bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between physicians’ personal preferences for end-of-life decisions and their own clinical practice: PROPEL survey study in Europe, North America, and Australia
Authors: Mroz Sarah , Daenen Frederick , Dierickx Sigrid , Mortier Freddy , De Panfilis Ludovica , Downar James , Lapenskie Julie , Anderson Koby , Skold Anna , Campbell Courtney , Campbell Toby C , Feeney Rachel , Willmott Lindy , White Ben P , Chambaere Kenneth , Deliens Luc 
Published: December 2024

Background: Physicians have significant influence on end-of-life decisions. Therefore, it is important to understand the connection between physicians’ personal end-of-life care preferences and clinical practice, and whether there is congruence between what they prefer for themselves and for patients. Aim: Study to what extent physicians believe their personal end-of-life preferences impact their clinical practice and to what extent physicians’ personal treatment option preferences differ from what they prefer for their patients. Design: A cross-sectional survey was conducted from May 2022 to February 2023. Setting/participants: Eight jurisdictions: Belgium, Italy, Canada, USA (Oregon, Wisconsin, and Georgia), and Australia (Victoria and Queensland). Three physician types were included: general practitioners, palliative care physicians, and other medical specialists. Results: We analyzed 1157 survey responses. Sixty-two percent of physicians acknowledge considering their own preferences when caring for patients at the end of life and 29.7% believe their personal preferences impact the recommendations they make. Palliative care physicians are less likely to consider their own preferences when caring for and making recommendations to patients. Congruence was found between what physicians prefer for patients and themselves with cardiopulmonary resuscitation considered “not a good option for both” by 99.1% of physicians. Incongruence was found with physicians considering some options “not good for the patient, but good for themselves”—palliative sedation (8.3%), physician-assisted suicide (7.0%), and euthanasia (11.6%). Conclusion: Physicians consider their own preferences when providing care and their preferences impact the recommendations they make to patients. Incongruence exists between what physicians prefer for themselves and what they prefer for patients.
A new approach to repair recurrent vescicourethral anastomotic strictures after radical prostatectomy: The use of prerectal access
Authors: Vitarelli Antonio , Minafra Paolo , Vulpi Marco , Piana Alberto , Torre Giuseppe , Carbonara Umberto , Divenuto Lucia , Papapicco Giuseppe , Chiaradia Francesco , Alba Stefano , Lucarelli Giuseppe , Battaglia Michele , Ditonno Pasquale 
Published: December 2024

Background: Vesicourethral anastomosis stenosis (VUAS) is a well-known complication of prostate cancer treatments, observed in up to 26% of the cases after radical prostatectomy. Conservative management, with single or even repeated transurethral dilation or endoscopic incision of the stenosis, is successful in many cases, but up to 9% of patients are destined to fail after endoscopic treatment. In these cases, a revision of the vesicourethral anastomosis is necessary and can be realized with different surgical approaches. We aim to describe the technique and the outcomes of a new prerectal approach for VUAS repair. Methods: Twelve patients with recalcitrant VUAS following radical prostatectomy were enrolled between May 2014 and September 2018 for prerectal transperineal re-anastomosis. The evaluated outcomes were: the rate of successful anatomical repair at 3 months after surgery and at the last follow-up, postoperative incontinence and complications rate, and the need for further treatments. Results: No major intraoperative complications occurred. After a median follow-up of 46 months (IQR 36–55), 10 patients (83.3%) achieved a good anatomical repair even if one man required an endoscopic urethrotomy, while two patients (16.67%) with a history of pelvic radiotherapy developed a surgical site infection that required toilette and external urinary diversion. Among the others, nine (75%) developed severe stress urinary incontinence, with resolution of their condition. No patient reported significant postoperative pain or fecal incontinence. Conclusions: The prerectal approach to VUAS repair allows direct access to the posterior urethra and the anastomosis, providing a better mobilization of the bladder neck for tension-free anastomosis. However, patients with a history of pelvic radiotherapy have a higher risk of complications. Postoperative incontinence is very common, but urinary continence could be restored with subsequent artificial urinary sphincter placement.
Efficacy of ranibizumab with laser in the treatment of diabetic retinopathy compare with laser monotherapy: A systematic review and meta-analysis
Authors: Huang Ju , Liang Xin , Liu Qiu-fen , Zhou Ming-jing , Hu Pan , Jiang Shi-chun 
Published: December 2024

Background Diabetic retinopathy (DR) is one of the serious complications of diabetes mellitus. Laser therapy is the traditional treatment for DR, and the role of vitreous injection of ranibizumab in DR requires evaluation. This meta-analysis aimed to compare the efficacy of ranibizumab combined with laser versus laser monotherapy in treating diabetic retinopathy. Method We searched PubMed, Scopus, Web of Science, Embase, China Biology Medicine Disc (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang databases, from their inception to October 2024. Randomized controlled trials (RCTs) that compared the effectiveness of ranibizumab combined with laser versus laser monotherapy in the treatment of diabetic retinopathy were searched. We used the Cochrane Collaboration tool to evaluate the risk of bias. Results Our analysis included 18 studies. The improvement time for retinal edema in the ranibizumab combined with the laser group was significantly shorter than that in the laser monotherapy group ( P < 0.05). The time to absorb fundus hemorrhage in the ranibizumab combined with the laser group was significantly shorter than that in the laser monotherapy group ( P < 0.05). The absorption time of fundus exudation in the ranibizumab combined with the laser group was significantly lower than that of the laser monotherapy group ( P < 0.05). The rate of improvement in vision in the ranibizumab combined with the laser group was significantly higher than that of the laser monotherapy group ( P < 0.05). There were no significant differences in the incidence of adverse reactions ( P > 0.05) and retinal thickness in the macula ( P > 0.05) between ranibizumab combined with the laser group and the laser monotherapy group. onclusion The combination of ranibizumab and laser for diabetic retinopathy is more effective than laser monotherapy.
Recognizing Variations in Primary Palatoplasty Billing: A Review of 9827 Cases
Authors: Elver Ashlie A. , Zhang Wesley Q. , Perry Nancy K. , Lewis Jamie , Humphries Laura S. , Hoppe Ian C. 
Published: December 2024

Objective Identify unbundling trends in primary palatoplasty. Design Retrospective study utilizing the American College of Surgeon Pediatric National Surgical Quality Improvement Program (PNSQIP). Setting Records available from 2016 to 2021. Patients All patients with primary CPT (current procedural terminology) code 42200 (palatoplasty for cleft palate, soft and/or hard palate only). Interventions Cohorts compared “unbundled”: additional CPT code 42235 (repair of anterior palate, including vomer flap) vs. “bundled”: 42200 billed alone. Main outcome measures Operative time, surgical specialty, and other perioperative variables. Results In total, 9827 had primary CPT 42200. Of these, 671 (6.8%) were unbundled. Operative time was longer in unbundled (157.08 min vs. 133.16 min; P < .001). Plastic surgeons were less likely to unbundle (6.2% vs. otolaryngology, 9.12%; P < .001). Conclusions Variations in primary palatoplasty billing exist. Longer operative times in unbundled cases suggest added complexity. Undervaluation of craniofacial CPT codes may contribute to non-standard billing practices.
Workflow evaluation of environmental contamination with hazardous drugs during compounding and administration in an UK hospital
Authors: Sessink Paul JM , Barry Beverley , Dunbar Lisa , Cameron Lisa T , Kirkness Tessa , Campbell Karen 
Published: December 2024

Introduction Exposure of healthcare workers to hazardous drugs may result in adverse health effects underscoring the importance of validating working procedures and safety precautions to minimise the risk. The objective was to monitor environmental contamination caused by the hazardous drug workflow: from drug vials, compounding process, to patient administration. Methods Surface wipe samples were collected from potentially contaminated surfaces in the compounding department and in the administration department. The outside of drug vials, compounded syringes, bags, elastomeric pumps, and gloves used by the nurses for administration were also monitored. Stationary air samples were collected near the isolators and above the bench top. Personal air samples were collected from pharmacy technicians, pharmacists, and nurses. Monitoring was performed in three trials during two-months. Samples were analysed for cyclophosphamide, 5-fluorouracil, docetaxel, and paclitaxel using liquid chromatography tandem mass spectrometry. Results Contamination was mainly found for 5-fluorouracil and cyclophosphamide on isolator surfaces, bench top, trays, and compounded products. Lower levels of contamination were measured in the administration department on trays, trolley arms and gloves of the nurses. Paclitaxel and docetaxel were incidentally detected. Air contamination was found for paclitaxel in the compounding department in one trial, and 5-fluorouracil was detected once in front of an isolator. Docetaxel was found in one air sample of a nurse. Conclusions Contamination was mainly found for 5-fluorouracil and cyclophosphamide on the products compounded in the isolators. Contamination was further spread along the workflow towards the administration department causing surfaces in between being contaminated too.
Geometric Deep learning Prioritization and Validation of Cannabis Phytochemicals as Anti-HCV Non-nucleoside Direct-acting Inhibitors
Authors: Charles Ssemuyiga , Edgar Mulumba Pius 
Published: December 2024

Introduction: The rate of acute hepatitis C increased by 7% between 2020 and 2021, after the number of cases doubled between 2014 and 2020. With the current adoption of pan-genotypic HCV therapy, there is a need for improved availability and accessibility of this therapy. However, double and triple DAA-resistant variants have been identified in genotypes 1 and 5 with resistance-associated amino acid substitutions (RAASs) in NS3/4A, NS5A, and NS5B. The role of this research was to screen for novel potential NS5B inhibitors from the cannabis compound database (CBD) using Deep Learning. Methods: Virtual screening of the CBD compounds was performed using a trained Graph Neural Network (GNN) deep learning model. Re-docking and conventional docking were used to validate the results for these ligands since some had rotatable bonds >10. About 31 of the top 67 hits from virtual screening and docking were selected after ADMET screening. To verify their candidacy, 6 random hits were taken for FEP/MD and Molecular Simulation Dynamics to confirm their candidacy. Results: The top 200 compounds from the deep learning virtual screening were selected, and the virtual screening results were validated by re-docking and conventional docking. The ADMET profiles were optimal for 31 hits. Simulated complexes indicate that these hits are likely inhibitors with suitable binding affinities and FEP energies. Phytil Diphosphate and glucaric acid were suggested as possible ligands against NS5B.
Care homes and primary care in England working together: A multi-method qualitative study
Authors: Warmoth Krystal , Aylward Alex , Goodman Claire 
Published: December 2024

Objective In England, most long-term care for older people with complex health care needs is provided by private care homes. They rely on primary care to provide medical care and access to specialist health care services. This study explored the working relationships between care homes and primary care in one region in England to inform a theory of change for achieving improved relationships. Methods We carried out a multi-method qualitative study using appreciative inquiry. We thematically analysed data from 33 survey responses, 15 interviews, and eight workshops with care home and primary care staff, family carers, and other community specialists to populate the theory of change. A patient and public involvement representative supported data collection, analysis, and write-up. Results Study participants described activities that encouraged role understanding, communication, and learning together benefitting staff, relationships, and quality of services. The lessons and experiences from the COVID-19 pandemic had shaped participants’ understanding of what is required to sustain cross-sector collaboration. Key inputs included time, staff, and funding to facilitate learning how to work together effectively, as well as the capacity to adapt to diverse care settings and address the complex, individual needs of care home residents. Participants noted the few opportunities they had to share their learning and discuss best practice. Conclusion The theory of change identified different dimensions of good practice, providing insight into areas for action to inform service design and practice. Ongoing organisational changes should consider what is already working well and build on these achievements to enable positive care home and primary care working relationships and so foster high quality care and equitable access to services.
Large-eddy simulations of noise reduction via fundamental-harmonic interactions in a supersonic rectangular jet
Authors: Malczewski Benjamin J , Salehian Saman , Golubev Vladimir V , Mankbadi Reda R 
Published: December 2024

This work explores the use of bi-modal excitation to reduce the noise in a supersonic rectangular jet. The excitation is guided by previously published reduced-order modelling, suggesting that harmonic interactions can reduce the dominant noise sources in the jet. An unexcited jet is considered first as the baseline case, which showed Strouhal number 0.15 as the most dominant near field coherent structure, which also appeared as a prominent peak in the far field noise at low emission angles and as a secondary peak at the peak emissivity angle, thus it was taken as the fundamental frequency to target with excitation. The jet is then excited with the single-mode harmonic, St 0.30. Other cases are considered with bi-modal excitation at St’s 0.15 and 0.30 with various phase lags. Both single-mode and bi-modal excitation show a considerable reduction of the near field coherent structures at St 0.15 and amplification at 0.30. Reduction of the fundamental in the bi-modal cases shows a dependence on the initial phase lag whereby reduction is maximized when harmonic amplification is maximized. All excited cases are also shown to reduce the eddy convection velocity. Reduction in far field sound pressure levels at St 0.15 is obtained for all excitation cases up to 13 dB. For all metrics, it is shown that bi-modal excitation is more effective than single-mode excitation given an optimized phase lag. All results ultimately support the use of fundamental-harmonic interactions as a noise reduction mechanism.
Subcutaneous Implantation of Open Microwell Islet Delivery Devices in Pigs
Authors: Tol Maarten C. , de Vries Rick H. W. , Engelse Marten A. , Carlotti Françoise , van Apeldoorn Aart A. , de Koning Eelco J. P. , Huurman Volkert A. L. 
Published: December 2024

Background Intraportal pancreatic islet transplantation is a treatment option for patients with severe beta cell failure and unstable glycemic control. However, this procedure is associated with loss of beta cells after intrahepatic transplantation. Islet delivery devices (IDDs) implanted at extrahepatic sites may support engraftment and improve survival of pancreatic islets. We assessed the surgical feasibility, tolerability and safety of implantation of open microwell devices at subcutaneous sites with varying friction in pigs. Methods Open, non-immunoisolating microwell islet delivery devices were made from polyvinylidene fluoride (PVDF). Empty (n = 26) and islet-seeded devices (n = 8) were implanted subcutaneously in 6 immunocompetent pigs in low-friction sites (abdomen and lateral hip) and high-friction sites (anterior neck) for 3 months. Retrieved grafts were analyzed histologically with haematoxylin and eosin, and Masson’s Trichrome staining. Results Islet-seeding and transportation of IDDs was free from complications with minimal islet spillage. IDDs were implanted subcutaneously using standard surgical equipment, without complications during the surgeries. IDDs implanted in the neck and IDDs co-transplanted with human islets were expelled and retrieved after 10 days. Empty IDDs were removed after 3 months. The abdominal site showed reduced signs of inflammation as compared to the neck region, while similar tissue ingrowth and vascularization of devices were found in the two locations. Conclusions Open microwell IDDs can safely be implanted with standard surgical equipment and successful islet-loading can be performed. Low-friction sites are preferable over high-friction sites for subcutaneous implantation in the porcine model since these lead to the least amount of foreign body reaction.
Inverted dome radial osteotomy and ulnar shortening for neglected paediatric distal radial epiphyseal injury with ulnar impaction syndrome
Authors: Wang Angela , Luo An-Jhih , Wang Jung-Pan 
Published: December 2024

Neglected distal radial epiphyseal injuries can result in radial deformity and positive ulnar variance. We describe an inverted-dome radial osteotomy and ulnar shortening osteotomy to treat a paediatric distal radial malunion with ulnar impaction syndrome. Level of evidence: V
Isolation, Characterization, Chemical Profiling and Evaluation of Antidiabetic and Antioxidant Potential of Innula cappa (Buch.-Ham. ex D. Don) DC Leaves in Alloxan-Induced Type 2 Diabetic Mice
Authors: Rahman Shahid , Jan Gul , Jan Farzana Gul 
Published: December 2024

Background Innula cappa (Buch.-Ham. ex D. Don) DC (Compositae) is used in folkloric medicine to treat diabetes and other ailments. The current study aimed to assess the anti-hyperglycemic and antioxidant effects of methanolic extract and solvent fractions of I. cappa leaves as well as bioassay guided isolation of active compounds from the active extract. Method The α-amylase and α-glucosidase inhibition of the extracts was evaluated by colorimetric assays, and the anti-diabetic activity was tested on alloxan-induced diabetic mice model. Moreover, flame emission and atomic absorption spectrometry techniques were employed to analyze the chemical composition of the plant. Compounds were identified and isolated from the leaf latex of I. cappa using FTIR, GCMS, silica gel column chromatography, and their structures were determined using 1H-NMR, 13C-NMR, and ESI-MS spectral data. Results The results showed that the ME showed significant α-amylase, α-glucosidase inhibitory hyperglycemic activities, significantly improving body weight, glucose tolerance, lipid profiles, and hematological markers. The UV-FTIR spectra revealed diagnostic peaks corresponding to several functional groups whereas GC-MS spectral analysis revealed 35 phytochemical components with different retention times in the ME of I. cappa. Spectroscopic isolation of the ME led to the isolation 5 compounds including ursolic acid, benzoic acid, 2-hydroxybenzoic acid, stigmasterol and β -sitosterol. Conclusion ME exert significant antihyperglycemic and antioxidant effects demonstrating the medicinal value of I. cappa and emphasize its significance as unexplored natural reservoirs of phytogenic chemicals that require further investigation using cutting-edge analytical techniques.
Curriculum Innovation: Clinical Documentation Integrity Education for Neurology Trainees
Authors: Aghajan Yasmin , Molyneaux Bradley J. 
Published: December 2024

Background and Purpose High quality clinical documentation is a fundamental skill for practicing physicians and important for quality improvement. However, documentation and coding are rarely integrated into medical education curricula and there is a lack of standard neurology curriculum on this topic. We developed and evaluated a teaching session on clinical documentation for neurology resident physicians. Methods The education consisted of a didactic session designed by a neurologist with content about risk-adjusted mortality, clinical documentation integrity (CDI), impact of documentation on patients, and neurology-specific documentation guidance. A pre-post survey design was used to compare baseline and post-intervention self-reported knowledge and attitudes. Results 61 responses were collected (37 pre- and 24 post-intervention). Residents had increased understanding of the impact of documentation on quality metrics ( P = 0.004), risk-adjusted mortality ( P < 0.0001), and impact on patients ( P = 0.02). Attitude towards CDI education improved significantly ( P = 0.0016), as well as agreement that CDI is important to resident physicians ( P = 0.003). The portion of residents who agreed training on CDI is useful and valuable increased significantly ( P = 0.004). 92% agreed this curriculum was useful, and 96% agreed they understood the role of CDI better after the session. Conclusions In this study of a teaching session for neurology residents on clinical documentation, we found this format of teaching was well-received and highly effective in improving resident attitudes and self-reported knowledge.
Nutrition information and the menopause: An online survey of perimenopausal and menopausal women
Authors: Davies Eleanor , Halliday Vanessa 
Published: December 2024

Objective This study aimed to explore where perimenopausal and menopausal women get their nutrition information from, and how reliable they perceive these sources to be. Study design This was a cross-sectional study that used an online survey to collect data about nutrition information seeking habits. The survey was generated using the Qualtrics software and promoted via social media. The convenience sample included women over the age of 40 years living in the UK. Main outcome measures: Quantitative data. Results Two hundred and sixty-nine responses were analysed. The majority of respondents were over the age of 50, and from a white British background. Online sources were most commonly used by women to access nutrition information, namely official websites such as the British Menopause Society (BMS) and National Health Service (NHS) websites. The majority of participants believed that these, along with research papers, were the most reliable sources. However, receiving nutrition information from healthcare professionals was most likely to cause women to change their behaviour towards nutrition. The majority of women were interested in receiving targeted menopausal nutrition information, and this would ideally be from official websites or their healthcare professionals. Conclusions Findings from this study suggest that women predominantly rely on online sources for information about nutrition, perceiving official websites as reliable sources. There is a demand among women for tailored nutritional guidance during the menopausal transition, emphasising the importance of providing accessible and targeted resources to support women’s health needs during this life stage.