bluuebunny/crossref_metadata_2025_split huggingface dataset:
Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study
Authors: Rhodin Kristen E. , Thornton Steven W. , Leraas Harold J. , Beckhorn Catherine B. , Alseidi Adnan , Greenberg Jacob A. , Shah Kevin N. , Migaly John , Tracy Elisabeth ,   the SubI Working Group
Published: August 2024

Abstract

Purpose
Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships.

Method
Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement.

Results
Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively).

Conclusions
This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.
WellNest: A Medical Student–Run Housing Support Program
Authors: Dalapati Trisha , George Ian A. , Tracey Skye , Chukrun Tamar , Brown Madeline , Biederman Donna J. 
Published: August 2024

Abstract

Problem
Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity.

Approach
Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student–volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients’ belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least 1 year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey.

Outcomes
From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity.

Next Steps
As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.
Is There a Problem With Evidence in Health Professions Education?
Authors: Ellaway Rachel H. , O’Brien Bridget C. , Sherbino Jonathan , Maggio Lauren A. , Artino Anthony R. , Nimmon Laura , Park Yoon Soo , Young Meredith , Thomas Aliki 
Published: August 2024

Abstract
What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume this knowledge might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris’ learning loops framework.
From a single-loop perspective (“How are we doing?”), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective (“Could we do better?”) suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more system-wide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective (“Are we asking the right questions?”) highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.
The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations and influencing decisions.
The Efficacy of GLP-1 Agonists in Treating Substance Use Disorder in Patients: A Scoping Review
Authors: Shen Mary R. , Owusu-Boaitey Kwadwo , Holsen Laura M. , Suzuki Joji 
Published: August 2024

Abstract
Substance use disorder (SUD) continues to be a leading cause of morbidity and mortality with limited treatments. There is interest in expanding the use of GLP-1 agonists in treating SUD. However, evidence for safety and efficacy in humans is limited. This review aims to bridge the existing knowledge gap by establishing a baseline of literature in this area to inform future trials and clinical practice. Our inclusion criteria were English peer-reviewed manuscripts reporting on use of GLP-1, GIP, and/or glucagon receptor agonists in treatment of SUDs, excluding case studies. The literature search was performed in accordance to PRISMA guidelines. Five studies were included in this review examining the use of this medication in tobacco use disorder, alcohol use disorder, and cocaine use disorder. No studies regarding substance withdrawal syndrome were identified. The included studies varied widely in terms of patient selection, dose/formulation of GLP-1 agonists, and follow-up. The results of this scoping review are mixed, with 3 studies demonstrating positive results and 2 studies finding no efficacy of this medication on SUD outcomes. It is premature to prescribe this medication off-label to patients. Further research is needed to determine the efficacy of GLP-1 agonists in treating SUD.
Bibliometric Patent Review of Minimally Invasive Spine Surgery
Authors: Zaidat Bashar , Ahmed Wasil , Song Junho , Maza Noor , Shrestha Nancy , Rajjoub Rami , Etigunta Suhas , Kim Jun S. , Cho Samuel K. 
Published: August 2024

Study Design:
This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform.

Objective:
The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents.

Summary of Background Data:
MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited.

Methods:
To conduct this study, we used the Lens platform to search for patents that included the terms “minimally invasive” and “spine” in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation.

Results:
Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year.

Conclusions:
Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.
Pinch Grafts Versus Second Intention Wound Healing for Mohs Micrographic Surgery Defects Below the Knee: A Prospective Randomized Trial
Authors: Willenbrink Tyler J. , Brodland David G. 
Published: August 2024

BACKGROUND
The surgical management of leg wounds following skin cancer extirpation is challenging. Pinch grafting (PG) is a technique that has been rarely described in the reconstruction of acute surgical wounds.

OBJECTIVE
The purpose of this study was to evaluate whether PG resulted in faster healing times for below the knee wounds following Mohs micrographic surgery (MMS) when compared with second intention healing (SIH).

MATERIALS AND METHODS
This was a prospective randomized trial of patients with post–Mohs micrographic surgical wounds of the lower extremity who were randomized either to receive pinch grafts or to heal by second intention. Patients were followed through a combination of in-person and virtual visits until their wounds were completely reepithelialized.

RESULTS
Median time to wound healing was 36 days in the PG group versus 56 days for the SIH group, representing a 56% improvement in healing time. There were no differences in complications between the 2 groups with trends toward decreased rates of pain and infection in the PG group.

CONCLUSION
PG is an effective simple method to hasten the healing of lower extremity wounds following MMS.
Unraveling Interactions Between Gut Epithelium and Microbiota Using Models of Intestinal Organoids
Authors: Huang Yi , He Kangxin , Chen Yanfei 
Published: August 2024

AbstractIntestinal microbiota is an indispensable part of intestinal homeostasis and is closely related to human health. Intestinal microbiota participates in the development of a variety of intestinal diseases in a complex and diverse manner. Previous results have confirmed microbiota dysbiosis in a variety of diseases, while the mechanism is not clear. It is valuable to unravel these complex mechanisms, which would guide future therapies. A limiting factor of studies exploring interaction mechanisms between gut epithelium and microbiota was a lack of an in vitro organ model. The development of organoids has provided an indispensable tool for gastrointestinal studies. Here, we review the applications of organoids in exploring the roles of gut microbiota and its metabolites in diseases, summarize the advantages and limitations of organoid models, and discuss future prospective and challenges in this area.
Interventions to achieve environmentally sustainable operating theatres: an umbrella systematic review using the behaviour change wheel
Authors: Almukhtar Aws , Batcup Carys , Bowman Miranda , Winter Beatty Jasmine , Leff Daniel , Demirel Pelin , Judah Gaby , Porat Talya 
Published: August 2024

Introduction:
The healthcare sector is a major contributor to the climate crisis and operating theatres (OTs) are one of the highest sources of emissions. To inform emissions reduction, this study aimed to (i) compare the outcomes of interventions targeting sustainable behaviours in OTs using the Triple Bottom Line framework, (ii) categorise the intervention strategies using the five Rs (reduce, recycle, reuse, refuse, and renew) of circular economy, and (iii) examine intervention functions (IFs) using the Behaviour Change Wheel (BCW).

Methods:
Medline, Embase, PsychInfo, Scopus, and Web of Science databases were searched until June 2023 using the concepts: sustainability and surgery. The review was conducted in line with the Cochrane and Joanna Briggs Institution’s recommendations and was registered on PROSPERO. The results were reported in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) (Supplemental Digital Content 1, http://links.lww.com/JS9/D210) guidelines.

Results:
Sixteen reviews encompassing 43 life-cycle analyses, 30 interventions, 5 IFs, and 9 BCW policy categories were included. 28/30 (93%) interventions successfully led to sustainability improvements; however, the environmental outcomes were not suitable for meaningful comparisons due to their using different metrics and dependence on local factors. The ‘reduce’ strategy was the most prolific and commonly achieved through ‘education’ and/or ‘environmental restructuring’. However, single-session educational interventions were ineffective. Improving recycling relied on ‘environmental restructuring’. More intensive strategies such as ‘reuse’ require multiple intervention functions to achieve, either through a sustainability committee or through an intervention package.

Conclusion:
Policymakers must examine interventions within the local context. Comparing the outcomes of different interventions is difficult and could potentially be misleading, highlighting the need for a tool integrating diverse outcomes and contextual factors. ‘Reduce’ strategy guarantees environmental and financial savings, and can be achieved through ‘Education’ and/or ‘environmental restructuring’.
Protective effect of sevoflurane on myocardial ischemia-reperfusion injury: a systematic review and meta-analysis
Authors: Nasiri-Valikboni Amirhossein , Rashid Mohamad , Azimi Amir , Zarei Hamed , Yousefifard Mahmoud 
Published: August 2024

Background:
Myocardial ischemia-reperfusion (I/R) injury significantly impacts recovery in both cardiac and noncardiac surgeries, potentially leading to severe cardiac dysfunction. Sevoflurane, a volatile anesthetic, is reputed for its protective effects against myocardial I/R injury, although evidence remains inconclusive. This systematic review and meta-analysis aim to clarify the cardioprotective efficacy of sevoflurane.

Methods:
The systematic search of databases including Medline, Embase, Scopus, and Web of Science, was supplemented with a manual search to retrieve studies using rat or mouse models of myocardial I/R injury, comparing sevoflurane pretreatment (≥24 h before I/R), preconditioning (within 24 h before I/R), or postconditioning (after I/R) against nontreated controls. The outcomes were cardiac function, myocardial infarct size, apoptosis, inflammation, oxidative stress, and cardiac biomarkers. Using the random effects model, standardized mean differences (SMD) were pooled to perform meta-analyses.

Results:
Fifty-one studies, encompassing 8189 subjects, were included in the meta-analysis. Pretreatment with Sevoflurane significantly reduced infarct size. Sevoflurane preconditioning exhibited positive effects on left ventricular parameters and ejection fraction, and reduced infarct size, apoptosis, and oxidative stress. Postconditioning with Sevoflurane demonstrated improvements in cardiac function, including enhanced left ventricular parameters and reduced infarct size, apoptosis, inflammation, oxidative stress, and cardiac biomarkers.

Conclusion:
Sevoflurane demonstrates a significant protective effect against myocardial I/R injury in animal models. These findings support the potential clinical utility of sevoflurane as an anesthetic choice in preventing and managing myocardial I/R injury during surgeries.
Development of huge keloid at donor site and recurrent keloid at graft site after excision of pubic keloid followed by split-thickness skin graft: A case report
Authors: Lee Jun Yong , Kim Su Ram , Yoo Gyeol , Baek Sang Oon 
Published: August 2024

Introduction:Keloids are the result of abnormal tissue scarring that occur after skin injuries leading to pain, psychological distress, and impaired quality of life. Despite the high recurrence rate after surgical treatment, excision is often inevitable for symptom control.Patient concerns:A 32-year-old female presented with a huge keloid on the pubic area accompanied by severe pain, pruritus, and infectious discharge. She also had multiple keloids on her chest and shoulders, indicating a strong predisposition to keloid formation.Interventions:While high potential for recurrence was anticipated, surgical excision was inevitable for symptom control. Complete keloid excision followed by split-thickness skin graft was performed.Diagnosis:Pathological report revealed keloid accompanied by ruptured epidermal inclusion cyst.Outcomes:Although postoperative care was highly recommended for prevention of keloid recurrence, the patient refused any additional management due to her financial difficulties. At postoperative 8 months, mild degree of keloid or hypertrophic scar at marginal area of the graft was observed, suggesting the potential sign of keloid recurrence. The patient voluntarily discontinued the outpatient follow-up for 2 years, and then returned with huge keloid not only at the graft site but also at the donor site.Conclusion:Keloid with inflamed epidermal inclusion cyst can cause severe pain where surgical excision is unavoidable, regardless of the high potential for recurrence. Additional postoperative care is necessary to prevent recurrence. Furthermore, attempts to minimize new keloid formation at the donor site after split-thickness skin graft, such as thin skin harvest or selecting the scalp as the donor site, should be considered.
SMARCA4-deficient undifferentiated tumor with high quality of life and far exceeding predicted survival: A case report
Authors: Lin Juan , Ren Qi , Liu Binbin 
Published: August 2024

Rationale:
SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a recently reported rare malignancy that can rapidly metastasize to tissues and organs throughout the body. The tumor is characterized by a lower response to platinum-based chemotherapy. More regrettably, the mean survival time of patients with this disease after diagnosis is only 4 to 7 months.

Patient concerns:
A 58-year-old man was admitted to a hospital for fatigue, sudden syncope, and a mass-like shadow of his left upper lobe demonstrated by a pulmonary computed tomographic. Based on his subsequent clinical and pathological features, he was highly suspected of SMARCA4-UT.

Diagnoses:
Combined with next-generation sequencing genetic testing and immunohistochemical examination results, the patient was diagnosed with SMARCA4-UT.

Interventions:
The patient received a left upper lobectomy and lymph node dissection, four-course chemotherapy divided into 8 sessions with the use of paclitaxel simply, and a proper post-discharge self-care.

Outcomes:
The patient’s operation and chemotherapy were all successful and he maintained a high quality of life after surgery that far exceeded his predicted survival.

Lessons:
Early diagnosis, higher education level, attention to the disease and complications, reducing chemotherapy damage, adequate nutrient intake, relieving symptoms, controlling depression, and maintaining immunity and the ability to perform activities of daily living may all be the positive factors that can prolong the survival of patients with SMARCA4-UT.