bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic health record system use and documentation burden of acute and critical care nurse clinicians: a mixed-methods study
Authors: Cho Hwayoung , Nguyen Oliver T , Weaver Michael , Pruitt Jennifer , Marcelle Cassie , Salloum Ramzi G , Keenan Gail 
Published: September 2024

Abstract

Objectives
Examine electronic health record (EHR) use and factors contributing to documentation burden in acute and critical care nurses.

Materials and Methods
A mixed-methods design was used guided by Unified Theory of Acceptance and Use of Technology. Key EHR components included, Flowsheets, Medication Administration Records (MAR), Care Plan, Notes, and Navigators. We first identified 5 units with the highest documentation burden in 1 university hospital through EHR log file analyses. Four nurses per unit were recruited and engaged in interviews and surveys designed to examine their perceptions of ease of use and usefulness of the 5 EHR components. A combination of inductive/deductive coding was used for qualitative data analysis.

Results
Nurses acknowledged the importance of documentation for patient care, yet perceived the required documentation as burdensome with levels varying across the 5 components. Factors contributing to burden included non-EHR issues (patient-to-nurse staffing ratios; patient acuity; suboptimal time management) and EHR usability issues related to design/features. Flowsheets, Care Plan, and Navigators were found to be below acceptable usability and contributed to more burden compared to MAR and Notes. The most troublesome EHR usability issues were data redundancy, poor workflow navigation, and cumbersome data entry based on unit type.

Discussion
Overall, we used quantitative and qualitative data to highlight challenges with current nursing documentation features in the EHR that contribute to documentation burden. Differences in perceived usability across the EHR documentation components were driven by multiple factors, such as non-alignment with workflows and amount of duplication of prior data entries. Nurses offered several recommendations for improving the EHR, including minimizing redundant or excessive data entry requirements, providing visual cues (eg, clear error messages, highlighting areas where missing or incorrect information are), and integrating decision support.

Conclusion
Our study generated evidence for nurse EHR use and specific documentation usability issues contributing to burden. Findings can inform the development of solutions for enhancing multi-component EHR usability that accommodates the unique workflow of nurses. Documentation strategies designed to improve nurse working conditions should include non-EHR factors as they also contribute to documentation burden.
Artificial intelligence for optimizing recruitment and retention in clinical trials: a scoping review
Authors: Lu Xiaoran , Yang Chen , Liang Lu , Hu Guanyu , Zhong Ziyi , Jiang Zihao 
Published: September 2024

Abstract

Objective
The objective of our research is to conduct a comprehensive review that aims to systematically map, describe, and summarize the current utilization of artificial intelligence (AI) in the recruitment and retention of participants in clinical trials.

Materials and Methods
A comprehensive electronic search was conducted using the search strategy developed by the authors. The search encompassed research published in English, without any time limitations, which utilizes AI in the recruitment process of clinical trials. Data extraction was performed using a data charting table, which included publication details, study design, and specific outcomes/results.

Results
The search yielded 5731 articles, of which 51 were included. All the studies were designed specifically for optimizing recruitment in clinical trials and were published between 2004 and 2023. Oncology was the most covered clinical area. Applying AI to recruitment in clinical trials has demonstrated several positive outcomes, such as increasing efficiency, cost savings, improving recruitment, accuracy, patient satisfaction, and creating user-friendly interfaces. It also raises various technical and ethical issues, such as limited quantity and quality of sample size, privacy, data security, transparency, discrimination, and selection bias.

Discussion and Conclusion
While AI holds promise for optimizing recruitment in clinical trials, its effectiveness requires further validation. Future research should focus on using valid and standardized outcome measures, methodologically improving the rigor of the research carried out.
The Influential Influenza: The “Russian Catarrh” Pandemic of 1781-1782
Authors: Romaniello Matthew P 
Published: September 2024

Abstract
The influenza pandemic of 1781-1782 was remarkably well-documented, with investigations and treatment records produced in Britain, France, Germany, Italy, and Russia. Everyone agreed that outbreak began in St. Petersburg in December 1781 and then spread across northern Europe, but the medical communities’ consensus did not solve all issues. Two questions would inspire years of debate. The first concerned the transmission vector of the pandemic: was it the result of neo-Hippocratic, miasmatic, or contagionist exposure? This was perhaps the greatest concern of the late-eighteenth century, and multiple physicians hoped the latest influenza pandemic could provide an answer. The second was no less difficult – where did the disease originate? This was not only because geography affected both prophylactic measures and treatment options but also produced diplomatic and commercial consequences. Was a quarantine necessary, preventing commercial exchanges? Did the risk of infection result in peace negotiations being delayed, potentially extending the American Revolution and the ongoing naval conflict in the Atlantic? Even if a consensus could be reached that this was a “Russian” catarrh, this would not resolve the method of disease transmission. The pandemic of 1781-1782 was not a turning point in the arguments among neo-Hippocratic, miasmatic, and contagionist physicians, but rather reveals all three positions could be held simultaneously.
Peer Support Ambassadors: A Program to Advance a Supportive and Inclusive Clinical Learning Environment
Authors: Moore Kendra A. , Ureste Peter , Davis Denise L. , Boscardin Christy , Thomas Larissa R. 
Published: September 2024

Abstract
Peer support is beneficial to physicians in distress, but few institutions have created formal programs that train residents and fellows to effectively support their peers. Existing curricula also do not address the differential experience of residents from historically excluded groups, who are more likely to experience distressing mistreatment and discrimination in the clinical learning environment. The Graduate Medical Education (GME) Peer Support Ambassador (PSA) Program aimed to address this gap by: (1) offering peer support skills and trauma-informed care training to a diverse cohort of resident leaders representing a range of specialties, (2) deploying these leaders to support their peers, and (3) facilitating opportunities for participants to train other residents in these skills. In the PSA program’s inaugural year, 10 residents were trained in fundamentals of peer support, trauma-informed care, and the restorative mindset. The training increased participants’ confidence and skills in these areas, their understanding of when to refer a co-resident for additional levels of support, and their awareness of resources for mental health care and addressing mistreatment and discrimination. Beyond the skills training, the program broadened participants’ perspectives about other residents’ experiences and helped them feel more connected to residents in other specialties. Opportunities to improve the PSA program include creating more opportunities for program participants to connect between sessions and after the training, publicizing the program more effectively to residents experiencing distress, and training a larger number of residents in peer support skills.
Comparing Pain Outcomes and Treatment Adherence Between In-Person and Virtual Interdisciplinary Pain Rehabilitation Programs at the San Francisco VA Health Care System
Authors: Murphy Emily , Toor Tiffany , Palyo Sarah , Librodo Sara , Schopmeyer Kathryn , Simmons Alan N. , Strigo Irina A. 
Published: September 2024

Objective:
This study compared clinical pain outcomes between patients in a pain treatment program that was conducted in-person, compared with a virtual program.

Methods:
In-person (N=127) and virtual (N=101) pain treatment programs were compared based on patient-reported, practitioner-collected, and medical record data. The patients were measured at baseline and post-treatment (week 12 for In-Person and week 8 for Virtual patients). We employed the last observation carried forward (LOCF) to handle missing data.

Results:
Both the In-Person and Virtual groups were similar in regard to all baseline outcomes, except the In-person group having significantly more co-morbidities at baseline, with particularly more cases of mental, behavioral, or neurodevelopmental diseases. Both groups demonstrated significant improvements in the pain-related measurements of pain interference and pain catastrophizing thoughts, but neither group displayed a change in average pain across treatment. Further, both groups improved significantly on emotional well-being scores, but not on physical functioning scores. No significant differences existed between groups on outcomes, except for pain catastrophizing, which was higher in the Virtual group at both time points. The Virtual group had lower rates of dropouts compared with In-Person, while the In-Person group had a larger proportion reach a clinically meaningful change in pain-related outcomes, defined as a >30% improvement.

Discussion:
While some changes were unique to the In-Person program, overall, patients in the Virtual program achieved similar treatment outcomes, suggesting that it can successfully treat Veterans seeking pain management, with less need for in-person facilities for both patients and clinicians.
Comparison of Cognitive Functions Between Individuals With Chronic Low Back Pain With High and Low Pain Catastrophizing and Pain-free Controls
Authors: Bakhshi Feleh Fatemeh , Mofateh Razieh , Orakifar Neda , Lohrasbi Soroush 
Published: September 2024

Objectives:
Researchers suggested that the interruptive effects of chronic pain on cognitive functions may be modulated by the level of pain catastrophizing (PC). However, in individuals with chronic low back pain (CLBP), domains of cognitive function that may be affected by the level of PC remain largely unclear. Therefore, this study aimed to compare cognitive functions between individuals with CLBP with high and low PC and pain-free controls.

Materials and Methods:
This cross-sectional study examined cognitive functions of 42 individuals with CLBP and 21 pain-free controls. The PC scale was used to stratify participants with CLBP into high and low PC. Participants performed 5 cognitive tests from the Cambridge Neuropsychological Test Automated Battery, namely 5-choice reaction time, rapid visual processing, spatial working memory, attention switching task, and stop signal task.

Results:
The statistical analyses revealed that compared with individuals with CLBP with low PC and pain-free controls, individuals with high PC demonstrated greater values of the between errors (P=0.01), reaction latency (P<0.001), and stop signal reaction time variables (P=0.004, 0.003, respectively) but lower values of probability of hit (P=0.02, 0.01, respectively), A′ (P=0.01, <0.001, respectively), and percent correct trials variables (P=0.002, <0.001, respectively).

Discussion:
The results of the current study showed deficits in sustained attention, working memory, cognitive flexibility, and inhibitory control in individuals with CLBP with high PC. From a clinical perspective, therapeutic interventions targeting PC should be considered to decrease catastrophic thinking about pain in individuals with CLBP. Additional research is warranted to explore cognitive functioning as an outcome of these interventions in individuals with CLBP.
False-Positive Human Immunodeficiency Virus-1 Test Results With Rapid Seroreversion After Third-Trimester Tdap Booster Vaccination
Authors: Yu Karl O. A. , Glassman Seth R. , Link Heather M. 
Published: September 2024

BACKGROUND:
False-positive and false-negative results in human immunodeficiency virus (HIV) testing are expected at some frequency. False-positive results have been reported in association with various conditions, including pregnancy, autoimmune disease, and infection. We present an atypical case of a pregnant patient receiving false-positive HIV results for both screening and antibody confirmatory tests after a recent routine vaccination.

CASE:
A 34-year-old woman, G4P1021, with a negative first-trimester HIV test result received a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster at 35 2/7 weeks of gestation. Test results at 36 2/7 weeks of gestation were positive in both HIV-1/2 antigen–antibody screening and a confirmatory HIV-1 antibody differentiation immunoassay, but follow-up test results at 36 5/7 weeks and later were negative. Repeat testing and erythrocyte typing confirmed that this was not a result of laboratory error or specimen mishandling. HIV antiretroviral therapy was started and was later discontinued. A scheduled primary cesarean delivery performed at 39 1/7 weeks of gestation due to breech presentation was uncomplicated.

CONCLUSIONS:
False-positive results in HIV screen and confirmation testing were associated with receipt of a Tdap vaccine booster 7 days prior. This test result pattern is similar to that seen very rarely in previous cases, and the rapid seroreversion to negative suggests an acute immunologic trigger leading to a falsely reactive antibody. Clinicians should be aware of the potential for false-positive HIV test results in patients who recently received vaccination or with other immune triggers and retest at a short interval if suspected.
Temporal Trends in the Epidemiology of Lower Back Pain in the United States
Authors: Gupta Nithin , Doad Jagroop , Singh Rohin , Chien Derek , Cotroneo Matthew , Reid Daniel B.C. , Cloney Michael , Paul David 
Published: September 2024

Study Design.
This was an observational study.

Objective.
This study aims to explore sociodemographic and regional geographic variations in lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000 to 2019).

Summary of Background Data.
LBP is a major contributor to lost wages and disability in the United States. As LBP is associated with increasing age and sedentary lifestyle, the incidence of LBP is expected to rise. Due to LBP’s multifactorial causes, US epidemiological trends lack sufficient data.

Materials and Methods.
Descriptive epidemiological data including disability-adjusted life years (DALYs), incidence, and prevalence per 100,000 population from 2000 to 2019 were collected from the Global Burden of Disease database. State-level data regarding poverty, insurance and employment status were obtained from the US Government Census Bureau and US Department of Labor. Statistical significance was indicated by P<0.05.

Results.
From 2000 to 2019, the US demonstrated reductions in LBP incidence, prevalence, and DALYs. Regional analysis demonstrated the Midwest to have the greatest mean incidence, prevalence, and DALYs; with Midwestern females significantly more affected than females in other regions. Those aged 25 to 49 in the Midwest were impacted significantly more across all measures compared with age-matched populations in other regions. Nationally, there were no significant associations between unemployment and LBP. Poverty was inversely correlated with LBP incidence. Uninsured status was positively correlated with prevalence and DALYs.

Conclusion.
Although there has been progress in reducing the impact of LBP in the United States, the Midwest region has greater rates for all measures compared with other US regions. Further, females and those aged 25 to 49 in the Midwest were more likely to be affected by LBP compared with counterparts in other regions. Future studies should identify specific factors contributing to elevated LBP rates in the Midwest in order to guide targeted interventions to reduce the incidence and burden of LBP there.
HEART vs EDACS Scores on Predicting Major Events Among Patients With Suspected Acute Coronary Syndrome at the Cardiac Emergency Department
Authors: Hasballa Shimaa Mohamed , Abdelmegid Mohamed Aboel-Kassem F , Mehany Mogedda Mohamed 
Published: September 2024

Background:
Coronary risk scores, such as History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) and Emergency Department Assessment of Chest Pain Score (EDACS) scores, help nurses identify suspected acute coronary syndrome (ACS) patients who have a risk for major adverse cardiac events (MACE) within 30 days. Aim: To compare the accuracy of HEART and EDACS scores in predicting major events among patients suspected of ACS in the cardiac emergency department (ED). Design and methods: A prospective correlational observational study design was performed on cardiac ED patients who presented with suspected ACS. Tools: Three tools were utilized to collect data pertinent to the study: Tool I comprises patients’ assessment (personal characteristics, risk factors for ACS, and chest pain assessment sheet); Tool II is the risk assessment tool that includes HEART and EDACS scores; and Tool III is MACE incidence among studied patients within 30 days. Results: HEART score was significantly (P < .01) higher among patients for whom MACE was present than absent. However, EDACS score showed no significant difference (P > .05) among patients whose MACE was present or absent. HEART risk score >6 correctly predicted MACE cases with sensitivity and specificity of 77.46% and 48.28%, respectively. However, EDACS score >18 correctly predicted MACE cases with sensitivity and specificity of 42.25% and 75.86%, respectively. Conclusion: This study concludes that HEART score has better sensitivity than EDACS in predicting MACE among suspected ACS patients at the cardiac ED. The HEART score provides the nurses with a quicker and more reliable predictor of MACE shortly after the arrival of the suspected ACS patients at the cardiac ED than the EDACS score. The study recommended the implementation of a HEART score in the cardiac ED for predicting MACE in suspected ACS patients. Follow up closely for high-risk patients to MACE. An educational program should be made for nurses about the implementation of the heart score in the cardiac ED.
Patient Handout
Authors: Bennett Copp Lauren 
Published: September 2024

ABSTRACT
Patient education is one of the more rewarding aspects of a dermatology visit. However, the time constraints placed upon staff and providers limits the amount of time available to spend on education. Having detailed patient handouts readily available ensures that patients receive all the necessary information, beyond what is discussed during the visit. Patient handouts also serve as a reference for patients to return to once they leave the office and inevitably forget some of the details that were discussed.
Sun protection is one of the most important aspects of skin cancer prevention education. Below is a comprehensive overview of sun protection that addresses many of the questions patients have regarding sunscreen use and sun protection as a whole. The “key takeaways” at the end of the article can easily be converted into a printable patient handout.
Further characteristics of Noonan Syndrome type 13 caused by MAPK1 loss of function variant: Case report and literature review
Authors: Boniel Snir , Rydzanicz Malgorzata , Ploski Rafal , Szczałuba Krzysztof 
Published: September 2024

Rationale:
Noonan syndrome type 13 (NS13, OMIM #619087; Orpha #648, NS13) is caused by MAPK1 gene mutations. Individuals generally present with short stature; delayed psychomotor development; attention deficit and hyperactivity; and typical dysmorphism including ptosis, hypertelorism, downslanting palpebral fissures, low-set and posteriorly rotated ears with prominent antitragus, wide nasal bridge, low posterior hairline, dental anomalies, upper lip dysmorphism, and webbed necks. Skin features include multiple pigmented lentigines and café-au-lait spots. Congenital heart defects include atrial septal defect and mitral valve insufficiency. Neurological abnormalities include hypotonia and epileptiform discharges on electroencephalography. We describe a new case of a 6-year-old boy with the clinical presentation characteristic of NS13.

Patient concerns:
He presented with characteristic dysmorphism, behavioral abnormalities, psychomotor and speech development delay, and global hypotonia among other symptoms.

Diagnoses:
A pathogenic heterozygous de novo missense variant in MAPK1 was identified upon genetic testing during the sixth year of his life.

Interventions:
The child is currently under multidisciplinary care.

Outcomes:
This case report sheds light on the rarity and clinical diversity of NS13. In comparison to other NS13 patients from the literature, our patient presented with similar dysmorphic features, joint hypermobility, and neurodevelopmental delay. In contrast, he did not present with short stature, but with downslanting palpebral fissures, epicanthal folds, micrognathia. Our patient carried a MAPK1 missense variant located close to the N-terminal. This variant could contribute to a milder phenotype by causing partial malfunction of the MAPK1 protein.

Lessons:
The identification of a milder form of NS13 highlights the importance of early diagnosis and targeted management. Early recognition may lead to improved patient outcomes and quality of life. It underscores the need for rapid diagnostic tools specific to NS13, emphasizing the importance of continued research.
The Maternal and Child Health Workforce: A Snapshot of Current and Future Needs From Public Health WINS 2021
Authors: Tissue Michelle Menser , Donney Julie Fife , Mullenix Amy , Schaffer Kay , Stampfel Caroline , Ramos Lauren Raskin , Cilenti Dorothy 
Published: September 2024

Objective
To summarize and examine data collected from the first-ever Public Health Workforce Interests and Needs Survey Maternal and Child Health (MCH) module.

Design, Setting, and Participants
Responses from MCH governmental public health employees in 47 state health departments and 288 local health departments (LHDs) in the United States.

Main Outcome Measure
Demographic characteristics; 4 measures from the MCH module: the importance of and skill level in 5 MCH competencies in daily work, growth and leadership development opportunities, and additional workforce development needs.

Results
The MCH workforce predominantly self-identified as women (91.2%) and as White, non-Hispanic (55.2%). At least 70% of respondents reported MCH competencies as important in their daily work, but only 44% to 57% reported being proficient in those competencies. The MCH workforce in LHDs were less likely than those in state health departments to report being proficient in MCH competencies (adjusted prevalence rate ratio range: 0.83-0.92) or have growth and leadership development opportunities (adjusted prevalence rate ratio range 0.76-0.90).

Conclusion
The MCH module highlights a need to further prioritize workforce development efforts for governmental public health staff, especially in LHDs. There is an ongoing need to meet public health professionals where they are and to tailor training models and workforce development plans to account for new and ongoing stressors faced by the workforce.