bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid Ventricular Pacing for Clipping of Intracranial Aneurysms: A Single-centre Retrospective Case Series
Authors: Ragulojan Malavan , Krolczyk Gregory , Al Aufi Safa , Wang Alick P. , McIsaac Daniel I. , Hicks Shawn , Sinclair John , Budiansky Adele S. 
Published: August 2024

Objective:
Multiple strategies exist to facilitate microdissection and obliteration of intracranial aneurysms during microsurgical clipping. Rapid ventricular pacing (RVP) can be used to induce controlled transient hypotension to facilitate aneurysm manipulation. We report the indications and outcomes of intraoperative RVP for clipping of ruptured and unruptured complex aneurysms.

Methods:
We completed a retrospective review of adult patients who underwent RVP-facilitated elective and emergent microsurgical aneurysm clipping by a single senior neurosurgeon between 2016 and 2023. Intraoperative RVP was performed at a rate of 150 to 200 beats per minute through a transvenous pacing wire and repeated as needed based on surgical requirements. Intraoperative procedural and pacing data and perioperative cardiac and neurosurgical variables were collected.

Results:
Forty patients were included in this study. The median (interquartile range) number of pacing episodes per patient was 8 (5 to 14), resulting in a median mean arterial pressure of 37 (30 to 40) mm Hg during RVP. One patient developed wide complex tachycardia intraoperatively, which resolved after cardioversion. Fifteen out of 36 (42%) patients who had postoperative troponin measurements had at least one troponin value above the 99th percentile upper reference limit. One patient had markedly elevated troponin with anterolateral ischemia in the context of massive postoperative intracranial hemorrhage. There were no other documented intraoperative or postoperative cardiac events.

Conclusions:
This retrospective case series suggests that RVP could be an effective adjunct for clipping of complex ruptured and unruptured aneurysms, associated with transient troponin rise but rare postoperative cardiac complications.
Transphyseal Hemiepiphysiodesis: Is it Truly Reversible?
Authors: Abdelaziz Tarek Hassan , Ghaly Nabil , Fayyad Tamer A. , Elbeshry Shady Samir , Gendy Poula Gad 
Published: August 2024

Background:
Although numerous studies reported the efficacy of percutaneous epiphysiodesis using transphyseal screws (PETS) in correcting angular knee deformities, many surgeons refrained from using it in younger children because of a lack of objective evidence of reversibility. Our hypothesis is that PETS is both truly reversible and effective.

Methods:
Twenty-one patients aged 8 to 13 years (36 lower limbs LL) with coronal plane knee deformity were enrolled into this prospective case series from January 2021 to September 2023. Besides the routine monitoring of PETS efficacy, low dose CT knee of 32 treated physes was done 6 months after screw removal. In addition, lower limb length, mechanical lateral distal femur angle (mLDFA), and medial proximal tibial angle (MPTA) were recorded preoperatively and 6 to 17 months after screw removal for 24 LL to investigate physis behavior, technique reversibility, and resumption of bone growth after screw removal.

Results:
The mean mechanical axis deviation (MAD) correction rate was 3.46 mm/mo and 1.78 mm/mo for genu valgum and genu varum patients, respectively. No physeal bony bars could be detected 6 months after screw removal for all patients. Out of 24 physis that underwent computerized radiography (CR) of the whole lower limb, 12 LL resumed their growth, 4 were stationary, while 8 were excluded due to inadequate calibration. A single physis showed rebound deformity, and another showed overcorrection in the genu valgum group.

Conclusions:
In addition to being a highly effective method of hemiepiphysiodesis, PETS was found to be reproducible, safe, and reversible when used in the juvenile and early adolescent pediatric population.

Level of Evidence:
IV—Prospective case series.
Surgically Treated Ischial Tuberosity Avulsion Fractures in Adolescents: Risks and Outcomes of 3 Fixation Constructs
Authors: Williams Brendan A. , Titus Matthew , Chaclas Nathan , Cardin Stefano , Wells Lawrence , Maguire Kathleen J. , Lawrence J. Todd 
Published: August 2024

Introduction:
Avulsion fractures of the ischial tuberosity (AFIT) are uncommon injuries that sometimes require operative fixation with screws, suture anchors, or cortical suspensory buttons. This study reviewed a series of surgically managed AFITs at a single institution and compared outcomes among fixation strategies. We hypothesized there would be no difference in outcomes between fixation types.

Methods:
We conducted a retrospective review of all patients treated operatively at a single institution from 2010 to 2022 for AFIT identified by CPT code (27215). We collected patient demographics, injury characteristics, Revised Modified Oxford Bone Score, radiographic measures, fracture classification (type 1—lateral vs. type 2—complete), surgical fixation technique, postoperative complications (Modified Clavien-Dindo-Sink [M-CDS] Complication Classification), and time to return to sport (RTS). Descriptive statistics and univariate analyses were performed.

Results:
Study criteria identified 16 patients with surgically treated AFITs during the study period. Patients were predominantly male (88%) with a mean age of 14.8±0.8 years. Injured patients most commonly participated in soccer (38%), with the most common mechanism of injury being running/sprinting (50%). The avulsed fracture fragments were a mean of 42.6 mm in size, with an average maximal displacement of 21.1 mm and predominantly type 1—lateral (75%). Surgical constructs included: screws (4), suture anchors (5), cortical suspensory buttons (6), and combined (1, screw and suture anchor). Postoperative complications occurred in 8 patients (50%) including 7 type 1 and 1 type 3 M-CDS. No statistically significant difference was found between fixation types among the studied outcome variables; however, re-fracture (1 case [M-CDS type 3]) was only observed with a combined (screw and suture anchor) construct.

Conclusions:
This retrospective cohort study demonstrated that postoperative complications after ORIF for AFIT were not infrequent but were largely low in severity. Refracture occurred only with a combined screw and suture anchor construct. Consistent return to sport was achieved across all fixation types, with no significant difference in complication rate between constructs, although the available study sample limited robust analysis. This study is also, of note, one of the first to report outcomes from cortical suspensory buttons (CSB)—a relatively novel intervention for AFIT. Findings from this retrospective case series of multiple surgical techniques serve to bolster the limited literature base regarding the operative treatment of AFITs in adolescents.
Outcomes following two-level Cervical Disc Arthroplasty Relative to two-level Anterior Cervical Discectomy
Authors: Ratnasamy Philip P. , Gouzoulis Michael J. , Jabbouri Sahir S. , Varthi Arya G. , Grauer Jonathan N. 
Published: August 2024

Study Design.
Retrospective cohort study

Objective.
To evaluate postoperative adverse events, readmissions, and five-year survival to reoperation for two-level cervical disc arthroplasty (CDA) relative to two-level anterior cervical discectomy and fusion (ACDF).

Background.
CDA and ACDF are both treatment options for degenerative cervical spine pathology. Relative to ACDF, CDA is a relatively novel treatment option, and limited research exists comparing outcomes between two-level CDA and two-level ACDF.

Methods.
Patients undergoing two-level CDA or two-level ACDF were isolated from the PearlDiver M165Ortho database. These two cohorts were matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores. The odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis. Overall cost-of-care for the first 90-days postoperatively, and five-year survival to cervical spine reoperation were then assessed.

Results.
Of the two-level cases identified, only 3.9% had CDA and the rest had ACDF. After matching, there were 4,224 patients in each of the study groups. With controlling for patient age, sex, and ECI on multivariable analysis, two-level CDA patients had significantly lower odds of experiencing 90-day dysphagia (OR 0.60, P<0.0001 driving aggregated any adverse event [OR 0.65, P<0.0001]) and readmission (OR 0.69, P=0.0002). Median 90-day cost of care was greater for two-level ACDF patients ($4,776.00 vs. $3,191.00, P<0.0001). No significant difference in five-year survival to cervical spine reoperation was identified (P=0.7).

Conclusions.
Relative to two-level ACDF patients, two-level CDA patients were found to have significantly lower odds of 90-day readmissions and minor adverse events (dysphagia), while rates of major adverse events (pulmonary embolism, deep vein thrombosis, sepsis, etc.) were comparable between the groups. Further CDA patients had lower cost of overall care, but no difference in five-year survival to cervical spine reoperation. Thus, it may be appropriate to further consider CDA when two-level surgery is pursued.
Practice variations in the surgical treatment of small bowel obstruction in Quebec
Authors: Rancourt Maude , Rioux Antoine , Cheng Oviedo Sonia G. , McFadden Nathalie 
Published: August 2024

Background:
Small bowel obstruction (SBO) is a common emergency and selectively requires surgical management. There is growing evidence supporting the use of laparoscopic surgery (LS) compared to open surgery for SBO.

Methods:
An online survey-based cohort study examining surgeon characteristics, patient factors, and clinical situations that impact decision making regarding the use of LS for SBO was sent to the 538 members of the Association Québécoise de Chirurgie and their answers were collected over a 4-month period in 2019.

Results:
The response rate was 27.1% (n=146). The gender, sex or the practice setting did not have an impact on the surgical approach. It was noted that surgeons who were more comfortable with laparoscopy used it more often (P=0.002). The three factors favoring the initial approach by laparotomy were most frequently cited: hostile abdomen, severe abdominal distension, and hemodynamic instability. Young surgeons had more homogenous answers (P=0.03). The surgeons having a practice oriented into LS had different decision criteria compared to those doing more open surgery.

Conclusion:
This article emphasizes key clinical scenarios and determinants that shape the surgical strategy for SBO treatment. The authors aim for this research to stimulate more discussions and contemplation about using laparoscopic methods for treating SBO in certain patients, thereby potentially elevating the frequency of surgeons adopting this approach. Moreover, considering the existing literature supports LS as a viable and safe method for SBO treatment, and noting the enhanced outcomes for patients, it becomes increasingly vital to advocate for this conversation.
Safety and Patient Experience With Early Mobilization After Transcatheter Aortic Valve Implantation
Authors: Kirk Bettina Højberg , Nørgaard Marianne Wetendorff , Palm Pernille , Norekvål Tone Merete , De Backer Ole 
Published: August 2024

Background
Immobilization after transcatheter aortic valve replacement (TAVR) is the standard treatment for preventing access-related complications. However, the length of bed rest varies, and possible complications and patient experience remain unexplored.

Objective
In this pilot study, our aim was to investigate safety and efficacy after bed rest after TAVR.

Methods
This single-center randomized trial included 298 patients. Patients were randomized to standard 6 hours (n = 149) or 3 hours (n = 149) of bed rest after TAVR. The primary safety endpoint was a composite of access-related bleeding (Bleeding Academic Research Consortium type ≥ 2), hematoma (>5 cm), pseudoaneurysm, and vascular complications requiring intervention. The primary efficacy endpoint was patient-reported back pain, rated ≥6 on a numeric rating scale 24 hours post procedure. The secondary endpoints were the individual components of the primary safety endpoint, patient-reported pain, urination problems, and comfort.

Results
The primary safety endpoint occurred in 14 (9.4%) and 12 (8.1%) patients in the 6-hour and 3-hour immobilization groups, respectively (risk ratio, 0.86 [95% confidence interval, 0.41–1.79]; P = .68). There were no significant differences in individual bleeding or vascular complication endpoints. Patients with 3 hours of bed rest reported less back pain (P < .001), fewer urination problems (P < .001), and better comfort (P < .001) than patients with 6 hours of bed rest.

Conclusions
Mobilization as early as 3 hours after TAVR was shown to be safe, not resulting in a higher rate of bleeding or vascular complications as compared with 6 hours of bed rest. However, there was a difference in patient-reported back pain, urination problems, and comfort, favoring early mobilization.
Physician Associate/Assistant Program Medical Directors Are Important Advocates for the Physician Associate/Assistant Profession: Results From a National Pilot Study
Authors: Bouton Marcia , Wild Jennifer , Bolch Charlotte , Mitzel Katherine , Zhou Tian 
Published: August 2024

Introduction
This pilot study aimed to evaluate whether and how physician associate/assistant (PA) program medical directors play a role in advocating on behalf of PAs and what factors correlate with this.

Methods
The study used a mixed-methods grounded theory approach and was deemed institutional review board exempt. After literature review, a survey was developed and piloted by study personnel and faculty to affirm validity. Recruits with known email addresses were sent a link to a survey that included demographic information and 10 Likert scale questions. There were 69 respondents, and the response rate was 26%. Fisher's exact test and analysis of variance were performed using the R program. A P-value <.05 indicated significance. Thematic analysis of qualitative data was performed using ChatGPT, followed by iterative analysis by the research team. Consensus was achieved for each response.

Results
Most of the respondents had the following characteristics: MD degree, male, White, practicing clinically, and worked as PA medical directors 8 to 12 hours per week. Participants did not support PA title change, nor had they engaged in legislative efforts to support optimal team practice. Participants were strong PA advocates by promoting PA leadership positions, PA employment, improved attitudes in health care organizations toward PAs, and securing clinical rotations. Many respondents (41%) felt that none of their professional organizations supported them in their role as PA program medical director.

Discussion
Exploring ways to support continued advocacy by our valued PA program medical directors within PA professional organizations could be advantageous to PA program medical directors' professional growth and the PA profession.
A Systematic Review of Interventions Targeting Cancer-Related Financial Hardship: Current Evidence and Implications
Authors: Jia Shumin , Cheung Denise Shuk Ting , Ho Mu-Hsing , Takemura Naomi , Feng Yongshen , Lin Chia-Chin 
Published: August 2024

Background
Despite an increasing emphasis on alleviating financial hardship in cancer care delivery, limited knowledge of evidence-based and effective interventions is available.

Objective
This systematic review aimed to identify gaps in the literature and provide insights for future evidence-based interventions targeting financial hardship from both micro and macro perspectives.

Methods
We comprehensively searched the PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and PsycINFO databases from inception to October 2022. Studies examining the effect of an intervention on mitigating cancer-related financial hardship were included.

Results
A total of 24 studies were included. Findings indicate that the most significant positive changes were in the material conditions domain from the micro perspective of financial hardship. From the macro perspective, positive effects were shown for improving access to care, affordability of care, healthcare utilization, and healthcare equity of interventions at the provider or care team level, the community healthcare environment level, and the healthcare system and policy level. Notably, significant heterogeneity was observed among interventions and outcome measurements.

Conclusions
This is the first comprehensive systematic review of interventions targeting cancer-related financial hardship from both micro and macro perspectives. No consistently positive effect of the interventions on all domains was reported. Multidisciplinary approaches and higher-level hierarchical and evidence-based interventions are needed to address financial hardship.

Implications for practice
Health practitioners should screen and manage financial hardship using a standard and comprehensive measurement at the dyadic level of cancer survivors and caregivers.
Association Between Dyadic Coping and Psychosocial Adjustment and the Mediation Effect of Fear of Disease Progression in Patients With Malignancy and Their Caregivers: Based on the Actor-Partner Interdependence Model
Authors: Ma Hualong , He Yongyue , Wu Weixin , Ye Qiuyun , Wu Qinyang , Hu Ke , Jiang Xiaohao , Tang Lu , Yang Qiaohong 
Published: August 2024

BackgroundPsychosocial adjustment (PSA) in patients exhibits a positive correlation with dyadic coping (DC) and a negative correlation with fear of disease progression (FoP). However, few studies have explored how DC impacts PSA and whether FoP mediates this relationship.ObjectiveTo investigate the status of DC, FoP, and PSA in patients with malignancy and their caregivers and to explore the actor-partner and mediating effect of FoP on the association between PSA and DC.MethodsThis study employed a cross-sectional design with convenience sampling to select patients with malignancy and their caregivers from 2 hospitals in China. SPSS and AMOS were used for data analysis.ResultsThe model showed the mediation effect accounts for 28.30% of the total effect. For the actor effects, patients’ and their caregivers’ DC influenced their PSA directly (bothβ= −.138,P <.05) or through their FoP (β =−.050 andβ= −.55, bothP <.05). As for partner effects, patients’ DC influenced the caregivers’ PSA directly or through the patients’ FoP (β= −.118 andβ= −.020, bothP <.05). Caregivers’ DC also influenced patients’ PSA directly (β= −.118,P <.05) or through the patients’ or caregivers’ FoP (β= −.098 andβ= −.018, bothP <.05).ConclusionsThe model revealed a significant mediating effect of FoP on the association between the PSA and DC of patients with malignancy and their caregivers.Implications for practiceNurses should adopt a comprehensive perspective that includes caregivers in holistic care to improve their PSA by improving their level of DC or mitigating FoP.
Foreseeably Early Deaths in Patients With Psychiatric Disorders
Authors: Yager Joel , Treem Jonathan , Strouse Thomas B. 
Published: August 2024

Abstract
Patients with psychiatric disorders often have foreshortened lives, attributed both to “natural” medical and “unnatural” external causes of death such as suicide, homicide, and accident. Many deaths are foreseeable due to circumstances linked to patients' psychiatric disorders. These can include illness-associated disparities, adverse treatment effects, lack of self-care, and behaviors stemming directly from psychopathological processes. Whereas some of these processes contribute indirectly to patients' causes of death, others are more directly consequential, causing patients to “die from” their psychiatric disorders. Some patients manifest likely fatal trajectories that may lead to “end-stage” psychiatric disorders. Palliative approaches may optimize their quality of life and potentially alter these trajectories, but patients with psychiatric disorders are less likely to receive optimal end-of-life care. Although assuring a “good death” can be challenging, systematic efforts can assist in providing patients with psychiatric disorders deaths with dignity rather than indignity.
The Role of Object Relations in the Physician-Patient Relationship in a Primary Care Setting
Authors: Porcerelli John H. , Richardson Laura A. , Huprich Steven K. 
Published: August 2024

Abstract
A good physician-patient relationship is essential for the delivery of quality health care and is associated with better health outcomes. This study explored the association between patients' object relations and the physician-patient relationship. Primary care patients (n = 72) and physicians (n = 21) participated in the study. Patients' early memories were obtained prior to their medical visit and were coded with the Social Cognition and Object Relations–Global Method (SCORS-G). Patients and physicians independently rated the quality of the physician-patient encounter. Results indicated that object relations (SCORS-G Cognitive-structural and Self factors) incrementally predicted physician-patient relationship ratings, as rated by the patient, above and beyond psychological distress, somatization, and level of physician training. Patient education, psychological distress, and level of physician training predicted physician ratings of the medical encounter. The authors discuss the discrepancy between physician and patient ratings as they relate to patients' object relations.
The Resurgence of Exogenous Psychosis
Authors: Ricci Valerio , Maina Giuseppe , Di Petta Gilberto , Martinotti Giovanni 
Published: August 2024

Abstract
The psychopathological manifestations associated with substance use, including induced psychotic experiences, are increasingly relevant but not well-understood within the medical community. Novel psychoactive substances and potentiated old compounds like cannabis and cocaine have emerged as a global concern, especially among adolescents and young adults. Transition rates from substance-induced psychosis (SIP) to persistent psychosis are significant, particularly in cases of cannabis-induced psychosis. Scientific inquiry into induced psychotic phenomena has revealed differences between SIP and primary psychotic disorders, highlighting the risk factors associated with each. The concept of exogenous psychosis, including its toxic variant known as lysergic psychoma, provides valuable insights into the role of external factors in psychosis development. A phenomenological approach characterizes this disruption in perception as a shift in temporal and spatial dimensions, leading to auditory and visual hallucinations. The “twilight state” of consciousness plays a crucial role in the transition from substance use to psychosis, with implications for spatiality, intersubjectivity, and temporality. This complex path to psychosis challenges traditional diagnostic models and underscores the need for a more nuanced understanding of substance-induced psychopathological experiences.