bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study*
Authors: van Herwerden Michael C. , Groenland Carline N. L. , Termorshuizen Fabian , Rietdijk Wim J. R. , Blokzijl Fredrike , Cleffken Berry I. , Dormans Tom , Epker Jelle L. , Feyz Lida , Gritters van den Oever Niels , van der Heiden Pim , de Jonge Evert , Latten Gideon H. P. , Pruijsten Ralph V. , Sir Özcan , Spronk Peter E. , Vermeijden Wytze J. , van Vliet Peter , de Keizer Nicolette F. , den Uil Corstiaan A. 
Published: August 2024

OBJECTIVES:
This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.

DESIGN, SETTING, AND PATIENTS:
We conducted a retrospective cohort study (2009–2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2–3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability (p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORsadjApache) was 1.24 (95% CI, 1.00–1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORsadjApache for ED-to-ICU times of 1.6–2.3, 2.3–3.4, and greater than 3.4 hours were 1.21 (1.01–1.46), 1.21 (1.00–1.46), and 1.34 (1.10–1.64), respectively. In NACT hospitals, no association was observed (p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORsadjED). In the academic hospitals the ORsadjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81–1.19), no overall association was observed (p = 0.08). In NACT hospitals, all time-ascending quintiles had ORsadjED values of less than 1.0 (p < 0.01).

CONCLUSIONS:
In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.
Serendipitous Pathways and Elusive Definitions: Leadership in Continuing Professional Development
Authors: Wiljer David , Paton Morag , Jeyakumar Tharshini , Do Victor , Maniate Jerry M. , Tavares Walter , Schneeweiss Suzan 
Published: August 2024

Introduction:
Although the Continuing Professional Development (CPD) field has rapidly expanded in scope, breadth, and depth, there is a gap in how we understand CPD leadership and the role of the leader. Previous scholarship indicates that there is neither an agreed on set of competencies for CPD leadership roles nor a distinct pathway towards those roles. This study is aimed at answering the following question: How is leadership described or defined in CPD and what are the contextual issues that are and/or should be shaping its evolution?

Methods:
Conducted between 2020 and 2022, CPD leadership program learners and CPD leaders with a range of leadership expertise were identified using convenience and purposive sampling and invited to participate in this study. Semistructured interviews were conducted with consenting participants. Interviews were recorded, transcribed, and analyzed using a qualitative thematic template analysis approach.

Results:
Seventeen interviews were conducted. There were multiple components identified that were important to CPD leadership, such as being visionary, or having strong collaboration skills with some components, such as adaptability and flexibility appearing more unique to the CPD context. The role of CPD leadership and the pathway to CPD leadership remain highly variable.

Discussion:
Attaining a CPD leadership position predominantly involves some degree of “serendipity.” While CPD leaders may fundamentally need basic and common leadership skills, an essential attribute of the CPD leader is to effectively respond to the context and the unique needs of the health system. We recommend better articulating and valuing the role of the CPD leader within the health system.
Demystifying Artificial Intelligence for Health Care Professionals: Continuing Professional Development as an Agent of Transformation Leading to Artificial Intelligence–Augmented Practice
Authors: Soleas Eleftherios K. , Dittmer Douglas , Waddington Ashley , van Wylick Richard 
Published: August 2024

Abstract:
The rapid rise of artificial intelligence (AI) is transforming society; yet, the education of health care providers in this field is lagging. In health care, where AI promises to facilitate diagnostic accuracy, and allow for personalized treatment, bridging the knowledge and skill gaps for providers becomes vital. This article explores the challenges of AI education, such as the emergence of self-proclaimed experts during the pandemic, and the need for comprehensive training in AI language, mechanics, and ethics. It advocates for a new breed of health care professionals who are both practitioners and informaticians, who are capable through initial training or through continuing professional development of harnessing AI's potential. Interdisciplinary collaboration, ongoing education, and incentives are proposed to ensure health care benefits from AI's trajectory. This perspective article explores the hurdles and the imperative of creating educational programming designed specifically to help health care professionals augment their practice with AI.
Long-term Health Outcomes After Hospital Discharge Among Children Hospitalized for MIS-C or COVID-19, September 29, 2021, to June 21, 2022
Authors: Godfred-Cato Shana , Kunkel Amber , Abrams Joseph Y. , Shah Ami B. , Yousaf Anna , Hammett Teresa A. , Choi Jong-Ha , Perez Maria A. , Hsiao Hui-Mien , Rostad Christina A. , Laham Federico R. , Kao Carol M. , Hunstad David A. , Oster Matthew E. , Campbell Angela P. , Belay Ermias D. 
Published: August 2024

Background:
The long-term effects of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) or acute COVID-19 are not well known. Our objective was to determine long-term outcomes.

Methods:
Children hospitalized with MIS-C or COVID-19 at 3 US hospitals from March 2020, through February 2021 were followed to assess health through 2 years post-hospitalization using medical records and patient surveys.

Results:
Medical record abstraction was performed for 183 patients hospitalized with MIS-C, 53 of whom participated in surveys, and 97 patients hospitalized with COVID-19, 35 of whom participated in surveys. Patients with MIS-C were younger (median, 9 vs. 14 years of age for COVID-19 patients; P = 0.004), more frequently male (62% vs. 39%; P < 0.001) and had more cardiac (14% vs. 2%; P = 0.001) and neurologic sequelae (8% vs. 1%; P = 0.023). Children with COVID-19 more often had other comorbidities (59% vs. 19%; P < 0.001). Full mental recovery at the time of survey 2 (median, 16 months post-hospitalization for patients with MIS-C and 20 months for patients with COVID-19) was 85% and 88%, respectively; full physical recovery was 87% and 81%, respectively; and nearly all had resumption of normal activities. Patients with MIS-C reported more frequent headache at 1 month (45% vs. 20%; P = 0.037). Patients with COVID-19 were more likely to report cough at 1 month (37% vs. 17%; P = 0.045). Fatigue persisted >1 year in 15%–20% of patients in both groups.

Conclusions:
Approximately 20% of children with MIS-C and COVID-19 continued to have symptoms including fatigue and headache >1 year after hospital discharge. The duration of these findings emphasizes the importance of providers following patients until sequelae have resolved.
Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum
Authors: Munoz Flor M. , Beigi Richard , Posavad Christine M. , Kelly Clifton , Badell Martina L. , Bunge Katherine , Mulligan Mark J. , Parameswaran Lalitha , Richardson Barbra A. , Olsen-Chen Courtney , Novak Richard M. , Brady Rebecca C. , DeFranco Emily , Gerber Jeffrey S. , Shriver Mallory , Suthar Mehul S. , Coler Rhea , Berube Bryan J. , Kim So Hee , Piper Jeanna M. , Miedema Joy , Pasetti Marcela , Neuzil Kathleen M. , Cardemil Cristina V. ,   on behalf of the DMID Study Group
Published: August 2024

Background:
Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.

Methods:
This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites. Pregnant or postpartum participants and their infants were enrolled after COVID-19 mRNA monovalent vaccination during pregnancy (primary 2-dose series) with booster (third dose) vaccination during pregnancy or within 2 months post-partum. SARS-CoV-2–binding and functional antibody responses at delivery and 2 months after delivery in mothers and infants were measured by spike and receptor-binding domain immunoglobulin (Ig) G, pseudovirus and live neutralizing antibody (nAb) titers to ancestral and Omicron BA.1 and BA.5 strains. Breast milk spike and receptor-binding domain IgG and IgA titers were also measured.

Results:
A total of 237 maternal/infant dyads were included (110 primary series during pregnancy, 99 pregnancy booster and 28 postpartum booster). A pregnancy booster resulted in 2.2-4.7-fold higher IgG and nAb at delivery and 2 months for both mothers and infants compared to the primary series alone (P < 0.001 for all comparisons). While infant IgG and nAb titers decreased by 2 months of age, the proportion of infants with detectable nAb at 2 months was greater in infants of mothers boosted during pregnancy compared with primary series for all variants (D614G: 99% vs. 56%; BA.1: 56% vs. 4% and BA.5: 57% vs. 9%; P < 0.001 for all comparisons). Breast milk spike IgA and IgG were present in 64%-100% and 100% of participants, respectively, and those boosted during pregnancy or postpartum had 3.1-4.6-fold higher levels of breast milk antibodies at 2 months compared to primary series during pregnancy (P < 0.001).

Conclusions:
mRNA COVID-19 monovalent booster vaccination during pregnancy results in significantly higher maternal and infant serum–binding IgG and nAb titers compared to a primary 2-dose series, including against Omicron variants, through 2 months of age. Breast milk antibodies following maternal vaccination during pregnancy or postpartum may provide additional protection during early infancy.
Electrocardiogram Abnormalities in Children With Lyme Arthritis
Authors: Hammett Deborah L. , Del Grippo Erica , Loiselle Claire E. , Thompson Amy D. 
Published: August 2024

Background:
Classically, Lyme disease follows a staged illness pattern with carditis occurring in early disseminated disease and arthritis in late-stage disease. A more comprehensive understanding of Lyme suggests that clinical stages may intersect. Little is known regarding the overlap of electrocardiogram (ECG) abnormalities in children with Lyme arthritis. This study aimed to estimate the prevalence of ECG changes in pediatric patients presenting with Lyme arthritis.

Methods:
In this retrospective, cross-sectional study was conducted at a tertiary care children’s hospital in a Lyme endemic area; patients were identified based on Lyme testing performed from January 2012 to August 2022. Children diagnosed with Lyme arthritis by 2-tiered serology with ECGs obtained within 2 days of antibiotic initiation were included. A study cardiologist reviewed all ECGs for evidence of carditis defined as atrioventricular block, ST-T wave changes, QTc interval prolongation, accelerated junctional rhythm or right bundle branch block.

Results:
Two hundred thirty-three patients were diagnosed with Lyme arthritis; 90 (38.6%) had ECGs completed. Five patients (5.6%) had ECG abnormalities: 3 were diagnosed with first-degree atrioventricular block, 1 with QTc prolongation, and 1 with ST-T wave changes. No clinical or laboratory features in patients with Lyme arthritis were associated with an increased likelihood of having an abnormal ECG. All patients with ECG abnormalities were treated with oral antibiotics, and none had clinically significant cardiac disease.

Conclusions:
ECG abnormalities in children with Lyme arthritis rarely occur and, when present, are not reflective of clinically significant cardiac disease. These results do not support routine screening ECGs on asymptomatic pediatric patients with Lyme arthritis.
Efficacy and Safety of Sphingosine 1-Phosphate Receptor Modulators for Ulcerative Colitis
Authors: Mahmud Omar , Fatimi Asad Saulat , Mahar Muhammad Umar , Jahangir Arshia , Kashif Aleena , Abbas Manzar , Waljee Akbar K. , Berinstein Jeffrey A. 
Published: August 2024

Background and Aims:
Sphingosine 1-phosphate receptor modulators (S1PRMs) are an effective treatment for ulcerative colitis (UC). This review summarizes all available randomized trial data on the efficacy and safety of S1PRM therapy.

Methods:
Multiple publication databases were systematically searched for randomized control trials (RCTs) of adults with moderate to severe UC treated with S1PRMs. Random effects meta-analysis was performed. The risk of bias was assessed using the Cochrane Risk-of-Bias 2 tool, and the overall quality of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results:
We identified 7 RCTs (1737 patients) involving the use of S1PRMs for moderate to severe UC. During induction, S1PRM therapy was efficacious when compared with placebo for clinical remission [RR: 2.65 (95% CI: 2.00, 3.53)], clinical response [RR: 1.68 (95% CI: 1.48, 1.91)], endoscopic improvement [RR: 2.17 (95% CI: 1.76, 2.68)], endoscopic normalization [RR: 2.56 (95% CI: 1.58, 3.83)], mucosal healing [RR: 2.88 (95% CI: 1.94, 4.26)], and histologic remission [RR: 2.42 (95% CI: 1.60, 3.66)]. Similar results were seen throughout the maintenance peroid, although fewer data were available to pool; notably, both sustained [RR: 3.57 (95% CI: 1.23, 10.35)] and steroid-free [RR: 2.92 (95% CI: 1.35, 6.33)] remission were significantly increased by S1PRM. There were no significant differences in adverse events [RR: 1.02 (95% CI: 0.90, 1.15)] and infections [RR: 1.15 (95% CI: 0.82, 1.60)] between S1PRM and placebo.

Conclusion:
Pooling of RCT data confirms that S1PRM therapy is both effective and safe for patients with moderate to severe UC.
Does radical cystectomy still have a role in BCG-unresponsive nonmuscle invasive bladder cancer?
Authors: Xia Leilei , Daneshmand Siamak 
Published: August 2024

Purpose of review
Several novel therapies approved by the Food and Drug Administration (FDA) and explosion of clinical trials have changed the landscape Bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC). Given the recent advancements in bladder sparing options, the role of radical cystectomy (RC) in BCG-unresponsive NMIBC remains a subject of debate.

Recent findings
All three novel agents currently approved by the FDA for BCG-unresponsive NMIBC have strict indication [carcinoma in situ (CIS)], low response rate, and short response duration. Some promising new agents are awaiting results and/or FDA approval. RC still provides the best oncologic control and acceptable quality of life, and potentially represents the most cost-effective option.

Summary
It is an exciting time for the urologic oncology community to see the FDA approvals of some of the novel bladder sparing therapies and expansion of ongoing clinical trials. Yet, RC should still be considered as the gold standard of BCG-unresponsive NMIBC. We also must be cautious and selective in recommending bladder sparing options for patients with BCG-unresponsive NMIBC.
Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature
Authors: Nedbal Carlotta , Tramanzoli Pietro , Castellani Daniele , Gauhar Vineet , Gregori Andrea , Somani Bhaskar 
Published: August 2024

Purpose of review
To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.

Recent findings
A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: ‘costs of different procedures: SWL, URS, PCNL’, ‘costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices’, ‘costs of KSD treatment in the emergency setting: emergency stenting versus primary URS’. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.

Summary
Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays’ practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.
Men’s Perceptions and Expectations of Fertility Clinics
Authors: Abdullahzadeh Mehrdad , Vanaki Zohreh , Mohammadi Eesa , Mohtashami Jamileh 
Published: August 2024

Background
Most of the research and care in fertility focuses on women, whereas men’s perspectives and expectations are often overlooked.

Objectives
The aim of the study was to explore the experiences and expectations of men with primary infertility regarding fertility clinics and to provide implications for personalized and inclusive care.

Methods
A qualitative study was conducted in Iran between November 2022 and October 2023. Thirteen men with primary infertility were interviewed in-depth using a semistructured approach. Data were analyzed using the inductive content analysis method.

Results
The central theme, “Therapy Environment: Private and Interactive,” was identified. The theme comprises four categories: Effective Interaction—A Key to Therapy Success; Infertility Treatment—A Joint Effort; Personal and Stress-Free Environment—Essential for Treatment; and Treatment Plan—Vital for Successful Outcome.

Discussions
Study findings underscore the importance of tailored approaches to male infertility care. Healthcare providers should prioritize personalized, stress-free environments for male infertility patients and encourage effective communication and joint participation with partners to achieve successful outcomes. Tailored approaches and therapeutic settings should be created to cater to male patients’ unique needs.
Mechanical Thromboprophylaxis and Hospital-Acquired Venous Thromboembolism Among Critically Ill Adolescents: A U.S. Pediatric Health Information Systems Registry Study, 2016–2023
Authors: Betensky Marisol , Vallabhaneni Nikhil , Goldenberg Neil A. , Sochet Anthony A. 
Published: August 2024

OBJECTIVES:
To estimate the rate of mechanical thromboprophylaxis (mTP) prescription among critically ill adolescents using a multicenter administrative database and determine whether mTP prescription is inversely associated with hospital-acquired venous thromboembolism.

DESIGN:
Multicenter, observational, retrospective study of the Pediatric Health Information Systems (PHIS) Registry cohort, January 2016 to December 2023.

SETTING:
Thirty PICUs located within quaternary pediatric referral centers in the United States.

PATIENTS:
Critically ill children 12–17 years old, excluding encounters with a principal diagnosis at admission of venous thromboembolism.

INTERVENTIONS:
mTP prescription within the first 24 hours of hospitalization.

MEASUREMENTS AND MAIN RESULTS:
A total of 107,804 children met the study criteria, of which 21,124 (19.6%) were prescribed mTP. Hospital center prescribing rates ranged from 1.4% to 65.4% and decreased by 1.6% per year from 28.2% in 2016 to 17.1% in 2023. As compared with those without mTP, those with mTP more frequently had a concurrent central venous catheter (17.2% vs. 9.4%, p < 0.001), underwent invasive mechanical ventilation (37.4% vs. 24.8%, p < 0.001), were admitted for a primary surgical indication (30.9% vs. 12.7%, p < 0.001), and experienced a longer median duration of hospitalization (7 [interquartile range (IQR): 4–15] vs. 4 [IQR: 2–9] d, p < 0.001). Hospital-acquired venous thromboembolism occurred in 2.7% of the study sample and was more common among those with, as compared with without, prescription of mTP (4% vs. 2.4%, p < 0.001). In multivariable logistic regression models for hospital-acquired venous thromboembolism adjusting for salient prothrombotic risk factors, we failed to identify an association between mTP and greater odds of hospital-acquired venous thromboembolism (HA-VTE) among low-, moderate-, and high-risk tiers. However, we cannot exclude the possibility of 17–50% greater odds of HA-VTE in this population.

CONCLUSIONS:
In the multicenter PHIS cohort, 2016–2023, the prescribing patterns for mTP among critically ill adolescents showed a low rate of mTP prescription (19.6%) that varied widely across institutions, decreased annually over the study period by 1.6%/year, and was not independently associated with HA-VTE risk reduction.
Ten-Year Follow-Up of Lower Limb Replantation
Authors: Zor Fatih , Tekin Levent , Bayram Yalcin , Kulahci Yalcin 
Published: August 2024

Abstract
The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.