bluuebunny/crossref_metadata_2025_split huggingface dataset:
First registry of patients treated with foam sclerotherapy using a new automated microfoam preparation device (2021-2022)
Authors: Roche Enric , Marqués Cristina 
Published: September 2024

Objectives: To present results for the use of an automated microfoam preparation system (AMPS) in the treatment of varicose veins in a real-world setting. Method: We performed a descriptive study based on a prospective database of patients treated with foam sclerotherapy between February 2021 and December 2022. Polidocanol foam was prepared using a capsule containing sterile air or a low-nitrogen mix. We recorded volume per session, percentage of sclerosing drug, number of sessions, release of thrombus entrapment, complications, and adverse events. A univariate descriptive analysis was performed using Stata V.16. Results: Over a 23-month period, 185 patients (84.9% women, 15.1% men) underwent 685 sessions. Median age was 51.6 years (range, 16-79 years). Thread veins were the condition treated in 68.9% of sessions, tributaries in 7.2%, and truncal veins in 22.6%. The average volume per session was as follows: thread veins, 8 mL; great saphenous vein (GSV), 6.9 mL; and small saphenous vein (SSV), 4.3 mL. The average drug concentration was as follows: thread veins, 0.18%; GSV, 1.49%; and SSV, 1.63%. The average number of sessions was 3.4 for thread veins, 2 for tributaries, 2.7 for the GSV, and 2.9 for the SSV. The occlusion rate at 15 months was 93.2% (41/43) for the great saphenous vein and 86% (13/15) for the small saphenous vein. We recorded a total of 21 complications (3.1% of sessions), 14 of which were minor complications (2% sessions), and 7 moderate adverse events (1% of sessions). Conclusions: This new device is highly versatile and can be used for preparing foam at all concentrations. It contributes to a high rate of occlusion in saphenous trunks, with a minimal number of sessions required for thread veins indicating that the system is a favorable option in the treatment of venous diseases. Additionally, the low frequency of residual pigmentation may be attributed to the system’s ability to tailor the foam concentration to the individual case, thus supporting optimal outcomes.
The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury
Authors: Bradley Lloyd , Wheelwright Sally 
Published: September 2024

Objective To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes. Design A retrospective observational case series. Setting A specialist brain injury inpatient rehabilitation service. Subjects Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022. Main Measures Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery. Results There was no relationship between admission wait and initial complexity ( rs = 0.006; p = 0.923), functional status ( rs = −0.070; p = 0.284) or care needs ( rs = 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation ( rs = −0.240; p = 0.0002) and change of care needs ( rs = −0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants ( n = 115; rs = −0.243; p = 0.009), with a tracheostomy ( n = 46; rs = −0.362; p = 0.013), requiring enteral nutrition ( n = 137; rs = −0.237; p = 0.005) or having had intracranial surgery ( n = 97; rs = −0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants ( rs = −0.319; p = 0.0005) and requiring enteral nutrition ( rs = −0.269; p = 0.001). Conclusion Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.
The ideal path to a good death: An international meta-synthesis of rural residents’ perspectives
Authors: Wang Huan , Cheng Meijing , Zhang Ziqing , He Xiaoyu , Hu Lei , Yang Dan , Gong Ni 
Published: September 2024

Background: Rural areas frequently encounter restricted access to healthcare and end-of-life services. Given current pressing realities, understanding their unique perspectives on what constitutes a good death is essential. Existing research has largely overlooked the voices of rural residents. Aim: To obtain a more comprehensive understanding of rural residents’ expectations regarding a good death. Design: A meta-synthesis. By exploring the logic within relevant content, the stages of the life course serve as the framework for integration. Data sources: PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), China National Knowledge Infrastructure (CNKI), WanFang, and China Biology Medicine disc (CBM) were systematically searched from their inception to May 2023. Result: Of the 1100 articles retrieved, 8 studies were included. This paper outlines “the path to a rural good death”: (1) When death is perceived as distant: acknowledge its inevitability while striving to achieve a successful and complete life journey. (2) As death approaches: maintain composure and have the capacity and support to face it. (3) When death truly arrives: depart in an envisioned scenario. (4) What’s left behind: be properly arranged. Conclusion: The essential characteristics of a rural good death align with previous interpretations. However, distinct aspects emerge: communities play a significant role, characterized by reciprocal relationships; the role of medicine is less emphasized; and “rurality” deeply shapes residents’ expectations of a good death. The pathway to a good death presented in this article is aspirational, requiring collaborative efforts to make it a tangible reality.
Natural Versus Board Standards: Similarity or Differences? Evaluation of Plaster Models of Nonorthodontic Optimal Occlusion Using ABO Criteria
Authors: Shivapuja Prasanna-Kumar , Smith Late Robert T. , Krishnaswamy Nathamuni Rengarajan 
Published: September 2024

Aim The main aim of the study was to evaluate tooth position in plaster models of nonorthodontic subjects that have optimal occlusion, using the American Board of Orthodontics (ABO) criteria and comparing it to ABO standards. Methods Forty nonorthodontic subjects with optimal occlusion were evaluated for teeth positioning with ABO measurement criteria, using the ABO gauge. These measurements were compared to the ABO standards. On the panoramic radiographs of these subjects, distances between the roots of teeth were measured using the digital ruler in Quick CephR. Lateral cephalograms were scanned and digitized into Quick CephR systems to evaluate the skeletal anteroposterior and vertical relationship. Means and standard deviations were calculated for all the variables and compared to ABO standards. Correlations were obtained between attrition and overjet. Correlations were also studied between anteroposterior skeletal relation, vertical skeletal relation, and teeth positioning. In subjects that had accurate age records, the relationship between age and change in buccolingual inclination was evaluated. Results A significant difference in the mean values for inclination of maxillary and mandibular first bicuspids, second bicuspids, first molars, and second molars as compared to the board criteria was observed. Accuracy of panoramic radiograph to measure root proximity, especially in the cuspid region, is questionable. There was a positive correlation between overjet at the cuspid region and attrition. There was a minimal correlation between age and buccolingual inclination of teeth, indicating only a trend for mandibular second bicuspid to upright with age. Conclusion The ABO criteria and standards used to evaluate finished orthodontic cases are consistent with naturally occurring optimal dentitions, except for buccolingual inclination of posterior teeth in both maxillary and mandibular arches.
Intubation and Mechanical Ventilation in Patients with Acute Pulmonary Embolism: A Scoping Review
Authors: Lee Eun Sang , Baltsen Cecilie Dahl , Stubblefield William B. , Granfeldt Asger , Andersen Asger , Stannek Karsten , Dudzinski David M. , Kabrhel Christopher , Lyhne Mads Dam 
Published: September 2024

Objectives High-risk acute pulmonary embolism (PE) is associated with significant mortality and may require emergency endotracheal intubation and mechanical ventilation. Intubation and ventilation are thought to exacerbate cardiorespiratory instability. Our purpose was to conduct a systematic literature review to identify studies investigating peri-intubation events in acute PE. Methods A systematic search of Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library was performed. Results were screened by two independent observers. Studies reporting on intubation and positive pressure ventilation in acute PE patients were included. The primary outcome was adverse events during the peri-intubation period. Data was synthesized and an assessment of risk of bias was conducted. The review was registered on PROSPERO (CRD42023444483). Results 4100 unique articles were screened. Three retrospective studies comprising 104 patients with acute PE met criteria and were included. Peri-intubation, hemodynamic collapse was observed in 19%-28% of cases. Patients with hemodynamic collapse exhibited higher rates of echocardiographic RV dysfunction. Conclusions Peri-intubation adverse events are common in patients with acute PE. Current evidence is limited and highlights the need for further research to optimize management of respiratory failure in acute PE and patient selection for intubation to improve patient outcomes.
Emergency Management Simulation of an Unexpected Opioid Overdose in a Rural Setting: An Innovative Use of Drone Technologies
Authors: Niles Lauren L. , Sullivan Veronica , Amiri Azita 
Published: September 2024

Background The utilization of unmanned aircraft systems (UAS) in healthcare presents an innovative and effective approach for the delivery of emergency medical supplies to rural communities. Providing healthcare students with opportunities to work with UAS prepares them to embrace novel technologies in their future careers. Caring for individuals living in rural communities and those with substance abuse disorders are critical components of current healthcare education. Intervention This simulation ready-to-use describes an innovative simulation learning exercise (SLE) developed using UAS technologies to address an unexpected opioid overdose in a rural setting. Methods Students received pre-simulation instruction on the concepts of addiction, emergency management of an opioid overdose, and rural healthcare. Students participated in an unfolding, two-part SLE. Results The first scenario simulated emergency management of the opioid overdose in which a UAS delivered rescue medications. This was followed by a second scenario simulating continuing care after initial stabilization. Debriefing of the simulation and reflection activities were completed. Discussion The integration of UAS in healthcare education provides a valuable opportunity for students to increase their knowledge of innovative technologies. The UAS provides educators with a novel resource to expand simulation experiences, increase student engagement, and promote knowledge retention of difficult concepts. Instructions for implementation and educational resources provided in the Appendix.
Risk Prediction Models for Preoperative Deep Vein Thrombosis in Older Patients with Hip Fracture: A Systematic Review and Meta-Analysis
Authors: Guo Huali , Xu Kuankuan , Deng Fangfang , Chen Qingqing , Liang Jie , Zhang Kun 
Published: September 2024

Objective To systematically assess the risk prediction models for preoperative deep vein thrombosis in older patients with hip fractures. Method We searched four databases for literature through November 17, 2023. We included patients aged ≥60 with hip fractures and considered English-language case-control or cohort studies that focused on developing and/or validating risk prediction models for DVT in this population. Excluded were studies that solely analyzed risk factors without constructing a prediction model, had fewer than 2 predictive variables, or were not available in full-text or were duplicate publications. The Predictive Model Bias Risk Assessment tool was utilized to evaluate risk of bias. The area under the curve (AUC) values were meta-analyzed using R Studio software. The I2 index and Cochrane q test were employed to assess heterogeneity. Additionally, sensitivity analysis was performed by systematically removing individual studies to explore the sources of heterogeneity. Results A total of 1880 studies were gathered. Out of these, seven studies were included, encompassing 8 models. The most commonly utilized factors in the models were D-dimer and the time from injury to admission. The pooled AUC value for the validation of 8 models was 0.84 (95% confidence interval: 0.80-0.87), indicating robust model performance. Conclusion Current risk prediction models for preoperative DVT in elderly hip fracture patients are still in the developmental phase. Future research should focus on developing new models with larger sample sizes, robust study designs, and multicenter external validation.
Identifying children at risk in Swedish Child Health Services
Authors: Wennergren Mattias , Fäldt Anna 
Published: September 2024

Background: Child Health Services plays an important role in identifying at-risk children and intervening early to break negative trends in child health. Sociodemographic risk factors can impact the workload of Child Health Services and affect the possibilities of providing the national child healthcare programme. Aims: This study aims to present the sociodemographic characteristics of families who are registered within the Child Health Services, as defined by the Child adjusted Care Need Index. Methods: By collecting personal identification numbers from children six years or younger registered at a child healthcare centre, and combining this with their caregiver’s sociodemographic background, this study was able to create a sociodemographic index for each child healthcare centre in Sweden. Results: The study included 687,543 children and 1,335,540 caregivers from 981 child healthcare centres in Sweden. Approximately 21% of all children in the study population had a caregiver born in Southern or Eastern Europe outside the European Union, or in Africa, Asia, or South America, 7% had single parents, 17% had at least one unemployed caregiver, and 9% had at least one caregiver who had not completed high school. The average input values and the average index values varied widely both between and within the regions. Conclusions: This study displays a large variation in sociodemographics for child healthcare centres both within and between regions. Since several regions and national agencies in Sweden use the Child adjusted Care Need Index, it is necessary to keep the dispersion in mind.
The Untold Story: Early and Mid-Term Results of Subintimal Angioplasty in Superficial Femoral Artery Versus Popliteal Artery Chronic Total Occlusion
Authors: Shahat Mohammed , Ali Sahar H. , Hussein Ahmed N. , Taha Ashraf G. , Taha Mohamed A. H. 
Published: September 2024

Objectives: This study aims to compare the immediate and mid-term outcomes of subintimal angioplasty (SIA) of chronic total occlusions (CTOs) of superficial femoral artery (SFA) versus popliteal artery (PA) and to identify possible predictors of loss of limb-based patency (LBP). Methods: This is a retrospective analysis of chronic lower-limb ischemia (CLI) patients (Rutherford classes 3–6) presenting with CTO of SFA or PA treated by SIA and selective stenting in the period 2018 to 2021. Immediate outcomes were compared between the SFA and PA groups, including technical success, perioperative complications, and 30-day major amputation and mortality rates. Mid-term outcomes for technically successful procedures included limb-based patency (LBP), wound healing rate, amputation-free survival (AFS), and major adverse limb events (MALEs). Results: A total of 450 CLI patients underwent SIA of CTO at the SFA (n=260, 57.8%) and the PA (n=190, 42.2%). The indication for revascularization was chronic limb-threatening ischemia in 80.8% of SFA group and 84.2% of PA group. Technical success rate was higher in the PA group compared to the SFA group (96.3% vs 91.2%; p=0.03). The 30-day amputation rates were comparable between the SFA and PA groups (7.7% vs 6.8%, p=0.7, respectively). No perioperative mortality or systemic major complications occurred in the present study. Kaplan-Meier estimate of the 1-year rates were significantly better for SFA group regarding LBP (82% for SFA group vs 43% for PA group, p=0.006), AFS (88% vs 64%, p=0.02), and wound healing (79% vs 58%, p=0.027), respectively. The number of runoff vessels was the only factor associated with loss of LBP (hazard ratio [HR], 0.055; 95% confidence interval [CI]: 0.001–3.020, p=0.039). Conclusions: Subintimal angioplasty is an effective and safe endovascular treatment option of CTO at SFA and PA with satisfactory immediate outcomes. The mid-term outcomes, however, are better for SFA lesions in terms of improved LBP, AFS, and wound healing rates. Clinical Impact: Subintimal angioplasty is a valuable tool in the armamentarium of endovascular surgeons, as re-entry devices aren’t always widely accessible. This study aims to assess the technical outcomes of peripheral vascular interventions for infrainguinal chronic total occlusions and identify possible predictors for successful subintimal angioplasty .Subintimal angioplasty is an effective treatment option for infrainguinal CTO with difference in result of immediate outcomes in popliteal lesions and SFA lesions
The ‘vulnerable nerve’; surgically acquired neuropathy in distal humeral surgery patients and the role of a tourniquet
Authors: Williams Mark G , Donoghue Sophie J , Thomas Ellen , Evans Jonathan P , Thomas William , Smith Christopher 
Published: September 2024

Background The complication of neuropathy is high in patients undergoing distal humerus surgery. Tourniquets (TQs) are typically used but can lead to nerve injury. Methods We present a comparative study of a pre-intervention group ( n = 38) and a post-intervention group ( n = 38) undergoing distal humerus surgery between November 2020 and July 2023. The intervention included TQ discontinuation and the introduction of intravenous tranexamic acid at induction. Our analysis encompasses patient, anaesthetic, and surgical variables, as well as the rates and severity of neuropathy. Results Post-intervention, the rate of surgically acquired or deterioration in nerve injury improved from 15.8% ( n = 6) to 2.6% ( n = 1). Pre-intervention, the mean TQ duration was significantly longer for patients with post-operative neuropathy versus those without (120 min, SD = 29 vs. 88 min, SD = 38, p = 0.032). Surgery duration was not significantly longer without a TQ but was associated with a greater reduction in haemoglobin (12.7 g/L, SD = 10.9 vs. 25.2 g/L, SD = 15.5, p = 0.03). Discussion Trauma patients have a high risk of acquiring a nerve injury following elbow surgery or deterioration of a pre-surgical nerve injury, which emphasises the concept of vulnerable nerves. The cessation of using a TQ was associated with a lower nerve injury rate, with no cases of major nerve injury and no significant increase in surgical time.
Is revision to anatomic shoulder arthroplasty still an option? A systematic review
Authors: Gulzar Musab , Welp Kathryn M , Chang Michelle J , Woodmass Jarret M , Worden Jacob A , Cooke Hayden L , Chopra Krishna N , Gottschalk Michael B , Wagner Eric R 
Published: September 2024

Background With the historical complications when using total shoulder arthroplasty (TSA) to revise failed arthroplasties, and the success of the reverse prosthesis in the revision setting, the question arises whether revision to TSA is still a reasonable option? This systematic review examines revision to TSA and the factors associated with outcomes. Methods A systematic review was performed for studies of TSA used to revise a failed hemiarthroplasty or TSA. The primary outcome was implant failure leading to a repeat revision arthroplasty. Secondary outcomes included visual analog scale (VAS) pain scores, shoulder motion and other clinical outcomes of shoulder function. Data were pooled to generate representative frequency-weighted means. Results Thirteen studies were included, totaling 312 shoulders. Etiologies for revision included glenoid arthrosis (62%), glenoid component failure (36%), and other (2%). Of which, 39% of cases experienced complications and 12% required another arthroplasty revision. Secondary outcomes such as VAS pain, Constant, ASES and UCLA score improved, but none were statistically significant. Unsatisfactory outcomes were higher among patients with glenoid bone loss, instability, and soft tissue deficiencies. Discussion Revision to anatomic TSA can be an acceptable option in certain patients. However, the high rate of complications and glenoid loosening, makes this a limited approach for a revision to anatomic TSA procedure.
An exploration of medical professionals’ attitudes, perceived knowledge and concerns around medical cannabis in the United Kingdom
Authors: Heeg Hallie , Morari Ana , Lynskey Michael , Turner John JD 
Published: September 2024

Background In the UK, there are over 40,000 specialist clinicians who are eligible to prescribe cannabis-based medical products (CBMPs); however, only approximately 100 actively do so (0.25%). Since the legalization of medical cannabis in the UK in 2018, there has been a limited number of prescriptions issued by the National Health Service (NHS). Availability through private healthcare is rising, with current estimates suggesting that 25,000–30,000 patients are accessing medical cannabis though private clinics. Objective The objectives of this study were (1) to assess attitudes, perceived knowledge and concerns around medical cannabis among medical/health care professionals (HCPs) in the UK, and (2) to examine differences between professionals who had previously undertaken training on medical cannabis and those who had not. Methods Using a quantitative cross-sectional survey design, a questionnaire was presented to participants to explore their personal and professional perspectives towards medical cannabis. Questions addressed HCPs’ perceived knowledge, confidence and concerns about medical cannabis prescribing, alongside their personal experiences and attitudes toward legalization. Results A total of 72 HCPs completed the survey, of which 55.6% had received training in medical cannabis. HCPs trained in medical cannabis reported a statistically significant higher perceived knowledge of medical cannabis, greater confidence in prescribing and increased recognition of its value as a medicine compared to their non-trained colleagues ( p < 0.05 for all comparisons). Notably, trained individuals were significantly less concerned that use of medical cannabis lacks sufficient evidence of efficacy ( X2(1) = 8.74, ( p = 0.003). Barriers to prescription and cost of medical cannabis were the most endorsed concerns among both HCP groups. Conclusions The study found that undergoing medical cannabis training is associated with less hesitancy in prescribing CBMPs and increased confidence in its medicinal value.