bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using value-focused thinking to elicit oncologic inpatients’ life and treatment objectives: a qualitative interview study
Authors: Fenkart Lukas , von Nitzsch Rüdiger , Höggemann Esther , Spreckelsen Cord 
Published: July 2024

Objective Value-focused thinking (VFT) is a decision-making method that places the qualitative elicitation of decisionmakers’ objectives at the beginning of the decision-making process. A potential healthcare application of VFT is to elicit patients’ objectives to better understand what matters to them. Only then can treatments be tailored accordingly. This is particularly important for patients with life-threatening diseases such as cancer. Thus, this interview study used VFT to elicit the life and treatment objectives of non-terminal oncologic inpatients. Methods Fifteen cancer inpatients (median age 66 years) were sampled in a German university hospital in September 2019. The participants completed questionnaires, the data of which were used to semi-structure the subsequent interviews. Data were analysed using inductive category formation to identify objectives in the transcribed interviews. Results Sixteen objectives in five life domains (optimising physical wellbeing, optimising mental wellbeing, optimising personal life, optimising family life and optimising financial life) were identified. Conclusion Comparison of the findings with previous research indicated that VFT is a reliable approach to elicit patients’ objectives. The identified objectives could increase understanding of the outcomes that cancer inpatients care about.
Crescent Mastopexy With Augmentation and Hemi-Interlocking Circumareolar Mersilene Suture: An Innovative Approach
Authors: Elfieshawy Hatem 
Published: July 2024

Introduction: Safety and patient satisfaction of crescent mastopexy and concurrent primary or revisional augmentation mammoplasty is controversial owing to secondary asymmetry and potential complications involving breast tissue and the nipple-areolar complex (NAC). The primary objective of this case series was to present a new technique that can achieve anatomic integrity and natural morphology of the NAC, while avoiding complications and minimizing scarring and hypertrophic alterations. Materials and Methods: Using white nonabsorbable 3-0 polyester mersilene suture for tension-free closure, the procedure was completed via intradermal insertion of the needleless end of the suture into the circumareolar NAC-skin junction at the inferior segment and an interlocking purse-string or spoke-wheel configuration in the superior segment, juxtaposing the NAC and cutaneous margin, thereby redistributing the tension line from the crescent scar to a circumareolar, cranially repositioned site. Patients were followed at 24 hours, 1, 3, 6, and 12 weeks, and 6 and 12 months. Postoperative pain was patient-measured using the Visual Analog Scale (possible scores ranged from 0 to 10), and esthetic satisfaction was determined by patient surveys (scores 0-5). Follow-up visits involved evaluation of scars, nipple sensation, nipple-areolar perfusion by capillary refill, asymmetry, and hypertrophic and pigmentation changes. Results: Six patients (ages 32-46) underwent 2 primary procedures and 4 revisions between January 2020 and March 2023 and were chosen retrospectively based on inclusion and exclusion criteria. One revision was completed using the traditional method while the rest were completed with the new technique. Surgical times ranged from 15:34 to 17:35 minutes, with patients reporting minimal initial and postoperative pain, high patient satisfaction, and reduced scar visibility. All patients reported postoperative pain assessments as negligible initial pain on days 0 to 3 (0) and 1 to 2 on days 4 to 7, with 1 patient scoring pain as 2 to 3. Scar visibility was minimal (<0.5 mm), although 1 patient experienced 1.5 mm at 12 months. Shape of the NAC was maintained in all cases at 6 months, with 1 patient evolving to oval shape at 12 months. Patient satisfaction was scored at 4 and 5 at 6 and 12 months. No complications, scarring, or alterations in NAC shape or position were noted. Conclusion: This technique avoided resection of the mammary gland, achieved minimal tension and thereby preserved the crescent scar, corrected preoperative asymmetry and mild ptosis, proved superior aesthetic enhancement, and reduced complications compared with traditional methods. These promising results warrant further evaluation in a larger cohort.
Clinical Outcomes for Arthroscopic Anterior Talofibular Ligament Repair After Suture Anchor Insertion Through the Anterolateral Portal vs the Lateral Accessory Portal
Authors: Guo Hao , Sun Nian , Zhou Qi , Chen Zhuhong , Liu Yijun , Wei Yuxuan , Zeng Canjun 
Published: July 2024

Background: Two types of suture anchor insertion pathways (anterolateral portal vs lateral accessory portal) are used in arthroscopic anterior talofibular ligament (ATFL) repair. However, it is not clear which one is the better choice. This study aims to compare the clinical outcomes of these 2 suture anchor insertion pathways when performing arthroscopic ATFL lasso-loop repair for the treatment of chronic lateral ankle instability (CLAI). Methods: From 2019 to 2021, patients with CLAI who underwent arthroscopic ATFL lasso-loop repair were retrospectively reviewed and divided into the anterolateral portal (ALP) group and the lateral accessory portal (LAP) group. A 1:1 propensity score matching was used to control confounding factors based on age, sex, body mass index, follow-up duration, preoperative visual analog scale (VAS) score, and Tegner score (ALP group, n = 26; LAP group, n = 26). Karlsson score, VAS score, Tegner score, operation time, anterior drawer test results, patient symptoms, and magnetic resonance (MR) evaluation of ATFL quality were used to describe the outcomes. Results: The patient characteristics and follow-up durations were similar between the 2 groups. After a mean follow-up duration of 28.8 ± 2.3 months, the ALP group had significantly better Karlsson score, VAS score, and Tegner score improvement than the LAP group, with fewer symptoms. Seven patients in the LAP group still had a feeling of ankle instability, and 3 of them exhibited ankle laxity. Conclusion: In this study, we found that inserting the suture anchor through the anterolateral portal was associated with better outcomes compared to that through the lateral accessory portal when performing arthroscopic ATFL lasso-loop repair for CLAI patients. The improvement was greater for pain relief and function and was associated with a lower frequency of subjective ankle instability.
The Role of the Flexor Hallucis Longus in the Treatment of the Painful Hallux Metatarsophalangeal Joint
Authors: Michelson James D. , Charlson Mark D. , Bernknopf Jacob W. , Carpenter Rachel L. , Brand Stephen J. 
Published: July 2024

Background: Pain in the hallux metatarsophalangeal joint (MTPJ) is very common, yet the underlying etiology remains unknown. Previous clinical research and biomechanical research has implicated stenosing flexor hallucis longus (FHL) tendonitis as a possible cause. The hypothesis of this study was that treatment solely focusing on alleviating restricted FHL excursion would be beneficial in patients with hallux MTPJ pain. Methods: This is a retrospective study of those treated in the Foot & Ankle Division between January 2009, and December 2018, who were diagnosed with FHL tendonitis with associated pain in the hallux MTPJ. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and outcome was obtained from the electronic medical record. The primary outcome was the improvement in the pain score (visual analog scale [VAS]). The surgical patients were included if their procedure was solely related to the FHL (posteromedial ankle release ± os trigonum resection). The decision to have surgery was analyzed by univariate and multivariable statistics using demographics, comorbidities, and clinical findings as potential factors ( P < .05). Results: In 75% (59 of 79 feet), nonoperative treatment of FHL stenosis resulted in a decrease in pain scores that the patients felt was satisfactory. The operative group that had an FHL release showed decreased pain in 90% (18 of 20 feet). Multivariable analysis identified the need for immobilization (OR 9.8, 95% CI 1.8-55.2, P = .009), participating in athletics (OR 8.7, 95% CI 1.8-42.2, P = .007), and higher initial VAS (OR 1.7, 95% CI 1.3-2.3, P < .001) as being associated with the decision for surgery. Conclusion: Previous biomechanical studies have suggested that stenosing FHL synovitis can cause increased intraarticular loading in the hallux MTPJ. The current clinical study supports this hypothesis, demonstrating that treatment focused on relieving restricted FHL excursion can ameliorate pain in the hallux MTPJ in select cases.
Health in Crisis: A Paradox of Access for Syrian Refugees and Lebanese Hosts
Authors: Fakhry Yasmine , F. Hassan Hussein , Diab Jasmin Lilian 
Published: July 2024

Background: This study examines the health security of both Lebanese citizens and Syrian refugees in Lebanon. It also assesses the readiness and resilience of the healthcare system in response to the multi-layered crisis that began in late 2019. Methods: A qualitative case study design was employed, utilizing 2 unstructured interviews with health experts/hospital staff, semi-structured interviews with 20 Lebanese participants and a document review. Thematic analysis was used to analyze the data. Results: The study found that Syrian refugees have access to health services under terms, conditions and restrictions including out-of-pocket (OOP) payment. In contrast, Lebanese citizens find traditional health guarantor systems largely ineffective, leading to high OOP costs for most healthcare services, with few exceptions. This study reveals a paradox in healthcare access within Lebanon’s fragile environment. Syrian refugees have greater access to health services, with minimal out-of-pocket (OOP) costs to a certain extent, compared to Lebanese citizens themselves who remain entrenched in inadequate health support services and poor public administration. Conclusion: To address this, targeted interventions and policies are crucial for policymakers and stakeholders, including the private and public sectors, local non-governmental organizations (NGOs), and the international community. Reforms are needed, spearheaded by the Ministry of Public Health (MoPH), other relevant ministries, and government payers, to refinance the traditional guarantor system and restore Lebanese citizens’ health security. Additionally, unifying health coverage across all government payers is vital.
The “Pre-Rotating Dilator Technique” for Optimal Endograft Orientation in Complex Endovascular Aortic Repair
Authors: Karelis Angelos , Sonesson Björn , Dias Nuno V. 
Published: July 2024

Purpose: To describe a novel technique for optimal orientation and accurate deployment of aortic endografts during complex endovascular aortic repair (cEVAR). Technique: After establishing the femoral access in the standard fashion, a long large-bore dilator is inserted before the cEVAR delivery system. The dilator is advanced beyond the renovisceral segment noticing the degree of axial rotation. The endograft markers are verified with fluoroscopy outside the patient in the standard way. Thereafter, the cEVAR delivery system is pre-emptively rotated by the same degree in the opposite direction than the dilator showed upon insertion. The endograft is then advanced into position with the markers ending with the markers roughly in position. Minor adjustments are done before and during deployment if needed as per standard technique. Conclusion: The use of long, large-bore dilator before the introduction of the aortic graft allows to proactively minimize the risk of endograft misalignment and malrotation especially in cases with challenging anatomies in both the visceral and iliac segments. This can potentially be used in all cases because it minimizes the manipulation of the delivery system and potentially increases the accuracy of endograft deployment. Clinical Impact This report describes a novel technique involving the use of a long large-bore dilator to predict the degree of rotation of the cEVAR delivery system during insertion and thereby enabling a pre-emptive compensation. This facilitates the precise orientation of the main aortic endograft with an easier alignment of any branches and/or fenestrations to their respective target arteries. This approach holds the potential to mitigate several of the difficulties commonly encountered with current cEVAR solutions, especially the challenges posed by small and tortuous access and severe angulation in the iliac and visceral aortic segment.
Causal associations of immune cell phenotypes with migraine: A mendelian randomization study
Authors: Chai Weifang , Chai Weihao , Guo Fei 
Published: July 2024

The interaction between the immune system and the brain, crucial for blood–brain barrier integrity, is a potential factor in migraine development. Although there’s evidence of a connection between immune dysregulation and migraine, a clear causal link has been lacking. To bridge this knowledge gap, we performed a two-sample Mendelian randomization (MR) analysis of 731 immune cell phenotypes to determine their causality with migraine, of which parameters included fluorescence, cell abundance, count, and morphology. Sensitivity and pleiotropy checks validated our findings. After applying a false discovery rate correction, our MR study identified 35 of 731 immune phenotypes with a significant causal link to migraine ( p < 0.05). Of these, 24 showed a protective effect (inverse variance weighting : p < 0.05, odds ratio <1), and 11 were risk factors (inverse variance weighting : p < 0.05, odds ratio >1). Although limited by population sample size and potential population-specific genetic variations, our study uncovers a significant genetic link between certain immune cell markers and migraine, providing new insights into the disorder’s pathophysiology. These discoveries are crucial for developing targeted biomarkers and personalized treatments. The research enhances our understanding of immune cells’ role in migraine and may substantially improve patient outcomes and lessen its socio-economic impact.
DOMINO trial post hoc analysis: evaluation of the diet effects on symptoms in IBS subtypes
Authors: Di Rosa Claudia , Van den Houte Karen , Altomare Annamaria , Guarino Michele Pier Luca , Besard Linde , Arts Joris , Caenepeel Philip , Piessevaux Hubert , Vandenberghe Alain , Matthys Cristophe , Biesiekierski Jessica R. , Capiau Luc , Ceulemans Steven , Gernay Olivier , Jones Lydia , Maes Sophie , Peetermans Christian , Raat Willem , Stubbe Jeroen , Van Boxstael Rudy , Vandeput Olivia , Van Steenbergen Sophie , Van Oudenhove Lukas , Vanuytsel Tim , Jones Mike , Tack Jan , Carbone Florencia 
Published: July 2024

Background: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by recurrent abdominal pain related to defecation and/or associated to a change in bowel habits. According to the stool type, four different IBS subtypes can be recognized, constipation predominant (IBS-C), diarrhea predominant (IBS-D), mixed (IBS-M), and undefined (IBS-U). Patients report that their IBS symptoms are exacerbated by food. Thus, it is important to find a nutritional approach that could be effective in reducing IBS symptoms. Objective: The present work is a post hoc analysis of the previously published DOMINO trial. It aimed to evaluate the effects of a self-instructed FODMAP-lowering diet smartphone application on symptoms and psychosocial aspects in primary care IBS stratifying the results for each IBS subtypes. Design: Post hoc analysis. Methods: Two hundred twenty-two primary care IBS patients followed a FODMAP-lowering diet for 8 weeks with the support of a smartphone application. Two follow-up visits were scheduled after 16 and 24 weeks. IBS–Symptoms Severity Score (IBS-SSS), quality of life (QoL), and adherence and dietary satisfaction were evaluated. Results: After 8 weeks, IBS-SSS improved in all IBS subtypes ( p < 0.0001). Physician Health Questiionnaire (PHQ-15) improved only in IBS-D ( p = 0.0006), whereas QoL improved both in IBS-D ( p = 0.01) and IBS-M ( p = 0.005). Conclusion: This post hoc analysis showed that the app is useful in all IBS subtypes; thus, it could be used as an effective tool by both general practitioners and patients to manage symptoms in primary care. Trial registration: Ethical Commission University Hospital of Leuven reference number: S59482. Clinicaltrial.gov reference number: NCT04270487.
Comparative risk of serious infections and tuberculosis in Korean patients with inflammatory bowel disease treated with non-anti-TNF biologics or anti-TNF-α agents: a nationwide population-based cohort study
Authors: Kim Min Jee , Kim Ye-Jee , Jeong Daehyun , Kim Seonok , Hong Seokchan , Park Sang Hyoung , Jo Kyung-Wook 
Published: July 2024

Background: The risk of serious infection and active tuberculosis in patients with inflammatory bowel disease (IBD) has not been concurrently evaluated based on the use of anti-tumor necrosis factor (TNF)-α agents versus non-anti-TNF biologics (vedolizumab/ustekinumab) in the Korean population. Objectives: We compared the risk of serious infection and active tuberculosis in Korean patients with IBD treated with non-anti-TNF biologics (vedolizumab/ustekinumab) or anti-TNF-α agents. Design: This study was a population-based cohort analysis of nationwide administrative claims data. Methods: Health Insurance Review and Assessment Service claims data (representing 97% of the South Korean population) from between January 2007 and February 2021 were reviewed, and adults with IBD who initiated vedolizumab/ustekinumab or anti-TNF-α treatment ( n = 6123) between 2017 and 2020 were enrolled. Intergroup differences in the risk of serious infection requiring hospitalization/emergency department visits or active tuberculosis during the follow-up period were analyzed. Results: In the patients treated with anti-TNF-α agents or vedolizumab/ustekinumab during a mean follow-up of 1.55 ± 1.05 and 0.84 ± 0.69 years, the incidence rates of serious infection were 9.43/100 and 6.87/100 person-years, respectively. Multivariable analysis showed no significant intergroup difference in the risk of serious infection with vedolizumab/ustekinumab or anti-TNF-α treatment; the adjusted relative risk of vedolizumab/ustekinumab compared with anti-TNF-α agents was 0.81 (95% confidence interval 0.46–1.44, p = 0.478). Among patients treated with anti-TNF-α agents and vedolizumab/ustekinumab, the incidence rates of active tuberculosis were 0.87 and 0.37 per 100 person-years, respectively. The relative risk of vedolizumab/ustekinumab compared with anti-TNF-α agents was 0.31 (95% confidence interval 0.07–1.26, p = 0.101). In a subset analysis comparing vedolizumab and ustekinumab with anti-TNF-α agents, similar results were observed. Conclusion: In Korean patients with IBD, non-anti-TNF biologics (vedolizumab/ustekinumab) tended to be associated with a lower risk of serious infection or active tuberculosis than anti-TNF-α agents.
Patients’ perspectives on oral decitabine/cedazuridine for the treatment of myelodysplastic syndromes/neoplasms
Authors: Zeidan Amer M. , Perepezko Kate , Salimi Tehseen , Washington Terri , Epstein Robert S. 
Published: July 2024

Background: Hypomethylating agents (HMAs) are guideline-recommended treatment for higher-risk myelodysplastic syndromes/neoplasms (MDS). However, a prior survey of patients with MDS reported challenges with intravenous (IV) and subcutaneous (SC) HMA therapies, including pain related to treatment administration and interference with daily activities; most patients also indicated a preference to switch to an oral therapy if one were available. Objectives: This study evaluated the perspectives of US patients with MDS receiving oral decitabine/cedazuridine (DEC-C), an alternative to IV/SC HMAs. Methods: An online survey was conducted among adult patients with MDS in the United States (10 November 2022 to 5 December 2022) who had filled a prescription for oral DEC-C between 2021 and 2022. Results: A total of 150 patients completed the survey; 61% were aged ⩾60 years and 63% were male. Of these, 123 (82%) were still receiving oral DEC-C, and 27 (18%) had stopped oral DEC-C treatment. Half (50%) of patients had received oral DEC-C for ⩾6 months. The majority reported that treatment was convenient (83%) and that they were satisfied with treatment (86%). Most patients also reported very little/no interference with regular daily activities (82%), social activities (78%), and productivity (78%). When queried about negative impacts on quality of life (QOL), treatment side effects were the most commonly reported (30% of respondents). Among patients who had previously received IV/SC HMAs ( n = 91), most agreed that oral DEC-C interfered less with daily life (91%) and had experienced improvement in QOL (85%) compared with previous treatment; 91% reported that oral DEC-C reduced the number of times they needed to travel to a healthcare facility. Conclusion: Survey results suggest very little/no impact on regular daily activities and improved QOL with oral DEC-C relative to IV/SC HMAs, highlighting the potential for oral DEC-C to reduce the treatment burden associated with parenteral HMA therapy.
Risk factors for treatment non-completion among patients with syphilis
Authors: Clarkson-During Abigail , Almirol Ellen , Eller Dylan , Hazra Aniruddha , Stanford Kimberly A. 
Published: July 2024

Background: With recent increases in syphilis, there is growing interest in expanding screening; however, treatment rates have historically been low. Objectives: This study examines demographic and clinical factors that may contribute to non-completion of syphilis treatment. Design: This is a retrospective comparative cohort study of all patients with syphilis from January through November 2018 at an urban, tertiary care hospital. Methods: Demographics and clinical information were extracted from the electronic medical record. Descriptive statistics and odds ratios (ORs) were calculated. Results: Of 171 patients with syphilis, 89 (52.0%) completed treatment. Patients ages 40–49 were least likely to complete treatment (OR 0.14; 95% CI 0.03–0.72, p = 0.02) compared to those ages 18–24. Non-heterosexual patients were significantly more likely to complete treatment (OR 3.60; 95% CI 1.13–11.49, p = 0.03) compared to heterosexual patients. Patients diagnosed in the emergency department completed treatment at the lowest rate. Conclusion: A major gap in syphilis treatment still exists, which must be addressed to achieve optimal impact from syphilis screening programs.