bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and Evaluation of Cultural Safety Initiatives in Australian Hospital Settings: A Scoping Review
Authors: Clough Belinda , Fraser Jennifer , Flemington Tara , Power Tamara 
Published: November 2024

Introduction: The aim of this scoping review was to synthesize and summarize existing evidence for implementing and evaluating Cultural Safety initiatives in Australian hospitals for Aboriginal and Torres Strait Islander peoples. The rationale for this work was to establish guidelines for best practice in providing culturally safe care across hospital and health services. Methodology: A systematic search guided by PRISMA Extension for Scoping Reviews was conducted across five databases: CINAHL, Scopus, MEDLINE, Embase, and Informit. Reference lists and citations of eligible studies were also examined. Studies were eligible for inclusion if they were in English and discussed the implementation and/or evaluation of Cultural Safety initiatives in Australian hospitals. Evaluations assessing both health care staff and patient perspectives were included. Studies were excluded if they presented future implementation protocols or initiatives among health care students. No date limiters were applied due to the small body of available literature. Results: Nine studies met the criteria and were included in this review. Five themes emerged: (a) process of implementation; (b) process of evaluation; (c) change in health professional’s behavior; (d) change in patient behavior; and (e) future recommendations. Discussion and Conclusions: Validated implementation frameworks and evaluation tools are needed for integrating Cultural Safety initiatives into Australian hospital settings. This review has highlighted that despite the availability of evidence-based tools, their use was lacking. This scoping review also highlighted that evaluation of Cultural Safety initiatives is primarily focused on the attitudes and knowledge of health professionals, rather than patient experience. As Cultural Safety is determined by recipients of care, future evaluation of initiatives should prioritize patient perspectives.
Association of Palliative Care With Readmission and Resource Utilization in Patients With Ovarian Cancer: A National Perspective
Authors: Francoeur Alex A. , Chervu Nikhil , Mardock Alexandra L. , Solaru Samantha , Sakowitz Sara , Benharash Peyman , Lai Tiffany S. 
Published: November 2024

Objective Palliative care (PC) utilization in cancer care has been shown to alleviate symptoms, increase goals of care discussions, and reduce invasive end of life measures. This study examined the association of inpatient PC consultation with readmission and hospitalization costs among patients with ovarian cancer. Methods All records for women (≥18 years) hospitalized with a diagnosis of ovarian cancer were tabulated from the 2010-2020 Nationwide Readmissions Database. Multivariable logistic, Poisson, and linear regressions were used to evaluate the association of PC consultation during index hospitalization with length of stay, rates of 30-day non-elective readmission, time to readmission, as well as overall number of readmissions and hospitalization costs. Results Of an estimated 285,487 patients included, 25,957 (9.0%) received a PC consultation, with an increase from 5.1 to 11.7% ( P < 0.001) across the period. Factors associated with use of PC included: increasing age (AOR 1.03/yr, 95% CI 1.03-1.03, P < 0.001) and Elixhauser comorbidity index (AOR 1.19/point, 95% CI 1.17-1.21). PC was associated with lower risk adjusted rates of 30 day (11.63%, 95% CI 11.0-12.3 vs 20.25%, 95% CI 20.0-20.6) non-elective readmission ( P < 0.001). The adjusted incident rate ratio of readmission after PC consultation was 0.41 [0.38-0.43], P < 0.001. Patients receiving PC additionally had less cost associated with their index hospital stay; −$2,407 [−$2,669.86- −$2,144.43], P < 0.001). Conclusions Inpatient PC consults appear to be associated with reduced medical readmissions for patients with ovarian cancer, as well as decreased hospital resource use, however disparities exist. Continued increase in access and early PC referral should be considered.
Usefulness of Suture-Tape Augmentation Based on Intraoperative Ankle Stress Radiographs During Anatomical Ligament Repair for Chronic Lateral Ankle Instability
Authors: Cho Byung-Ki , Kim Sung-Hoo , Choi Seung-Myung , Hwang Eun-Taek 
Published: November 2024

Background: During the modified Broström procedure for chronic ankle instability, surgeons often experience cases with insufficiently restored mechanical stability even after anatomical ligament repair. In these cases, longer postoperative immobilization and delayed rehabilitation can be required, and a risk for recurrence of instability may persist. This study aimed to evaluate the clinical usefulness of suture-tape augmentation based on intraoperative stress radiographs during anatomical ligament repair for chronic ankle instability. Methods: Twenty-four patients who underwent additional suture-tape reinforcement because of residual mechanical instability on intraoperative stress radiographs were followed up ≥3 years. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Changes in mechanical stability were analyzed through periodic stress radiographs, and postural control ability was evaluated with the modified Romberg test. Results: FAOS and FAAM scores improved significantly from preoperative mean 55.1 and 52.4 points to 92.3 and 90.2 points at final follow-up, respectively ( P < .001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean 15.8 degrees and 13.6 mm to 2.9 degrees and 4.2 mm, respectively ( P < .001). Balance retention time improved significantly from preoperative mean 3.6 to 6.4 seconds ( P < .001). Although 9 patients experienced sprain injury after surgery, no patient showed recurrence of mechanical and subjective instability, and 21 patients (87.5%) were able to return to preinjury level of sports activity. Conclusion: Evaluation of residual mechanical instability through intraoperative stress view and additional suture-tape augmentation showed satisfactory clinical outcomes at midterm follow-up. Suture-tape augmentation based on intraoperative stress radiographs seems to be a useful surgical option for patients with insufficiently restored mechanical stability even after anatomical ligament repair. This combined procedure can provide a reliable mechanical stability that can be performed after recognition of residual instability during the index surgery.
Risk Factors for Chronic Syndesmotic Instability After the First Episode of Acute Ankle Sprain: A Cross-Sectional Study of 356 Cases
Authors: Fu Ke , Jia Shenghong , Lin Shiwei , Xu Chenyu , Fang Zhenhua 
Published: November 2024

Background: Chronic syndesmotic instability (CSI) can be associated with severe long-term pain and disability. This study aimed to investigate the risk factors associated with the development of CSI in patients who underwent conservative treatment after the first episode of acute ankle sprain (AAS) that did not result in a satisfactory outcome. Methods: We retrospectively analyzed the clinical data of patients who underwent ankle arthroscopy for suspected CSI between January 2020 and September 2023. The patients were divided into the instability and stability groups based on the syndesmotic space width measured under arthroscopy, with 3 mm as the critical value. Demographic, arthroscopic, and imaging information such as the anterior talofibular ligament (ATFL), calcaneofibular ligament, posterior talofibular ligament (PTFL), anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), deltoid ligament (DL), interosseous membrane, height of the syndesmotic fluid, injuries of the talus, calcaneus, tibia, and fibula, effusion of the tibiotalar and talocalcaneal joints, fibular morphology, and fibular incisura features, were recorded. Univariate and multivariate analyses were performed successively to identify the risk factors. Results: Of the 356 patients, 102 developed CSI after the first episode of AAS. In the multivariate analysis, development of CSI was associated with 5 clinical factors: DL injury (odds ratio [OR] 7.453, 95% CI 3.007-18.471; P < .001), positive bandage-binding test (OR 7.196, 95% CI 2.942-17.599; P < .001), grade 2 to 3 injury of the PITFL (OR 2.727, 95% CI 1.044-7.124; P = .041), positive squeeze test (OR 2.455, 95% CI 1.045-5.770; P = .039), and body mass index (BMI) (OR 1.306, 95% CI 1.121-1.522; P < .001). Conclusion: Five key factors were associated with CSI development in patients who underwent conservative treatment after the first episode of AAS that did not result in a satisfactory outcome: DL injury, positive bandage-binding test, grade 2 to 3 injury of the PITFL, positive squeeze test, and BMI.
Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds for Foot and Ankle Ability Measure and Visual Analog Scale Scores After Hallux Valgus Surgery
Authors: Pasqualini Ignacio , Teplensky Jason R. , Turan Oguz , Poirier Sarah E. , Cantrell William A. , Mueller James , Chawla Sagar , Miniaci-Coxhead Sara Lyn 
Published: November 2024

Background: Although clinically relevant thresholds such as minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) have been widely described across orthopaedics, their application in hallux valgus surgery remains scarce. The purpose of this study was to determine the MCID and PASS thresholds for the visual analog scale (VAS) and Foot and Ankle Ability Measure (FAAM) scores after hallux valgus surgery. Methods: A retrospective review was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected preoperatively and 1 year postoperatively. The specific PROMs used were the FAAM–activities of daily living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. Two methods were used to calculate MCID and PASS thresholds: a distribution-based approach for MCID and an anchor-based approach using responses to a 1-year postoperative satisfaction question for PASS. The analysis identified optimal cutoff points that maximized sensitivity and specificity based on the Youden index. Overall, 86% (136/158) completed baseline PROMs, and 73% (99/136) completed 1-year PROMs. Results: The distribution-based MCID for FAAM-ADL, SANE, and VAS were calculated to be 10.8, 14.1, and 1.2, respectively. The percentage of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for SANE, and 96% for VAS. The PASS threshold for FAAM-ADL, SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The percentage of patients who achieved PASS thresholds was 78% for FAAM-ADL, 72% for SANE, and 69% for VAS. Conclusion: This study identified useful values for the MCID and PASS thresholds of FAAM-ADL, SANE, and VAS scores at 1-year follow-up for patients undergoing hallux valgus surgery. Overall, despite not meeting the MCID thresholds, patients undergoing hallux valgus surgery were still likely to be satisfied with their surgery.
Unveiling missing voices – Lifelong Experiences of fathers parenting autistic sons: An interpretative phenomenological analysis
Authors: Koltai Borbála Gabriella , Pados Eszter , Rácz József 
Published: November 2024

This study addresses the underrepresentation of fathers in autism research, particularly those with adult-aged autistic offspring. The authors explored the lifelong experiences and interpretations of fathers raising their autistic sons. Ten Hungarian fathers participated in a one-time semi-structured interview. Interpretative phenomenological analysis revealed four Group Experience Themes: ‘A revolving cycle around losing and regaining control’, ‘Crossing boundaries: accepting and adapting’, ‘Being in the world as a father: experiences of eternality and liminality’, and ‘Personal growth through pervading experience’. The findings highlight unique fatherhood experiences and offer implications for professionals and service providers. Lay abstract Being a father of an autistic son is a profound and complex experience. Fathers adapt to their autistic sons’ unique needs and are always in search of services to ease uncertainties about their sons’ present and future. We interviewed 10 Hungarian fathers who have adult-aged autistic children. We asked them about their experiences raising their autistic sons during childhood and adulthood. Our study focused on fathers of adult-aged sons because most research has studied mothers’ experiences of autistic children under 18 years old. It is also essential to know how to be like a father with adult-aged autistic children. Fathers shared their ongoing struggle with uncertainty, always seeking the best possible solutions for their sons. They also talked about how they understand and adapt to autism and accept their sons with their special, autism-related characteristics. The findings of this research provide a deeper understanding of fathers’ parenting experience, giving suggestions for professionals on supporting them and making their experiences valuable to the community of parents raising autistic children.
Attitudes of health and social care professionals towards the use of blended diets for enteral tube feeding for children and young people
Authors: Phillips Gemma , McCullough Fiona , Hemingway Pippa 
Published: November 2024

Using a blended diet as an alternative to commercial formula is becoming more popular amongst parents and carers of children and young people (CYP) requiring long-term enteral tube feeding (ETF). Emerging evidence has demonstrated physiological and social benefits; however, families report feeling unsupported to use a blended diet in settings outside the home. This study aimed to explore the attitudes of health and social care staff towards the use of blended diets for CYP. Health and social care professionals with experience of blended diets were invited to partake in an online semi-structured qualitative interview. Thematic analysis was used to identify themes. Five participants from health, education and social care settings were interviewed. Online interviews worked effectively for data collection to allow flexibility to accommodate participants’ care roles and avoid face-to-face contact necessary with Coronavirus disease 2019 restrictions. Three themes were identified in the data: • Change from medicalised enteral tube feeding practice. • Individual, person-centred approach. • Open support networks and responsibility. Findings showed that blended diets can be accommodated; however, barriers to implementation remain. Medicalisation of ETF continues to impair acceptance of blended diets whilst effective multi-disciplinary team communication and support facilitates its use in settings outside the home.
Red Leg Dilemma: Development and Validation of Clinical Decision Tools for Non-Necrotizing Bacterial Dermohypodermitis, Necrotizing Fasciitis, and Eczematous Dermatitis
Authors: Skayem Charbel , Charras Thulan , Tran Viet-Thi , Hua Camille , Pham Giao Do , Hirsch Gaëlle , Zehou Ouidad , Duong Tu Anh 
Published: November 2024

Background Diagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics. Objective Develop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema). Methods We collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients. Results A total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema. Conclusion Presentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.
Comparison of 2 Types of Local Anesthetic Techniques in the Reduction of Distal Radius Fracture: A Prospective Cohort Study
Authors: Cela-López Miguel , Domínguez-Prado Diego M. , García-Reza Alejandro , Álvarez-Álvarez Lucía , Pérez-Alfonso Elena , Oiartzabal-Alberdi Inés , Castro-Menéndez Manuel 
Published: November 2024

Background: The treatment of distal radius fractures may require manipulation of the fracture assisted by finger traction, causing pain both at the fracture site and at the fingers. The usual type of anesthesia used does not anesthetize the fingers. Methods: We conducted a prospective cohort study with two groups, hematoma block (HB) and hematoma with associated median nerve block (MHB). Characteristic variables of the patients were collected. The main variable for the analysis was pain, measured using the Visual Analogical Scale (VAS). It was measured prior to the injection (VAS1), during fracture reduction (VAS2), and 30 minutes after the injection (VAS3) in both groups. Results: The study included a total of 140 fractures (70 anesthetized with HB), 78% were women. There were no significant differences in the variables age, sex, Elixhauser index. and need for surgery between the groups. In the HB group, the VAS means were VAS1 5.23 cm (SD 2.31), VAS2 5.80 cm (SD 2.52), and VAS3 1.89 cm (SD 1.94); while in the MHB group, VAS1 5.13 cm (SD 2.36), VAS2 3.15 cm (SD 1.70), and VAS3 1.09 cm (SD 1.38). Area of greatest pain during fracture reduction in the HB group was finger traction in 78% cases ( p < .05), while in the MHB group it was the manipulation of the fracture site in 71% cases ( p < .05). Conclusions: The study demonstrates that the use of hematoma with associated median nerve block decreases pain perception in patients with distal radius fracture that needs closed reduction, when compared to HB alone.
Comprehensive geriatric assessment guided radiotherapy in elderly patients with locally advanced rectal cancer—exploratory results on nonoperative cohort of a multicenter prospective study
Authors: Yang Yue-Xin , Tang Yuan , Li Ning , Tang Yu , Cheng Yun-Jie , Yang Lin , Fang Hui , Lu Ning-Ning , Qi Shu-Nan , Chen Bo , Wang Shu-Lian , Song Yong-Wen , Liu Yue-Ping , Li Ye-Xiong , Liu Zheng , Liang Jian-Wei , Zhang Hai-Zeng , Zhou Hai-Tao , Wang Jun , Liu Wen-Yang , Jin Jing 
Published: November 2024

Background: Chemoradiotherapy (CRT) is the main treatment for elderly patients with non-metastatic rectal cancer who are ineligible for or decline surgery, but the optimal modality remains unclear. Objectives: This study was to validate the safety and efficacy of comprehensive geriatric assessment (CGA) guided radiotherapy in older patients. Design: An exploratory analysis of a single-arm, multicenter, Phase II trial. Methods: Patients aged over 70 and diagnosed with rectal cancer were enrolled and evaluated by CGA. CGA-guided radiotherapy was individually conducted in a multidisciplinary setting. Patients in fit, intermediate, and frail groups were scheduled to receive CRT, long-course radiotherapy, and short-course radiotherapy (SCRT) alone respectively. Patients who were unfit for or refused surgery were analyzed for acute toxicities and survival outcomes. Results: In a total of 109 enrolled patients, 47 individuals who did not undergo surgery were included, with 26, 9, and 12 categorized into fit, intermediate, and frail groups. Only 11 (23.4%) grade 3 or above toxicities were observed overall. Within a median follow-up of 69.0 months, the 3-year overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS) rates were 44.3% (95% CI: 32.1%–61.2%), 25.5% (95% CI: 15.7%–41.6%) and 61.0% (95% CI: 47.8%–77.6%) in total. The 5-year OS, PFS, and CSS reached 15.0% (95% CI: 7.4%–30.3%), 14.6% (95% CI: 7.3%–29.4%), and 36.2% (95% CI: 22.0%–59.4%), with no significant difference among the three subgroups. SCRT ( p < 0.001) and dose boost ( p = 0.045) contributed to lower tumor-related death rates in multiple competing risk regressions. Conclusion: Radiotherapy guided by CGA was effective and well-tolerated in non-surgical elderly patients. SCRT alone seemed to achieve similar clinical outcomes as CRT in corresponding subgroups. However, given the limited size of this study, further investigation in a larger population is still needed for this strategy.
The AFCRPLITY score for predicting the prognosis of immunotherapy combined with local–regional therapy in unresectable hepatocellular carcinoma
Authors: Zuo Mengxuan , Wei Ran , Li Da , Li Wang , An Chao 
Published: November 2024

Background: Immunotherapy combined with intra-arterial therapy (IAT) has shown great potential in the treatment of unresectable hepatocellular carcinoma (uHCC). However, there are currently no available biomarkers that can predict the prognosis of immune-based combined therapy. Objectives: To establish a scoring method to predict prognosis in uHCC patients undergoing IAT plus immunotherapy. Methods: Between March 2019 and August 2022, uHCC patients undergoing IAT in combination with programmed cell death (ligand) 1 (PD-1)/PD-L1-based immunotherapy were retrospectively analyzed. Results: Among 1046 patients included, 780 patients were enrolled into hepatic arterial infusion chemotherapy immunotherapy cohorts (training set: n = 546, one center; external testing set: n = 234, three centers) and 266 patients were treated with trans-arterial chemoembolization (TACE) plus immunotherapy were enrolled into TACE immunotherapy cohort (validation set: n = 266). We developed the easy-to-apply alpha-fetoprotein (AFP), C-reactive protein (CRP), and platelet-to-lymphocyte ratio (PLR) in immunotherapy (AFCRPLITY) score and investigated the prognostic value of baseline variables on the disease control rate (DCR) and progression-free survival (PFS). HCC patients with low AFCRPLITY scores would have better PFS and DCRs than patients with high AFCRPLITY scores (AFCRPLITY 0: vs AFCRPLITY 1: vs AFCRPLITY 2: vs AFCRPLITY 3: p < 0.001 for PFS, p = 0.001 for DCRs) in the training set, which was confirmed in the external testing set and validation set. The highest level of CD8+ T cells was in the AFCRPLITY score = 0 group than the other two groups. Conclusion: The AFCRPLITY score is associated with PFS and DCR in uHCC patients receiving IATs plus immunotherapy. This score may be helpful for counseling, but prospective validation is needed. Design: A retrospective, multi-institutional study. Trial registration: The study has been retrospectively registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2300075828).