bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of factors effecting survival of patients following massive transfusion and analyzing characteristics of massive transfusion protocol
Authors: Ram Nakhul , Ganvir Aditya , Pathinangil Antony Joseph , Jumkhawala Khatija , Bhusare Dattatray B. , Alla Sai Santhosha Mrudula , Gowda Anoushka , Alla Deekshitha , Pillai Sanjay , Thapa Rubina , Alluri Hanisha , Sree Krithi , Tulala Ramakrishna 
Published: November 2024

Objective:
To examine the impact of the time elapsed between a traumatic event and the implementation of a massive transfusion protocol on the patient outcomes and to analyze the characteristics of the protocol depending on the type of injury sustained.

Methods:
A total of 50 polytrauma patients who received blood transfusion by massive transfusion were included in the study. Demographic details, mechanism of injury, duration of time between injury, and other vital data were collected for analysis.

Results:
Our study revealed that the mean duration between the occurrence of injury and massive transfusion protocol activation (185 min) was highest among individuals who succumbed to their injuries within 1 hour and shortest among individuals who survived beyond the 24 hours following trauma (20.3 min) (P < 0.005). Blunt trauma had a lesser mortality rate (35.1%) than the penetrating type of trauma (61.5%). The average amount of fresh frozen plasma administered to patients with penetrating trauma (3.15) was significantly higher than that of blunt trauma (2.35) (P < 0.05).

Conclusion:
Delaying massive transfusion increases trauma patient mortality. Swift initiation of massive transfusion stabilizes severe blood loss cases. Varied blood product ratios and initiation times highlight the necessity for a standardized protocol.
The WHO surgical safety checklist for cesarean section in an Ethiopian teaching hospital: a prospective cross-sectional study
Authors: Mogessie Yidnekachew , Woldehana Nathnael Abera , Rhee Daniel S. , Kennedy Caitlin , Baral Stefan , Tufa Tesfaye 
Published: November 2024

Background:
Implementing the World Health Organization (WHO) Surgical Safety Checklist is crucial for preventing post-surgical complications, including surgical site infections, in low-resource settings such as Ethiopia. The country has the lowest measured rate of safe surgery worldwide, with a significant unmet need for safe and affordable surgical care. The WHO checklist can improve maternal health equity by enhancing surgical and obstetric care safety, ultimately improving maternal outcomes in low- and middle-income countries (LMICs).

Objective:
This study aimed to assess the compliance, completeness, and determinants of using the WHO’s Surgical Safety Checklist during cesarean section (CS).

Methods:
This prospective study was conducted in the Obstetrics and Gynecology Department of a large tertiary hospital in Addis Ababa, Ethiopia. Primary data were collected from observations of clinical interactions in the obstetrics operating room (OR) during CSs. The rates of performing the checklist and completing each section were analyzed.

Results:
Of 250 observed CSs, 26.4% were elective, and 73.6% were emergency procedures. Patient ages ranged from 18 to 45 years, with a median age of 28. The overall compliance rate for the WHO surgical safety checklist was 98%, with 100% compliance for elective procedures and 97.2% for emergency procedures. The completeness rates for sign-in, time-out, and sign-out were 80.1%, 66.4%, and 45.3%, respectively.

Conclusion:
The study revealed high compliance but low completeness rates for the surgical safety checklist during CS. A noticeable distinction was observed, with elective procedures exhibiting superior compliance and completeness rates compared to emergency procedures. This could be attributed to the sense of urgency and limitations in available time.
Eccentric Superficial Anterior Lamellar Keratoplasty for Bilateral Limbal Stem Cell Deficiency
Authors: Ashton Christopher , Sibley Daniel , Balal Shafi , Ahmad Sajjad 
Published: November 2024

Purpose:
To describe and report the outcomes of allogeneic eccentric superficial anterior lamellar keratoplasty (SALK), a novel surgical technique, in the management of total bilateral limbal stem cell deficiency (LSCD).

Methods:
Data were collected retrospectively on all patients with total bilateral LSCD who underwent SALK. Previous surgery, preexisting glaucoma, conjunctivalization, vascularization, lens status, and preoperative best-corrected visual acuity (BCVA) were collected from medical notes.

Results:
Fifteen eyes underwent eccentric SALK between November 2018 and October 2021. The average age of patients at the time of SALK was 50.3 (SD ± 21.0). There were 4 male and 11 female patients, 9 left eyes and 6 right eyes. The mean difference between pre- and post-BCVA scores were 0.43 LogMAR (95% CI, 0.23–0.63). Ten patients noted an improvement in the features of LSCD with an improvement in BCVA. Five cases were deemed a complete success with a complete resolution of corneal epithelium, no recurrence of LSCD features and an improvement in BCVA. Patients who developed fungal keratitis had poor outcomes.

Conclusions:
This study describes a new surgical technique of eccentric SALK to treat anterior stromal opacity and restore limbal stem cell function without systemic immunosuppression. The surgery improves the vision in most patients. However, in this complicated patient group, close postsurgical management is vital to recognize complications and intervene with treatment as needed.
Patient Education in Health Care: Exploring Strategies for Effective Comprehension, Recall, and Compliance
Authors: Casey Erin , Sherman Jeremy 
Published: November 2024

ABSTRACT

Introduction
Patient education is recognized to be essential in orthotic and prosthetic care. However, there are no current standardized methods of educating patients. This literature review looked at the most effective current methods of educating patients in terms of comprehension, recall, and compliance.

Methods
Inclusion and exclusion criteria for articles were determined. Search strategy was developed using keywords, MeSH terms, and Boolean operators and applied to three different databases (Medline Ovid, Embase, and Web of Science).

Results
After searching on Medline Ovid, Embase, and Web of Science, 833 articles were found after deduplication, with 49 articles included in the final review.

Conclusions
The review found that delivering the education in terms of behavioral advice and multimodal methods was the most effective. Patients’ preference of education delivery, mood, attitude toward their condition, and relationship with their provider also need to be considered. Further research needs to be done on effective methods of delivering patient education.

Clinical Relevance
This research has the potential to lead to future studies in educating patients who utilize orthotic and prosthetic devices. The aim of the project is to eventually standardize or create best practice guidelines for patient education in the field of Orthotics and Prosthetics with the intent of improving comprehension, recall, and compliance.
Annual Survey of State and Territorial Chronic Disease Prevention and Health Promotion Capacity and Organizational Development Needs—United States, 2023
Authors: Lankau Emily W. , Chiang Monica , Dudley Julie , Miller Kimberly , Shields Ann Marie , Alongi Jeanne , Macchi Marti , Hohman Katherine H. 
Published: November 2024

Objective:
The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD’s 2023 survey outcomes and place those findings into the broader public health policy context.

Design:
State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size.

Results:
State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity.

Conclusions:
During this period of pandemic recovery, turnover, hiring, and training—particularly of the many new public health staff—remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development—particularly workforce development, chronic disease data systems, and tools for addressing health equity—could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.
Genomic Surveillance of Foodborne Pathogens: Advances and Obstacles
Authors: Gensheimer Kathleen , Allard Marc W. , Timme Ruth E. , Brown Eric , Hintz Leslie , Pettengill Jamie , Strain Errol , Tallent Sandra M. , Vélez Lili F. , King Ewa , Shea Sharon L. 
Published: November 2024

Context:
The genomic surveillance of foodborne pathogens in the United States has grown exponentially in the past decade, grounded in a powerful combination of novel sequencing technologies, bioinformatic approaches, data-sharing networks, and metadata harmonization efforts. This practice report examines recent advances in genomic epidemiology as applied to food safety programs and delineates State, Tribal, Local, and Territorial infrastructure necessary for continued life-saving improvements in public health.

Program:
National databases of foodborne pathogen genomes, along with data sharing and evaluation networks such as GenomeTrakr and PulseNet, have transformed how connections are made among isolates and how root causes of outbreaks are determined, allowing much more timely interventions to protect public health. Freely available bioinformatics tools such as GalaxyTrakr and the National Center for Biotechnology Information Pathogen Detection database have allowed laboratories with limited local computing resources to participate in surveillance efforts and contribute to traceback investigations.

Implementation:
In this report, we describe advances in genomic epidemiology that have occurred over the past decade and examine obstacles to fully implementing this technology within State, Tribal, Local, and Territorial public health systems.

Evaluation:
Despite a clear return on investment from governmental expenditures on genomic surveillance of foodborne pathogens, we identify significant obstacles to further sustained progress. These obstacles include workforce gaps, ineffective data sharing, and lack of constitutive and sustained funding.

Discussion:
Many public health laboratories face major obstacles to widespread and routine adoption of genomic surveillance technologies. While whole genome sequencing has become an integral part of routine public health microbiology, the seamless integration of these protocols into the existing practices, laboratory workflows, and information systems remains challenging. Centralized efforts to address these issues include (1) support through the Food and Drug Administration Laboratory Flexible Funding Model, (2) training and proficiency assessments, (3) open-source, standardized protocols for collecting high-quality genomic data, and (4) open access informatics software.
Development of 3D-printed braces protocol for juvenile idiopathic scoliosis: From the torso measurement and mechanical properties to preliminary experience on fitting
Authors: Liu Xue-Cheng , Rizza Robert , Hebert Claire , Thometz John , Tassone Channing , Escott Benjamin , Thiessen Adam , Anewenter Vincent 
Published: November 2024

Background:
There has been no standard for a rapid prototyping process in manufacturing of the 3D-printed brace with respect to its design, biomechanical properties, procedures, and brace adjustment and fitting.

Objective:

Objective of this study was to develop the 3D-printed brace protocol for juvenile idiopathic scoliosis.

Methods:
With the help of the Torso Measurement Frame, the child stands still and is positioned with 1 of 2 manipulation techniques by the physician. Although the patient is in the corrected position, a hand-held scanner registers the three-dimentional (3D) torso, and then the brace is designed using computer aided design (CAD) model. Finite element analysis is used to determine the minimum required thickness of the brace. Acrylonitrile Butadiene Styrene (ABS) material (thermoplastic polymers) and DuraForm PA plastic (Nylon) material were printed by 2 different systems, respectively, and were tested using standard tensile test procedures.

Results:
The minimum thickness of the brace should be 2 mm to maintain a standard structural factor of safety twice that of the material failure strength. The strain in elongation was less for the ABS compared to the 3D-printed Nylon (6% vs. 14%), and the tensile strength was reduced more for ABS as compared to Nylon (42% vs. 14%). The ABS brace could not withstand changes in tension and cracked when drilled into, heat flared, or donned tightly. However, the Nylon brace improved strength and eliminated the vulnerable aspects.

Conclusions:
The Nylon material for the 3D-printed brace improved ease of adjustments in trimming, drilling, and heat modifications for better fit and function.
Development and Clinical Evaluation of a Contrast Optimizer for Contrast-Enhanced CT Imaging of the Liver
Authors: Setiawan Hananiel , Ria Francesco , Abadi Ehsan , Marin Daniele , Molvin Lior , Samei Ehsan 
Published: November 2024

Objective
Patient characteristics, iodine injection, and scanning parameters can impact the quality and consistency of contrast enhancement of hepatic parenchyma in CT imaging. Improving the consistency and adequacy of contrast enhancement can enhance diagnostic accuracy and reduce clinical practice variability, with added positive implications for safety and cost-effectiveness in the use of contrast medium. We developed a clinical tool that uses patient attributes (height, weight, sex, age) to predict hepatic enhancement and suggest alternative injection/scanning parameters to optimize the procedure.

Methods
The tool was based on a previously validated neural network prediction model that suggested adjustments for patients with predicted insufficient enhancement. We conducted a prospective clinical study in which we tested this tool in 24 patients aiming for a target portal-venous parenchyma CT number of 110 HU ± 10 HU.

Results
Out of the 24 patients, 15 received adjustments to their iodine contrast injection parameters, resulting in median reductions of 8.8% in volume and 9.1% in injection rate. The scan delays were reduced by an average of 42.6%. We compared the results with the patients' previous scans and found that the tool improved consistency and reduced the number of underenhanced patients. The median enhancement remained relatively unchanged, but the number of underenhanced patients was reduced by half, and all previously overenhanced patients received enhancement reductions.

Conclusions
Our study showed that the proposed patient-informed clinical framework can predict optimal contrast enhancement and suggest empiric injection/scanning parameters to achieve consistent and sufficient contrast enhancement of hepatic parenchyma. The described GUI-based tool can prospectively inform clinical decision-making predicting optimal patient's hepatic parenchyma contrast enhancement. This reduces instances of nondiagnostic/insufficient enhancement in patients.
Risk of Infertility in Reproductive-Age Patients With Thyroid Cancer Receiving or Not Receiving 131I Treatment
Authors: Lin Chun-Yi , Lin Cheng-Li , Kao Chia-Hung 
Published: November 2024

Background
Fertility is the crucial concern for many survivors of cancer diagnosed as children, adolescents, and young adults. The objective of this study was to determine the risk of infertility in reproductive-age patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan.

Methods
This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2009 to 2019. A total of 20,259 thyroid cancer patients aged from 15 to 50 years (8037 did not receive 131I treatment, and 12,222 received 131I treatment) and 20,259 controls were enrolled. A Cox proportional hazards model was applied to estimate the risk of infertility in thyroid cancer patients receiving or not receiving 131I treatment in terms of hazard ratios and 95% confidence intervals.

Results
The incidence rates of infertility in thyroid cancer receiving 131I therapy, those not receiving 131I therapy, and controls were 5.55, 5.07, and 3.61 per 1000 person-years, respectively. Compared with thyroid cancer patients treated with a cumulative 131I dose of 4.44 GBq or less, the risk of infertility was not significantly increased in those treated with a cumulative 131I dose of more than 4.44 GBq (adjusted hazard ratio, 1.13; 95% confidence interval, 0.95–1.36).

Conclusions
The greatest increased risk of infertility in reproductive-age patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of 131I administration. 131I treatment or cumulative dose of 131I greater than 4.44 GBq did not further increase the risk of infertility.
Standardized Patient Education Focused on Equity Deserving Groups
Authors: Sheth Urmi T. , Last Nicole A. , Keuhl Amy C. , Azim Arden R.K. , Chen Ruth P. , Dhir Jasdeep , Farrugia Patricia R. , Geekie-Sousa Aaron G. , McCarthy Jeffrey M. , Tong X. Catherine , Monteiro Sandra D. , Sibbald Matthew G. 
Published: November 2024

Introduction
Health professions training programs must train future healthcare providers to meet the needs of equity-deserving patient populations. Standardized patient (SP) programs are one mechanism by which this training can occur. Our aim was to develop a set of recommendations for SP programs and educators around planning, organizing, and delivering SP-based education involving equity-deserving groups.

Methods
We undertook a qualitative analysis of interview transcripts of SPs, educators, and trainers involved in SP work with equity-deserving groups. Subsequently, we conducted a three-stage modified Delphi process to generate recommendations.

Results
We derived 10 tips to help stakeholders improve SP-based education involving equity-deserving groups. The underlying themes included collaborative involvement, including co-creation and co-delivery of content with members of equity-deserving groups, as well as consistent prioritization of the needs of SPs throughout the process.

Conclusions
Our findings suggest ways in which SP programs and educators can better train future healthcare providers to meet the needs of equity-deserving patient populations.
Value in acute care surgery, part 4: The economic value of an acute care surgery service to a hospital system
Authors: Leichtle Stefan , Murphy Patrick , Nahmias Jeffry , Bruns Brandon , Agapian John , Smith Sawyer , Kim Phillip , Dowzicky Phillip , Haddad Diane , Adams Raeanna C. , Hu Parker , Ayung Chee Patricia , Crandall Marie , Martin R. Shayn , Staudenmayer Kristan ,   AAST Health Economics Committee
Published: November 2024

ABSTRACT
The Healthcare Economics Committee of the American Association for the Surgery of Trauma has published a series of three articles on the topic of value in acute care surgery (ACS). In this series, the key elements of value, cost and outcomes, and the impact of stakeholder perspective on what constitutes high-value care are discussed. The fourth article in this series continues the discussion by focusing on the unique economic value that an ACS service brings to a hospital system and its patients. Characterized by the immediate 24-hour availability of surgeons trained in trauma management, emergency general surgery, and surgical critical care, acute care surgeons extend the benefits of surgical rescue and critical care to all hospitalized patients. As such, an ACS service acts as a vital part of a hospital's infrastructure to successfully care for complex and seriously ill patients, in addition to enabling the establishment of other, high revenue-generating services such as vascular, transplant, and complex oncologic surgery programs. The trauma service acts as intake for patients that lead to downstream revenue creation by other disciplines such as orthopedic and neurological surgery, while trauma center designation itself results in dedicated state funding to ensure trauma readiness in many states in the United States. The traditional “value equation” in health care of outcomes achieved per dollar spent is ill-suited to capture many of these unique aspects and benefits of ACS. This article provides the background to understand the economic value of an ACS service and future directions toward improving overall value of care.

LEVEL OF EVIDENCE
Economic & Value-based Evaluations: Level IV.
Early versus delayed laparoscopic cholecystectomy for gallbladder perforation
Authors: Wu Renqing , Dumas Ryan P. , Nomellini Vanessa 
Published: November 2024

BACKGROUND
Gallbladder perforation occurs in 2% to 11% of patients with acute cholecystitis, with associated mortality estimated to be at 12% to 42%. Because of its low incidence, the data on management remain sparse. There is a lack of evidence to suggest whether early or delayed cholecystectomy is superior in the treatment of perforated cholecystitis. We hypothesize that an early definitive operation is associated with decreased total hospital length of stay (THLOS).

METHODS
Using the National Surgical Quality Improvement Program database from the American College of Surgery, we identified patients who underwent laparoscopic cholecystectomy for gallbladder perforation on an urgent or emergent basis from 2012 to 2021. We divided them into those who underwent early (<2 days from the date of admission to the date of operation) and delayed cholecystectomy (≥2 days from the date of admission to the date of operation). Our primary outcome was the THLOS. We created multivariate regression models to assess for the association of early versus delayed operation and THLOS.

RESULTS
The THLOS was found to be 2.94 days longer in the delayed group compared with the early group (p < 0.05). In those who did not present with sepsis on admission, the THLOS was noted to be 4.71 days longer in the delayed group compared with the early group (p < 0.05). Early versus delayed operation was not associated with a difference in the postoperative length of stay, 30-day postoperative complications, rate of readmission, and reoperation, regardless of preoperative sepsis status.

CONCLUSION
Early laparoscopic cholecystectomy for gallbladder perforation is associated with decreased THLOS, and there were no other differences in outcomes compared with delayed laparoscopic cholecystectomy. Patients with gallbladder perforation would likely benefit from an early operation within 2 days of admission.

LEVEL OF EVIDENCE
Therapeutic/Care management; Level III.