bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Delphi Exploration of Toileting Activity Performance in Individuals With Cerebral Palsy Within the ICF‐CY Framework: Unveiling Influential Factors
Authors: Riyahi Azade , Akbarfahimi Malahat , Rassafiani Mehdi , Pournasiri Zahra , Ahmadi Maryam , Hassani Mehraban Afsoon 
Published: October 2024

Introduction: Cerebral palsy (CP) is a common motor and postural developmental disability impacting daily activities like toileting. Despite its importance, toileting has often been undervalued in healthcare. This study is aimed at identifying and assessing the level of influence of various factors affecting toileting in individuals with CP using the International Classification of Functioning, Disability and Health for Children and Youth (ICF‐CY) framework.Methods: The Delphi method was employed to reach a consensus on factors influencing toileting in individuals with CP. One hundred fifty‐eight professionals from 17 countries, each with at least 3 years’ experience in CP and/or toileting, participated in this two‐round study. Ethical approval (IR.IUMS.REC.1400.1111) and informed consent were obtained. The questionnaire, available in Farsi and English, used a Likert scale (5 = very high impact to 1 = no impact). Factors with 75% agreement and a mean above 3.75 were included in the final list, while those with 50%–75% agreement or a mean between 2.5 and 3.75 proceeded to the second round. Factors were initially identified through a literature review and research team consultation and categorized according to the ICF‐CY framework using the ICF 10 RULES. Validation and refinement were done through focus groups with caregivers and experienced professionals to ensure alignment with the framework and methodological rigor.Results: The study highlighted significant factors influencing toileting activities in individuals with CP. Within the ICF‐CY framework, “neuromusculoskeletal and movement‐related functions” scored highest at 94.5% in “body functions and structures.” “Toilet environment” scored 90.5% in “environmental factors.” Support and relationship factors scored 82.3%. Attitudes toward “menstruation” ranked highest at 92.9%. Associated deficits with CP ranked top in personal factors at 93.7%.Conclusion: The study identifies key factors influencing toileting activity performance in individuals with CP. “Main caregiver” emerges as a pivotal factor, followed by neuromusculoskeletal functions, personal factors, attitudes toward menstruation, the toilet environment, and support and relationships.
Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement: A Review
Authors: Patel Kush P. , Rathod Krishnaraj S. , Lansky Alexandra J. , Prendergast Bernard , Kharbanda Rajesh K. , Mathur Anthony , Perry Richard , Baumbach Andreas 
Published: October 2024

Cerebrovascular events (CVEs) are a dreaded complication of transcatheter aortic valve replacement (TAVR). They are associated with significant mortality, morbidity, and reduced quality of life and impose a significant burden to health care systems. Although the rates of clinical stroke have reduced since the advent of TAVR, it remains an important complication, particularly as TAVR is increasingly utilized. CVE may occur at the time of the TAVR, as a direct consequence of the procedure, or may occur later, related to thrombosis of the prosthetic valve, atrial fibrillation, and other comorbidities. Imaging of the brain has revealed a high prevalence of subclinical cerebral infarcts (68%–98%) associated with the TAVR procedure. Although their clinical significance has not been fully established, clinically evident CVE ranges between 3% and 5% in patients considered at high operative risk to between 1% and 3% in low operative risk patients. Periprocedural CVEs are largely the result of embolization of the thrombus and tissue derived from the valve, vasculature, or myocardium. Cerebral embolic protection devices have been studied in multiple trials, with some evidence supporting a reduction in new cerebral lesion volume, number, and potentially disabling strokes. However, thus far, there is no robust evidence that they reduce the overall stroke rate. The number and severity of comorbidities, in particular, new-onset atrial fibrillation, are associated with CVEs. Valve thrombosis diagnosed using computed tomography as areas of hypoattenuated leaflet thickening has been identified in 10% to 15% of patients. This is a dynamic process associated with an increase in CVEs, but that resolves with anticoagulation or sometimes without it. Routine use of anticoagulation compared with a single antiplatelet agent is associated with an increased risk of bleeding, without any additional alleviation in risk of thromboembolism.
Future studies to improve risk stratification could facilitate the tailoring of preventive therapies to patients at high risk of CVE, who stand to gain the most benefit.
Mediastinal Hematoma as a Potential Complication of Endovascular Intracranial Intervention
Authors: Gutierrez‐Aguirre Salvador F. , De Toledo Otavio F. , Freitas Eduarda M. , Benalia Victor H.C. , Aghaebrahim Amin , Hanel Ricardo A. , Sauvageau Eric 
Published: October 2024

Objective
To highlight the rare incidence of mediastinal hematoma as a complication associated with transradial access, as reported in both cardiovascular and neurovascular fields. Interventionists must be aware of this potential risk and the strategies to manage it.

Case Presentation
A 66‐year‐old woman presented to an outside hospital's emergency department with 2 months of dizziness and vertigo. A right posterior communication artery aneurysm was discovered incidentally on workup images. On discussing potential options, including observation, the patient opted for endovascular intervention. The aneurysm was treated using a Woven Endobridge Single‐Layer Sphere (SLS) intrasaccular flow disrupter device. After the procedure, the patient was extubated but subsequently required reintubation because of the context of stridor. Radiologic evaluation revealed a mediastinal hematoma, which was suspected to be a direct complication from the transradial access. This required immediate treatment with coil embolization of the perforated vessel at the subclavian artery originating from the costocervical trunk.

Conclusion
Mediastinal hematoma is a rare complication after neurointerventional procedures by transradial access. Prompt diagnosis and appropriate treatment are critical to managing this potentially lethal condition.
Comprehensive Airway Quality Improvement Program: Reducing Life-Threatening Airway Complications
Authors: Helmen Zachary M. , Larkin Riley , Peifer Sophia , Escanelle Miguel A. , Hall Alexander W. M. , Luka Thomas , De Varona Carlos , Hombreiro Pilar , Farrell Jennifer , McClure Brittany , Harris Michele , Ruche Alexander , Levy Diana , Falise Joseph P. , Ashley Doreen , Gabrielli Andrea , Sosa Marie Anne , Sargi Zoukaa , Ruiz Jose W. , Arnold David J. , Ferreira Tanira , Nicolli Elizabeth 
Published: October 2024

Objective: There is often unfamiliarity with the care of artificial airway devices (ie, endotracheal tubes, tracheostomies, and laryngectomies). The objective of this study was to design an Airway Quality Improvement Program (AQIP) to improve airway care. Methods: This was a retrospective chart review of a prospectively-initiated AQIP. The AQIP has 3 parts: 1) Mandatory “airway signs” 2) In-service teaching with a corresponding order set and 3) an overhead “Surgical Airway Emergency” page involving automatic pages to Anesthesia, Otolaryngology, and Respiratory Therapy. Pre- and post-intervention survey data was collected. The incidence of airway emergency was the primary patient outcome and was hypothesized to decrease after AQIP intervention. Results: Airway emergencies decreased 8.4% after AQIP ( P = .45). Length of stay decreased after AQIP, 47.0 ± 76.5 days compared to 23.5 ± 23.6 ( P = .004). Two hundred eight-one nurses and 76 respiratory therapists were educated. Pre-AQIP comfortability scores improved for the routine care of endotracheal tubes, tracheostomies, and laryngectomies, 4.3 ± 0.9, 4.3 ± 0.8, and 3.5 ± 1.2, compared to 4.7 ± 0.6, 4.5 ± 0.7, and 4.4 ± 0.7 post-AQIP ( P = .0006, P = .02, P = .0001). The same improvement was noted for emergency airway care. Tracheostomy vs. laryngectomy recognition increased from 66.5 to 97.0% ( P = .0001). Quiz questions regarding emergency airway management for laryngectomies improved from 76.2 to 93.8% ( P = .0001). Conclusion: The AQIP was associated with decreased length of hospital stay and improved competency in airway care among hospital staff. Further application of AQIP is needed for replication in other institutions and long-term application.
Clinical value of a radiomics model based on machine learning for the prediction of prostate cancer
Authors: Chen Zhen-Lin , Huang Zhang-Cheng , Lin Shao-Shan , Li Zhi-Hao , Dou Rui-Ling , Xu Yue , Jiang Shao-Qin , Li Meng-Qiang 
Published: October 2024

Objective Radiomics models have demonstrated good performance for the diagnosis and evaluation of prostate cancer (PCa). However, there are currently no validated imaging models that can predict PCa or clinically significant prostate cancer (csPCa). Therefore, we aimed to identify the best such models for the prediction of PCa and csPCa. Methods We performed a retrospective study of 942 patients with suspected PCa before they underwent prostate biopsy. MRI data were collected to manually segment suspicious regions of the tumor layer-by-layer. We then constructed models using the extracted imaging features. Finally, the clinical value of the models was evaluated. Results A diffusion-weighted imaging (DWI) plus apparent diffusion coefficient (ADC) random-forest model and a T2-weighted imaging plus ADC and DWI multilayer perceptron model were the best models for the prediction of PCa and csPCa, respectively. Areas under the curve (AUCs) of 0.942 and 0.999, respectively, were obtained for a training set. Internal validation yielded AUCs of 0.894 and 0.605, and external validation yielded AUCs of 0.732 and 0.623. Conclusion Models based on machine learning comprising radiomic features and clinical indicators showed good predictive efficiency for PCa and csPCa. These findings demonstrate the utility of radiomic models for clinical decision-making.
Laparoscopic segmental colectomy with extensive D3 lymph node dissection for right transverse colon cancer
Authors: Huang Xing 
Published: October 2024

Objective We herein propose a novel approach, laparoscopic segmental colectomy with extensive D3 lymph node dissection (ED3LND), for right-sided transverse colon cancer (TCC). Methods Forty-two patients with right-sided TCC were randomly assigned to two groups: Group 1 (segmental colectomy with D3LND) and Group 2 (segmental colectomy with ED3LND). Clinical characteristics, surgical and pathological outcomes, and oncological outcomes were retrospectively compared between the two groups. Results The number of lymph nodes retrieved, apical lymph nodes retrieved, and apical lymph node metastases were significantly lower in Group 1 than in Group 2. No significant differences were observed in the operation time, length of hospital stay, estimated blood loss, lymph node metastases, postoperative lymphoceles, or other Clavien–Dindo grade ≥III postoperative complications between the two groups. The 3-year disease-free survival rate was 82.6% in Group 1 and 84.2% in Group 2, with no significant difference. Conclusions Laparoscopic segmental colectomy with ED3LND for right-sided TCC may offer better oncological outcomes than D3LND. A large-scale prospective randomized controlled study is needed to further validate the oncological benefits of this novel procedure.
Enhanced patient journey associated with improved overall survival in colon cancer patients: A study by the Ligurian Oncology Network
Authors: Boutros Andrea , Diaz Gaitan Nidia Sofia , Orengo Giovanni , Blondeaux Eva , Pastorino Alessandro , Zacconi Monica , Ferrè Francesca , Boni Luca , Cardinali Barbara , Del Mastro Lucia 
Published: October 2024

Background: Colon cancer imposes a significant burden on global healthcare systems, necessitating efforts to improve oncology care quality and patient outcomes. We studied the correlation between care quality and survival outcomes among colon cancer patients within the Ligurian Oncology Network (Italy). Methods: We developed an Overall Quality Score (OQS) to evaluate the impact of oncology care quality on survival outcomes within the Ligurian Oncology Network. OQS indicators were selected through expert consensus, covering screening, diagnosis, treatment, and follow-up. A sample of colon cancer patients diagnosed in 2012 was randomly selected from administrative healthcare data. Analyses were performed using two models: a binary model (High and Low OQS) and a stratified model (Low, Medium, and High OQS). Statistical analysis involved survival curves, log-rank tests, and Cox proportional hazards models using SAS 9.4. Results: Of 175 eligible colon cancer patients, 150 were included. Following a median follow-up of 7.6 years, a correlation between High-OQS (⩾ 65%) and prolonged disease-free survival was observed (unadjusted HR 0.57, 95%CI 0.33-0.99, log-rank p=0.041). The five-year disease-free survival rate for High-OQS patients was 70% (95%CI 57–80%), compared to 53% (95%CI 41–64%) for Low-OQS patients. Similarly, the five-year overall survival rate was 78% (95%CI 65-86%) for High-OQS patients, compared to 58% (95%CI 45–68%) for Low-OQS patients (unadjusted HR 0.56, 95%CI 0.31-1.00, log-rank p=0.048). Conclusions: Our findings highlight the potential impact of the patient journey on colon cancer survival outcomes. Optimising care pathways might improve patient outcomes in colon cancer management.
Utilization of NIRS Monitor to Compare the Regional Cerebral Oxygen Saturation Between Dexmedetomidine and Propofol Sedation in Mechanically Ventilated Critically ill Patients with Sepsis- A Prospective Randomized Control Trial
Authors: Patidar Atul Kumar , Khanna Puneet , Kashyap Lokesh , Ray Bikash R. , Maitra Souvik 
Published: October 2024

Aim & Background Delirium frequently occurs in the acute phase of sepsis and is associated with increased ICU and hospital length of stay, duration of mechanical ventilation, and higher mortality rates. We utilized the Near-Infrared Spectroscopy monitor to measure and compare the regional cerebral oxygen saturation in mechanically ventilated patients of sepsis receiving either dexmedetomidine or propofol sedation and assessed the association between delirium and regional cerebral oxygen saturation. Methods A single center prospective randomized control trial conducted over a period of two years, 54 patients were included, equally divided between propofol and dexmedetomidine groups. Patients received a blinded study drug, propofol (10 mg/mL) or dexmedetomidine (5 mcg/mL) via infusion pump according to randomization. Infusion rates were adjusted every 10 min based on weight-based titration tables, aiming for target sedation (RASS −2 to 0). Management components included pain monitoring using the CPOT score and delirium assessment using CAM-ICU score. Results Dexmedetomidine group showed higher mean regional cerebral oxygen saturation as compared to propofol group ( P = .036). No significant differences were found in mechanical ventilation or ICU stay durations, delirium-free days, or sedation cessation reasons. Delirium occurred in 36 patients, with lower mean regional cerebral oxygen saturation as compared to non-delirious patients. Conclusion The dexmedetomidine group had higher regional cerebral oxygen saturation compared to the propofol group. Delirious patients showed lower cerebral oxygen saturation than non-delirious patients, suggesting a link between sedation type, cerebral oxygenation, and delirium. CTRI registration: REF/2021/11/048655 N
Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions
Authors: Jones Heather A. , Wilson Stephanie A. , Parks Amanda M. , Floyd Alfonso L. , Rabinovitch Annie E. , Miller Chantelle C. 
Published: October 2024

Introduction: Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology. Method: With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States. Results: Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance. Discussion: Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.
The Effect of Maternal Oxytocin Induction during Birth on Early Neonatal Pain and Stress: A Quasi-Experimental Study
Authors: Aksoy Sena D. , Yel Seda Y. , Akyildiz Deniz 
Published: October 2024

Objective Oxytocin induction is a commonly used intervention during childbirth worldwide. This study aimed to compare the pain and stress levels of newborns born to mothers who administered synthetic oxytocin at birth with those who did not. Methods This quasi-experimental study included 164 participants and their newborns who were delivered vaginally in a public hospital. The data were collected using an Information Form, a Neonatal Follow-Up Form, and the Assessment of Neonatal Pain and Stress Scale (ALPS-Neo). Results In the study, there were no differences between the two groups in terms of the participants’ and newborns’ demographic characteristics ( p > .05). During and after drying, before, during, and after the first injection, and before, during, and after blood glucose measurement, the mean ALPS-Neo scores were higher in the oxytocin induction group, with the difference being statistically significant ( p < .001). Conclusion Although the data presented here are observational, the findings indicate that infants born to participants who underwent oxytocin induction exhibit more intense pain and stress responses. The pain-stress scores of newborns born to participants who underwent oxytocin induction were higher than those of newborns whose mothers did not receive oxytocin induction.
Conventional single articulation constrained liners in revision hip arthroplasty: risk factors for failure and their combinations
Authors: Tikhilov Rashid M , Efimov Nikolai N , Shubnyakov Igor I , Goncharov Maksim Y , Stafeev Dmitrii V , Karelkin Vitalii V 
Published: October 2024

Background: Constrained liners (CLs) have been used in revision total hip arthroplasty (rTHA) with varying results. Relatively few studies have identified specific risk factors for failure. This study aimed to assess implant survivorship and complication rates, identify risk factors for constraint-related complications, and assess the effect of multiple factors present in a single case. Methods: We conducted a retrospective analysis of 101 rTHAs for various aseptic indications and as second-stage procedures for periprosthetic joint infection (PJI) utilising 2 models of conventional single-articulation CLs. We excluded 8 cases in which the liners were removed early due to PJI and assessed the risk factors for constraint-related complications in the remaining 93 cases. The mean follow-up duration for complication-free cases was 6.5 years (range 4.7–10.5 years). Results: The incidences of dislocation of a prosthetic head and loosening of the acetabular component were 19.8% and 5.0%, respectively. We also observed 8 cases where the locking ring of the liner was dislodged without dislocation (1 case required re-revision). The presence of factors related to impingement (cup retention, smaller internal diameter CLs, signs of probable impingement from the femoral side) was associated with higher rates of constraint-related complications. The presence of factors related to soft-tissue stabilisers did not increase the rate of complications. The simultaneous presence of multiple impingement-related risk factors resulted in worse outcomes. Conclusions: CLs may be less effective for treating or preventing instability related to impingement. CLs should be used with caution or avoided when multiple impingement-related risk factors are present.
Comparative study between the halfway technique and the standard technique for exchange of tunneled hemodialysis catheter
Authors: Kamhawy Adel , Nagy AbdelRahman A , Sallam Emad M 
Published: October 2024

Objectives: When indicated, tunneled hemodialysis catheters are usually inserted using the standard technique but, this technique has its complications. The halfway method is performed by exchange of an already-inserted dialysis catheter (tunneled or non-tunneled) to a tunneled one over a guidewire mounted via the old catheter. In this study, we aimed at evaluating the feasibility, safety, and durability of halfway method in comparison to the standard technique (de novo puncture). Patients and methods: This prospective study was conducted during the period from May 2020 till May 2022 and included 87 patients with end-stage renal disease (ESRD) on regular hemodialysis (HD) in need for insertion new tunneled dialysis catheters instead of temporary or malfunctioning tunneled ones. According to the technique of catheter insertion, these patients were divided into two groups: group A (the halfway technique: catheters were exchanged over guidewires under fluoroscopic control; 48 patients) and group B (the standard technique: via de novo ultrasound-guided vein puncture; 39 patients). Instant, delayed complications and 12-months patency rates were reported and analyzed. Results: The frequency of peri-operative bleeding complications was better in the halfway group with comparable infection rate and late catheter dysfunction results between the two groups. One year patency rates were 87.5% in halfway technique group compared to 79.5% in standard technique group, yet without statistical significance. However, there was a statistically significant shorter operative time in halfway group (15.54 ± 2.6 min vs 26.97 ± 5.6 min, p < 0.001). Conclusion: The halfway technique may be recommended over the standard technique of tunneled catheter insertion due to shorter operative time, lower rate of hematoma formation, with non-inferior 1-year patency rates and comparable technical success and infection rates. The advantage of access sites preservation for future demand makes this technique of great value to this group of ESRD patients.