bluuebunny/crossref_metadata_2025_split huggingface dataset:
Updated Geriatrics Competencies for Graduating Medical Students: Training Physicians to Provide Age-Friendly Care
Authors: Schwartz Andrea Wershof , Sehgal Mandi , Dawson Catherine M.P. , Granville Lisa J. , Powers Becky B. , Shah Amit A. , Sullivan Amy M. , Leipzig Rosanne M. 
Published: January 2025

Abstract

Purpose
Medical student education in geriatrics is a critical need for every doctor-in-training as the population ages, with fewer than 7,000 geriatricians, and older patients, who now approach 20% of the U.S. population, having unique health care needs. This study presents the updated competencies in geriatrics for graduating medical students, framed by the Geriatrics 5Ms (Mind, Mobility, Medications, Multicomplexity, and What Matters Most).

Method
From 2019-2022, a working group of the American Geriatrics Society (AGS) drafted the updated medical student geriatrics education competencies, using a modified Delphi approach.
The working group reviewed the literature, conducted an initial survey of working group members, and drafted and refined proposed updates to the competencies. The 27 resulting competencies were disseminated as a national survey to geriatrics experts and medical school education deans. Following the national survey, the competencies were updated and presented at the 2021 AGS Annual Scientific Meeting and open to public comment before they were finalized.

Results
The 27 updated geriatrics competencies for medical students included several new competencies, such as a focus on health equity, frailty, deprescribing, and patient priorities. A total of 211 respondents completed the national survey, including geriatrics experts (187/398, response rate: 47.0%) and education deans (24/191, response rate: 12.6%). All 27 proposed competencies met the predetermined threshold of 70% cumulative agreement, with a range of 93.0% (174/187) to 100% (187/187) among geriatrics experts and 87.5% (21/24) to 100% (24/24) among education deans.

Conclusions
The updated Geriatrics Competencies for Graduating Medical Students met with broad agreement among the geriatrics experts and medical school education deans who responded to the national survey. By focusing on the Geriatrics 5Ms, the competencies highlight key knowledge and skills graduating medical students need for the first day of internship to be prepared to deliver age-friendly care to older adults under their care.
THC Ingestions and Child Protective Services: Guidelines for Practitioners
Authors: Raz Mical , Gupta-Kagan Josh , Asnes Andrea G. 
Published: January 2025

Abstract
The decriminalization of tetrahydrocannabinol (THC)-containing products has resulted in an increased presence of these products in households. This increased presence, along with frequent use of product packaging that mimics recognizable and appealing treats, has led to a rise in accidental ingestions of THC-containing substances by children. Some clinicians and child protective services (CPS) professionals have recommended that every accidental THC ingestion by a child, irrespective of the circumstances, should be reported for investigation by CPS. We argue that this recommendation has the potential to waste scarce resources, harm families, and worsen current inequities in CPS reporting. We offer an alternative framework to this blanket recommendation that clinicians can employ when providing care to a child who has ingested THC.
Geographic Variation in Inpatient Rehabilitation Outcomes After Traumatic Brain Injury
Authors: Darji Nathan , Zhang Bei , Goldstein Richard , Shih Shirley L. , Iaccarino Mary Alexis , Schneider Jeffrey C. , Zafonte Ross 
Published: January 2025

Objective:
To determine whether regional variations exist in functional outcomes of patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation facilities (IRFs) across the United States, while controlling for demographic and clinical variables.

Setting:
Inpatient rehabilitation facilities (IRFs) across 4 U.S. regions: West, Midwest, South, and East.

Participants:
Adult patients with open or closed TBI (Rehabilitation Impairment Codes 2.21 or 2.22) discharged from an IRF between 2016 and 2019.

Design:
This is a retrospective analysis de-identified data from the Uniform Data System for Medical Rehabilitation. The study compared total functional independence measure (FIM) scores and discharge dispositions across the 4 regions.

Main Measures:
Primary outcomes were FIM scores at discharge, changes in FIM scores between admission and discharge, and community discharge rates, adjusted for demographic and clinical factors. Cohen’s d effect sizes were calculated to assess the clinical significance of regional differences on FIM scores. Prevalence ratios were used for discharge disposition outcomes.

Results:
Regional differences were identified in functional outcomes for patients with TBI. The West had the highest community discharge rate (80.9%) compared to the East (70.5%). Discharge FIM scores were significantly lower in the Midwest and East compared to the South (−1.98 and − 2.31, respectively, P < .01), while the West showed no significant difference from the South (−0.78, P = .11). Effect sizes for FIM total scores were small across regions, with Cohen’s d for West versus South at 0.017, Midwest versus South at 0.047, and East versus South at 0.047. Prevalence ratios for community discharge showed minor differences: West versus South at 1.010, Midwest versus South at 0.937, and East versus South at 0.918; all without statistical significance.

Conclusions:
Regional disparities in functional outcomes following inpatient rehabilitation for TBI were observed, particularly in community discharge rates and total FIM scores. However, based on the effect sizes and prevalence ratios, these differences may not be clinically meaningful and could not be fully explained by demographic and clinical factors. Further studies are needed to explore region-specific factors influencing rehabilitation efficacy to improve outcomes for patients with TBI nationwide.
Risk Factors for Proliferative Vitreoretinopathy in a Large Clinical Database
Authors: Oncel Damla , Minaker Samuel , Shepherd E Annie , Rezaei Sam , Boucher Nick , Aggarwal Nitika , MacCumber Mathew 
Published: January 2025

Purpose:
Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure following rhegmatogenous retinal detachment (RRD). In this study, we aimed to explore ocular and systemic risk factors for PVR due to RRD in a large patient database.

Methods:
Patients who have a diagnosis of RRD and PVR, and who have been seen in the last seven years prior to analysis (January 2015-February 2023) were identified in the Vestrum Health database. The variables selected for univariate and multivariate analysis in this study included age, gender, history of smoking, diabetes, hypertension, dyslipidemia, anemia, Wagner syndrome, Stickler syndrome, vitreous hemorrhage, high myopia, ocular trauma, choroidal detachment, uveitis, giant retinal tear, aphakia and endophthalmitis. Eyes with proliferative diabetic retinopathy and those that had a history of PVR before the RRD diagnosis date were excluded from the study. The incidence of PVR was determined within each subset of the patient population.

Results:
There were 57,264 eyes that underwent a post-operative examination within 1 month following RRD diagnosis. Systemic factors younger age, female gender, smoking history, and hypertension, and ocular factors poor baseline visual acuity, history of ocular trauma, choroidal detachment, history of uveitis, giant retinal tear, pseudophakia, aphakia, and endophthalmitis were significantly and independently associated with increased odds of PVR development.

Conclusion:
The findings of this study indicate that there are several systemic and ocular risk factors that increase PVR development. Ophthalmologists should keep these in mind when planning surgical and therapeutic interventions for PVR prevention and treatment in patients with RRD.
Optical Coherence Tomography Angiography findings in Syphilitic Outer Retinitis
Authors: Zeman Luis , Cartier Mauricio Martínez , Couto Cristóbal , Schlaen Ariel 
Published: January 2025

Purpose:
to report optical coherence tomography angiography findings in syphilitic outer retinopathy, a singular clinical manifestation of ocular syphilis.

Methods:
case report

Results:
Multimodal imaging including optical coherence tomography angiography was performed in a patient presenting syphilitic outer retinopathy. Optical coherence tomography angiography showed multifocal areas of flow deficit at the choriocapillaris level at presentation, whereas no vascular abnormalities were observed at deep and superficial capillary plexuses. After a one-year follow-up period, choriocapillaris flow showed an almost complete recovery.

Conclusion:
Syphilitic outer retinopathy represents a singular clinical manifestation of ocular syphilis. The almost complete recovery of initial ischemic changes at one year of follow-up suggests that this entity may have a good prognosis with timely and proper antibiotic treatment.
Correlation of Mindfulness Practices, Resilience, and Compassion Satisfaction in Hospital-Based Healthcare Workers: A Randomized Controlled Trial
Authors: Liska Heather , Bentzoni Megan , Donovan Courtney , Gaibel Ben , Hueth Alison , Johnson Adrienne , Shepler Mary , Roybal Deb , Mealer Meredith 
Published: January 2025

Goal:
A lack of healthcare worker well-being is a serious threat to patient care quality and safety, as well as to the overall operational performance of hospitals in the US healthcare delivery system. Extreme resilience depletion and compassion fatigue are known to negatively influence individual well-being and have contributed to the rise in turnover in the healthcare workforce. The primary aim of this research was to identify interventions that health system leaders can use to combat resilience depletion and exhaustion among healthcare workers.

Methods:
Researchers deployed a randomized controlled trial methodology to study the association between the use of regular mindfulness practices, resilience, and compassion satisfaction. After completing an initial screening questionnaire and preassessments, participants were randomized into one of two groups: (1) an experimental group with mindfulness practices as the intervention and (2) a control group. The experimental group participated in structured mindfulness practices during their regular workday on three different days per week for a minimum of 10 minutes per day. At the end of the six-week study period, both groups completed postassessment questionnaires. Results from the pre- and postassessments were analyzed to determine the correlation between mindfulness practices, resilience, and compassion satisfaction.

Principal Findings:
Data analysis revealed that baseline resilience scores in the experimental group increased by 4 points, with a progressive 92% power. In addition, the experimental group demonstrated a statistically significant improvement in resilience (p mean difference pre-post = .147/.002) and compassion satisfaction (p mean difference pre-post = 3.99/.019).

Practical Applications:
Readily available, low-cost mindfulness practices may be introduced to hospital staff to build resilience and improve compassion satisfaction. In turn, this may help support hospital efforts to reduce turnover in the healthcare workforce.
Advance Care Planning Billing Codes Associated With Decreased Healthcare Utilization in Neurological Disease
Authors: Brown Gregory , Jesus Sol De , Leboffe Emily , Esch Andy , Newport Kristina 
Published: January 2025

Goals:
Advance care planning (ACP) procedure codes have been established to reimburse meaningful care goal discussions; however, the utilization frequency of these codes in neurological disease is unknown. The objective of this study is to identify the association between ACP codes and healthcare utilization in chronic neurodegenerative diseases.

Methods:
This is a multicenter cohort study using real-world electronic health data. Using the TriNetX database, we collected electronic health data from 92 institutions in the United States. We included patients aged 65 and older who had been diagnosed with one of four neurological diseases: Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or amyotrophic lateral sclerosis (ALS). Patients with congestive heart failure were included as a reference. From the 64,683,009 total patients in the database, 877,138 had Alzheimer’s disease, 544,610 had Parkinson’s disease, 208,341 had multiple sclerosis, 9,944 had amyotrophic lateral sclerosis, and 1,500,186 had congestive heart failure. For each disease, we compared hospitalizations and emergency department (ED) visits over a two-year period between patients with and without ACP codes documented. Then, in patients with ACP, we investigated the rates of hospitalizations and ED visits over the two years before ACP and two years after ACP to understand the impact of ACP on the healthcare utilization trend. All patients had records for at least two years after index.

Principal Findings:
The rate of ACP code documentation ranged from 1.8% of multiple sclerosis patients to 3.6% of Alzheimer’s disease patients. After matching for demographic and health variables, usage of ACP codes was associated with significantly fewer hospitalizations for Alzheimer’s disease patients. Across all diseases, there was a 20% to 30% decrease in ED visits, which was significant. Furthermore, there was a significant change in the trend of hospitalizations and ED visits for patients after ACP documentation. Patients went from increasing utilization before ACP documentation to decreasing utilization after documentation.

Practical Applications:
ACP billing codes are used infrequently in neurological disease, which may indicate that reimbursement alone is not sufficient to drive code usage. Usage of ACP billing codes was associated with decreased healthcare utilization, particularly in terms of ED visits. Beyond the primary objective of providing goal-concordant care, ACP may impact the economic burden of chronic neurodegenerative disease, which has high costs of care in our aging society. There may be particular benefits with Alzheimer’s disease, which had an impact on both hospitalizations and ED visits and is the most prevalent neurodegenerative disease. Future work is needed to better understand the best implementation strategy for ACP in a multifaceted approach that emphasizes patient care preferences for their illness.
Long-term (12 months) vs. short-term (<12 months) dual antiplatelet therapy post-percutaneous coronary intervention with drug-eluting stents: a critical appraisal and systematic review
Authors: Abbott Kolten , Seton Nicholas , Kaur Gurjeevan , Zhao Jilai , Jones Mark , Singh Kuljit 
Published: January 2025

Background
A growing body of evidence supports short-term DAPT as safe and efficacious following PCI with DES. However, methodological criticism of RCTs has led to caution when translating results into clinical practice. This study aimed to critically appraise the methodological rigour of included studies and consolidate the evidence on the safety and efficacy of short-term DAPT.

Methods
Medline, Cochrane Library and Embase were searched from inception until August 2022. The primary outcome was the methodological quality of published primary studies. Risk of bias was assessed using RoB 2.0 and the CASP tool. Evidence was rated for quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) score approach. Other endpoints were all-cause mortality and major bleeding.

Results
Eighteen RCTs were included. Based on GRADE score, there was a moderate level of certainty that the reported results for both outcomes are probably close to the true effect. A total of 78% (14/18) of RCTs had a low risk of bias when assessing all-cause mortality and 61% (11/18) when assessing major bleeding. The CASP tool confirmed methodological rigour; however, only 33% (6/18) of studies were applicable beyond the studied populations. Compared with 12 months of DAPT, short-term DAPT was associated with a reduced risk of major bleeding [relative risk (RR): 0.69, 95% CI: 0.54–0.88, P = 0.003, I
2 = 45%] and trended towards a reduced risk in all-cause mortality (RR: 0.90, 95% CI: 0.79–1.01, P = 0.08, I
2 = 0%).

Conclusion
With moderate certainty evidence, short-term DAPT appears safe and efficacious post-PCI with DES in the studied populations.
Association Between Average Daily Activity Counts and Knee Osteoarthritis Progression
Authors: Tang Xiaozhen , Li Dongze , Yao Haishan , Chen Xuanchen , Fan Liangquan , Hou Zhenhai 
Published: January 2025

Abstract

Objective
To explore the relationship between daily activity counts and knee osteoarthritis (OA) progression.

Design
A cohort study using Osteoarthritis Initiative (OAI) data included 610 participants aged 45-79 years with knee OA or at risk. Daily activity counts were measured using ActiGraph GT1M accelerometers. OA progression was assessed via Kellgren-Lawrence (KL) grade and joint space narrowing (JSN) scores over two years. Cox proportional hazard and Restricted Cubic Spline models identified the dose-response relationship and optimal activity threshold.

Results
The average age of participants was 63.7 years, with 44.8% male. A U-shaped relationship was observed between daily activity counts and OA progression. Moderate activity levels could be associated with a reduced risk of KL-grade (adjusted HR: 0.33; 95% CI: 0.24-0.44) and JSN-score progression (HR: 0.31; 95% CI: 0.25-0.38) for activity below 3263.3 counts/min. However, higher activity levels may increase KL-grade (HR: 1.57; 95% CI: 1.40-2.75) and JSN-score progression risk (HR: 1.27; 95% CI: 1.13-1.43).

Conclusion
Moderate activity may protect against knee OA progression, while low and high levels may increase risk. Tailored activity recommendations are needed for individuals with or at risk for OA. Future research should investigate the mechanisms and refine activity thresholds for OA management.
Risk Factors and Treatment Strategies for Subcutaneous Effusion Secondary to Cerebrospinal Fluid Leakage After Craniotomy
Authors: Yuan Susu , Chen Yanlin , Jin Yichao , Jia Feng 
Published: January 2025

Objective:
To confirm the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy, analyze the risk factors for cerebrospinal fluid leakage leading to subcutaneous effusion, summarize the underlying causes of its occurrence and explore the corresponding treatment strategies.

Methods:
A retrospective analysis was conducted on 757 patients who underwent craniotomy at our hospital from January to December 2023. The authors documented the sex, age, surgical characteristics, and history of chronic diseases for all patients, including those who developed subcutaneous effusion secondary to cerebrospinal fluid leakage. These factors were subjected to univariate regression analysis, and the identified risk factors were evaluated in a multivariate regression analysis.

Results:
Among 757 patients who underwent craniotomy, 15 developed subcutaneous effusion secondary to cerebrospinal fluid leakage, representing an incidence of 1.98%. This group included 5 patients with acoustic neuroma surgery, 4 with neurovascular decompression, 4 with meningioma surgery, 1 patient undergoing a posterior corpus callosotomy for epilepsy, and 1 patient with cerebellar cavernoma resection. Factors such as acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgical durations, larger cranial bone removals, higher body mass index, and smoking were associated with an increased risk of developing subcutaneous effusion secondary to cerebrospinal fluid leakage. The average time to onset was 40.8 ± 37.16 days. Three patients with subcutaneous effusion experienced elevated body temperatures, with one testing positive in blood cultures; no other complications were noted. All patients initially received conservative treatment and subsequently underwent surgical repair for the cerebrospinal fluid leak an average of 45.4 ± 57.94 days later, ultimately resulting in recovery and discharge.

Conclusion:
In 2023, the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy at our hospital was 1.98%. The fundamental cause of this complication is the pressure difference between the inside and outside of the dura mater, leading to incomplete dural closure and subsequent fluid leakage. Factors such as younger age, acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgery durations, larger cranial bone removals, higher body mass index, and smoking are associated with an increased risk of subcutaneous effusion. Once subcutaneous effusion occurs, conservative management is the initial step. To optimize outcomes, surgical repair of the cerebrospinal fluid leak should follow conservative treatment. This approach can significantly reduce the likelihood of treatment failure, decrease hospital stays, and cut unnecessary costs.
The American Clinical Neurophysiology Society Guideline on Indications for Continuous Electroencephalography Monitoring in Neonates
Authors: Wusthoff Courtney J. , Numis Adam L. , Pressler Ronit M. , Chu Catherine J. , Massey Shavonne , Clancy Robert R. , Nguyen Sylvie , Hahn Cecil D. , Scher Mark S. , Pilon Betsy , King Donald T. , Wong Hong-nei , Tsuchida Tammy N. , Riviello James J. , Shellhaas Renée A. 
Published: January 2025

Purpose:
Continuous EEG (cEEG) monitoring is increasingly used in the management of neonates with seizures. There remains debate on what clinically relevant information can be gained from cEEG in neonates with suspected seizures, at high risk for seizures, or with definite seizures, as well as the use of cEEG for prognosis in a variety of conditions. In this guideline, we address these questions using American Clinical Neurophysiology Society structured methodology for clinical guideline development.

Methods:
A working group was formed from American Clinical Neurophysiology Society membership with expertise in neonatal cEEG and a set of priority questions developed. We performed literature searches in PubMed and EMBASE to identify relevant studies. Evidence tables were compiled from extracted data and quality assessments performed. A modification of the GRADE process was used to evaluate the body of evidence and draft recommendations.

Results:
Our working group identified six priority questions to evaluate the accuracy of cEEG for neonatal seizure diagnosis and the formulation of prognosis. An initial literature search yielded 18,167 results, which were distilled to a set of 217 articles. Overall, the quality of evidence for most priority questions was rated as very low and we provided conditional recommendations based on published literature and expert consensus. For each priority question, we also considered the benefits and harms of cEEG, with relative harms considered to be far less than the potential benefits across recommendations.

Conclusions:
We present evidence-based clinical guidelines regarding indications for cEEG monitoring in neonates. Considering resource utilization and feasibility, when cEEG monitoring results have a likelihood of altering clinical decision making, the authors felt the resource investment was justifiable.