. , Wilson Andrew , Hernandez Thais Del Rosario , Choate Aidan
Published: May 2024

Individuals affected by schizophrenia often relay frustration that persons in their life are unable to understand their symptoms. We sought to examine whether a brief virtual reality (VR) experience for students in an undergraduate psychopathology course entailing simulated hallucinations could increase empathy, decrease negative affect, and positively affect attitudes toward persons with schizophrenia. After the unit on schizophrenia, 41 participants engaged in a VR experience with simulated auditory and visual hallucinations. We sought to maximize fidelity and immersion by incorporating the actual classroom and course instructor into the virtual world. By collecting data at multiple points, we were able to isolate the impact of the simulation on affect and attitudes. Participants experienced an increase in empathy and favorable attitudes toward individuals with schizophrenia and reported the simulation to be highly educational. The favorable results are notable given the brevity of the simulation and the absence of any explicit (declarative) knowledge being conveyed.
Artificial Intelligence Helps Pathologists Increase Diagnostic Accuracy and Efficiency in the Detection of Breast Cancer Lymph Node Metastases
Authors: Retamero Juan Antonio , Gulturk Emre , Bozkurt Alican , Liu Sandy , Gorgan Maria , Moral Luis , Horton Margaret , Parke Andrea , Malfroid Kasper , Sue Jill , Rothrock Brandon , Oakley Gerard , DeMuth George , Millar Ewan , Fuchs Thomas J. , Klimstra David S.
Published: May 2024

The detection of lymph node metastases is essential for breast cancer staging, although it is a tedious and time-consuming task where the sensitivity of pathologists is suboptimal. Artificial intelligence (AI) can help pathologists detect lymph node metastases, which could help alleviate workload issues. We studied how pathologists’ performance varied when aided by AI. An AI algorithm was trained using more than 32 000 breast sentinel lymph node whole slide images (WSIs) matched with their corresponding pathology reports from more than 8000 patients. The algorithm highlighted areas suspicious of harboring metastasis. Three pathologists were asked to review a dataset comprising 167 breast sentinel lymph node WSIs, of which 69 harbored cancer metastases of different sizes, enriched for challenging cases. Ninety-eight slides were benign. The pathologists read the dataset twice, both digitally, with and without AI assistance, randomized for slide and reading orders to reduce bias, separated by a 3-week washout period. Their slide-level diagnosis was recorded, and they were timed during their reads. The average reading time per slide was 129 seconds during the unassisted phase versus 58 seconds during the AI-assisted phase, resulting in an overall efficiency gain of 55% (P<0.001). These efficiency gains are applied to both benign and malignant WSIs. Two of the 3 reading pathologists experienced significant sensitivity improvements, from 74.5% to 93.5% (P≤0.006). This study highlights that AI can help pathologists shorten their reading times by more than half and also improve their metastasis detection rate.
Special anatomy series. Imaging inner ear structures with high-frequency ultrasound: Application to physical rehabilitation space medicine
Authors: Strakowski Jeffrey , Zhang Han , Reschke Millard , Chiou-Tan Faye Y.
Published: May 2024

Objective:

The objective of this paper is to document the feasibility of image acquisition, image optimization, and sonographic appearance of the exposed anatomic windows of cadaveric inner ear dissection for purposes of potential future clinical evaluation as part of the developing area of physical and rehabilitation space medicine.

Methods:

Cadaveric dissection of the inner ear was conducted with the goal of exposing areas relevant to vestibular balance. Middle and inner ear structures of 3 human cadavers were imaged with multiple broadband transducers, including emphasis with higher frequency transducers.

Results:

The images were best optimized with 17 MHz and 22 MHz small footprint transducers. High-frequency ultrasound (US) images of the semicircular canals, vestibular and facial nerves, and utricles with reflected otoliths (otoconia) were obtained and reported in this article. Detailed visualization of both the vestibular nerve and facial nerve was accomplished, including identification of fascicular architecture. In addition, US reflection from the otoliths contained within the utricle was identified with sufficient clarity to provide surface measurements. Bony acoustic landmarks of the middle ear bones were identified by scanning externally from the tympanic membrane, including the dynamic movement of the bones with manual manipulation.

Conclusion:

US visualization has the potential to be an effective imaging modality to monitor potential changes to the otolith's size throughout extended space flight. To our knowledge, no prior study has reported US images of human inner ear structures.
Improving Turnaround Time of Transabdominal Pelvic Ultrasounds with Ovarian Doppler in a Pediatric Emergency Department
Authors: Dupont Amanda S. , Drayna Patrick C. , Nimmer Mark , Baumer-Mouradian Shannon H. , Wirkus Kendra , Thomas Danny G. , Boyd Kevin , Chinta Sri S.
Published: May 2024

Introduction:

Adnexal torsion is an emergent surgical condition. Transabdominal pelvic ultrasound (US) with ovarian Doppler is used to diagnose adnexal torsion and requires a sufficient bladder volume. Reduce the turnaround time for US by 25% in girls 8–18 years of age who present to the emergency department (ED) for 24 months.

Methods:

Our baseline period was from January 2020 to June 2021, and the intervention period was from July 2021 to June 2023. Patients 8–18 years old who required an US in the ED were included. There are two key drivers: early identification of US readiness and expeditious bladder filling. Interventions were (1) bladder volume screening; (2) utilization of bladder volume nomogram to identify US readiness; (3) epic order panels; and (4) rapid intravenous fluid method. The primary outcome was US turnaround time. Secondary outcomes were percentage of patients requiring invasive interventions to fill the bladder and patients with an US study duration of ≤45 minutes. The percent of patients screened by bladder scan was used as a process measure. Balancing measures used episodes of fluid overload and ED length of stay.

Results:

Turnaround time for USs improved from 112.4 to 101.6 minutes. The percentage of patients who had successful USs without invasive bladder filling improved from 32.1% to 42.6%. Bladder volume screening using a bladder scan increased from 40.3% to 82.9%. The successful first-pass US completion rate improved from 77% to 90% consistently.

Conclusions:

Through quality improvement methodology, we have identified pelvic US readiness earlier, eliminated some invasive bladder-filling measures, and implemented a rapid fluid protocol. We have sustained these successful results for 2 years. This study can be generalized to any ED with similar patients.
Sleep and circadian rhythm dysfunctions in movement disorders beyond Parkinson's disease and atypical parkinsonisms
Authors: Sringean Jirada
Published: May 2024

Purpose of review

This review aimed to comprehensively outline sleep and circadian rhythm abnormalities in hyperkinetic movement disorders beyond Parkinson's disease and atypical parkinsonisms, including tremor, dystonia, choreiform movements, tics, and ataxia disorders.

Recent findings

Insomnia, poor sleep quality, and excessive daytime sleepiness (EDS) are commonly reported in essential tremor, Wilson's disease, tics or Tourette's syndrome, and spinocerebellar ataxia (SCA). REM sleep behavior disorder (RBD) have been observed in Wilson's disease and SCA. A combination of REM and non-REM parasomnias, along with nocturnal stridor with the initiation of sleep and re-entering after awakening, are characterized by undifferentiated Non-REM and poorly structured N2 in anti-IgLON5 disease. Restless legs syndrome (RLS) has been reported commonly in SCAs. Sleep-related dyskinesia has been reported in ADCY5-related disease and GNAO1-related movement disorder.

Sleep problems can manifest as a result of movement disorders, either through direct motor disturbances or secondary nonmotor symptoms. Medication effects must be considered, as certain medications for movement disorders can exacerbate or alleviate sleep disturbances. Distinguishing sleep problems in some diseases might involve pathognomonic symptoms and signs, aiding in the diagnosis of movement disorders.