bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring factors affecting patient satisfaction in online healthcare: A machine learning approach grounded in empathy theory
Authors: Chen Junbai , Wu Guoping , Zhang Tong , Zhao Butian , Wang Ruojia , Zhai Xing , Guo Fengying 
Published: December 2024

Objective Empathy between doctors and patients is crucial in enhancing patient satisfaction with medical consultations. This study, grounded in empathy theory, employs natural language processing and machine learning algorithms to explore the factors influencing patient satisfaction in online healthcare services, particularly the impact of doctor–patient empathy. Methods Utilizing the three dimensions of the Jefferson Scale of Physician Empathy, seven variables were extracted from patient–doctor dialogs as independent variables, with patient satisfaction as the dependent variable. Employing machine learning algorithms, a classification model was constructed to identify the best-fitting model for exploring the pivotal factors influencing patient satisfaction in online medical services. The optimal model was then chosen to investigate the essential factors impacting patients’ satisfaction with online healthcare. Results A total of 7586 data points were collected, with 5447 consultation dialogs (71.8%) receiving a satisfactory rating from patients. LightGBM emerged as the best-performing model, achieving an F1 score of 0.78 and an area under the curve value of 0.81. Factors within the Standing in Patient's Shoes and Perspective Taking dimensions were identified as key determinants of patient satisfaction in online healthcare services. Conclusion This study broadens the conventional scope of applying empathy theory, signifying its crucial role in cultivating doctor–patient empathy within the realm of online healthcare and elevating the overall quality of medical services. The findings indicate that two pivotal factors influencing patients’ satisfaction with online healthcare are doctors’ perceived competence and ability to empathize, understanding patients’ perspectives, and offering assistance.
Serum neurofilament light chain levels in patients with small-fiber neuropathy
Authors: Zohar Daniela Noa , Keren Daria , Qassim Lamis , Eltity Mailam , Shavit-Stein Efrat , Chapman Joab , Dori Amir 
Published: December 2024

Background Serum neurofilament light chain (sNfL) levels are an increasingly employed tool for the assessment of active axonal injury in a variety of neurological disorders including polyneuropathy. Injury to the small nerve fibers can lead to small fiber neuropathy (SFN), a neurological condition which is clinically manifested by combination of burning pain, various sensory disturbances and symptoms of autonomic dysfunction. SFN is evident by identifying reduced epidermal nerve fiber density (ENFD) in skin biopsy. Objective To assess the utility of sNfL measurement as a marker for active axonal injury in a population of patients who were referred for skin biopsy as part of the evaluation of chronic sensory symptoms. Methods sNfL levels were measured in 94 patients at the time of skin biopsy. Clinical, electrodiagnostic, and imaging data were collected and neurological comorbidities including central nervous system disorders, large-fiber polyneuropathy, and radiculopathy which may increase sNfL levels were reviewed. Results Eighty-six patients had pathological skin biopsy result supporting the diagnosis of SFN. sNfL was increased in 9 (10%) SFN patients. Seven of them had neurological comorbidities which may explain the elevated sNfL. The other two patients had history of hypothyroidism and endometriosis. Conclusions sNfL levels are typically normal in patients with SFN. Furthermore, when sNfL are elevated, evaluation for another neurological disorder should be considered.
Platelet-Derived Growth Factor has Context-Dependent Effects on Osteogenesis in Bone Marrow-Derived Cells
Authors: Huffman Nicholas , Gillis Julianne , Magesh Amogh , Sangadala Sreedhara , Patel Jay M. , Bariteau Jason T. 
Published: December 2024

Category: Basic Sciences/Biologics; Ankle Arthritis Introduction/Purpose: Arthrodesis stands as the primary method for treating advanced osteoarthritis in the foot and ankle [1]. However, a significant hurdle in this procedure is non-union occurrence, emphasizing the need for adjuncts to enhance osteogenesis and ensure successful fusion. Platelet-Derived Growth Factor (PDGF) emerges as the only clinically approved bone graft substitute for ankle and hindfoot fusion. Bone marrow stimulation, crucial for recruiting cells to aid healing in arthrodesis, is a standard step in all fusions. While preclinical studies on PDGF have mainly focused on human cell lines, the in vitro impact of PDGF on marrow-derived cells, crucial for arthrodesis sites, remains unexplored. This study aims to assess the osteogenic potential of PDGF on heterogeneous marrow-derived cells in both 2D and 3D environments. Methods: Marrow-derived cells (MDCs) from young bovine femoral condyle were utilized without sorting or filtering, to maintain heterogeneity. For 2D assays, MDCs were plated at 10,000 cells per well and cultured in osteogenic media. Both alizarin staining and alkaline phosphatase activity were assessed at 14 days. For 3D assays, we cultured MDCs in fibrin gels at 2M/mL. in osteogenic media for 28 days. For 3D analysis, micro CT and alizarin red staining were performed on fibrin gels. Results: In 2D in vitro analysis, PDGF demonstrated significant increase in alizarin red staining and ALP activity [Figure 1A, 1B]. In 3D analysis, PDGF showed no significant increase in and has trended toward a decrease in alizarin red staining and in micro CT [Figure 1C, 1D]. Conclusion: While many studies have examined the impact of PDGF on human cell lines, this is the first work to analyze the effects of PDGF in a representative distal extremity fusion environment. In our current study, in 2D PDGF demonstrates significant osteoinducton, while in 3D, no increase is seen and a trend towards decreased osteogenic function was observed. Our findings reveal that the differential effects of PDGF in 2D and 3D which may vary depending on the surrounding environment. This work highlights the need for further studies to fully grasp how PDGF functions in an arthrodesis.
Preoperative Opioid Dependence Associated with Increased Costs and Wound Dehiscence Following Total Ankle Arthroplasty
Authors: McDonald Weston E. , Guareshi Alexander S. , Morningstar Joshua L. , Friedman Richard J. , Gross Christopher E. , Scott Daniel J. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: The overuse of opioid medications in patients undergoing orthopaedic surgery has become widely labeled as a national epidemic. Recent literature, particularly in the fields of orthopaedic spine surgery and joint arthroplasty, has illustrated an association between chronic opioid use and increased costs and postoperative complications. The purpose of this study is to evaluate the influence of chronic opioid dependence on postoperative outcomes following total ankle arthroplasty (TAA). We hypothesized that preoperative opioid dependence would be associated with higher rates of complications, revisions, readmissions, and mortality following TAA, as well as increased cost and longer hospital stays. Methods: The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 29,751 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative opioid dependence, with 861 (2.9%) being chronic opioid users or having opioid use disorders. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to identify independent predictors of postoperative outcomes other than preoperative opioid dependence. Results: The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). When stratifying by preoperative opioid dependence, it was found that opioid dependent patients were statistically significantly older (Opioid=62.74 years; Nonopioid=65.21 years; p<.001), from lower income quartile (p=.042), more likely to have Medicaid insurance (p<.001), and had a higher CCI score (Opioid=0.97; Nonopioid=0.64; p<.001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative opioid dependence was significantly predictive of increased risk of wound dehiscence (p<.001), adverse discharge (p<.001), and extended stay greater than 4 days (p<.001). Further, preoperative opioid dependence is predictive of more than a $1,000 increase in total cost of procedure (β= 1,052.27; 95% CI= 117.62-1,986.91; p=.027). (Table1) Conclusion: Chronic preoperative opioid use was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians should consider this modifiable risk factor when identifying patients and tailoring medication regimens for patients receiving ankle arthroplasty.
Progressive Collapsing Foot Deformity Classes Correction after Isolated Arthroscopic Anterolateral Subtalar Arthrodesis
Authors: Bernasconi Alessio , Lalevée Matthieu , Fernando Céline , Izzo Antonio , Cesar Netto Cesar de , Lintz François 
Published: December 2024

Category: Hindfoot; Midfoot/Forefoot Introduction/ Purpose: Subtalar osteoarthritis in the context of flatfoot recently renamed Progressive Collapsing Foot Deformity (PCFD) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA). Methods: In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes. Results: Thirtythree PCFD (33 patients, median age 62) were included. Preoperative medial facet subluxation was 28.3%. Overall PCFD 3D deformity improved with a reduction of the foot and ankle offeset from 9.3 points to 4 (p< 0.001). Class A (hindfoot valgus, measured through the tibiocalcaneal angle, the calcaneal moment arm, the calcaneal offset and the hindfoot angle), class B (midfoot abduction, measured using the talonavicular coverage angle and the axial talo-first metatarsal angle) and class C (forefoot varus, measured through the sagittal talo-first metatarsal angle and the forefoot arch angle) significantly improved after surgery (p< 0.001 for all measurements). No patient had a valgus deformity at the ankle pre-operatively (therefore no patient presented with class E), and no significant change of the talar tilt was observed (p=0.12). Conclusion: In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus.
Quality of Initial Reduction of Tibial Plafond Fractures as Predictors of Trauma Injury Outcome
Authors: Wilson Jennie-Ann L. 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: High energy trauma to the ankle joint can cause soft tissue damage and bone disruption of the tibial plafond. Currently, the most widely accepted treatment options are the External Fixation and the Open Reduction and Internal Fixation (ORIF) surgical procedures. The goal of this study was to determine if the quality of these procedures in patients with a Type-C Tibial Plafond Fracture has a relationship with a patient’s chances of developing a post-surgical complication. Methods: This retrospective study included a population of 131 patients with a Type-C Tibial Plafond Fracture who were operated on at Grady Memorial Hospital from 2012 to 2023. No exclusions based on past medical history were applied. Grady Sectra Fluoroscopy videos as well as AP and Lateral x-rays were evaluated and the AP translation, Lateral Translation, Anatomic Lateral Distal Tibia Angle (aLDTA), and Anterior Distal Tibia Angle (ADTA) measurements of the tibial plafond fracture post External Fixation and ORIF procedures were recorded, and any differences were assessed. Binary Logistic Regression was used to determine if there was a significant difference in any of the External Fixation measurements and post-operative complications. Pearson Correlation was used to determine if the alignment in the External Fixation was a predictor of the alignment after ORIF. Results: The initial population sample of 131 patients was reduced to 99 patients due to patients being excluded from the study because their imaging files were incomplete. The data showed that neither the translational nor angular alignments post External Fixation nor ORIF had any statistically significant correlation to a patient’s chances of developing a post-surgical complication. Using the Pearson Efficient, the External Fixation AP and Lateral translation measurements were 0.16 (p-value 0.12) and 0.171 (p-value 0.095) respectively, so there was no significant correlation to the final AP and Lateral measurements of the ORIF procedure. The External Fixation aLDTA and ADTA values of 0.289 (p-value 0.004) and 0.336 (p-value < 0.001) respectively, were significantly related to the final aLDTA and ADTA angles of the ORIF procedure. Conclusion: The results from this study will have a positive implication on clinical practice as it encourages trauma orthopedic surgeons to achieve tibial plafond alignment angles during the External Fixation procedure that are as anatomically correct as possible in order to improve the efficacy and accuracy of the ORIF procedure.
Randomised Prospective Trial Comparing the Salto Talaris Fixed-Bearing and Salto Mobile-Bearing Total Ankle Replacement
Authors: Sevic Aleksandar , Patel Chetan , Tomlinson Matthew P. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Comparative studies examining Fixed-Bearing (FB) and Mobile-Bearing (MB) Total Ankle Replacement (TAR) designs have demonstrated similar results and successful long-term outcomes for both. To date there has been no study directly comparing FB and MB designs of the same prosthesis. We present the first randomised prospective trial comparing patient satisfaction, functional outcomes and radiographic results of the Salto Talaris Fixed-Bearing and the Salto Mobile-Bearing Total Ankle Replacement in the treatment of end-stage ankle arthritis. Methods: A total of 106 adult patients with end-stage ankle arthritis were enrolled in the study between November 2014 and October 2021 with similar demographic comparison. Prospective patient-reported outcomes and standardised weightbearing ankle radiographs were performed preoperatively, at 6 weeks, 6 months and 12 months post-operatively, followed by yearly intervals. Foot Function Index, Revised Foot Function Index, 12-Item Short Form Survey and Total Ankle Joint Replacement Questionnaire were used for patient reported scoring. All surgeries were performed by a single non-design orthopaedic foot and ankle specialist with experience in over 200 Salto and Salto Talaris TAR prior to the study. Radiographs were examined independently by two clinicians. Complete patient data and radiographs were available for 101 patients with an average follow up of 3 years. Results: Both groups demonstrated statistically significant improvement from preoperative evaluation to most recent follow up with no statistically significant difference between the two groups in all outcome measures. Radiographic incidence of subchondral cyst formation was 17.4% and 49.1% for FB and MB, respectively. Talar subsidence occurred in 8.7% and 18.2% of FB and MB, respectively. Implant subluxation was observed in 1.8% of MB TAR. Two patients required revision, one from each cohort reflecting a revision rate of 2.2% for FB and 1.8% for MB TAR. Conclusion: Our study demonstrates a higher than previously reported rate of subchondral cyst formation in the MB TAR and comparatively higher talar subsidence in the MB TAR vs FB however this did not correlate with clinical outcome measures which were favourable for both groups.
Return to Work after Total Ankle Arthroplasty
Authors: Sakkab Ramez , Jain Vikram , McAlister Jeffrey 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: End-stage ankle arthritis has demonstrated as detrimental an impact on work status and quality of life as that of the knee or hip. Inability to return to work, whether sedentary or physical, can incur significant economical burden. Total ankle arthroplasty has emerged as an increasingly common surgical treatment for end-stage ankle arthritis but its ability to enable patients’ return to work has not been elucidated. Methods: Patients from January 1st, 2020 to January 1st, 2024 were included in a multicenter prospective database for end-stage ankle arthritis treated with a total ankle replacement. Inclusion criteria included patients younger than 65 years, actively employed at the time of surgery, and two years of follow up. This cohort had 57 patients with an average age of 50.6 ± 12.6 years and was balanced in terms of sex (49% female). Foot function index (FFI), ankle osteoarthritis (AOS), and SF-36 scores were obtained pre and post-operatively. Results: All patient outcome scores significantly improved after arthroplasty (p < 0.01). The employment rate prior to surgery was 86% (49), which decreased to 78.9% (45) at the 2-year postoperative mark and was significant (p=0.024). Patients returned to sedentary and manual labor work at an average 2.8 and 13.3 weeks after surgery, respectively. Conclusion: After total ankle arthroplasty, patients younger than 55 returned to sedentary work at a mean 2.8 weeks post-operatively. And 13.3 weeks when returning to weight bearing labor. At 2-year follow-up, significantly more were unemployed (86% to 78.9%, p=0.024). This small cohort provides a launch point for patient discussion regarding their timeline to return to manual labor after total ankle arthroplasty.
Revision of Recurrent Hallux Valgus Deformity Using a Percutaneous Distal Transverse Osteotomy: Surgical Considerations and Mean 3.6 Year Results
Authors: Lewis Thomas L. , Ray Robbie , Murphy Evelyn , Chua Min Jia , Watt Clare , Lam Peter 
Published: December 2024

Category: Bunion; Lesser Toes Introduction/Purpose: Hallux Valgus (HV) is a common forefoot deformity that can cause pain and difficulty with walking. There are a range of surgical techniques to treat HV deformity, but there is a risk of recurrence. This paper reviews the clinical assessment and management of recurrent HV as well as a detailed description of how percutaneous surgical techniques can be used to treat recurrent HV. This paper identifies technical challenges of percutaneous HV surgery for recurrent HV deformity as well as strategies to address and mitigate these. Methods: This was a multicenter retrospective review of adult patients who had recurrent hallux valgus deformity (defined as hallux valgus angle>15° and having previously undergone primary surgical intervention for HV deformity correction) who were treated with a percutaneous metatarsal extra-capsular transverse osteotomy (META) technique between 5/12/2013 and 8/1/2022, with at least one year of follow-up data. Demographic information, hallux valgus angle, 1-2 intermetatarsal angle, Manchester-Oxford Foot Questionnaire (MOXFQ;validated for hallux valgus surgery), visual analog scale (VAS), and EQ-5D-5L scores were collected. All p-values < 0.05 were considered significant. Results: We retrospectively evaluated 34 feet from 32 patients with a mean age of 63.1±9.2 (range 41-82) who underwent revision hallux valgus surgery using a percutaneous technique. The mean follow up was 3.6±2.3 (range 0.5-8.7 years. The breakdown of index HV surgeries was: 17 Chevron, 9 Scarf/Akin, 6 medial bunionectomy, 1 Lapidus, 1 proximal rotation osteotomy. There was a statistically significant improvement in both clinical foot function and radiographic deformity after surgery. The mean hallux valgus angle decreased from 32.9±8.6° to 13.4±7.3°, and the intermetatarsal angle decreased from 12.7±3.8° degrees to 3.8±3.1°(p< 0.05). The mean MOXFQ Index score significantly improved from 49.4±23.1 to 14.6±19.4 (p< 0.05). Conclusion: This paper suggests that percutaneous surgical techniques using a transverse osteotomy and screw fixation can successfully treat a wide range of recurrent HV deformity severities with significant improvement in clinical and radiographic outcomes.
Developing a systematic fall risk assessment tool for outpatient clinics
Authors: Drees Allison , Heinlein Lewis , Yang Yushi 
Published: December 2024

Background In healthcare settings, fall incidents represent a significant public health issue and often result in severe injuries, prolonged hospital admissions, and substantial healthcare costs. Despite current fall risk reduction strategies, falls continue to be among the leading causes of sentinel events. Objective This study aims to identify fall risk factors present in an outpatient clinic work system and develop tools to support proactive risk mitigation. Research Design We introduced a systematic fall risk assessment (SFRA) tool where front-line staff can evaluate their work systems for fall risks. The tool was developed using literature review, observations, and interviews with focus groups. The tool includes step-by-step instructions for an outpatient clinic fall risk assessment, factors to consider in various settings of patient care, and guiding principles to address fall risks in an outpatient work system. Results This tool underwent user testing, which validated its learnability, usability, and usefulness, and was rated positively by a diverse range of clinics and roles. Our preliminary results suggested that the tool was effective in identifying potential fall risk factors of outpatient clinics, even when used by non-experts. Conclusion We demonstrated the effective use of human factors methods to equip front-line staff with tools to proactively evaluate outpatient clinic work systems for fall risks and develop mitigation strategies.