bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of the IASP Grading System to Identify Underlying Pain Mechanisms in Patients With Knee Osteoarthritis
Authors: Vervullens Sophie , Meert Lotte , Meeus Mira , Heusdens Christiaan H.W. , Verdonk Peter , Foubert Anthe , Abatih Emmanuel , Durnez Lies , Verbrugghe Jonas , Smeets Rob J.E.M. 
Published: July 2024

Objectives:
This study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a “probable” versus “no or possible” nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response.

Methods:
A secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed.

Results:
Thirty (15.22%—approach 4 pain locations) and 46 (23.35%–approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group.

Discussion:
This study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.
Clinical Presentation and Outcomes of Diabetic Ketoacidosis in Pregnancy
Authors: Grasch Jennifer L. , Lammers Sydney , Scaglia Drusini Florencia , Vickery Selina S. , Venkatesh Kartik K. , Thung Stephen , McKiever Monique E. , Landon Mark B. , Gabbe Steven 
Published: July 2024

OBJECTIVE:
To examine the presentation, management, and outcomes of pregnancies complicated by diabetic ketoacidosis (DKA) in a contemporary obstetric population.

METHODS:
This is a case series of all admissions for DKA during pregnancy at a single Midwestern academic medical center over a 10-year period. Diabetic ketoacidosis was defined per the following diagnostic criteria: anion gap more than 12 mEq/L, pH less than 7.30 or bicarbonate less than 15 mEq/L, and elevated serum or urine ketones. Demographic information, clinical characteristics, and maternal and neonatal outcomes were assessed. Patient characteristics and clinical outcomes were compared between individuals with type 1 and those with type 2 diabetes mellitus.

RESULTS:
Between 2012 and 2021, there were 129 admissions for DKA in 103 pregnancies in 97 individuals. Most individuals (n=75, 77.3%) admitted for DKA during pregnancy had type 1 diabetes. The majority of admissions occurred in the third trimester (median gestational age 29 3/7 weeks). The most common precipitating factors were vomiting or gastrointestinal illness (38.0%), infection (25.6%), and insulin nonadherence (20.9%). Median glucose on admission was 252 mg/dL (interquartile range 181–343 mg/dL), and 21 patients (17.6%) were admitted with euglycemic DKA. Fifteen admissions (11.6%) were to the intensive care unit. Pregnancy loss was diagnosed during admission in six individuals (6.3%, 95% CI, 2.3–13.7%). Among pregnant individuals with at least one admission for DKA, the median gestational age at delivery was 34 6/7 weeks (interquartile range 33 2/7–36 3/7 weeks). Most neonates (85.7%, 95% CI, 76.8–92.2%) were admitted to the neonatal intensive care unit and required treatment for hypoglycemia. The cesarean delivery rate was 71.9%. Despite similar hemoglobin A1C values before pregnancy and at admission, individuals with type 1 diabetes had higher serum glucose (median [interquartile range], 256 mg/dL [181–353 mg/dL] vs 216 mg/dL [136–258 mg/dL], P=.04) and higher serum ketones (3.78 mg/dL [2.13–5.50 mg/dL] vs 2.56 mg/dL [0.81–4.69 mg/dL] mg/dL, P=.03) on admission compared with those with type 2 diabetes. Individuals with type 2 diabetes required intravenous insulin therapy for a longer duration (55 hours [29.5–91.5 hours] vs 27 hours [19–38 hours], P=.004) and were hospitalized longer (5 days [4–9 days] vs 4 days [3–6 days], P=.004).

CONCLUSION:
Diabetic ketoacidosis occurred predominantly in pregnancies affected by type 1 diabetes. Individuals with type 1 diabetes presented with greater DKA severity but achieved clinical resolution more rapidly than those with type 2 diabetes. These results may provide a starting point for the development of interventions to decrease maternal and neonatal morbidity related to DKA in the modern obstetric population.
Visual Mapping of Operating Theater Team Dynamics and Communication for Reflexive Feedback and Surgical Practice Optimization
Authors: Surendran Surya , Bonaconsa Candice , Nampoothiri Vrinda , Mbamalu Oluchi , George Anu , Mallick Swetha , OV Sudheer , Holmes Alison , Mendelson Marc , Singh Sanjeev , Birgand Gabriel , Charani Esmita 
Published: July 2024

Background:
Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices.

Methods:
Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics.

Results:
Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data.

Conclusions:
Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.
Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging
Authors: Kelso Martha R. , Jaros Mark 
Published: July 2024

ABSTRACT

BACKGROUND
High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs).

OBJECTIVE
To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs.

METHODS
In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging.

RESULTS
Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (−4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced.

CONCLUSIONS
Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.
Enoxaparin and Early Postoperative Tibial Nailing: Increased Nonunion Revision Rates
Authors: Lindsay Sarah E. , Working Zachary M. , Friess Darin , Smith Spencer , Yoo Jung 
Published: July 2024

OBJECTIVES:
To determine the association between postoperative enoxaparin use and the risk of requiring surgery for nonunion in patients treated with intramedullary nailing for midshaft fractures of the tibia.

METHODS:

Design:
Retrospective cohort analysis.

Setting:
Data were sourced from the PearlDiver national database.

Patient Selection Criteria:
Patients were identified through the PearlDiver database by using Current Procedural Terminology and International Classification of Diseases (ICD-10) codes. Included patients had undergone intramedullary nailing for midshaft fractures of the tibia between 2015 and 2020 and subsequently underwent revision surgery due to nonunion.

Outcome Measures and Comparisons:
The primary outcome measured in this study was the rate of nonunion following intramedullary nailing for the different types of tibial shaft fractures (closed, Type I/II open, Type III open). For each fracture subtype, the study compared nonunion rates between those who received enoxaparin in the postoperative period and those who did not receive enoxaparin at any time during the first 6 weeks postoperatively. Factors such as the timing and duration of enoxaparin therapy and demographic variables were also considered.

RESULTS:
The study included 16,986 patients, average age was 49.2 years (SD 17.3); 43.1% were female. Five hundred four patients required revision surgery for nonunion (3.4%). Among patients who did not receive enoxaparin, the nonunion rates were 1.6%, 3.9%, and 6.9% for closed, Type I/II open, and Type III open fractures, respectively. For patients who received enoxaparin within the first 2 weeks, the nonunion rates were 2.6%, 4.7%, and 7.9% for closed (RR = 1.67, P < 0.0001), Type I/II open (RR = 1.21, P < 0.0001), and Type III open (RR = 1.17, P = 0.355) fractures, respectively. Logistic regression confirmed enoxaparin was independently associated with nonunion (odds ratios [OR] = 1.75, P = 0.0013 for closed fractures; OR = 1.51, P = 0.034 for Type I/II open fractures). Tobacco use was also a contributing factor (OR = 2.43, P < 0.0001 for closed fractures; OR = 2.00, P < 0.0001 for Type I/II open fractures; OR = 2.04, P = 0.0008 for Type III open fractures).

CONCLUSIONS:
The postoperative use of enoxaparin was associated with an elevated risk of nonunion in patients treated with intramedullary nailing for fractures of the tibial shaft.

LEVEL OF EVIDENCE:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Stanford Network for Advancement and Promotion: The impact of a community building-focused leadership development program on the success of underrepresented groups in academic medicine
Authors: Fassiotto Magali , Jerome Barbara , Stefanac Lisa , Oaiya Osagie , Quihuis Gisell , Maldonado Yvonne , Harris Odette 
Published: July 2024

Background
Leadership can be an isolating experience and leaders from underrepresented groups (URGs) may experience even greater isolation and vulnerability because of lack of representation. Given the collaborative nature of medicine, leadership programs for physicians need to address isolation. Social support is one mechanism to combat this isolation; however, most leadership programs focus exclusively on skills building.

Purpose
The Stanford Network for Advancement and Promotion (SNAP) program was developed to reduce isolation among physician leaders from URGs in academic medicine leadership by building a supportive network of peers.

Methodology/Approach
Ten women physicians from diverse racial/ethnic backgrounds were invited to participate in SNAP. Annual surveys were administered to participants to assess the effectiveness of SNAP on decreasing feelings of isolation and increasing professional leadership growth. The authors charted the expansion and adaptation of the program model across gender and in additional settings.

Results
SNAP effectively created a sense of community among the physician leaders. Participants also reported feeling challenged by the program and that they had grown in terms of critical thinking, organizational knowledge, and empowerment as leaders. Participants found community building to be the most valuable program component. Because of this success, the SNAP model has been adapted to create 10 additional cohorts.

Conclusion
Leadership programs like SNAP that focus on reducing isolation are instrumental for retaining and promoting the career advancement of physicians from URGs.

Practice Implications
Developing a diverse workforce of academic physicians is essential to providing high-quality and equitable clinical care, research, and medical education.
Selective Laser Trabeculoplasty Versus Medical Therapy for the Treatment of Open Angle Glaucoma or Ocular Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Chavez Matheus Pedrotti , Guedes Guilherme Barroso , Pasqualotto Eric , Lopes Lucca Moreira , Ferreira Rafael Oliva Morgado , de Souza Eduardo Soares Maia Vieira , de Souza Tiago Tomaz 
Published: July 2024

Précis:
Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects.

Purpose:
To evaluate the efficacy and safety of SLT compared with medical therapy in the treatment of open angle glaucoma (OAG) or ocular hypertension (OHT).

Methods:
A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I
2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group.

Results:
Fourteen RCTs comprising 1706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects.

Conclusions:
SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT.
Prevalence and Predictors of Tuberculosis Infection in Children and Adolescents in Rural Uganda: A Cross-sectional Study
Authors: Kakande Elijah , Ssekyanzi Bob , Abbott Rachel , Ariho Willington , Nattabi Gloria , Landsiedel Kirsten , Temple Jennifer , Chamie Gabriel , Havlir Diane V. , Kamya Moses R. , Charlebois Edwin D. , Balzer Laura B. , Marquez Carina 
Published: July 2024

Background:
Much of the latent tuberculosis (TB) reservoir is established in childhood and adolescence. Yet, age-specific data on prevalence and predictors of infection in this population are sparse and needed to guide prevention and case finding.

Methods:
From December 2021 to June 2023, we measured TB infection in children 1–17 years in 25 villages in rural Southwestern Uganda. We defined TB infection as a positive QuantiFERON Gold Plus Test (QFT). We estimated overall and age-stratified population-level prevalence and adjusted risk ratios (aRR) of TB infection for individual, household, and community-based predictors, accounting for age, TB contact, and clustering by household.

Results:
Estimated TB infection prevalence was 9.6% [95% confidence interval (CI): 8.7–10.5%] among the 5789 participants, and prevalence varied slightly with age. Household-level risk factors included crowding (aRR: 1.25, 95% CI: 1.03–1.53), indoor cooking (aRR: 1.62, 95% CI: 1.14–2.30), living with ≥2 persons who drink alcohol (aRR: 1.47, 95% CI: 1.04–2.07). The predominant community-based risk factor was child mobility (aRR: 1.67, 95% CI: 1.24–2.26). In age-stratified analyses, household predictors were important in early childhood but not adolescence, where mobility was predominant (aRR: 1.66, 95% CI: 1.13–2.44).

Conclusion:
We detected a high prevalence of TB infection in children and adolescents in rural Uganda. On a population level, TB risk factors change throughout the early life course, with child mobility a key risk factor in adolescence. Age-specific TB case finding and prevention strategies that address both household and extra-household risk factors are needed to address TB transmission.
Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection
Authors: Li Chia-Ju , Lee Pei-Chang , Huang Kuo-Wei , Huang Kuan-Jung , Chang Tien-En , Chang Ching-Chih , Wang Shin-E. , Shyr Yi-Ming , Li Chung-Pin , Luo Jiing-Chyuang , Hou Ming-Chih 
Published: July 2024

Background:
Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection.

Methods:
From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed.

Results:
PNI decreased in patients after SR for SBA (median change: −1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001).

Conclusion:
PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.
Prevalence, Bother, and Risk Factors Associated With Occurrence of Pelvic Floor Dysfunctions in Young Women: A Cross-Sectional Survey
Authors: Campos Natália Cardoso , de Carvalho Gabriela Martins , Santos Rafaela Aparecida de , Oliveira Rafael Dias de Brito , Sunemi Mariana Maia de Oliveira , Figueiredo Elyonara Mello 
Published: July 2024

Purpose:
Pelvic floor dysfunctions (PFD) have been increasingly reported in young female athletes, but it is likely that young women, not specific to athletes, might also experience symptoms of PFD. This study investigated the occurrence of PFD symptoms in young women from the general population, their degree of bother and functional and clinical factors associated with these occurrences.

Methods:
Online survey was conducted with young women from the general population, not specific to athletes. Sociodemographic and clinical data, symptoms of urinary (UI) and anal incontinence (AI), pelvic organ prolapse, dyspareunia, chronic pelvic pain, and functional constipation, as well as their degree of bother were collected using validated questionnaires. Fisher exact and χ2 tests, Student t tests, and logistic regression models were applied (α = .05).

Results:
A total of 337 women aged 18 to 25 years were investigated. The overall occurrence of PFD was 60.0%. Dyspareunia was the most prevalent symptom (49.2%), followed by UI (44.2%) and constipation (21.7%). Higher degree of bother was reported for UI, AI, and chronic pelvic pain, respectively. Constipation (P < .001) and anxiety (P = .004) were associated with occurrence of PFD, increasing the chances of PFD by 4 and 2 times, respectively.

Discussion:
The high occurrence, co-occurrence, and bother of PFD in young women suggest impairments in pelvic floor muscle functions that should be investigated by physical therapists. Educational programs including preventive strategies and the role of physical therapists in the treatment of PFD should be provided from early ages.