bluuebunny/crossref_metadata_2025 huggingface dataset:
The double whammy: Advanced medical training and parenting
Authors: Alkhawashki Samah , Alasiri Rahaf , Ruetalo Mariela , Maggi Julie
Published: January 2024

Clinicians may become parents during their clinical training and may be exposed to several challenges in career development, burnout and work-life balance. Previous research findings have reported that stressors facing trainees with children warrant greater attention from graduate medical institutions. Additionally, parenting-related information and considerations about the needs of trainees with children across clinical specialties are needed to inform institutional and national policies. A quantitative approach was used to examine clinical trainees’ perceptions and experiences of parenting in relation to different specialties, sociodemographic traits, levels of support, and other potential factors influencing their residency and fellowship training and well-being. We used a survey that was distributed to all University of Toronto medical trainees (2214) via email correspondence and social media platforms. The trainees were asked to base their answers on their experience during the academic year of 2019 to 2020 (before the Coronavirus Disease 2019-related shutdown). Our study revealed that clearly, burnout is a concern for physicians who are raising children while in training. Notably, it was higher among younger aged trainees and those beginning their training journey including, first-year fellows and second-year residents, in addition to parents with toddlers. Moreover, female residents and male fellows showed higher burnout than their counterparts. Institutional support was associated with lower rates of burnout, evidenced by access to opportunities, allowing time to breastfeed/express milk and having access to medical care. We found multiple independent and significant factors affecting their rate of burnout including limited access to opportunities, lack of a self-care routine and absence of social community outside of work.

The results show the importance of creating a positive learning experience for trainees juggling parenting and training needs, especially those starting their training both as residents and as fellows and those with younger children. Interventions can be categorized into those targeted at the individual and family levels, and institutional levels, with the overarching goal of balancing training and parenting. This can be achieved by fostering learning environments that prevent and decrease burnout and enhance the well-being of trainees and their families, which can start with ensuring trainees are aware of available resources and possible accommodations.
Accuracy of dual-energy computed tomography for bone marrow edema in the sacroiliac joint: A systematic review and meta-analysis
Authors: Li Xin , Wang Jianguo , Li Ping , Zhuang Shunda , Jiang Shun , Liu Wenqian
Published: January 2024

Background:

This systematic literature review and meta-analysis aimed to assess the accuracy, sensitivity, and specificity of dual-energy computed tomography (DECT) of the sacroiliac joint. Bone marrow edema (BME) of the sacroiliac joint is an early manifestation of some diseases, such as ankylosing spondylitis, and is usually examined by nuclear magnetic resonance imaging (MRI); however, MRI can be intolerable for some patients; hence, numerous studies have analyzed DECT examinations.

Methods:

We searched PUBMED, CNKI, and EMBASE in 2023 for articles containing the following terms (DECT) or (DE-CT) or (dual-energy CT) or “dual-energy CT” or (dual-energy computed tomography) and ((sacroiliac joint) or (ankylosing spondylitis) or (sacroiliac arthritis) or (sacroiliitis)). An initial search identified 444 articles, of which 7 met the criteria. Data were extracted to calculate the sensitivity, specificity, and diagnostic odds for analysis using R software.

Results:

Out of 291 patients and 577 sacroiliac joints, 429 (74.35%) exhibited BME. All studies used magnetic resonance as the control group. The overall sensitivity and specificity of DECT were 79%, and 92%, respectively, with positive prediction rate of 92.55% and negative prediction rate of 83.73%.

Conclusion:

DECT appears to be a promising diagnostic tool for detecting BME in the sacroiliac joint and can be used as an alternative examination method for patients in whom MRI is contraindicated.
A meta-analysis of the efficacy and safety of the traditional Chinese medicine formula Kaixinsan decoction for depression
Authors: Li Jia-liang , Lin Lin , Wu Min-min , Zhang Jing-yu , Zhang Yi-xin , Cao Meng-ru , Wang Long
Published: January 2024

Background:

Kaixinsan (KXS) decoction is a traditional Chinese herbal formulation commonly used to treat depression. This study aimed to evaluate the efficacy and safety of KXS, which is widely used, alone and in combination with other therapies, for the treatment of depression. The main objective was to assess the efficacy and safety of KXS in the treatment of depression as a single agent or in combination with other methods.

Methods:

Randomized controlled trials of KXS in the treatment of depression were systematically searched from several Chinese and English databases with no language restriction. Patients in these studies met the relevant diagnostic criteria for depression. Data on HAMD, SDS, practical situations, and occurrence of side effects in the studies were extracted. Finally, the methodological quality and risk of bias of the included studies were assessed using the Jadad scale and Cochrane bias evaluation tool.

Results:

Twelve studies with 1034 patients were included after screening. The Jadad scale and Cochrane bias evaluation tool indicated that the quality of the studies ranged from fair to good, with 41.7% categorized as good and 58.3% as poor. Egger test and funnel plots showed that the publication bias remain low.

Conclusion:

The results showed that the frequency of side effects in the control group was higher than that in the treatment group, and there was a statistically significant difference. KXS was comparable or superior to antidepressants in treating depression and has fewer side effects. The data analysis showed that effectiveness and other indicators differed significantly by geographic area and dosage form, which has implications for future clinical work.
The Brunner adenoma of the duodenum with positive fecal occult blood and anemia: A case report
Authors: Duan Junwei , Wang Xiaoyan , Xu Chenxi , Guo Rongxin
Published: January 2024

Rationale:

Brunner gland adenoma (BGA) is a rare benign duodenal tumor that is an adenomatoid lesion in nature rather than an actual tumor. Patients with different adenoma sizes have various clinical manifestations with nonspecific clinical symptoms. Here, We report a case of BGA with black stool and anemia as the primary manifestations.

Patient concerns:

A young female patient was admitted to the hospital because of black stool and anemia. Endoscopic surgery was performed to a definitive diagnosis, and endoscopic tumor-like lesions were resected.

Diagnosis:

The patient was diagnosed with duodenal Brunner adenoma and received related treatment.

Outcomes:

After treatment, the patient symptoms improved, and he was discharged.

Lessons:

Brunner adenoma of the duodenum is a rare benign duodenum tumor. This report paper describes a case of BGA with black stool and anemia as the primary manifestations, followed by endoscopic resection and treatment. The literature on Brunner adenoma of the duodenum has been analyzed and discussed. Clinicians should pay attention to differentiating the disease based on atypical symptoms.
The effects of mobile technology-based support on young women with depressive symptoms: A block randomized controlled trial
Authors: Jeong Sookyung , Cha Chiyoung , Nam Sujin , Song Jiyoon
Published: January 2024

Background:

The current body of knowledge highlights the potential role of mobile technology as a medium to deliver support for psychological and physical health. This study evaluated the influence of mobile technology support on depressive symptoms and physical activity in female university students.

Methods:

A block randomized controlled trial design with a single site was used. Ninety-nine participants were block-randomized into 3 arms: Experimental Group 1 (emotional and informational support group), Experimental Group 2 (informational support group), and the control group. Interventions were delivered via mobile technology for 2 weeks. Data on depressive symptoms and physical activity were collected from 84 participants at baseline and on Days 8 and 15. Data analyses included descriptive statistics, t tests, one-way analysis of variance, and repeated-measures analysis of variance.

Results:

This study showed no interaction effect of time and group on depressive symptom scores and physical activity, considering the emotional and informational support from mobile technology. However, Experimental Group 1 exhibited a significant reduction in depressive symptoms during the first week of the study compared to Experimental Group 2 and the control group. While physical activity in Experimental Group 2 and control group increased only during the first week of the study and subsequently decreased, Experimental Group 1 showed an initial increase during the first week that was sustained into the second week.

Conclusions:

Since informational and emotional support showed a strong effect over a short period of time, mobile technology offering emotional support could be used to provide crisis interventions for depression among young women when a short-term impact is required.
Comparative analysis of doublet chemotherapy regimens plus bevacizumab in patients with recurrent ovarian cancer
Authors: Khanmammadov Ni̇jat , Doğan İzzet , Okay Necla Simay , Azizy Abdulmunir , Saip Pinar , Aydiner Adnan
Published: January 2024

Among all gynecological malignancies, ovarian cancer is the predominant cause of mortality. Hence, various chemotherapy protocols have been established for managing metastatic ovarian cancer cases. The present study aimed to assess and compare the efficacy of dual chemotherapy regimens plus bevacizumab in patients diagnosed with recurrent platinum-sensitive epithelial ovarian cancer. This was a retrospective observational study. Data on the clinical, pathological, radiological, and treatment characteristics of the patients were recorded. Survival analyses were performed using the Kaplan–Meier method. Moreover, multivariate Cox regression analysis was conducted. Data of a total of 198 patients with a median follow-up duration of 18.7 months after bevacizumab treatment were analyzed. Serous carcinoma was found to be the most common pathological subtype in the analyzed patients, accounting for 85.8% of all cases. In total, 46.5% (n = 92), 38.4% (n = 76) and 15.2% (n = 30) patients had received gemcitabine plus carboplatin, paclitaxel plus carboplatin (PC), and gemcitabine plus cisplatin combined with bevacizumab, respectively. The complete response rate was 18.7%, partial response rate was 56.1%, stable disease rate was 6.6%, and progressive disease rate was 18.7%. The patients received bevacizumab treatment at a median of 9 cycles and doublet chemotherapy at a median of 7 cycles. The median progression-free survival was 11.9 (95% CI: 9.2–14.5) months, and the median overall survival (OS) was 24.7 (95% CI: 19.9–29.4) months. The results showed that a history of surgery prior to bevacizumab treatment was a significant factor affecting OS (P = .006). Patients who had received gemcitabine plus carboplatin with bevacizumab (28 months) had significantly better OS than patients who had received paclitaxel plus carboplatin (20.1 months) and gemcitabine plus cisplatin (17 months) (P = .009). Doublet chemotherapy regimens plus bevacizumab are safe and effective against recurrent platinum-sensitive epithelial ovarian cancer. Gemcitabine plus carboplatin with bevacizumab was superior to other treatment regimens in terms of OS outcomes.
A comparative study of laparoscopic choledocholithotomy with primary suture and T-tube drainage
Authors: Zhang Zhengdong , Ji Hui , Chen Gongfu , Hou Yafeng
Published: January 2024

To investigate the clinical efficacy of laparoscopic choledocholithotomy with one-stage suture. The clinical data of 68 patients who underwent laparoscopic choledocholithotomy in our hospital from January 2015 to December 2021 were retrospectively analyzed. Among them, 29 patients underwent laparoscopic primary closure (PC group) and 39 underwent T-tube drainage (T-tube group). All patients were diagnosed with choledocholithiasis by B-ultrasound, CT or MRCP. The operation time, intraoperative blood loss, pain index, incidence of shoulder and back pain, postoperative satisfaction, postoperative bowel function recovery time, hospitalization time and expenses, and operation-related complications in the 2 groups were compared. 29 cases in PC group were successfully operated, and 39 cases in the T-tube drainage group (T-tube group) were successfully operated. The average operation time, postoperative bowel function recovery time, postoperative pain index, hospitalization time and expenses in PC group were significantly shorter or lower than those in T-tube group (P < .05) and the patient satisfaction in PC group was significantly higher than that in T-tube group (P < .05). In addition, the intraoperative blood loss and the incidence of surgical complications were similar between the 2 groups (P > .05). After laparoscopic common bile duct exploration, primary suture of common bile duct is a safe and effective treatment method, but the incidence of bile leakage is high, and clinical indications for surgery should be strictly controlled.
Effects of diaphragm electrical stimulation in treating respiratory dysfunction on mechanical ventilation after intracerebral hemorrhage: A single-center retrospective study
Authors: Wu Yan , Wang Suqin , Zhang Jing , Wang Yan , Zhong Jiaojiao , Wang Yuhai
Published: January 2024

Intracerebral hemorrhage (ICH) is a major cause of death and disability worldwide. The benefits of electrical stimulation in the treatment of respiratory dysfunction in patients on mechanical ventilation is unknown. Nevertheless, there is a dearth of evidence-based medical research concerning its clinical efficacy. From January 2019 to January 2023, every enrolled patients experienced respiratory dysfunction after ICH while being supported by mechanical ventilation. A total of 205 eligible patients were enrolled and then allocated into 2 groups: control group and observation group. 133 patients was selected and administered standard treatment as control group. Based on conventional treatment, other 72 patients were administered diaphragm electrical stimulation (DES) treatment. We examined information from current medical records, encompassing all initial data and predictive follow-up data, such as the weaning success rate, occurrence of ventilator-associated pneumonia (VAP), duration of stay in the intensive care unit (ICU) and hospital, expenses related to hospitalization, and mortality within 30 days. The baseline clinical data of the 2 groups did not exhibit any statistically significant disparities (all P > .05). The rate of successful weaning showed a significant increase in the DES group when compared to the control group (P = .025). In patients with respiratory dysfunction due to ICH, treatment with DES resulted in a significant reduction in the duration of invasive ventilation (9.8 ± 2.1 vs 11.2 ± 2.6, P < .01) and total ventilation time (9.8 ± 2.1 vs 11.2 ± 2.6, P < .01). It also led to a decrease in the length of stay in the ICU (15.67 ± 3.76 vs 17.53 ± 4.28, P = .002) and hospitalization cost (11500 vs 13600, P = .001). Additionally, DES treatment resulted in a lower incidence of VAP (73.61% vs 86.46%, P = .022) and improved 30-day mortality (P < .05), without any significant adverse effects. The findings of this research indicate that DESs have a positive impact on enhancing the rate of successful weaning and reducing the incidence of VAP. It decreases the duration of invasive ventilation and total ventilation time while also improving the mortality rate within 30 days. This therapy could offer a fresh alternative for respiratory impairment in patients undergoing mechanical ventilation.
Abnormal femoral trochlea morphology is a risk factor for secondary injury of anterior cruciate ligament after reconstruction
Authors: Cai Qiangqiang , Wang, Dongqin , Yan Liang , Kuang Hailin , Tang Wubing , Min Zhihai , Wang, Xin
Published: January 2024

Secondary injury of the anterior cruciate ligament (ACL) is a common concern after anterior cruciate ligament (ACL) reconstruction, and identification of morphological risk factors is essential to prevent these injuries. We hypothesized that abnormal femoral trochlea morphology is associated with secondary ACL injuries after reconstruction. This study aimed to investigate the relationship between femoral trochlear morphology and secondary ACL injuries after reconstruction. A retrospective analysis was conducted on 20 patients who experienced secondary ACL injuries after reconstruction in our hospital between 2017 and 2022 (experimental group), and 40 patients were included in the control group. The following femoral trochlear characteristics were compared between the 2 groups: medial condylar height (MCH), trochlear sulcus height (TSH), lateral condylar height (LCH), trochlear sulcus depth (TSD), trochlear sulcus angle (TSA), medial trochlear inclination (MTI), and lateral trochlear inclination (LTI). The study found that patients in the secondary ACL injury after reconstruction group exhibited the following differences when compared to the control group: decreased MCH (56.33 ± 3.52 vs 59.93 ± 3.24, P value = .015), decreased TSD (4.89 ± 1.56 vs 6.98 ± 1.23, P value ˂ .001), decreased MTI (12.54 ± 6.57 vs 19.45 ± 6.35, P value ˂ .001), and increased TSA (145.23 ± 9.76 vs 139.25 ± 8.42, P value ˂ .001). This study demonstrated a significant correlation between abnormal femoral trochlear morphological characteristics and secondary ACL injuries after reconstruction. Decreased MCH, TSD, and MTI along with increased TSA are associated with a higher risk of secondary ACL injury. These data could thus help identify individuals susceptible to secondary ACL injuries after reconstruction.
Risk factors and their association with mortality in patients undergoing long-term hemodialysis or/and kidney transplant patients or late-stage chronic kidney disease: A single center, prospective observational study
Authors: Zhang Yi , Wu Minxiang , Mao Congbo
Published: January 2024

Cardiovascular diseases (CVDs) are a very common occurrence in patients with chronic kidney disease (CKD) and that was the main cause of mortality in these patients. The aims of the present study were to examine the effects of inflammation, malnutrition, and an oxidative stress in patients undergoing long-term hemodialysis or/and kidney transplant patients or patients with late-stage CKD, with its coherent consequences during a 38-month follow-up period. The present study included 137 patients with renal insufficiencies (48 patients had CKD, 29 patients had kidney transplants, and 60 CKD patients underwent hemodialysis [HD] and 39 normal individuals [controls]; aged 49 ± 20 years, 96 males and 80 females). All patients with renal insufficiencies were dialyzed 3 times a week for 4 to 5 hours/day (dialysis commenced in March 2017 and continued for 38 months). Biochemical parameters, Paraoxonoase (PON)-1 status, and inflammatory-markers were assayed using the standard laboratory protocols. The Kaplan–Meier method with the log-rank test was used for survival analysis of CKD patients. Older aged patients had a higher risk of developing CKD than the controls (P < .001). The albumin level, body mass index, and total cholesterol were found to be lower, and the triglyceride value was found to be higher in the patients of the HD group (P < .05 for all). The patients of the HD group exhibited a higher activity of PON-1 than the patients who received a kidney transplant (P < .001). The control patients had a higher activity of PON-1 than the patients of the HD group, those with CKD, and those of the kidney transplant group (P < .001 for all). Following a follow-up of 16 patients with CKD for 38 months, 15 patients undergoing HD succumbed due to cardiovascular diseases and one patient received a kidney transplant. At 8 to 10-month of follow-up 85% of survival function was noted. As the disease progressed, the survival function decreased to 30% due to the malnutrition in patients with CKD. Lipid oxidation and malnutrition/inflammation are associated with in various stages of CKD patients. With progressing CKD patients’ biomarkers of lipid oxidation and malnutrition/inflammation show an increasing trend.
The novel predictive nomograms for early death in metastatic hepatocellular carcinoma: A large cohort study
Authors: Wang Yue , Ge Long , Cai Yan
Published: January 2024

Metastatic hepatocellular carcinoma (HCC) is an aggressive disease which usually have a poor prognosis. Early mortality and risk factors in patients with metastatic HCC are poorly understood. Our study sought to identify associated risk factors and develop the nomograms for predicting early death in metastatic HCC patients. The patients diagnosed with metastatic HCC were chosen from the surveillance, epidemiology, and end results database between 2010 and 2015. To identify significant independent risk factors for early death, both univariate and multivariate logistic regression models were used. We constructed a pragmatic nomogram and then evaluated by using receiver operating characteristic curves, calibration plots, and decision curve analysis. The prediction model included 2587 patients with metastatic HCC. Among them, 1550 experienced early death (died within 3 months of initial diagnosis) and 1437 died from cancer-specific causes. Multivariate logistic regression analysis found that grade, surgery, radiation, chemotherapy, alpha-fetoprotein levels, and lung metastasis were independent risk factors for both all-cause early death and cancer-specific early death. In addition, bone metastasis were independent risk factors for all-cause early death, T-stage and brain metastasis were also independent risk factors for cancer-specific early death. Then we used the relevant risk factors to developed the practical nomograms of all-cause and cancer-specific early deaths. The nomograms demonstrated good predictive power and clinical utility under receiver operating characteristic curves and decision curve analysis. We developed 2 novel comprehensive nomograms to predict early death among metastatic HCC patients. Nomograms may help oncologists develop better treatment strategies and implementation of individualized treatment plans.
The saturation effect of body mass index on total lumbar bone mineral density for adults: The NHANES 2011–2020
Authors: Chen Cong , Jia Jun , Wang Peng
Published: January 2024

To explore the association between body mass index (BMI) and total lumbar bone mineral density (BMD) in adults. This study included 9927 participants from 2011 to 2020 National Health and Nutrition Examination Survey (NHANES). The date on BMI, total lumbar BMD and other covariates were collected. Multivariate linear regression analyses were performed to evaluate the association between BMI and total lumbar BMD. Smoothing curve fitting and saturation effects analysis models were used to analyze the nonlinear relationships and saturation values. Multivariate linear regression analyses revealed that BMI was positively linked to total lumbar BMD in non-adjusted models (β = 0.003, 95% CI: 0.003–0.003, P < .00001). After adjusting for gender and race (β = 0.003, 95% CI: 0.003–0.004, P < .00001) and all covariates (β = 0.004, 95% CI: 0.003–0.004, P < .00001), the association still existed. Smoothing curve fitting showed that there was nonlinear correlation between BMI and total lumbar BMD with saturation effect. The BMI saturation value was 21.2 kg/m2 in the total lumbar BMD based on saturation effects analysis models. There was nonlinear positive correlation between BMI and total lumbar BMD with saturation effect. For adults, keeping the BMI at a reasonable value (21.2 kg/m2) would obtain an optimal balance between BMI and total lumbar BMD.
Visual analysis of obesity and hypothyroidism: A bibliometric analysis
Authors: Yao Lanying , Zhang Long , Tai Yuxing , Jiang Rongsheng , Cui Jianzhong , Gang Xiaochao , Liu Mingjun
Published: January 2024

Background:

The prevalence of obesity is gradually increasing and is closely associated with hypothyroidism. It is of research interest to explore the association between obesity and hypothyroidism and the current status of research.

Methods:

We chose the Web of Science Core Collection (WoSCC) database as the data source and searched to obtain relevant literature on obesity and hypothyroidism. And we used CiteSpace and VOSviewer to analyze the related literature.

Results:

A total of 508 articles were included in the literature, with an overall increasing trend in the number of publications. There were 170 relevant countries or organizations, and the United States was the country with the most publications. There were 1742 related organizations, and the Egyptian Knowledge Bank (EKB) was the organization with the most publications. There are 3015 authors involved, and there is a clear collaboration between authors. There are 227 related journals and J CLIN ENDOCR METAB is the most cited journal. The most frequently occurring keywords were obesity and hypothyroidism, but also other related topics such as bariatric surgery, metabolic syndrome, insulin resistance, body mass index, and leptin.

Conclusion:

The research related to obesity and hypothyroidism is gradually gaining attention, and the research direction is gradually expanding to metabolic syndrome, insulin resistance, leptin, and other related topics.
Thoracentesis techniques: A literature review
Authors: Mohammed Asna , Hochfeld Uri , Hong Sung , Hosseini Davood K. , Kim Kevin , Omidvari Karan
Published: January 2024

Thoracentesis is performed by 4 methods: gravity, manual aspiration, vacuum-bottle suction, and wall suction. This literature review investigates the safety of these techniques and determines if there is significant difference in complication rates. A comprehensive literature search revealed 6 articles studying thoracentesis techniques and their complication rates, reviewing 20,815 thoracenteses: 80 (0.4%) by gravity, 9431 (45.3%) by manual aspiration, 3498 (16.8%) by vacuum-bottle suction, 7580 (36.4%) by wall suction and 226 (1.1%) unspecified. Of the 6 studies, 2 were smaller with 100 and 140 patients respectively. Overall, there was a 4.4% complication rate including hemothoraces, pneumothoraces, re-expansion pulmonary edema (REPE), chest discomfort, bleeding at the site, pain, and vasovagal episodes. The pneumothorax and REPE rate was 2.5%. Sub-analyzed by each method, there was a 47.5% (38/80) complication rate in the gravity group, 1.2% (115/9431) in the manual aspiration group including 0.7% pneumothorax or REPE, 8% (285/3498) in the vacuum-bottle group including 3.7% pneumothorax or REPE, 4% (309/7580) in the wall suction group all of which were either pneumothorax or REPE, and 73% (166/226) in the unspecified group most of which were vasovagal episodes. Procedure duration was less in the suction groups versus gravity drainage. The 2 smaller studies indicated that in the vacuum groups, early procedure termination rate from respiratory failure was significantly higher than non-vacuum techniques. Significant complication rate from thoracentesis by any technique is low. Suction drainage was noted to have a lower procedure time. Symptom-limited thoracentesis is safe using vacuum or wall suction even with large volumes drained. Other factors such as procedure duration, quantity of fluid removed, number of needle passes, patients’ BMI, and operator technique may have more of an impact on complication rate than drainage modality. All suction modalities of drainage seem to be safe. Operator technique, attention to symptom development, amount of fluid removed, and intrapleural pressure changes may be important in predicting complication development, and therefore, may be useful in choosing which technique to employ. Specific drainage modes and their complications need to be further studied.
Factors affecting quality of life among patients with corrosive injury
Authors: Hsu Wen-Chuan , Cheng Hao-Tsai , Lin Chiu-Tzu , Lin Jui-Hsiang , Chiu Hsiao-Yean , Yu Wen-Pin , Lu Yen-Yi
Published: January 2024

This study aimed to investigate the factors influencing quality of life (QOL) among patients with corrosive injuries, considering the rising incidence of such cases, particularly in developing countries. Corrosive ingestion is a serious global public health problem and a common form of self-harm. This was a cross-sectional study using purposive sampling. A total of 82 patients with corrosive injuries who were admitted to the gastroenterology ward of a medical center in Taiwan between June 2018 and July 2020 completed the Perceived Stress Scale, Coping Strategy Scale, and World Health Organization Quality of Life Scale. We used an independent t-test and analysis of variance to examine the distribution and differences in demographic and disease characteristics, perceived stress, and the coping strategy scale. Multiple linear regression was then used to analyze the main predictors of QOL. The mean patient age was 58.2 (standard deviation = 2.4) years. A significant difference was observed between patients with a history of mental illness and perceived stress (P < .05). The patients were highly stressed and used emotional coping strategies to solve problems. Stress perception was significantly negatively correlated with overall QOL. Multiple linear regression analysis showed that a history of mental illness was a significant factor for overall QOL. The results of this study suggest that a history of mental illness significantly affects the QOL of patients with corrosive gastrointestinal injuries, and regular assessment and monitoring are essential.
Prognostic variables predict clinical outcome after decompressive craniectomy: A single institute experience; A retrospective study
Authors: Abdulla Ebtesam , Das Krishna , Sridharan Kannan , Waheed Mohammed , Abdulla Fatima , Ravindra Joseph , Luther Harleen , Wireko Andrew Awuah
Published: January 2024

Decompressive craniectomy (DC) is a well-established neurosurgical intervention in patients with high intracranial pressure who fail to respond to medical treatment. Data on predictive factors for functional outcomes in patients with DC who have malignant middle cerebral artery (MCA) infarction as opposed to intracranial hemorrhage (ICH) are scarce. Eighty-four patients who underwent DC treatment for ICH and malignant MCA infarction were examined. All patients underwent surgery in the Bahrain Salmaniya Medical Complex Neurosurgery Unit between January 2017 and June 2021. To determine whether any of these demonstrated a link to the functional outcome, radiographic factors were compared with clinical data. The postsurgical midline shift (MLS) (ICH group) showed the strongest correlation (ρ = 0.434; P = .006), as in the MCA infarction group as well (ρ = 0.46; P = .005). Further analyses using binary logistic regression with postsurgical basal cistern status and ∆ MLS, and it was observed to be statistically significant (odds ratios: 0.067, 95% CI: 0.007, 0.67; P = .021). The initial Glasgow coma scale, postsurgical MLS, basal cistern status, and ∆ are Measurable variables that can be used to predict outcomes in the groups with ICH and MCA infarction.
Use of telemedicine to tackle health problems in South Asia during the COVID-19 era and beyond: a systematic review
Authors: Saleem Muhammad K. , Sattar Komal , Ejaz Khawaja F. , Rehman Muneeb U. , Saleem Humayun , Khursheed Soffia , Akbar Amna , Ahmed Jahanzeb , Tariq Maham , Jadoon Sarosh K. , Saleem Khan Mohammad , Tasneem Sabahat , Khandker Shahad S. , Kundu Shoumik , Alvi Sarosh
Published: January 2024

Introduction:

Telemedicine (TM) and teleconsultation services flourished during coronavirus disease 2019 (COVID-19) transmission to avoid COVID-19 infection and physical contact. Many physicians switched to the virtual treatment mode and nearly all types of health disciplines were covered. Through this systematic review, the authors tried to explore the strengths and weaknesses of TM, identify the barriers to adopting TM by population, and explain the limitations of this healthcare delivery model.

Methods and results:

In this systematic review, 28 studies were included (>53% high-quality studies) as eligible, where nearly 75% (n=21) of the studies were from India, and the remaining 25% (n=7) were from Pakistan, Bangladesh, Sri Lanka, and Nepal. Advice related to cancer, autoimmune diseases, and neurological diseases were the most common among the health disciplines in which TM was used. A peak in teleconsultation was observed during the high transmission phase of COVID-19, although major queries were associated with existing health complications and comorbidities.

Conclusion:

Other than a few concerns regarding connectivity, privacy, and diagnosis, TM was in fact affordable, timesaving, feasible, and accurate, which ensured a highly satisfying experience among the participants (>80%).
Patient Experiences and Perceptions of Care Coordination in Primary Care
Authors: Whitebird Robin R. , Solberg Leif I. , JaKa Meghan M. , Kindt Joan M. , Bergdall Anna , Beran Mary Sue , Winger Melissa
Published: January 2024

Background:

Understanding patient perceptions of care coordination in primary care can help improve responsiveness to patients' needs, outcomes, and quality of care.

Purpose:

The purpose of this study was to explore patient experiences and perceptions of care coordination in primary care.

Method:

Interviews with 13 patients from 10 clinics were conducted and analyzed using directed content analysis.

Results:

Three primary themes arose: care coordinators provide a gateway to accessing needed care; patients needed and valued the support and trusted advice of their care coordinators; and patients valued care coordinators' help with navigating, engaging, and educating them about their care.

Conclusions:

Understanding what patients value in care delivery can help frame a vision for a more responsive approach in delivering primary care, as well as create a pathway to quality improvement, moving toward a truly patient-centered focus in primary care.
Evaluating the Efficiency of Survey Collection Methods to Trauma Patients
Authors: Moran Vicki , Oberle Andrew , Israel Heidi
Published: January 2024

Background:

Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).

Purpose:

The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10.

Methods:

This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels.

Results:

Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency.

Conclusion:

The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.
Parallel Osteotome Technique: New Approach to Reduce Neurosensory Disturbances following Bilateral Sagittal Split Osteotomy
Authors: Parameswaran Anantanarayanan , Panneerselvam Elavenil
Published: January 2024

Background:

The purpose of this study was to determine clinically whether the parallel osteotome technique (POST) reduces the incidence of neurosensory disturbances (NSDs) following bilateral sagittal split osteotomy (BSSO), and to corroborate the findings with finite element analysis.

Methods:

The authors conducted a quasiexperimental study of 30 patients requiring BSSO. The sample was divided into two groups: a control group who underwent the conventional osteotomy technique and an experimental group who underwent POST osteotomy. A finite element analysis simulation of the two techniques was also generated for computational analysis. The primary outcome was clinical comparison of subjective and objective measures for NSDs; the secondary outcome was a comparison of stress, strain, and deformation. The osteotomy technique was the exposure studied. Data were analyzed for differences in proportions and means.

Results:

Thirty patients (12 female and 18 male patients; age range, 18 to 28 years; mean age, 21.6 years) were recruited for the study, providing 60 sides as a sample. The experimental group had significantly lower subjective scores for NSD at the 3-month (P = 0.03) and 6-month follow-ups (P = 0.025). Objective testing revealed a lower incidence of NSDs for the experimental group during postoperative months 3 (P = 0.07), 6 (P = 0.007), and 12 (P = 0.17). The computational analysis also revealed significantly lower stress (P = 0.007), strain (P = 0.009), and deformation (P = 0.04) on the inferior alveolar nerve with the POST osteotomy.

Conclusions:

The incidence of NSDs following BSSO is lower with the POST osteotomy. This technique also induced significantly lower deformational forces on the inferior alveolar nerve when compared with the conventional osteotomy.
The disease burden of respiratory syncytial virus in older adults
Authors: Kenmoe Sebastien , Nair Harish
Published: January 2024

Purpose of review

To highlight the respiratory syncytial virus (RSV) disease burden and the current developments and challenges in RSV prevention for older adults ≥60 years through analysis of RSV epidemiology and the effectiveness of emerging vaccines.

Recent findings

In industrialized countries, RSV incidence rates and hospitalization rates among older adults are estimated to be 600.7 cases per 100 000 person-years and 157 hospitalizations per 100 000 person-years, respectively. Yet, accurately determining RSV morbidity and mortality in older adults is challenging, thus resulting in substantially under-estimating the disease burden. The in-hospital fatality rates vary substantially with age and geographies, and can be as high as 9.1% in developing countries. Two promising RSV vaccines for the elderly have been approved, demonstrating efficacies of up to 94.1%, signifying considerable advancement in RSV prevention. However, concerns over potential side effects remain.

RSV is associated with a significant burden in older adults. While the landscape of RSV prevention in older adults is promising with the licensure of vaccines from two companies, current trial data underscore the need for additional studies. Addressing the real-world effectiveness of these vaccines, understanding potential rare side effects, and ensuring broad inclusivity in future trials are crucial steps to maximize their potential benefits.
Veterinary High-Stakes Immersive Simulation Training With Repeat Practice Following Structured Debriefing Improves Students' Ability to Cope With High-Pressure Situations
Authors: Pollock Kristina , MacKay Jill R.D. , Hearns Stephen , Morton Carolyn , Pollock Patrick John
Published: January 2024

Introduction

Immersive simulation is used increasingly in medical education, and there is increasing awareness of the impact of simulation scenarios on emotional state and cognitive load and how these impact learning.
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There is growing awareness of the requirement to equip veterinarians with skills for managing high-pressure environments and provide training on human factors.

Methods

Veterinary students participated in a high-fidelity immersive simulation of a road traffic collision involving multiple casualties. The students took part in the same simulation twice, the second time after a debrief. Each participant's emotional state and cognitive load were assessed after participating in each simulation. Each participant was asked to score the effect of pressure on their performance.

Results

One hundred twenty-five students participated and demonstrated a higher cognitive load with more positive emotional states during the second scenario after the completion of a structured debrief and discussion focusing on pressure relief techniques (cognitive load - ¯μ Scenario run 1 = 4.44 ± 1.85 [SD], ¯μ Scenario2 = 5.69 ± 1.74 [SD]). Most (63%) participants described being in a low-performance state of frazzle during the first scenario compared with most (61%) who described being in a high-performance state of flow during the second.

Conclusion

Immersive simulation scenarios, with structured debriefing, may allow the measurement of emotional state and cognitive load in participants. Furthermore, this study suggests that curriculum training in human factors and pressure relief techniques, coupled with immersive simulation and debrief, may improve future performance in high-stakes and high-pressure scenarios.
Trauma surgeons experience compassion fatigue: A major metropolitan area survey
Authors: Hoefer Lea , Tatebe Leah C. , Patel Purvi , Tyson Anna , Kingsley Samuel , Chang Grace , Kaminsky Matt , Doherty James , Hampton David
Published: January 2024

INTRODUCTION

Compassion fatigue (CF), the physical, emotional, and psychological impact of helping others, is composed of three domains: compassion satisfaction (CS), secondary traumatic stress (STS), and burnout (BO). Trauma surgeons (TSs) experience work-related stress resulting in high rates of CF, which can manifest as physical and psychological disorders. We hypothesized that TSs experience CF and there are potentially modifiable systemic factors to mitigate its symptoms.

METHODS

All TSs in a major metropolitan area were eligible. Personal and professional demographic information was obtained. Each participant completed six validated surveys: (1) Professional Quality of Life scale, (2) Perceived Stress Scale, (3) Multidimensional Scale of Perceived Social Support, (4) Adverse Childhood Events Questionnaire, (5) Brief Coping Inventory, and (6) Toronto Empathy Questionnaire. Compassion fatigue subscale risk scores (low, <23; moderate, 23–41; high, >41) were recorded. Linear regression analysis assessed the demographic and environmental factors association with BO, STS, and CS. Variables significant on univariate analysis were included in multivariate models to determine the independent influence on BO, STS, and CS. Significance was p ≤ 0.05.

RESULTS

There were 57 TSs (response rate, 75.4% [n = 43]; White, 65% [n = 28]; male, 67% [n = 29]). Trauma surgeons experienced CF (BO, 26 [interquartile range (IQR), 21–32]; STS, 23 [IQR, 19–32]; CS, 39 [IQR, 34–45]). The Perceived Stress Scale score was significantly associated with increased BO (coefficient [coef.], 0.52; 95% confidence interval [CI], 0.28–0.77) and STS (coef., 0.44; 95% CI, 0.15–0.73), and decreased CS (coef., −0.51; 95% CI, −0.80 to −0.23) (p < 0.01). Night shifts were associated with higher BO (coef., 1.55; 95% CI, 0.07–3.03; p = 0.05); conversely, day shifts were associated with higher STS (coef., 1.94; 95% CI, 0.32–3.56; p = 0.03). Higher Toronto Empathy Questionnaire scores were associated with greater CS (coef., 0.33; 95% CI, 0.12–0.55; p < 0.01).

CONCLUSION

Trauma surgeons experience moderate BO and STS associated with modifiable system- and work-related stressors. Efforts to reduce CF should focus on addressing sources of workplace stress and promoting empathic care.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Trends and variation in cervical spine imaging utilization across children's hospitals for pediatric trauma
Authors: Ross Erin E. , Ourshalimian Shadassa , Spurrier Ryan G. , Chaudhari Pradip P.
Published: January 2024

BACKGROUND

Cervical spine (c-spine) evaluation is a critical component in trauma evaluation, and although several pediatric c-spine evaluation algorithms have been developed, none have been widely implemented. Here, we assess rates of c-spine imaging use across children's hospitals, specifically temporal trends in imaging use, variation across hospitals in imaging used, and timing of magnetic resonance imaging in admitted patients.

METHODS

Data from the Children's Hospital Associations Pediatric Health Information System were abstracted from 2015 to 2020. Patients younger than 18 years seen in the emergency department with an International Classification of Diseases, Tenth Revision, code indicative of trauma and c-spine plain radiograph or computed tomography (CT) in the emergency department were included. Data visualization and descriptive statistics were used to assess rates of imaging use by age, year, hospital, injury severity, and day of service. Changes in rates of imaging use over time were evaluated via simple linear regression.

RESULTS

Across 25,238 patient encounters at 35 children's hospitals, there was an increase in use of c-spine CT from 2015 to 2020 (28.5–36.5%). There was substantial interinstitutional variation in rates of use of plain radiographs versus CT for initial evaluation of the c-spine across all age groups. Magnetic resonance imaging was obtained more than 3 days after admission in 31.5% of intensive care patients who received this imaging.

CONCLUSION

Increasing use of CT, substantial interinstitutional variation in rates of use of plain radiographs versus CT, and heterogenous timing of magnetic resonance imaging for evaluation of the pediatric c-spine demonstrate the growing need for development and implementation of an age-specific c-spine evaluation algorithm to guide judicious use of diagnostic resources.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Decompressive craniectomy versus craniotomy for acute subdural hematoma: Updated meta-analysis of real-world clinical outcome after RESCUE-ASDH trial
Authors: Chang Yu , Wong Chia-En , Perng Pang-Shuo , Atwan Hany , Chi Kuan-Yu , Lee Jung-Shun , Wang Liang-Chao , Huang Chih-Yuan
Published: January 2024

INTRODUCTION

The Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of Acute Subdural Hematoma trial found that disability and quality-of-life outcomes were similar between craniotomy and decompressive craniectomy for traumatic acute subdural hematoma (ASDH), contrasting previous literature. This meta-analysis aimed to validate the applicability of RESCUE-ASDH results using real-world data in ASDH patients.

METHODS

We searched Chocrane, Embase, and MEDLINE for relevant articles reporting clinical outcomes of craniotomy and decompressive craniectomy. Meta-analysis used R software (Ross Ihaka and Robert Gentleman at the University of Auckland, New Zealand) with the restricted maximum likelihood method for random-effects meta-analyses, presenting odds ratios (ORs) and 95% confidence intervals (CIs) with Hartung-Knapp-Sidik-Jonkman adjustment for heterogeneity.

RESULTS

Besides RESCUE-ASDH, five retrospective studies were included, spanning 2006 to 2016. A total of 961 patients with traumatic ASDH were included in this study (craniotomy, 467; decompressive craniotomy, 494). The pooled analysis of retrospective studies showed no significant difference in poor clinical outcomes between the two groups (OR, 0.59; 95% CI, 0.32–1.10). These findings align with the RESCUE-ASDH trial (OR, 0.84; 95% CI, 0.58–1.23). Mortality rate was significantly higher in patients undergoing craniectomy in pooled result of retrospective studies (OR, 0.59; 95% CI, 0.32–1.10). In RESCUE-ASDH trial, reoperation rate was higher in the craniotomy group, but the pooled result of retrospective did not show significant difference between the craniotomy and craniectomy group.

CONCLUSION

This real-world evidence confirms the RESCUE-ASDH trial results. Both craniotomy and decompressive craniectomy yielded similar disability and quality-of-life outcomes for traumatic ASDH patients.

LEVEL OF EVIDENCE

Systematic Review/Meta-Analysis; Level III.