bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of low-dose ketamine on electroencephalographic spectrum during gynecology surgery under desflurane anesthesia
Authors: Huang Yu-Pin , Lin Shih-Pin , Horng Huann-Cheng , Chang Wen-Kuei , Tsao Cheng-Ming 
Published: August 2024

Background:
The perioperative administration of low-dose ketamine has shown potential in postoperative pain management, opioid sparing, and enhancing pain control. This study aimed to investigate the impact of low-dose ketamine on processed electroencephalography (EEG) signals during anesthesia.

Methods:
Forty patients with American Society of Anesthesiologists physical status I-II undergoing elective gynecological surgery were enrolled. EEG monitoring was initiated upon induction of anesthesia. Anesthesia was maintained with desflurane and alfentanil immediately after induction. Fifteen minutes after induction, the ketamine group received a 0.3 mg/kg bolus followed by 0.05 mg/kg/h infusion until completion of surgery. The control group received equivalent saline. Postoperative assessments included pain score (visual analog scale), morphine usage, and quality of recovery.

Results:
The ketamine group had significantly higher Patient State Index (PSi) values at 10, 20, and 30 minutes after ketamine administration compared to the controls. Ketamine administration led to significant alterations in EEG patterns, including reduced relative power in delta and theta frequency bands, and increased relative power in beta and gamma frequency bands at 10 minutes post-administration. Relative power in the alpha frequency band significantly decreased at 10, 20, and 30 minutes post-administration. However, there were no differences in intraoperative alfentanil consumption, postoperative morphine usage, and pain scores between the two groups.

Conclusion:
Low-dose ketamine administration during desflurane anesthesia led to notable changes in EEG patterns and PSi values. These findings provide valuable insights into the impact of ketamine on brain activity, and offer essential information for clinical anesthesiologists.
Associated factors of osteoporosis in Chinese patients with rheumatoid arthritis: A systematic review and meta-analysis
Authors: Song Zhiming , Fan Liangliang , Wang Hongyan , Cao Jun , Wen Zhifei , Tao Yanmin , Zhang Xiangeng 
Published: August 2024

Background:
The aim of this systematic review and meta-analysis was to analyze the factors associated of osteoporosis in patients with rheumatoid arthritis (RA) in China.

Methods:
PubMed, Embase, Web of Science, Cochrane Library, CINAHL, and four Chinese electronic databases were searched for observational studies without language restrictions that reported the factors associated of osteoporosis from inception to February 2023. A modified Newcastle-Ottawa Scale evaluated the risk of bias. Statistical heterogeneity among the included studies was analyzed using Cochran Q and I
2 tests. Begg and Egger tests were used to assess the publication bias.

Results:
A total of 15 studies were finally included. The meta-analysis showed that 10 factors were grouped into three themes with statistical significance: (1) demographics theme: age ≥50 (odds ratio [OR] = 1.161; 95% CI, 1.111-1.231; p < 0.001), low body mass index (BMI) (OR = 1.248; 95% CI, 1.192-1.312; p < 0.001), female (OR = 5.174; 95% CI, 3.058-7.290; p < 0.001), and menopause (OR = 4.917; 95% CI, 1.558-15.523; I
2 = 0.0%; p = 0.007); (2) RA-related factor theme: disease duration (OR = 1.083; 95% CI, 1.038-1.127; p < 0.001), and glucocorticoids (OR = 2.740; 95% CI, 2.000-3.750; p < 0.001); (3) relevant physiological indicators or scores theme: low 25(OH)D3 (OR = 1.009; 95% CI, 1.003-1.016; p < 0.001), erythrocyte sedimentation rate (ESR) (OR = 1.489; 95% CI, 1.041-2.130; p = 0.029), high Disease Activity Score in 28 joints (DAS28) score (OR = 2.5991; 95% CI, 1.094-6.138; p < 0.001); and β-isomerized C-terminal telopeptide (β-CTx) (OR = 1.009; 95% CI, 1.003-1.016; p = 0.005).

Conclusion:
Osteoporosis in patients with RA is associated with various factors. Therefore, patients with RA should be monitored in a timely manner and targeted interventions should be taken. In addition, further longitudinal studies are needed to confirm the direct link between multiple factors and osteoporosis.
Global Leadership Initiative on Malnutrition cachexia: an inflammation-first approach for the diagnosis of disease-related malnutrition
Authors: McGovern Josh , Skipworth Richard J.E. , Laird Barry J.A. , McMillan Donald C. 
Published: August 2024

Purpose of review
The following article examines the rationale for an inflammation-first approach for diagnosing cachexia and how the current Global Leadership Initiative on Malnutrition (GLIM) framework may be adapted to facilitate this.

Recent findings
Recently, the GLIM have published guidance on the measurement of inflammation in the context of cachexia, advocating that C-reactive protein (CRP) should be utilized for quantification. The inclusion of a systemic inflammatory biomarker for the diagnosis of cachexia questions whether it may be more aptly considered a systemic inflammatory syndrome.

Summary
The current consensus of the GLIM is that cachexia is ‘disease-related malnutrition with inflammation’. In line with this definition, the GLIM proposed a two-step diagnostic framework: screening for malnutrition using validated screening tools and then confirming the presence of disease-related malnutrition with phenotypic (nonvolitional weight loss, low BMI, and reduced muscle mass) and aetiologic criterion reduced food intake/assimilation, and inflammation or disease burden). The GLIM are to be commended for guidance on the measurement of systemic inflammation in their current proposal, given the relative importance to clinical outcomes in patients with cancer. However, the use of CRP is somewhat rudimentary and contrasts other cancer cachexia guidelines and contemporary clinical cancer research.
Nurse-Driven Process for the Successful Removal of Urinary Catheters Among Elderly Patients After Hip Fracture Surgery
Authors: Joseph Lissa Vazhayil , SB Koh Joyce , Yatim Juriyah , Kaysar Dr Mamun , Hendrix Cristina C. 
Published: August 2024

Background:
Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery.

Local problem:
The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery.

Methods:
A pre/post-implementation design was used for this quality improvement initiative.

Interventions:
A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery.

Results:
There was a significant reduction in post-operative urinary retention (P = .042), UTI rate (P = .047), and IUC reinsertion (P = .042) in the post-implementation group. IUC duration decreased by 1.1 days, however this was not significant (P = .206). Nurse compliance with following the new process was 93.3%.

Conclusion:
The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.
Secondary Traumatic Stress in Nursing Students
Authors: Oakley Kristen N. , Copel Linda Carman , Ross Jennifer Gunberg 
Published: August 2024

Background:
Nurses have frequent interactions with traumatized individuals and may develop secondary traumatic stress (STS). Similarly, nursing students are at risk for STS development while completing clinical training.

Purpose:
To critique and synthesize available research on the prevalence, severity, and experience of STS and its associated factors in prelicensure nursing students.

Methods:
The Whittemore and Knafl integrative review methodology was used to perform structured searches of 6 electronic databases.

Results:
Twenty-five studies met the inclusion criteria. Findings revealed a range of STS symptom severity levels and associated factors; however, measurement is hampered by researchers’ use of other concepts, like compassion fatigue.

Conclusions:
Conceptual clarity is needed to improve STS measurement in nursing students; however, students experience STS and are at risk of developing its negative consequences. Educators should implement trauma-informed educational practices targeted at reducing factors associated with STS.
Health Service Utilization Patterns Among Medicaid Enrollees With Intellectual and Developmental Disabilities Before and During the COVID-19 Pandemic: Implications for Pandemic Response and Recovery Efforts
Authors: Kearly Alexandra , Hluchan Madison , Brazeel Caroline , Lane J.T. , Oputa Janet , Baio Jon , Cree Robyn A. , Cheng Qi , Wray Allison , Payne Claire , Gerling Jason , Pham Truc , Ekart Sarah 
Published: August 2024

Objectives:
To assess the impact of COVID-19 on health service utilization of adults with intellectual and developmental disabilities (IDDs) through an analysis of Medicaid claims data.

Design:
Retrospective cohort study of Medicaid claims.

Setting and Participants:
Medicaid members aged 25 to 64 years from January 1, 2018, to March 31, 2021, from the states of Louisiana, Pennsylvania, and Wyoming.

Intervention:
We analyzed data from two 12-month time periods (pre-COVID-19 and during COVID-19) and assessed the potential impact of the COVID-19 pandemic on health service utilization and service intensity for 3 cohorts: (1) IDD with preexisting mental health diagnoses, (2) IDD without mental health diagnoses, and (3) all other Medicaid members.

Main Outcome Measure:
Health service utilization determined by specific claims data classifications.

Results:
The analysis showed reduced utilization for nonmental health service types with differing utilization patterns for IDD with preexisting mental health diagnoses, IDD without mental health diagnoses, and all other Medicaid members. Change in utilization varied, however, for mental health service types. Measures of service intensity showed decreased numbers of members utilizing services across most service types and increased Medicaid claims per person across most mental health service categories but decreased Medicaid claims per person for most nonmental health services.

Conclusions:
Results suggest a need for mental health services among all Medicaid members during the COVID-19 pandemic. By anticipating these needs, communities may be able to expand outreach to Medicaid members through enhanced case management, medication checks, and telemedicine options.
Interpreting and managing preservation fluids positive for Gram-negative bacteria
Authors: Peghin Maddalena , Graziano Elena , Grossi Paolo Antonio 
Published: August 2024

Purpose of review
Culturing preservation fluids of solid organs before transplantation is not a standardized procedure. In this review, we aim to describe the state-of-the-art of literature evidence in this debated setting with a special focus on Gram-negative bacteria (GNB).

Recent findings
Contamination of preservation fluids is frequent, but preservation fluids related infections are rare and most commonly caused by high-risk pathogens, including GNB. GNB preservation fluids related infections are characterized by high morbidity and mortality. Recent studies showed improved outcomes in solid organ transplant recipients receiving antibiotic therapy tailored according to preservation fluids cultures especially when multidrug-resistant GNB are found. A robust procurement network is needed to alert recipients’ centers in cases of positivity and the support of transplant infectious diseases specialists is essential to choose the best therapy.

Summary
Culturing preservation fluids is a further step into preventing donor-derived infections. Interpreting and managing GNB positivity require a multidisciplinary team with specific skills. Standardized randomized trials are needed for insight into the real utility of preservation fluids cultures, the role of preservation fluids positivity, and the impact of antimicrobial therapy.
Substitution of a Traditional Face-to-Face Workshop With Virtual Escape Room in Higher Education
Authors: Krishnan Sunanthiny , Ademi Zanfina , Malone Daniel , Abebe Tamrat Befekadu , Lim Angelina 
Published: August 2024

Introduction
Online education games are gaining ground in health profession education, yet there is limited literature on its costs. This study is an economic evaluation of the substitution of a face-to-face (F2F) workshop with an online escape room game teaching the same content.

Methods
A traditional F2F workshop on hepatitis management was conducted with 364 students in 2021 and was compared with a virtual self-run escape room game called Hepatitiscape™, which was used by 417 students in 2022. The outcomes were final examination and objective structured clinical examination (OSCE) scores for hepatitis stations. An incremental cost-effectiveness ratio was used to compare costs and outcomes. Student perceptions of the delivery of Hepatitiscape™ were also captured using an online questionnaire.

Results
Delivering the hepatitis case workshop via Hepatitiscape™ yielded an additional 4.77% increase in the final examination score and a 21.04% increase in the OSCE score at an additional cost of AUD $4212 in the first year compared with F2F delivery. This equated to an incremental cost-effectiveness ratio of AUD 883 per additional score of final examination and AUD 200 per additional score of OSCE for hepatitis stations. Hepatitiscape™ became cost saving from the second year onward. Student perception data revealed their recall of content was higher owing to the iterative design of the gaming elements.

Conclusions
Hepatitiscape™ is likely to be a cost-effective strategy to deliver workshops that are routinely delivered F2F to test knowledge-based constructs. In addition, virtual gaming has a logistical advantage over F2F delivery in that it enhances student participation from remote locations and allows for better control and flexibility of content delivery with increasing or decreasing cohort sizes, and can have potential long-term sustainable savings.
Recommendations of the Blue Ribbon Committee II for the Optimization of Surgical Education and Training in the United States
Authors: Johnson Wali R. , Mainali Bigyan B. , Chen Xiaodong , Alobuia Wilson , Anderson Erik M. , Martin Rebecca , Caldwell Katharine E. , Dawson-Amoah Kwesi , Doyle Kathleen , Ellis Danielle , Fazzone Brian , Ghio Michael , Godfrey Caroline M. , Gomes Camilla , Hoefer Lea , Kearse LaDonna , Niehaus Hannah , Phelps Hannah , Riner Andrea N. , Sharon Cimarron , Shin Thomas H. , Yelorda Kirbi , Coleman Julia R. 
Published: August 2024

Objective:
This study aims to appraise recommendations from an expert panel of surgical educators on optimizing surgical education and training in the setting of contemporary challenges.

Background:
The Blue Ribbon Committee (BRC II), a group of surgical educators, was convened to make recommendations to optimize surgical training, considering the current changes in the landscape of surgical education. Surgical trainees were recruited to assess their impressions of the recommendations.

Methods:
A mixed-methods study design was employed, with a survey, followed by focus group interviews. Participating residents and fellows were recruited through a purposeful sampling approach. Descriptive statistics were applied to analyze the survey data, and a thematic data analysis on interview transcripts was employed.

Results:
The majority of trainee respondents (n=16) thought that all of the subcommittee recommendations should be included in the final BRC II recommendations and paper. According to the interviews, overall, the feedback from the trainees was positive, with particular excitement around work-life integration, education support and faculty development, and funding pitfalls. Some themes about concerns included a lack of clarity about the recommendations, concern about some recommendations being in conflict with one another, and a disconnect between the initial BRC II survey and the subsequent recommendations.

Conclusions:
The residents gathered for this focus group were encouraged by the thought, effort, and intention that gathered the surgical leaders across the country to make the recommendations. While the trainees wanted clarity on some areas, the overall opinion was in agreement with the recommendations.
Do Prophylactic Postoperative Antibiotics Prevent Sacral Neuromodulation Infections?
Authors: Murillo Ashley J. , Lindsey Caroline , Chermansky Christopher J. , Bradley Megan S. 
Published: August 2024

Importance
There are no definitive guidelines for use of postoperative antibiotics after sacral neuromodulation (SNM) leading to practice pattern variation among health care professionals.

Objectives
The objectives of this study were to determine if additional antibiotics beyond preoperative intravenous antibiotics and surgical preparation decrease postoperative infections and to determine if additional antibiotics are associated with other postoperative complications.

Study Design
This was a single-center, retrospective cohort study of all SNM procedures from 2014 to 2023 performed by 12 surgeons. Cohorts were stratified between patients who received preoperative antibiotics only (OnlyPreAbx) and patients who received both preoperative antibiotics and postoperative antibiotics (PrePostAbx) after either insertion of tined lead and/or after insertion of a neurostimulator.

Results
There were 212 patients included in this study: 70 (33.0%) in the OnlyPreAbx group and 142 (67.0%) in the PrePostAbx group. Of patients receiving postoperative antibiotics, 76 (53.5%) received cephalexin, 49 (34.5%) received sulfamethoxazole-trimethoprim, and 17 (12.0%) received alternative antibiotics. Six patients overall (2.8%) experienced infections after SNM. There was no difference in the rates of infection between groups (4 [1.9%] PrePostAbx vs 2 [0.9%] OnlyPreAbx, P = 0.99). Of the 4 patients with postoperative infections in the PrePostAbx group, 2 had cellulitis requiring antibiotics and 2 required full explantation. Of the 2 patients with postoperative infections in the OnlyPreAbx group, both patients required explantation. In a subanalysis comparing infected and noninfected patients, infected patients (n = 6) had higher rates of hypertension (n = 6, 100%; P = 0.02) and diabetes mellitus (n = 3, 50%; P = 0.05).

Conclusions
Additional postoperative antibiotics did not decrease infection rates in patients undergoing SNM. Similar comparative analyses should be performed with larger sample sizes.
Cut-off Cq value of GeneXpert in comparison to gold standard RT-PCR for diagnosis of SARS-CoV-2: A retrospective study
Authors: William Ashish , Rai Yogita , Rawat Deepti , Gogoi Sanjib , Dhakad Megh Singh , Jais Manoj , Kaur Ravinder 
Published: August 2024

Background
The novel coronavirus disease (COVID-19) has highlighted vulnerabilities in healthcare systems and has single-handedly literally brought the world to a standstill. Diagnostic testing for COVID-19 is critical for understanding epidemiology, contact-tracing, case management, and to control the transmission of the SARS-CoV-2. RT-PCR test, the gold standard test, involves fairly complex steps and take nearly 24–48 h for generating the results. GeneXpert is a rapid nucleic-acid-detection-based test approved by ICMR (Indian Council of Medical Research), which can shorten the turnaround time significantly.
Aim
The aim of the study was to compare the performance of GeneXpert against the gold standard rRT-PCR for SARS-CoV-2.

Materials and methods
This retrospective study was conducted at a tertiary care centre from 25th March 2020 to 8th December 2020. The Nasopharyngeal/Oropharyngeal swabs that were sent to the VRDL laboratory for testing of SARS-CoV-2 by GeneXpert (CBNAAT) were included for the study. A total 220 samples positive and 50 samples negative for SARS-CoV-2 by GeneXpert were simultaneously tested for rRT-PCR. rRT-PCR was considered as gold standard test (reference) for calculating the sensitivity and specificity of GeneXpert (CBNAAT) test.
Results
Out of 220 samples positive for COVID-19 by GeneXpert, 118 (53.64%) were also positive by rRT-PCR while 102 (46.36%) showed negative results by rRT-PCR. However, 50 GeneXpert negative samples showed 100% agreement with rRT-PCR i.e. they were also negative by rRT-PCR. The GeneXpert sensitivity and specificity for COVID-19 was seen to be 100% (95% CI: 96.92 to 100%) and 32.89% (95% CI: 25.50 to 40.97%) respectively as compared to gold standard RT-PCR test. The positive predictive value (PPV) and negative predictive value (NPV) of GeneXpert for COVID-19 was found to be 53.64% and 100% respectively.
Conclusion
This study highlights that the GeneXpert test is highly sensitive and found to be helpful in emergency and challenging situations, where it can be useful in the early diagnosis and management of COVID-19 infection and thus, prevention of morbidity and mortality.
Dual-Targeted Microbubbles Promote Apoptosis of M1 Macrophages by Inhibiting Telomerase Activity for Atherosclerosis Therapy
Authors: Zeng Wei , Huang Zhengan , Huang Yalan , Xiong Kaifen , Sheng Yuanyuan , Lin Xiaoxuan , Zhong Xiaofang , Ye Jiayu , Guo Yanbin , Arkin Gulzira , Xu Jinfeng , Fei Hongwen , Liu Yingying 
Published: August 2024

AbstractIt is known that M1 macrophages are the dominant phenotype in progressive atherosclerosis (AS). Studies have shown that telomerase in macrophages can be activated during the atherosclerosis formation, but how to regulate the telomerase activity of M1 macrophages is the focus of treatment of AS. Herein, we report a dual-targeted microbubbles delivery system encapsulating the telomerase inhibitor BIBR1532 (Ab-MMB1532), designed for precise targeted therapy of AS. The Ab-MMB1532exhibits excellent biocompatibility and remarkable targeting capability towards M1 macrophages with its targeting advantage notably accentuated under high shear forces. Furthermore, it significantly downregulates telomerase activity. Metabolomics analysis indicates that the decrease in telomerase activity upregulates the expression of aspartic acid, a key protein in the Caspase pathway of apotosis. In vivo, Ab-MMB1532efficiently targeted and accumulated within AS lesions, leading to significantly delay of the AS progression by inhibiting telomerase activity and promoting apoptosis of M1 macrophages after 4-week treatment. In summary, Ab-MMB1532provides a new approach for potentially safer and more effective treatment of AS in the future.