bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Fovea Plana in patients with rhegmatogenous retinal detachment
Authors: Chatzistergiou Vasileia , Lejoyeux Raphaël , Bonnin Sophie , Tadayoni Ramin 
Published: September 2024

Purpose To assess the prevalence of fovea plana in patients with rhegmatogenous retinal detachment and compare characteristics of the detachment between patients with and without fovea plana. Methods This retrospective, cross-sectional, case–control study included individuals with rhegmatogenous retinal detachment. We collected demographics and data on the operated eye, spherical equivalent, best-corrected visual acuity, lens status, macula status, number of retinal holes or tears, and presence of intravitreal hemorrhage, macular hole, epiretinal membrane, posterior vitreous detachment and proliferative vitreoretinopathy. The type of surgery, the tamponade, and cataract surgery following retinal surgery were also recorded. Spectral-domain optical coherence tomography macular cubes were used to evaluate the fovea by using the Spectralis HRA-OCT device (Heidelberg Engineering, Germany). Images were graded by two different investigators and a third investigator in case of disagreement. Results We included 204 individuals; 35 (17.2%) had fovea plana, a proportion significantly higher than in the general population (p = 0.041). Individuals with and without fovea plana did not differ in any of the characteristics mentioned above apart from posterior vitreous detachment, which was more frequent in those with than without fovea plana (p = 0.038). Conclusion The prevalence of fovea plana is higher in patients with rhegmatogenous retinal detachment, which suggests an association between fovea plana and potential vitreoretinal interface changes.
Novel Retractor–Camera System Facilitates Less Traumatic Minimally Invasive Procedures and Declutters the Operation Field
Authors: Sazzad Faizus , Ng Wee Han , Feng Gao , Moideen Irwan Shah Bin Mohd , Gohary Abdulrahman El , Han Kim Ki , Stevens John C. , Kofidis Theo 
Published: September 2024

Objective: To develop a novel endoscopic system that reduces trauma to the patient and declutters the surgical field for the surgeon in minimally invasive heart valve surgery. Methods: We designed and developed a retractor–camera combination for minimally invasive heart surgery; the cable and camera were connected to the underbelly of the left atrial retractor blade to provide an illuminated, wide-angle view of the mitral valve. We conducted ex vivo, in vivo, and, ultimately, a first-in-man randomized, nonanonymized clinical trial on 20 patients who required minimally invasive mitral valve surgery. Data from the preoperative period and the immediate postoperative period were gathered, and patients were followed for 3 months. Results: Our camera–retractor combo demonstrated safe and efficient exposure and vision in all detailed studies. The total operation time for the intervention group (316.5 ± 65.1 min) was slightly shorter than for the control group (317.5 ± 50.8 min). There was no significant difference in the ability to provide exposure of the mitral valve and surrounding left atrial tissue for both control and test articles. The novel camera–retractor reduced clutter in the operation field substantially and eliminated chest penetration for the camera. We also observed that the camera did not fog, did not stain with blood, and did not require frequent corrections to its position. Conclusions: We launch a novel atrial retraction–imaging platform that is less invasive for the patient and eliminates clutter and redundant movements for the surgeon.
The effect of oral clonidine and intravenous dexmedetomidine administration on the quality of functional endoscopic sinus surgery
Authors: Samadi Shahram , Ghahremaniyeh Zahra , Khanahmadi Shima , Ghavipanjeh Rezaiy Somayeh , Bagheri Shalaleh , Prakash Pasupulla Ajay , Khalilollah Shayan , Fassbinder Marius , Kazemi Haki Behzad , Khanahmadi Shahriar , Mohtashami Saghar 
Published: September 2024

Background: Clonidine and dexmedetomidine are alpha-2 receptor blockers administered for haemorrhage control during surgery in limited settings. Functional endoscopic sinus surgery (FESS) may be associated with bleeding, thus making it challenging. This study aims to evaluate the effect of dexmedetomidine and clonidine on haemorrhage control during FESS and surgical outcomes. Methods: This three-blinded prospective study included 102 patients who underwent FESS at the Imam Khomeini public referral hospital at the Imam Khomeini public referral hospital, in Urmia, Iran. It was either American Society of Anaesthesiologists (ASA) class I or II. They were divided into three groups (clonidine, dexmedetomidine, and placebo). The volume of blood loss, mean arterial pressure, surgical field visualisation, and surgeon satisfaction were assessed in the three groups. Data analysis was performed using SPSS version 23.0. Results: Dexmedetomidine and clonidine decreased mean arterial pressure, heart rate, and blood loss volume while improving surgical field visualisation. The effect of dexmedetomidine was associated significantly statistically with surgeon satisfaction (p < 0.0001). Furthermore, dexmedetomidine improved the surgical field and reduced operating times in the dexmedetomidine group (p < 0.0001). Conclusion: The present clinical trial findings indicated that the administration of dexmedetomidine during FESS decreased mean arterial pressure, provided balanced anaesthesia and appropriate analgesia, and improved the visibility of the surgical field and increased surgeon satisfaction.
Performance-based reimbursement for digital therapeutics in Germany: A misconceptualized opportunity
Authors: Benning Leo , Teepe Gisbert Wilhelm , Pooth Jan-Steffen , Hans Felix Patricius 
Published: September 2024

Background Germany has one of the oldest social security systems in the world. Population coverage has subsequently increased, reaching coverage of approximately 90% of the population in the statutory health insurance (SHI) system today. Before this background, Germany has been pioneering the integration of digital therapeutics (DTx) into its SHI system by the introduction of the Digital Healthcare Law (Digitale-Versorgung-Gesetz, DVG) in 2019. Thereby, patients became eligible for digital health applications (Digitale Gesundheitsanwendungen, DiGA), which are available upon prescription by qualified healthcare professionals. Challenge As conventional healthcare delivery often lacks direct outcome measures as and is mostly still reimbursed on a fee-for-service basis, DiGA offer the opportunity to continuously provide individual outcome and performance data. They are, therefore, well-suited for a performance-based payment framework. While the DVG introduced the option for performance-based reimbursement components in 2019 already, the ongoing debate about the value of DiGA and to what extent they can contribute to the healthcare system has now been reflected in a 2023 health policy bill by the German Federal Ministry of Health, which aims to introduce a mandatory performance-based reimbursement component for DiGA. Proposal In this light, we propose a framework for performance-based reimbursement of DiGA, involving an intervention-specific, performance-linked reimbursement framework with shared accountability between manufacturers and payers. The approach aims to align the often contradicting interests of the involved stakeholders to incentivize the delivery of high-value digital health care. Yet, the proposal also acknowledges the need for further research to establish a robust foundation for implementing such a framework.
Sectoral Convergence Trends in per Capita Energy Use Among US States
Authors: Tzeremes Panayiotis 
Published: September 2024

This research studies the convergence hypothesis in per capita energy consumption across 51 US states, not only at an aggregated level but also at a sectoral one during the period 1960–2018. As regards methodology, we applied Phillips and Sul’s framework, and as a robustness test, we used the von Lyncker and Thoennessen calculation. Initially, the findings unveil the rejection of full panel convergence at total energy consumption and at the sectoral level, but when it comes to subgroup analysis, a crucial number of clubs are detected. By and large, for the total energy consumption per capita sample, the club clustering algorithm shows the presence of four convergent clubs and one divergent group. Concerning the commercial sector, the absence of a divergent group is found, while we can detect two subgroups. The convergence findings of the electric power sector divulged four subgroups and one state with divergent action. As regards the industrial sector, the outcomes reported seven clubs and one divergent group, while three clubs and one divergent group emerged in the residential sector. Lastly, with respect to the transportation sector, four clubs and one divergent group are revealed. It could be said then that policy implications are substantial and valuable not only for the convergent states but also for the divergent states. JEL Classifications: C33, O47, Q4, Q40
Decisional needs for older adults, home health care nurses and dental hygienists during team-based oral health assessments in ordinary home settings – a qualitative study
Authors: Persson Kylén Jessica , Björns Sara , Hägglin Catharina , Grönbeck-Lindén Ingela , Piper Laurence , Wårdh Inger 
Published: September 2024

Abstract
Background
Participation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing.

Objective
The aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists.

Methods
Data was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide.

Results
The analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out.

Conclusion
It is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.
Utilization frequency and patient-reported effectiveness of symptomatic therapies in post-COVID syndrome
Authors: Reuner Miriam , Krehbiel Johannes , Rech Jürgen , Greiner Brigitte , Schäfer Isabel , Herold Regina , Morawa Eva , Erim Yesim 
Published: September 2024

Abstract
Background
To date there is no causal treatment for post-COVID syndrome, leaving symptomatic treatments as the primary recourse. However, the practical implementation and effectiveness of these interventions remain underexplored. This study aimed to investigate the utilization frequency of symptomatic therapies and patient-reported effectiveness across various treatment modalities at a German post-COVID center.

Methods
As the baseline investigation we conducted a single-cohort retrospective study to analyze the frequency of symptomatic therapies among post-COVID patients who attended the post-COVID center of the University Hospital of Erlangen, between December 2022 to July 2023. Additionally, we administered a follow-up at least 3 months after the initial presentation, using a questionnaire to assess patient-reported improvements in post-COVID symptoms associated with the symptomatic therapies received.

Results
Our study included 200 patients (mean age: 44.6 ± 12.6 years; 69.0% women; mean duration since acute infection: 15.3 ± 8.3 months). Pharmacotherapy was the predominant symptomatic treatment (79.5%), with psychotropic drugs (32.5%) and analgesics (31.5%) being the most frequently prescribed. Over half of the patients (55.5%) utilized vitamins and nutritional supplements. Hospital admission rates to acute care occurred in 35.5% of cases; 33.0% underwent inpatient rehabilitation and 31.0% pursued outpatient psychotherapy. Cardiologists (76.5%), pulmonologists (67.5%), and neurologists (65.5%) were the most consulted specialists. Therapies involving medical devices were infrequently employed (12.0%). In a follow-up questionnaire (response rate: 82.5%, 6.3 ± 2.2 months post-baseline), beta-blockers were the most effective pharmacological intervention with 31.5% of patients reporting strong to very strong symptom improvement, followed by antibiotics (29.6%). Furthermore, 33.0% of the patients perceived plasmapheresis to strongly alleviate symptoms. Only a small proportion of the sample attributed a strong or very strong symptom improvement to outpatient psychotherapy (11.0%).

Conclusion
This study provides initial insights into symptomatic therapy utilization and patient-reported symptom improvement in post-COVID syndrome. Further research into symptoms clusters and interdisciplinary collaboration are warranted to comprehensively address the multifaceted physical and psychological symptomatology.

Trial registration
The study was registered at the German Clinical Trials Register (DRKS-ID: DRKS00033621) on March 20, 2024.
Implementing telemedicine with 5G technologies in a nursing home for reducing emergency admissions– study protocol of a mixed-methods study
Authors: Lubasch Johanna Sophie , Eder Patrick Andreas , Kaiser Christian , Klausen Andrea Diana , Overheu Daniel , Partheymüller Anja , Rashid Asarnusch , Schäfer Simon Thomas , Scharonow Maximilian , Seeger Insa 
Published: September 2024

Abstract
Background
By transmitting various types of data, telemedical care enables the provision of care where physicians and patients are physically separated. In nursing homes, telemedicine has the potential to reduce hospital admissions in nonemergency situations. In this study, telemedicine devices were implemented with the new 5G mobile communications standard in selected wards of a large nursing home in Northwest Germany. The main aim of this study is to investigate which individual and organizational factors are associated with the use of telemedicine devices and how users perceive the feasibility and implementation of such devices. Moreover, it is investigated whether the telemedical devices help to reduce the number of emergency admissions.

Methods
Telemedicine devices are implemented over an 18-month period using a private 5G network, and all users receive training. This study uses qualitative and quantitative methods: To assess the individual and organizational factors associated with the use of telemedicine devices, survey data from employees before and after the implementation of these devices are compared. To assess the perception of the implementation process as well as the feasibility and usability of the telemedical devices, the nursing staff, physicians, medical assistants and residents are interviewed individually. Moreover, every telemedicine consultation is evaluated with a short survey. To assess whether the number of emergency admissions decreased, data from one year before implementation and one year after implementation are compared. The data are provided by the integrated dispatch centre and emergency medical services (EMS) protocols. The interview data are analysed via structured qualitative content analysis according to Kuckartz. Survey data are analysed using multivariable regression analysis.

Discussion
Learnings from the implementation process will be used to inform future projects implementing telemedicine in care organizations, making the final telemedicine implementation and care concept available to more nursing homes and hospitals. Moreover, the study results can be used to provide use cases for appropriate and targeted application of telemedicine in nursing homes and to define the role of 5G technologies in these use cases. If the intervention is proven successful, the results will be used to promote 5G network rollout.

Trial registration
German Clinical Trials Register – trial registration number: DRKS00030598.
Integrated bioinformatic analysis of protein landscape in gingival crevicular fluid unveils sequential bioprocess in orthodontic tooth movement
Authors: Chen Yao , Mei Li , Qian Yuran , Zhou Xinlianyi , Zhao Zhihe , Zheng Wei , Li Yu 
Published: September 2024

Abstract
Background
The biological mechanisms driving orthodontic tooth movement (OTM) remain incompletely understood. Gingival crevicular fluid (GCF) is an important indicator of the periodontal bioprocess, providing valuable cues for probing the molecular mechanisms of OTM.

Methods
A rigorous review of the clinical studies over the past decade was conducted after registering the protocol with PROSPERO and adhering to inclusion criteria comprising human subjects, specified force magnitudes and force application modes. The thorough screening investigated differentially expressed proteins (DEPs) in GCF associated with OTM. Protein-protein interaction (PPI) analysis was carried out using the STRING database, followed by further refinement through Cytoscape to isolate top hub proteins.

Results
A comprehensive summarization of the OTM-related GCF studies was conducted, followed by an in-depth exploration of biomarkers within the GCF. We identified 13 DEPs, including ALP, IL-1β, IL-6, Leptin, MMP-1, MMP-3, MMP-8, MMP-9, PGE2, TGF-β1, TNF-α, OPG, RANKL. Bioinformatic analysis spotlighted the top 10 hub proteins and their interactions involved in OTM. Based on these findings, we have proposed a hypothetic diagram for the time-course bioprocess in OTM, which involves three phases containing sequential cellular and molecular components and their interplay network.

Conclusions
This work has further improved our understanding to the bioprocess of OTM, suggesting biomarkers as potential modulating targets to enhance OTM, mitigate adverse effects and support real-time monitoring and personalized orthodontic cycles.
Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients
Authors: Abdelsalam Ahmed , Ramsay Ian A. , Luther Evan M. , Burks Joshua D. , Wu Eva M. , Silva Michael A. , Thompson John W. , Bandes Miguel , Fountain Hayes B. , Eatz Tiffany , Sanikommu Sai , Abla Adib A. , Salem Mohamed M. , Burkhardt Jan-Karl , Srinivasan Visish M. , Brunozzi Denise , Alaraj Ali , Atwal Gursant , Al-Mufti Fawaz , Kellner Christopher P. , Rai Ansaar T. , Starke Robert M. 
Published: September 2024

BACKGROUND AND OBJECTIVES:
As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH.

METHODS:
A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications.

RESULTS:
The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P < .001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up.

CONCLUSION:
MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates.
Cadaveric Feasibility of Robotic-Assisted Radial Artery-Internal Carotid Artery-Middle Cerebral Artery Anastomosis for Neurovascular Surgery
Authors: Muto Jun , Nakatomi Hirofumi , Hirose Yuichi 
Published: September 2024

BACKGROUND AND OBJECTIVES:
To the best of our knowledge, this is the first reported cadaveric feasibility study of leader-follower type robotic-assisted middle cerebral artery (MCA)-radial artery-internal carotid artery anastomosis in the neurovascular surgery field using the da Vinci Xi system (da Vinci Surgical System; Intuitive Surgical, Inc.). Vascular suturing is a necessary skill in neurosurgery; however, the learning curve for deep and high-flow bypasses is severely low. Thus, robot-assisted surgery has been introduced. Here, we describe the surgical workflow adaptations of vascular anastomosis using the da Vinci system to assess the feasibility of robot-assisted anastomoses of the radial and middle cerebral arteries.

METHODS:
Two fresh cadaver heads were studied using the da Vinci Xi Surgical System with 0° and 30° stereoscopic endoscopes to visualize the neuroanatomy.

RESULTS:
The da Vinci Xi Surgical System was used throughout the anastomosis of the MCA and intracarotid artery. The optic nerve, optic chiasm, carotid artery, and oculomotor nerve were visualized using standard microdissection techniques. The Sylvian fissure was exposed from the proximal Sylvian membrane to the distal MCA. Using black diamond microforceps and Potts scissors, suturing was achieved on the radial artery-middle cerebral artery using 8-0 Prolene and on the radial artery-internal carotid artery using 7-0 Prolene.

CONCLUSION:
A bypass of the MCA-radial artery-internal carotid artery can be achieved using the da Vinci Xi Surgical System in cadaver models. This system provides experts and less experienced neurosurgeons with stable bypass techniques for both superficial and deep-seated arteries. However, further studies are needed to evaluate the safety and benefits of the da Vinci Xi Surgical System for bypass procedures.