bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cleft Team Clinicians’ Perspectives on the Process of Patient Transition from Childhood to Adulthood in New Zealand
Authors: Entwistle Maia Rose , Macrae Phoebe , Ardouin Kenny 
Published: December 2024

Objective This study sought to understand cleft team clinician experiences of transitioning patients from pediatric to adult cleft care services in New Zealand. Design The qualitative study conducted 4 interviews and 4 focus groups with Cleft Team clinicians either in person or over Zoom. Data were analyzed using inductive thematic analysis to identify themes. Participants Twelve Cleft Team clinicians from 4 Health New Zealand cleft services. Results Patients are treated by the same clinicians both before and after transition, however, changes at age 16 include gaining treatment decision-making autonomy, inpatient stays within general plastic surgery wards, and evolving life experiences outside of the hospital. Clinicians reported unmet psychosocial needs of patients and their families, and difficulties experienced by patients returning to cleft services as adults. The development of peer support networks between adolescents and young adults who have experiences of cleft care is also recommended. Conclusions Ongoing cleft care provision and expansion of services are recommended. Furthermore, future studies to understand patients’ perspectives of transition are paramount, and incorporating patient voice into any proposed interventions is essential. Potential supports for families of patients with a cleft should also be further investigated, and the application of international standards would promote increased consistency and collaboration between the practice of Cleft Team clinicians around the world.
Interpretable Machine Learning Approach for Predicting 30-Day Mortality of Critical Ill Patients with Pulmonary Embolism and Heart Failure: A Retrospective Study
Authors: Liu Jing , Li Ruobei , Yao Tiezhu , Liu Guang , Guo Ling , He Jing , Guan Zhengkun , Du Shaoyan , Ma Jingtao , Li Zhenli 
Published: December 2024

Background Pulmonary embolism (PE) patients combined with heart failure (HF) have been reported to have a high short-term mortality. However, few studies have developed predictive tools of 30-day mortality for these patients in intensive care unit (ICU). This study aimed to construct and validate a machine learning (ML) model to predict 30-day mortality for PE patients combined with HF in ICU. Methods We enrolled patients with PE combined with HF in the Medical Information Mart for Intensive Care Database (MIMIC) and developed six ML models after feature selection. Further, eICU Collaborative Research Database (eICU-CRD) was utilized for external vali- dation. The area under curves (AUC), calibration curves, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were performed to evaluate the prediction performance. Shapley additive explanation (SHAP) was performed to enhance the interpretability of our models. Results A total of 472 PE patients combined with HF were included. We developed six ML models by the 13 selected features. After internal validation, the Support Vector Ma- chine (SVM) model performed best with an AUC of 0.835, a superior calibration degree, and a wider risk threshold (from 0% to 90%) for obtaining clinical benefit, which also outperformed traditional mortality risk evaluation systems,as evaluated by NRI and IDI. The SVM model was still reliable after external validation. SHAP was performed to explain the model. Moreover, an online application was developed for further clinical use. Conclusion This study developed a potential tool for identify short-term mortality risk to guide clinical decision making for PE patients combined with HF in the ICU. The SHAP method also helped clinicians to better understand the model.
Midostaurin-Associated acute pancreatitis
Authors: Akyildiz Mert , Geygel Nebi Cankat , Burhan Esma Hazal , Gulumsek Erdinc , Avci Begum Seyda , Ozturk Huseyin Ali , Arici Fatih Necip , Bankir Mehmet , Saler Tayyibe , Sumbul Hilmi Erdem 
Published: December 2024

Introduction The multikinase inhibitor midostaurin is the first targeted drug for the treatment of AML FLT3. It reduces mortality by 23% more than standard chemotherapy group. Although it has many gastrointestinal side effects, there is no data in the literature regarding its association with acute pancreatitis. We wanted to present an acute pancreatitis case that developed after midostaurin treatment in our clinic. Case Report A patient with AML FLT3 who developed abdominal pain, elevated amylase-lipase enzymes and increased volume around the pancreas on abdominal imaging after the addition of midostaurin to chemotherapy was hospitalized with a prediagnosis of acute pancreatitis. Management & Outcome Oral feeding was stopped, intravenous hydration was provided and anti-symptomatic treatment was given. The patient was discharged on the 4th day of hospitalization after the acute pancreatitis clinic resolved. Discussion Drug induced acute pancreatitis is a rare clinical condition which is difficult to diagnose. It has a good prognosis and low mortality rate. The mechanisms of drug-induced pancreatitis include immunological reactions, direct toxic effect, accumulation of toxic metabolites, overstimulation of pancreatic acinar cells, ischemia, intravascular thrombosis and increased viscosity of pancreatic secretion. Although there are many gastrointestinal side effects of midostaurin, there are no clear data in the literature regarding the relationship with acute pancreatitis.
Early adoption of telehealth/remote patient monitoring and hospital revenue changes during COVID-19
Authors: Rhoades Claudia A , Whitacre Brian E , Davis Alison F 
Published: December 2024

Introduction The COVID-19 pandemic dramatically affected the financial performance of hospitals across the U.S. The prompt availability of telehealth options likely impacted both a hospital's healthcare options and opportunities for revenue in the short-term. The aim of this study was to explore the association between early adoption of telehealth and changes in revenue during the early phase of the pandemic, and to compare whether the results differed between rural and urban hospitals. Methods We performed first-difference regressions on a cross-sectional dataset of 1,742 U.S. hospitals. Our dependent variables were percent changes in four categories of revenue between 2019 and 2020: inpatient, outpatient, gross, and net. The adoption of telehealth and remote patient monitoring as of 2019 served as the primary independent variables of interest. We controlled for changes in hospital characteristics from 2019 to 2020, including case mix index and number of employees. Results Our results suggest that telehealth adoption prior to the COVID-19 pandemic was associated with significant increases in all four revenue categories from 2019 to 2020, ranging from 1.79% (net patient revenue) to 2.92% (outpatient revenue). However, RPM implementation in 2019 was associated with significant declines in gross patient (0.08%) and outpatient revenue (1.50%). The results were largely similar across rural and urban locations. Discussion Adopting telehealth before the onset of COVID-19 helped hospitals increase revenue during the initial phase of the pandemic. Alternatively, implementation of remote patient monitoring was associated with revenue declines, likely due to limited ability for monetization. Whether these relationships have persisted needs further investigation.
A randomized double-blind noninferiority clinical multicenter trial on oral moxifloxacin versus placebo in the outpatient treatment of uncomplicated acute appendicitis: APPAC IV study protocol
Authors: Lund Heidi , Haijanen Jussi , Suominen Saku , Hurme Saija , Sippola Suvi , Rantanen Tuomo , Rautio Tero , Mattila Anne , Pinta Tarja , Nordström Pia , Kössi Jyrki , Ilves Imre , Salminen Paulina 
Published: December 2024

Background: Antibiotic therapy is currently considered a safe and effective treatment alternative for computed tomography (CT)-confirmed uncomplicated acute appendicitis with recent studies reporting good results on both oral antibiotics only and outpatient management. Furthermore, there are promising pilot results on uncomplicated acute appendicitis management with symptomatic treatment (placebo). This trial aims to assess whether both antibiotics and hospitalization can be safely omitted from the treatment of uncomplicated acute appendicitis. Methods: The APPAC IV (APPendicitis Acuta IV) trial is a randomized, double-blind, multicenter noninferiority clinical trial comparing oral moxifloxacin with oral placebo in an outpatient setting with a discharge directly from the emergency room (ER). Adult patients (18–60 years) with CT-confirmed uncomplicated acute appendicitis (absence of appendicolith, abscess, perforation, tumor, appendiceal diameter ⩾15 mm on CT, or body temperature >38 °C) will be enrolled in nine Finnish hospitals. Primary outcome is treatment success at 30 days, that is, the resolution of acute appendicitis resulting in discharge from the hospital without appendectomy during the 30-day follow-up evaluated using a noninferiority design with a noninferiority margin of 6 percentage points. Noninferiority will be evaluated using one-sided 95% confidence interval of proportion difference between groups. Secondary endpoints include postintervention complications, recurrent appendicitis after the 30-day follow-up, duration of hospital stay, admission to hospital and reason for admission, readmissions to emergency department or hospitalization, VAS pain scores, quality of life, sick leave, and treatment costs. The follow-up after discharge from the ER includes a phone call at day 1, and at 3–4 days, 30 days, and 1, 3, 5, 10, and 20 years. Those eligible patients, who decline to undergo randomization, will be invited to participate in a concurrent observational cohort study with follow-up at 30 days, and 1 and 5 years. Discussion: To our knowledge, APPAC IV trial is the first large randomized, double-blind, noninferiority multicenter clinical trial aiming to compare oral antibiotics and placebo for CT-diagnosed uncomplicated acute appendicitis in an outpatient setting. The study aims to bridge the major knowledge gap on whether antibiotics and hospitalization or both can be omitted in the treatment of uncomplicated acute appendicitis. Trial registration: The study protocol has been approved by the Clinical Trials Information System (CTIS) of the European Medicines Agency (EMA), study number: 2023-506213-21-00 and the trial has been registered in ClinicalTrials.gov, NCT06210269.
Fourth-generation Pipeline™ Vantage flow diversion: First reported US experience of safety and feasibility
Authors: Sweid Ahmad , Chahine Ahmad , Hage Stephanie , Morsi Rami Z , Thind Sonam , Karar Lina , Baskaran Archit , Carrión-Penagos Julián , Desai Harsh , Kothari Sachin A , Rana Rohini , Verhagen Metman Okker , Zakaria Jehad , Siegler James E , Awad Issam , Hurley Michael C , Prabhakaran Shyam , Polster Sean , Kass-Hout Tareq 
Published: December 2024

Background The Pipeline™ Vantage embolization device (Medtronic, Irvine, CA) is the fourth generation of Pipeline flow diverter devices, offering numerous technical improvements. This study aimed to assess the feasibility and safety of The Pipeline™ Vantage embolization device (Medtronic, Irvine, CA). Methods This was a single-center retrospective study describing the use of The Pipeline™ Vantage embolization device for the treatment of intracranial aneurysms. Technical feasibility and safety were assessed in terms of intra and postprocedural complications, as well as neurological morbidity upon follow-up. Both ruptured and unruptured aneurysms were included. Results We included 12 patients in our study (mean age 62; females: n = 9/12, 75%). Aneurysm morphology varied between saccular (41.6%), fusiform (41.6%), blister (8.3%), and pseudoaneurysm (8.3%). Three cases (25%) involved ruptured aneurysms treated in the acute setting. A transradial access was used in 10 cases (83.3%). There was a 100% success in deployment. Seven cases (58.3%) were treated with adjunct embolization device other than a flow diversion. Eight cases (66.6%) were treated with a single flow diversion, three cases (25%) were treated with two flow diversion, and one case (8.3%) was treated with three flow diversion stents. There were no intraoperative complications. There was one postprocedural complication in a dissecting ruptured PICA aneurysm that was ultimately treated with two flow diversion stents and an intrasaccular device. Discussion To our knowledge, this is the first US series assessing the periprocedural safety and feasibility of consecutive patients with intracranial aneurysms treated with the Pipeline™ Vantage device (Medtronic, Irvine, CA).
Indian Trial of Tranexamic acid in Spontaneous Intracerebral Hemorrhage study protocol
Authors: Pandian Jeyaraj Durai , Phillips Atul , Verma Shweta Jain , Arora Deepti , Dhasan Aneesh , Raju Pheba S , Sylaja PN , Ray Biman Kanti , Chakraborty Uddalak , Johnson Jacob , Sharma Praveen Kumar , Bhoi Sanjeev , Jha Menka , Iype Thomas , P Chithra , Khurana Dheeraj , Ray Sucharita , Das Dwijen , Kalita Naurima , Adhikari Sweekriti , Sharma Ashish , Roy Jayanta , Sahonta Rajeshwar , Singh Sulena , Chaudhary Vikram , Menon Girish , Aaron Sanjith , Bal Deepti , Dhamija Rajinder K , Chaturvedi Monali , Maheshwari Siddarth , Saroja Aralikatte Onkarappa , Naik Karkal R , Bhutani Neeraj , Dhankhar Kailash , Sharma Dinesh , Bhatia Rohit , Gorthi Sankar Prasad , Sarmah Binod , Pamidimukkala Vijaya , Saravanan Sankaralingam , Narayan Sunil , Basumatary Lakshya J , Sundarachary Nagarjunakonda V , Upputuri Aruna K , Karadan Ummer , Pradeep Kumar VG , Parthasarathy Rajsrinivas , Doshi Darshan , Wagh Satish , Ramakrishnan TCR , Akhtar Saleem , Desai Soaham , Borah NC , Das Rupjyoti , Mittal Gaurav , Jain Agam , Alapatt Paul J , Kulkarni Girish Baburao , Menon Deepak , Raja Pritam , Puri Inder , Nambiar Vivek , Yerasu Muralidhar Reddy , Jaiswal Shyam K , Zirpe Kapil , Gurav Sushma , Sharma Sudheer , Kumaravelu S , Benny Rajesh , Thakkar Vicky , Pathak Abhishek , Kempegowda Madhusudhan , Chander Praveen , Ramrakhiani Neetu , KS Arya Devi , Sarma P Sankara , Huilgol Rahul , Sharma Meenakshi , Dhaliwal Rupinder S 
Published: December 2024

Rationale: Early mortality in intracerebral hemorrhage (ICH) is due to hematoma volume (HV) expansion, and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug that is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Hypothesis: Administration of TXA in ICH patients when given within 4.5 h of symptom onset will reduce early mortality at 30 days. Design: Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 h of symptom onset or when last seen well. Study participants received 2 g of TXA administered within 45 min while control group received standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed is done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction in HV at 24 h from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90. Summary: If proven to be beneficial, TXA will have a major impact on medical management of ICH. Trial registration: Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831).
Racial and ethnic disparities in short-stay primary total shoulder arthroplasty
Authors: Pandey Vivek N , Thomas Sarah K , Moore John W , Guareschi Alexander S , Rogalski Brandon L , Eichinger Josef K , Friedman Richard J 
Published: December 2024

Background There is a paucity of literature evaluating the utilization of short-stay total shoulder arthroplasty (TSA) in different racial groups. The purpose of this study is to compare short-stay TSA utilization and postoperative outcomes across racial groups. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried from 2010 to 2018 to identify patients who underwent primary short-stay TSA, defined as a length of stay of less than 2 midnights. Annual proportions of short-stay TSA, demographic variables, preoperative comorbidities, and postoperative complications were compared across groups. Results All racial groups showed increases in the proportion of short-stay TSA cases over time, but this increase was most evident in Whites. Hispanics had increased rates of pneumonia (0.8% vs. 0.2%; p = 0.002) and transfusion (2.0% vs 1.0%; p = 0.015) compared to Whites, but no other differences in outcomes were observed between groups. Discussion Postoperative outcomes were similar across groups despite differing comorbidity profiles, suggesting that short-stay TSA is being implemented appropriately based on perceived preoperative risk. However, differences in utilization across groups suggest that underlying disparities may exist. Given the continued increase in short-stay TSA procedures, opportunities to resolve racial disparities are essential in mitigating the effects of social determinants of health in minority patient groups.
Frequency of depression in Huntington's disease: A systematic review and meta-analysis
Authors: Zadegan Shayan Abdollah , Ramirez Frank , Park Jung Woo , Rocha Natalia Pessoa , Furr Stimming Erin , Teixeira Antonio L 
Published: December 2024

Background Huntington's disease (HD) is a hereditary neurodegenerative disease characterized by a combination of motor, cognitive, and mental health issues, with depression being the most common. Despite its importance, the relationship between depression and disease progression is still debatable. Objective The primary objective of this study was to examine the frequency of depression across different disease stages in individuals with HD. We also explored the associations between depression and other HD-related factors. Methods This systematic review comprehensively searched MEDLINE, APA PsycINFO, and Embase databases for studies on depression in individuals with HD. Pooled depression frequencies were calculated for premanifest and manifest HD. Depression was analyzed based on HD functional stages and diagnostic tools, alongside reviewing its association with various HD factors. Results We assessed 6523 records and included 104 studies. Our meta-analyses revealed that the overall frequency of depression was higher in manifest HD compared to premanifest HD (0.38 vs. 0.23). However, the progression of depression did not follow a consistent pattern, with peaks occurring in earlier rather than later stages. Additionally, the frequency of depression was lower in studies using diagnostic criteria compared to those using clinical scales (0.25 vs. 0.42). Conclusions Our findings showed that the rate of depression is high in HD and varies depending on the disease stage and the criteria used. This emphasizes the necessity for tailored and unified diagnostic criteria for depression in HD.
Improvement in Newly Defined Continuous Glucose Monitor Metrics, Extended Hypoglycemia, and Extended Hyperglycemia With Automated Insulin Delivery Initiation in Adults With Type 1 Diabetes
Authors: Karakus Kagan E. , Snell-Bergeon Janet , Mason Emma , Akturk Halis K. 
Published: December 2024

Objective: Extended hypoglycemia (Ehypo) and extended hyperglycemia (Ehyper) are recently defined continuous glucose monitoring (CGM) metrics by the International Consensus for clinical trials as secondary endpoints for continuous outcomes. This study aims to evaluate the changes in Ehypo and Ehyper before and after automated insulin delivery (AID) initiation in adults with type 1 diabetes (T1D). Research Methods: This is a retrospective single-center study that evaluated Ehypo and Ehyper in addition to other CGM metrics in 154 adults that initiated an AID system. Metrics were compared before and after AID initiation by Wilcoxon signed-rank test. Results: Median (interquartile range) Ehypo (<70 mg/dL) events/week decreased from 0.1 (0-0.4) to 0 (0-0.1) and Ehyper (>250 mg/dL) events/week decreased from 2.2 (0.9-4.5) to 0.8 (0.3-1.7) (both P < .001) after AID initiation compared with before AID initiation. All other CGM metrics improved after AID initiation. There was a strong positive correlation between Ehyper (>250 mg/dL) and mean glucose (before AID: r = 0.947, after AID: r = 0.894), glucose management indicator (before AID: r = 0.947, after AID: r = 0.887), and time above range (TAR; >180 mg/dL) (before AID: r = 0.957, after AID: r = 0.917) and a strong positive correlation between Ehypo (<70 mg/dL) and time below range (TBR; <70 mg/dL) (before AID: r = 0.823, after AID: r = 0.608) before and after AID initiation, respectively. Conclusion: Automated insulin delivery initiation significantly improved Ehypo and Ehyper metrics. Ehypo and Ehyper had a strong positive correlation with TBR and TAR, respectively. Ehypo and Ehyper events can be used in addition to TBR and TAR metrics in clinical studies as secondary outcomes.
Engaging, Binding and Retaining Nurses: The Success Formula of an Exemplary Ward
Authors: Spoolder D.A.E. , van Duijn A.G. , Schreuder-Cats H.A. , de Bie-Timmer M.J. 
Published: December 2024

Background Nurse staffing remains an ongoing issue in healthcare worldwide. However, a Dutch urology ward has hardly any staffing difficulties. Nevertheless, it remains challenging to grasp what exactly is the success formula of the ward. Investigating a practical example of a successful ward will facilitate a deeper understanding of the application of current knowledge. Furthermore, novel concepts offer potential solutions to current problems. There is a need of putting the knowledge into practice. Objective The objective is to identify the factors that contribute to the success of the urology ward in engaging, binding, and retaining nurses, to provide practical insights and opportunities for other wards. Methods The Dutch Model for Excellent Care forms the basis of a prospective, qualitative research study with focus groups. Twelve nurses were divided into three focus groups, based on work experience. They were asked about why they love working on the ward. Analysis was performed using Braun and Clarke's method for thematic analysis. Emerged themes were presented, substantiated by quotes. Results Four themes and twelve subthemes became apparent: (a) Supportive structures: nursing governance, professional development, and quality of leadership. (b) Optimal work environment: working with skilled nurses, a professional relationship with physicians and professional autonomy. (c) Team culture: feeling seen, good ambiance, and equality. (d) Specialty of urology: variation in work, workload, and the type of patient. Conclusions Nurses are uniquely positioned to provide invaluable insight into their needs. They illuminated the crucial importance of fostering a work environment that prioritizes both professional as well as personal needs.