bluuebunny/crossref_metadata_2025_split huggingface dataset:
Entrustment and EPAs for Artificial Intelligence (AI): A Framework to Safeguard the Use of AI in Health Professions Education
Authors: Gin Brian C. , O’Sullivan Patricia S. , Hauer Karen E. , Abdulnour Raja-Elie , Mackenzie Madelynn , ten Cate Olle , Boscardin Christy K. 
Published: November 2024

Abstract
In this article, the authors propose a repurposing of the concept of entrustment to help guide the use of artificial intelligence (AI) in health professions education (HPE). Entrustment can help identify and mitigate the risks of incorporating generative AI tools with limited transparency about their accuracy, source material, and disclosure of bias into HPE practice. With AI’s growing role in education-related activities, like automated medical school application screening and feedback quality and content appraisal, there is a critical need for a trust-based approach to ensure these technologies are beneficial and safe. Drawing parallels with HPE’s entrustment concept, which assesses a trainee’s readiness to perform clinical tasks—or entrustable professional activities—the authors propose assessing the trustworthiness of AI tools to perform an HPE-related task across 3 characteristics: ability (competence to perform tasks accurately), integrity (transparency and honesty), and benevolence (alignment with ethical principles). The authors draw on existing theories of entrustment decision-making to envision a structured way to decide on AI’s role and level of engagement in HPE-related tasks, including proposing an AI-specific entrustment scale. Identifying tasks that AI could be entrusted with provides a focus around which considerations of trustworthiness and entrustment decision-making may be synthesized, making explicit the risks associated with AI use and identifying strategies to mitigate these risks. Responsible, trustworthy, and ethical use of AI requires health professions educators to develop safeguards for using it in teaching, learning, and practice—guardrails that can be operationalized via applying the entrustment concept to AI. Without such safeguards, HPE practice stands to be shaped by the oncoming wave of AI innovations tied to commercial motivations, rather than modeled after HPE principles—principles rooted in the trust and transparency that are built together with trainees and patients.
Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial
Authors: Cloyd Jordan M. , Khatri Rakhsha , Sarna Angela , Stevens Lena , Heh Victor , Dillhoff Mary , Kim Alex , Pawlik Timothy M. , Ejaz Aslam , Wells-Di Gregorio Sharla , Scott Erin , Kale Sachin S. 
Published: November 2024

Background:
Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable.

Methods:
This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up.

Results:
Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, P = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, P = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, P = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline.

Conclusions:
Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.
Effects of Noise Exposure on Peripheral Auditory Function, Binaural Envelope Coding, and Speech Perception in Student Musicians With Normal Hearing
Authors: Patro Chhayakanta , Singer Aviya , Monfiletto Angela , Peitsch Katherine , Bologna William J. 
Published: November 2024

Objectives:
Musicians face an increased risk of hearing loss due to prolonged and repetitive exposure to high-noise levels. Detecting early signs of hearing loss, which are subtle and often elusive to traditional clinical tests like pure-tone audiometry, is essential. The objective of this study was to investigate the impact of noise exposure on the electrophysiological and perceptual aspects of subclinical hearing damage in young musicians with normal audiometric thresholds.

Design:
The study included 33 musicians and 33 nonmusicians, all aged between 21 and 35 years, with normal audiometric thresholds. Participants underwent a comprehensive test battery, which encompassed standard and extended high-frequency (EHF) pure-tone audiometry (0.25 to 16 kHz), a Noise Exposure Structured Interview, auditory brainstem responses (ABRs) to clicks at various presentation rates and levels, thresholds for detecting interaural envelope time difference, and a spatial release from masking (SRM) paradigm in which the target speech was presented in the presence of either colocated or spatially separated time-reversed two-talker babble.

Results:
The results indicated the musician group reported greater lifetime noise exposure than the nonmusician group, but the Noise Exposure Structured Interview scores were neither correlated with the ABR results nor with the speech perception outcomes. The ABR analyses indicated diminished level-dependent growth and increased rate-dependent decline in wave I amplitudes among musicians compared with nonmusicians. The student musicians exhibited better binaural envelope processing skills than nonmusicians, emphasizing their perceptual advantages in auditory processing associated with musicianship. Speech perception results indicated no significant differences in SRM between student musicians and nonmusicians. However, in both groups, individuals with poorer EHF hearing exhibited reduced SRM compared with those with normal EHF hearing, underscoring the importance of assessing and addressing EHF hearing.

Conclusions:
Student musicians exhibit peripheral neural deficits; however, no clear relation was found between these neural deficits and their perceptual skills. Notably, reduced EHF thresholds were clearly related to reduced SRM, which poses a challenge for speech perception in complex multi-talker environments, affecting both musicians and nonmusicians alike.
Injury Patterns and Surgical Approaches
Authors: Shaikh Humza S. , Haase Douglas R. 
Published: November 2024

Summary:
Effective management of bony and cartilaginous thoracic injury is a vital part of the care of the polytraumatized patient. Commonly because of high-energy accidents including motor vehicle collisions and falls, these patients routinely require multidisciplinary care and surgical intervention. As our understanding of unstable chest wall injuries and pulmonary sequelae of the injury grows, it is imperative that injury patterns and surgical approaches become familiar to the orthopaedic trauma-trained surgeon. Common rib fracture patterns and muscle-sparing surgical approaches are detailed, with the goal of restoring chest wall stability to improve the mechanics of respiration and pain control in these challenging patients.
Surgical Fixation of Flail Chest Injuries: Reduction and Fixation Options, Tips and Tricks
Authors: Dehghan Niloofar , Taylor Benjamin C. 
Published: November 2024

Summary:
Modern techniques of rib fracture fixation surgery follow the AO principles of fracture reduction, fixation, and appropriate soft tissue handling. Fixation techniques can be performed using anatomic reduction and rigid fixation, or bridge plate fixation for comminuted fractures. Anatomic and nonanatomic plates can be used, although titanium precontoured locking plates are the most commonly used. Other contemporary intra- and extramedullary fixation strategies have also been developed. Intrathoracic fixation is a novel technique, however, limited literature on clinical outcomes currently exists. This article discusses techniques of reduction, fixation, and tips and tricks for surgical fixation of rib fractures.
Rib and Sternum Nonunions: Diagnosis and Treatment and Awareness of Other Potential Posttraumatic Pathology
Authors: Cole Peter A. 
Published: November 2024

Summary:
As the operative management of acute, chest wall, skeletal injury escalates throughout the world, it has become commonplace for patients with posttraumatic conditions to present with clinical reconstructive challenges as well. In addition, it is becoming clear that rib nonunions are not rare, likely more than 5% of rib fractures. No subspecialty is better equipped to address such painful conditions than orthopaedic surgery. Likewise, there are a plethora of other posttraumatic problems that patients face, from intercostal neuralgia, pleural herniation, rib synostosis, and costal margin and sternal injuries that do not heal properly, which require treatment solutions. This emerging new field of surgery is optimized by an interdisciplinary approach, between general and orthopaedic trauma surgeons, and between thoracic, anesthesia, and rehabilitation specialists. This article emphasizes the workup and operative treatment of painful rib and sternal nonunions, in particular, and familiarizes the orthopaedist with other cold skeletal trauma in general. From the distinctive history and physical examination of the patient with a rib psuedoarthrosis to proper diagnostic studies, the surgeon is led through a principled approach to nonunion surgery, inclusive of autogenous graft harvest to provide both biologic and mechanical variables to bear in the successful treatment of this condition.
Comparison of Single-Stage and Dual-Stage Approaches for Nonunion Repair in the Absence of Evident Infections
Authors: Gupta Rajul , Burkhart Andrew , Barnes Tyler , Beltran Michael , Laughlin Richard , Sagi Henry Claude 
Published: November 2024

OBJECTIVES:
The aim of the study was to determine if routine dual-stage nonunion repair (DSR) surgery leads to better outcomes than single-stage nonunion (SSR) repair surgery in fracture nonunions without evident clinical or laboratory signs of infection.

METHODS:

Design:
Retrospective comparison study.

Setting:
Level 1 Trauma Center affiliated with an academic teaching hospital.

Patient Selection Criteria:
Skeletally mature patients diagnosed with fracture nonunion between June 2013 and January 2022 were included. Patients with previous nonoperative treatment, definitive external fixation, previous or current diagnosis of fracture-related infection, or <12 months of follow-up were excluded.

Outcome Measures and Comparison:
Patient characteristics and details of the primary and the revision surgery were recorded. Comparison of the primary outcome measures, fracture-related infection, recalcitrant nonunion, and implant failures was performed between SSR and DSR groups.

RESULTS:
A total of 113 patients met the eligibility criteria. Eighty-six patients (mean age 44.8 years, range 17–80 years, 64% men) underwent SSR, while 27 patients (mean age 50.8 years, range 21–77 years, 52% men) underwent DSR. Seventy-six percent underwent SSR and 24% underwent DSR. Baseline characteristics were similar between groups (open fractures, P = 0.918; smoking, P = 0.86; lower limb fractures, P = 0.238; diabetes, P = 0.503; erythocyte sedimentation rate, P = 0.27; C-reactive protein, P = 0.11; age, P = 0.11; Charlson comorbidity index, P = 0.06) except for a higher rate of DSR in cases initially treated elsewhere (P = 0.015) and in obese patients (P = 0.044). Bone grafting was more frequent in DSR using plates (P = 0.030). No significant differences were observed in subsequent infections (6.97% vs. 7.41%, P = 0.939), persistent nonunion (28.2% vs. 14.81%, P = 0.169), or implant failure (19.76% vs. 22.22%, P = 0.782) between SSR and DSR.

CONCLUSIONS:
No difference was found in infection, recalcitrant nonunion, and implant failure between SSR and DSR for nonunions without overt signs of infection. The study challenges the routine use of DSR, questions the necessity of subjecting patients to 2 surgical procedures, and advocates for a more judicious approach in the absence of overt fracture-related infection in a fracture nonunion.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Impact of Low-density Lipoprotein Levels on Rates of Pseudarthrosis After Anterior Cervical Discectomy and Fusion
Authors: Hirpara Ankit , Ackert-Bicknell Cheryl L. , Patel Vikas V. 
Published: November 2024

Study Design.
Retrospective cohort study.

Objective.
To understand how preoperative LDL levels, statin intake, and fish oil intake affect rates of pseudarthrosis after single-level and multilevel ACDF.

Summary of Background Data.
Anterior cervical discectomy and fusion (ACDF) is commonly performed to treat cervical degenerative diseases or injuries causing neck pain, myelopathy, and radiculopathy. Pseudarthrosis following ACDF can lead to persistent symptoms and may require revision surgery. No studies have explored the link between low-density lipoprotein (LDL) levels and statin or fish oil intake on pseudarthrosis in ACDF.

Materials and Methods.
Patients undergoing ACDF were identified using TriNetX, a health care database with over 100 million patients. Pseudarthrosis rates following single-level and multilevel ACDF were compared between patients with high versus low LDL within one year before surgery. Pseudarthrosis rates were also compared between patients taking or not taking a statin as well as patients taking or not taking fish oil within six months before surgery. For all analyses, patients underwent propensity score matching in a 1:1 ratio based on relevant demographic factors and comorbidities.

Results.
Patients with an LDL above 142 mg/dL, compared with below 66 mg/dL, had significantly higher rates of pseudarthrosis at six months, one year, and two years after single-level and multilevel ACDF. Patients not taking a statin or fish oil, compared with those taking a statin or fish oil, respectively, also had significantly higher rates of pseudarthrosis at all time points after multilevel ACDF, but not single-level ACDF.

Conclusion.
Low LDL levels are associated with reduced rates of pseudarthrosis after single-level and multilevel ACDF. Statin and fish oil intake before surgery are also associated with reduced rates of pseudarthrosis after multilevel, but not single-level ACDF. These associations may be used for preoperative planning, patient optimization, and risk stratification.
Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery
Authors: Ghali Abdullah , Lawand Jad , Singh Aaron , Mihas Alexander , Jami Meghana , Farhat Anthony , Deveza Lorenzo 
Published: November 2024

Study Design:
Retrospective cohort study of national database.

Objective:
This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery.

Summary of Background Data:
Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery.

Methods:
Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months.

Results:
In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24 mo), hardware failure (OR 1.42, P=0.013 at 24 mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24 mo) were also significantly higher in the ADP group.

Conclusions:
Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications.

Level of Evidence:
III
Small-Vessel Vasculitis or Perifolliculitis in Small-Fiber Neuropathy With TS-HDS, FGFR-3, or Plexin D1 Antibodies
Authors: Zeidman Lawrence A. , Levine Todd , Cangelosi John 
Published: November 2024

Abstract

Introduction:
Small-fiber neuropathy (SFN) is highly prevalent but often idiopathic. TS-HDS, FGFR-3, and Plexin D1 autoantibodies (seropositive) may be present in more than 40% of idiopathic cases. Another autoimmune biomarker is a non–length-dependent (NLD) skin biopsy pattern. Our goal was to demonstrate that small-vessel vasculitis and perifolliculitis (inflammation) on skin biopsies are additional biomarkers.

Methods:
All pure SFN skin biopsy reports were reviewed for inflammation, and their charts were examined for other relevant history.

Results:
Seven of 80 patients with pure SFN had inflammation (8.8%); 5 patients were female (71%) and 2 were male (29%); average age was 45 (16–67). All 7 patients with inflammation were seropositive (100%, P = 0.0495), and 6 patients (86%) had either NLD inflammation or NLD pathology (P = 0.0003).

Discussion:
Inflammation is present only in a small portion of punch biopsies, but may be another autoimmune SFN biomarker. It is strongly associated with seropositivity and NLD-pathology. Further studies are likely indicated to assess inflammation pathophysiology and immunotherapy responsiveness.
A cross-sectional geospatial analysis of access to cesarean delivery in Uganda by facility functionality
Authors: Garba Deen L. , Buda Alexandra M. , Okolo Isioma , Tindiweegi Praise , Babweteera Alan , Tibaijuka Leevan , Ngonzi Joseph , Kayondo Musa , Byamukama Onesmus , Adu-Bonsaffoh Kwame , Juran Sabrina , Lugobe Henry M. , Boatin Adeline A. 
Published: November 2024

Introduction:
There is minimal data on spatial access to surgical maternal care in Uganda. We aimed to determine geospatial access to facilities performing cesarean delivery in Uganda at differing facility functional levels.

Methods:
We defined three levels of facility functionality: level 1 – functional by designation, i.e., health system level; level 2 – performed at least one cesarean delivery in the past year; and level 3 – performed at least 20 cesarean deliveries in the past year. We mapped facilities in ArcGIS Pro using GPS coordinates, calculated Manhattan distances, and using transportation network data, identified the area indicating 30-minute, 1-hour, and 2-hour geographic walking and driving access to facilities. The population estimate raster was overlain with drive time analysis areas to calculate the total population catchment within each travel time.

Results:
Of 6937 total facilities, 339 (4.9%) met level 1 functionality, 287 (4.1%) met level 2 functionality, and 241 (3.5%) met level 3 functionality. The percentages of women within 30-minute, 1-hour, and 2-hour walking times from level 1 facilities were 9.7%, 19.8%, and 34.8%, respectively. These percentages decreased to 9.2%, 19%, and 33% for level 2 functionality and 8.1%, 17.4%, and 30.5% for level 3 functionality, respectively. Access varied regionally, with the poorest access in the Northern region (20% within 2 hours walking) compared to the Central region (55.2% within 2 hours walking).

Conclusion:
We demonstrate a substantial proportion of the Ugandan population does not have timely access to cesarean delivery, with substantial subnational variation. This inequity in access to surgical obstetric care is vital information that can assist policymakers in achieving universal maternal health access.
Streamlining outpatient prepectoral breast reconstruction: The role of polyurethane oxygen-enriched bra cups from pandemic innovation to standardized cost analysis
Authors: Sordi Silvia , Kaciulyte Juste , Marzouk El Araby Mohamed , Luridiana Gianluigi , Marchesi Andrea , Gatto Arianna , Seth Ishith , Rozen Warren Matthew , Casella Donato , Cuomo Roberto 
Published: November 2024

Background:
The COVID-19 pandemic necessitated a reassessment of healthcare delivery, emphasizing on strategies to reduce hospital visits without compromising patient care. In response, plastic surgery units explored innovative approaches to ensure high-quality care and enhanced protection for vulnerable groups, such as oncologic patients undergoing mastectomy and breast reconstruction. This study evaluates the implementation of a polyurethane-polyester bra cup enriched with oxygen to diminish the need for postoperative outpatient visits.

Methods:
Patients who underwent mastectomy and prepectoral breast reconstruction between February 2020 and March 2021 were selected. A novel postoperative management protocol with a polyurethane-polyester bra cup was adopted, and a cost-benefit analysis evaluated the economic impact of integrating this medical device into postoperative care.

Results:
The polyurethane-polyester bra cup wound dressing significantly reduced the frequency of outpatient visits, enhancing patient autonomy in postoperative care. Patients reported high satisfaction levels, particularly appreciating the ability to manage the device independently, which contributed to the substantial reduction of hospital accesses. Economic analysis revealed that the devices’ utilized resulted in a notable reduction of 333.5 working hours, translating to a financial saving, ranging between €9990 and €40,020 for nursing and medical staff, respectively. The device cost was established at €20 per unit, demonstrating an effective cost-saving strategy in postoperative care.

Conclusions:
The adoption of polyurethane-polyester bra cup in postsurgical care for mastectomy patients undergoing implant-based prepectoral breast reconstruction proved to be a strategic measure in reducing hospital visits and maintaining high levels of patient satisfaction.