bluuebunny/crossref_metadata_2025_split huggingface dataset:
Level of nurse–nurse collaboration and influencing factors in Türkiye and Italy: a mixed-methods study
Authors: Çelik Durmuş Serpil , Gülnar Emel , Marcomini Ilaria , Özveren Hüsna , Tessadori Beatrice , Locatelli Giulia , Sponton Anna 
Published: October 2024

Background: Collaboration between nurses is crucial in improving quality in healthcare and plays a key role in increasing nurses’ job satisfaction. Objectives: Our study aimed to investigate the level of collaboration between nurses working in Turkey and Italy and its related factors. The study also deepened the point of view of clinical nurses and nurse managers on this topic. Methods: This study was carried out as mixed-methods research including both qualitative and quantitative methods. The study’s quantitative sample included 348 clinical nurses. The Nurse–Nurse Collaboration Scale was used to collect quantitative data. Five open-ended questions were used to analyse the nurses’ point of view about intraprofessional collaboration. Individual interviews were conducted with 10 clinical nurses and 10 nurse managers. Results: Nurse–nurse collaboration was above the cut off value in both countries. However, significant inter-country differences were found in the collaboration subscales. Qualitative results emphasised that personal characteristics, a specific training in collaboration, the opportunities for comparison and mutual consultation during working shifts may affect the level of collaboration. Nurse managers argued that factors such as manpower planning, suitable working conditions, sufficient materials, empathy, job satisfaction, motivation and effective communication affect collaboration. Conclusion: Greater efforts should be made to implement collaboration between nurses in healthcare settings. Our results help healthcare services in implementing new collaboration policies.
Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study
Authors: Chun Sohyun , Han Kyungdo , Kim Bongseong , Lee Dagyeong , Cho In Young , Choi Hea Lim , Park Jun Hee , Jeon Junseok , Jang Hye Ryoun , Shin Dong Wook 
Published: October 2024

Background: Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden. Aim: Our objective was to assess the risk of ESKD in patients compared to a matched stroke-free control cohort. Methods: A nationwide retrospective cohort study was conducted in 315,326 stroke subjects and 390,781 matched stroke-free control subjects. Health examination results and claims data were collected from the Korean National Health Insurance Service during 2010–2018. Cox proportional hazard models were used to assess the risk of ESKD in the stroke cohort. Results: During a mean follow-up period of 4.3 years, the incidence of ESKD was 1.83 per 100,000 person-years in the stroke cohort versus 0.57 per 100,000 person-years in the control cohort. The stroke cohort exhibited a significantly higher risk of developing ESKD compared to the matched control, with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.67–1.93). Stroke survivors were associated with a higher risk of developing ESKD, regardless of the severity of disability (aHRs of 1.93, 95% CI = 1.69–2.21 for severe disability; 1.71, 95% CI = 1.41–2.07 for mild disability; and 1.78, 95% CI = 1.65–1.92 for no disability), compared to the matching control cohort. The elevated risk was observed in both hemorrhagic stroke (aHR = 1.96, 95% CI = 1.73–2.23) and ischemic stroke (aHR = 1.75, 95% CI = 1.62–1.89). Conclusions: This study demonstrates that stroke patients have a significantly higher risk of incident ESKD. This highlights the need for heightened clinical awareness and improved monitoring of kidney function in this population.
Serum transthyretin levels and disease activity in patients with primary Sjögren’s syndrome
Authors: Peng You-Fan , Lu Fei-Yan , Deng Yi-Bin 
Published: October 2024

Background: A strong association has been demonstrated between serum transthyretin (TTR) levels and autoimmune diseases. However, there is limited information regarding the role of serum TTR in patients with primary Sjögren’s syndrome (pSS). Objectives: This study was designed to explore the association between serum TTR and disease activity in patients with pSS. Design: This study was a retrospective observational study. Methods: This study included 84 patients with pSS and 135 age- and sex-matched healthy controls retrospectively, and collected data were analyzed. The European League Against Rheumatism (EULAR) Sjögren’s Syndrome Disease Activity Index (ESSDAI) and Clinical ESSDAI (ClinESSDAI) scores were used to assess the disease activity in patients with pSS. Results: Serum TTR levels were significantly lower in patients with pSS than those in healthy controls (181.9 ± 69.2 vs 241.8 ± 48.9 mg/L, p < 0.001). Serum TTR levels were significantly and negatively correlated with ESSDAI ( r = −0.385, p < 0.001) and ClinESSDAI ( r = −0.340, p = 0.002) scores in patients with pSS, respectively. Multivariable linear regression analysis showed that serum TTR was significantly associated with ESSDAI (Beta = −0.248, p = 0.017) and ClinESSDAI (Beta = −0.215, p = 0.036) scores in patients with pSS, respectively. Conclusion: Serum TTR is a potential marker for assessing disease activity in patients with pSS, which may contribute to the clinical management of pSS.
Exploring the clinical factors affecting lithium dose and plasma level and the effect of brand
Authors: Paton Carol , Bassett Paul , Rendora Olivia , Barnes Thomas R. E. 
Published: October 2024

Background: Optimal use of lithium involves adjustment of the dose, to keep the plasma level within the narrow, recommended range. Brand-specific prescribing has long been considered critical to achieving this aim, but this is a convention based on very limited data. Objectives: To explore the effect of selected demographic and clinical factors on the relationship between lithium dose and plasma level and determine whether there is an independent effect of lithium brand. Design: Analysis of clinical audit data collected in 2023 as part of a quality improvement programme addressing the use of lithium, conducted by the Prescribing Observatory for Mental Health. Methods: Data were collected from clinical records using a bespoke proforma, submitted online and analysed using SPSS. Results: Data were submitted for 4405 patients who had been prescribed solid-dosage formulations of lithium for more than a year. Priadel® was prescribed for 3722 (84%) of these patients, Camcolit® for 112 (2.5%) and the prescription was written generically for 554 (12.5%). Compared with Priadel, where Camcolit was prescribed, the mean daily dose was 10% higher and the mean plasma lithium level was 11% higher. A multivariable analysis was conducted to explore the relationship between selected clinical variables and maintenance lithium dose. This found that in 4213 patients whose most recent plasma lithium level was between 0.3 and 1.19 mmol/L, the variables age, sex, ethnicity, psychiatric diagnosis and the severity of chronic kidney disease were independently associated with dose while the brand of lithium prescribed was not. Conclusion: Our findings replicate those of previous studies with respect to the demographic and clinical variables that can be expected to influence lithium dosage in routine clinical practice. This reinforces the need to titrate the dosage for each individual patient, to achieve and maintain the target plasma level. However, the findings suggest that the Priadel and Camcolit brands of lithium are essentially interchangeable.
Cost Analysis of a Patient Portal Used to Remotely Monitor COVID-19 Patients in Quebec
Authors: Attieh Randa , Pomey Marie-Pascale , Lebouché Bertrand , Ma Yuanchao , Hijal Tarek , Poder Thomas G. 
Published: October 2024

Background: Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated. Objective: To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology. Methods: A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec’s health-care system perspective. Results: 27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient. Conclusion: This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.
Using Machine Learning Algorithms to Predict Postoperative Anterior Bone Loss Following Anterior Cervical Disc Replacement
Authors: Zong Rui , Guo Can , He Jun-bo , Wu Ting-kui , Liu Hao 
Published: October 2024

Study Design Machine learning model. Objectives This study aimed to develop and validate a machine learning (ML) model to predict moderate-severe anterior bone loss (ABL) following anterior cervical disc replacement (ACDR). Methods A retrospective review of patients undergoing ACDR or Hybrid surgery (HS) at a single center was performed. Patients diagnosed as C3-7 single- or multi-level cervical disc degenerative diseases (CDDD) with more than 2 years of follow-up and complete pre- and postoperative radiological imaging were included. An ML-based algorithm was developed to predict moderate-severe ABL based on perioperative demographic, clinical, and radiographic parameters. Model performance was evaluated in terms of discrimination and overall performance. Results A total of 339 ACDR segments were included (61.65% female, mean age 45.65 ± 8.03 years). During a follow-up period of 45.65 ± 8.03 months, 103 (30.38%) segments developed moderate-severe ABL. The model demonstrated good discrimination and overall performance according to precision (moderate-severe ABL: 0.71 ± 0.07, none-mild ABL: 0.73 ± 0.08), recall (moderate-severe ABL: 0.69 ± 0.08, none-mild ABL: 0.75 ± 0.07), F1-score (moderate-severe ABL: 0.70 ± 0.08, none-mild ABL: 0.74 ± 0.07), and area under the curve (AUC) (0.74 ± 0.10). The most important predictive features were higher height change, higher post-segmental angle, and longer operation time. Conclusions Utilizing a ML approach, this study successfully identified risk factors and accurately predicted the development of moderate-severe ABL following ACDR, demonstrating robust discrimination and overall performance. By overcoming the limitations of traditional statistical methods, ML can enhance discovery, clinical decision-making, and intraoperative techniques.
Effectiveness of In-Home, Augmented Reality–Based Telerehabilitation After Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial
Authors: Lim Ji Young , Yu Hee Ju , Kim Seo Hyun , Lee Jong In , Lim Jae-Young , Wang Joon Ho , Hwang Ji Hye 
Published: October 2024

Background: New digital technology–based rehabilitation may be a viable option for patients after anterior cruciate ligament reconstruction (ACLR), with advantages such as easy access to treatment and learning as well as cost-effectiveness. Purpose: To investigate the effects of an augmented reality (AR)–based, telerehabilitation system in patients after ACLR compared with a brochure-based rehabilitation program in terms of patient-reported outcomes and functional performance measures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: This was a multicenter, assessor-blinded study. Enrolled participants were allocated randomly to either the intervention group, who underwent AR-based telerehabilitation system, or to the control group, who underwent a brochure-based rehabilitation program with a self-log. Both groups performed the same postoperative rehabilitation exercise protocol. Subjective knee function was assessed using the International Knee Documentation Committee (IKDC) as the primary outcome; secondary outcomes were a numeric rating scale for pain, the EuroQol 5-Dimension 5-Level, isometric knee strength, range of motion, and the single-leg hop test. The intervention group also completed a satisfaction survey. Follow-up was conducted at 2, 6, 12, and 24 weeks postoperatively. Results: A total of 28 patients were enrolled in each group; 1 patient in the control group was lost to follow-up. Patients in both groups demonstrated improvement on all outcomes over time. There were no significant between-group differences in the IKDC score from baseline to 12 weeks postoperatively. The intervention group saw a greater increase in the relative isometric strength of the quadriceps on the involved limb at 6, 12, and 24 weeks postoperatively ( P < .05 for all). No significant group differences were observed in the remaining secondary outcomes. Conclusion: Study findings indicated that patients who underwent AR-based telerehabilitation in the early rehabilitation phase after ACLR demonstrated similar improvements as those who followed a brochure-based rehabilitation program and had a quicker recovery of knee extensor strength. Registration: NCT04513327 (ClinicalTrials.gov identifier).
Migrant Deaths in New Mexico: What is Known; What is Unknown
Authors: Hernandez Jasmine R. , Edgar Heather J. H. 
Published: October 2024

Executive Summary The United States is no stranger to migration across its borders. In 2020, its Southwestern border saw a drastic increase in apprehensions by the Border Patrol. While imperfect and an undercount of the true number of migration events, apprehension data is often used as a proxy to understand migration patterns. The rise in migration was coupled with an increased but unknown number of deaths along migration routes. This article focuses on the New Mexico portion of the El Paso Border Patrol Sector and the increased migrant caseload at New Mexico’s Office of the Medical Investigator (OMI) over the last few years. To the best of our knowledge, this article is the first academic study to examine migrant deaths in detail in southern New Mexico. We begin by contextualizing the changing pattern of migrant deaths in New Mexico within the broader framework of border policing strategies that have intentionally pushed migration routes to remote areas. We describe the work of the OMI, highlighting its very recent initiatives to track migrant deaths in its database. We then discuss the changes seen by the OMI in its migrant caseload from fiscal year (FY) 2009 to 2023, with the most drastic increase in cases occurring from 2022 to 2023. For instance, the data indicate that most of the identified migrants that have died in New Mexico were recovered in June and July (45 percent), crossed through Doña Ana County (66 percent), were male (60 percent), and among those identified, were from Mexico (65 percent) and between 20 and 39 years of age (69 percent). Of the 248 cases of migrant deaths, 87 percent have been identified. The most common causes of death were undetermined (46 percent) and environmental exposure (41 percent). We then explore the effects of changing governmental policies and state initiatives to curb/reduce migration in the US on OMI’s increased caseload. We discuss the impact that the rapid shift in migration deaths is having on the OMI and how OMI is working to respond and adjust to the dynamic situation. This work highlights the collateral damage of border security measures, underscored by the increasing number of deaths and challenges faced by the OMI. We consider the need for new and amended policies aimed at mitigating the humanitarian crisis that continues to unfold, emphasizing the need for the humane treatment of migrants. Finally, we suggest allocating resources to death investigating agencies. These resources would provide essential support to find, identify, and repatriate migrants, improve agencies’ abilities to collaborate with governmental agencies and programs such as Border Patrol’s Missing Migrant Program, and improve our understanding of the circumstances along the Southwestern border.
Hemiarthroplasty in Proximal Humerus Fractures: Does Modular Metaphyseal Stem Design Lead to Better Results? An Analysis of 24 Cases
Authors: Godolias Periklis , Plümer Jonathan , Cibura Charlotte , Gerstmeyer Julius R , Bernstorff Maria A , Heep Hansjörg , Dudda Marcel , Schildhauer Thomas A , Königshausen Matthias 
Published: October 2024

Introduction Anatomic hemiarthroplasty (aHA) is a treatment option for non-reconstructable constructable multifragment proximal humeral fractures that preserves range of motion. Our study aims to evaluate the radiographic and clinical outcomes of patients who received a modular aHA with anatomical sizing of the tubercle-bearing metaphyseal components. Materials and Methods The medical records of thirty-nine consecutive patients were reviewed. Patients were treated at a single institution with aHA as first-line treatment following a non-reconstructable constructable proximal humeral fracture. Tubercle resorption and cranialization of the aHA were analyzed using radiographic controls. Patient clinical function was assessed using the Constant Murley Score (CS). Results Twenty-four patients (62%) were available for clinical follow-up, with a mean CS of 54 points after a mean 56-month follow-up period. There was no significant difference in functional outcome on average between patients with healed tubercles (CS = 57) and resorbed tubercles (CS = 51). Radiographic follow-up was available in 33 patients (85%), demonstrating healed tubercles in 33% of the patients. Patients with resorbed tubercles had significant smaller acromio-humeral distances (AHD) than patients with healed tubercles (p = 0.043). A positive correlation was observed between greater AHD and increased constant scores (p = 0.022). Conclusions The final patient outcome measures demonstrated a positive correlation with a greater acromio-humeral distance and tubercle healing rates. However, the modular stem design with sizing of the metaphyseal components did not result in superior outcomes when compared with the literature.
Use of Fast-Setting Bone Graft Substitute to Allow Single-Stage Revision Anterior Cruciate Ligament Reconstruction
Authors: Khan Shehzaad A. , Stephens Alastair , Spalding Tim , Thompson Peter 
Published: October 2024

Background: The overall revision rate for primary anterior cruciate ligament reconstruction (ACLR) has increased over the past decade, with the commonest mode of failure being a combination of traumatic, technical, and biological factors. The challenge in revision ACLR is the need to address malpositioned or widened tunnels with the ideal scenario being single-stage revision, with widened and type 2 tunnels being the most difficult scenarios to deal with. Tunnels can be filled using autograft, allograft, and more recently described bone graft substitute (BGS). In this video, we describe a technique using fast-setting BGS to fill the problem of malpositioned tunnel or tunnels to allow single-stage revision ACLR. Indications: This technique is indicated in patients undergoing revision ACLR where tunnels are nearly right (type 2) with no widening at the joint surface aperture. Technique Description: Following preparation of the notch, the femoral tunnels are prepared in the normal fashion to remove all the previous graft and to create fresh bleeding surfaces. The fluid in the knee is completely drained, and the femoral tunnel is repeatedly dried with ribbon gauze that is left in place until ready to inject. The BGS, genex (Biocomposites Ltd), is mixed and loaded into the delivery syringe before injecting arthroscopically. After 15 minutes, the new anatomic femoral tunnel is then prepared in routine fashion. The same steps are repeated for the tibial tunnel. Results: Twenty patients underwent single-stage revision ACLR using this technique. There have been no reruptures in this series. All eligible patients at the 12-month follow-up had grade 0 or 1 laxity on clinical examination and full incorporation of the BGS on radiographs. There were no complications related to the BGS during the intra- or postoperative period. Discussion/Conclusion: We describe a technique that allows revision ACLR to be performed as single stage in a subset of patients with type 2 tunnels with successful short- to mid-term results. We have found this to be a safe and effective way to avoid 2-stage surgery in a subgroup of cases who have a challenging problem for surgeons to manage. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
“It’s Really About Those Social Determinants of Health that Drive It”: Addressing Food Insecurity in Rural Veterans
Authors: Heuer Jacquelyn N. , Bradley Sarah E. , Hahm Bridget , Pettey Kristin , Besterman-Dahan Karen 
Published: October 2024

Background The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans. Methods Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices. Results Current VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health. Conclusions Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.