bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 306: Establishing the Minimum Clinically Important Difference Two Years Following Medial Patellofemoral Ligament Reconstruction
Authors: Elias Tristan , Haneberg Erik , Phillips Andrew , Kaplan Daniel , Sachdev Divesh , Chahla Jorge , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam 
Published: August 2024

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is used to address cases of recurrent patellar instability. Minimal clinically important difference (MCID) is an important marker that relays the smallest clinical improvement in which patients feel a significant change after surgery. MCID has been previously established for MPFL reconstruction after 6 months and 1 year. To date, no study has established MCID for patient reported outcomes 2 years after MPFL reconstruction. The purpose of this study is to define the MCID for the Kujala, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score for Joint Reconstruction (KOOS JR) at minimum two-year follow-ups after isolated MPFL reconstruction. Methods: All patients undergoing isolated MPFL reconstruction for recurrent patellar instability at a single institution between December 2015-June 2021 were included. Patients with concomitant osseous procedures beyond chondroplasty and any ligamentous procedure were excluded. A distribution-based approach was used to calculate the MCID. This was performed by determining the standard deviation (SD) of the delta two-year patient reported outcome scores (PROS) and then multiplying the SD by 0.5. The number of patients achieving MCID were then presented as a percentage. Results: Eighty-six of 117 patients who underwent isolated MPFL reconstruction completed preoperative and a two-year follow-up PRO survey (59 female, 27 male; age 21.1 ± 8.7 years). For Kujala, the preoperative mean was 59.3 ± 17.1, two-year follow-up mean was 87.6 ± 13.6, and MCID was 9.2 with 88% of the cohort achieving MCID. For IKDC, preoperative mean was 50.2 ± 17.2, two-year mean was 80.5 ± 18.6, and MCID was 12.4 with 80% of patients achieving MCID. KOOS JR had a preoperative man of 66.0 ± 14.6, two-year follow-up mean of 88.8 ± 11.9, and MCID of 8.5 with 72% of patients meeting this MCID (Figure 1). Conclusions: At two years following MPFL reconstruction, the MCID’s for clinically relevant subjective PROS were 9.2 (Kujala), 12.5 (IKDC), and 8.5 (KOOS JR). MCID’s for MPFL reconstruction are already established for 6-month and 1-year time points, and this was the first presentation of two-year MCID values. Establishing the 2-year MCID for MPFL reconstruction gives surgeons another tool to use in the diagnoses of patellar instability patients who may be struggling post-operatively.
Poster 313: Short-Term Patient Reported Outcomes and Physical Performance Tests Following Anterior Cruciate Ligament Reconstruction With and Without Modified Lemaire Tenodesis in Younger Patients: a Prospective Comparison
Authors: van der List Jelle , Blom Ingmar , Benner Joyce , Jonkers Freerk , Hofstee Dirk Jan 
Published: August 2024

Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, a modified Lemaire extra-articular tenodesis (LET) has been added to the procedure, which has been shown to decrease failure rates. However, not much is currently known about the short-term rehabilitation following this procedure. Therefore, the goal was to assess the short-term patient-reported outcomes (PROMS), strength-testing and functional testing following ACLR with and without LET. Methods: A prospective study was performed for all patients undergoing ACL reconstruction in a regional teaching hospital from 2019 to 2022, in which LET was added in 2020. All patients underwent standard four- or five-strand autologous hamstring ACL reconstruction using femoral button fixation and tibial screw fixation and one group underwent additional LET with anchor fixation. Preoperatively, patients completed patient-reported outcome measures (PROMs; International Knee Documentation Committee questionnaire, Lysholm, Numeric Rating Scale questionnaires for pain, EQ5D), Biodex testing for flexion and extension strength at 60 and 180 peak torque, and range of motion. These outcomes were also obtained at 3, 6, 9 and 12 months postoperatively and single-leg and timed-6m-hop tests were performed at 6 and 9 months postoperatively. Results: One-hundred-sixty-seven patients were prospectively enrolled of which 61 (36.5%) received additional LET. Patients preoperatively had similar age, gender, Body Mass Index (BMI), meniscus and chondral damage, collateral ligament injury, PROMs or Biodex, except thicker grafts in the LET group (9.0 vs 8.7 mm, p=0.009). At three months, Lemaire patients reported less pain (NRS 16.2 vs. 35.6, p<0.001) and better Lysholm score (78.4 vs. 70.8, p=0.039) compared to the isolated ACLR group. At six months, Lemaire patients had better LSI for 6m hop tests (115% vs 105%, p=0.011). At 12 months, the Lemaire group reported higher Tegner score (7.3 vs 6.2, p=0.062), and more patients returned to their preinjury Tegner level compared to isolated ACLR (80% vs. 51%, p=0.032). Conclusions: This prospective comparative study noted that patients undergoing ACLR with LET had less pain and better Lysholm scores at 3 months, and better LSI for 6m hop tests at 6 months follow-up. Furthermore, patients with additional LET had a higher postoperative Tegner activity level and a higher percentage of patients reaching pre-injury level of sports at 1-year follow-up.
Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel
Authors: Larsen Jesper Juul , Lauridsen Halfdan , Gundersen Laurits Wullum , Riecke Birgit Falk , Schmidt Thomas A. 
Published: August 2024

Abstract
Background
Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians.

Methods
Data from 120,901 patients registered in a secondary care ED from the 4tth quarter of 2021 to the 1st quarter of 2024 was drawn from the electronic health record’s data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student’s two tailed t-test for unpaired values.

Results
Before and after ED changes crowding of 130% amounted to 123.8 h and 19.3 h in the latter. This is a difference of -104.6 ± 23.9 h with a 95% CI of -159.9 to -49.3, Δ% -84 (p = 0.002).
There was the same amount of patients / day amounting to 135.8 and 133.5 patients / day Δ% = -1.7 patients 95% CI -6.3 to 1.6 (p = 0.21).
There was no change in readmittances within 72 h before and after changes amounting to 9.0% versus 9.5%, Δ% = 0.5, 95%, CI -0.007 to 1.0 (p > 0.052).

Conclusion
It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.
Understanding the role of video direct observed therapy for patients on an oral short-course regimen for multi-drug resistant tuberculosis: findings from a qualitative study in Eswatini
Authors: Mukooza Esther , Schausberger Bernadette , Mmema Nqobile , Dlamini Velibanti , Aung Aung , Kerschberger Bernhard , Ciglenecki Iza , Vambe Debrah , Wringe Alison 
Published: August 2024

Abstract
Background
Improving treatment success rates among multi drug-resistant tuberculosis (MDR-TB) patients is critical to reducing its incidence and mortality, but adherence poses an important challenge. Video-based direct observed therapy (vDOT) may provide adherence benefits, while addressing the time and cost burden associated with community treatment supporter (CTS)-DOT. This study explored experiences of patients, family members and healthcare workers with different DOT modalities for adherence support in Eswatini.

Methods
Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.

Results
Four themes emerged that reflected participants’ experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.

Conclusions
vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.
Exploration of the molecular characteristics and potential clinical significance of shared immune-related genes between preterm preeclampsia and term preeclampsia
Authors: Huang Zhengrui , Sun Lu , Gao Yudie , Shi Meiting , Zhang Ping , Ding Yuzhen , Wang Jian , Wei Jiachun , Yang Xiuli , Li Ruiman 
Published: August 2024

Abstract
Background
Preeclampsia is a severe obstetric disorder that significantly affects the maternal and neonatal peri-partum safety and long-term quality of life. However, there is limited research exploring the common mechanisms and potential clinical significance between early-onset preeclampsia and full-term preeclampsia from an immunological perspective.

Methods
In this study, data analysis was conducted. Initially, immune-related co-expressed genes involving both subtypes of preeclampsia were identified through Weighted Gene Co-expression Network Analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were further employed to investigate the shared pathways regulated by immune-related genes. Binary logistic regression identified co-expressed genes with diagnostic value for preeclampsia, and a diagnostic model was constructed. Gene Set Enrichment Analysis (GSEA) predicted the potential biological functions of the selected genes. Lasso and Cox regression analyses identified genes closely associated with gestational duration, and a risk score model was established. A 4-gene feature, immune-related gene model for predicting the risk of preterm birth in preeclamptic pregnant women, was developed and validated through qPCR experiments. Immune cell infiltration analysis determined differences in immune cell infiltration between the two subtypes of preeclampsia.

Results
This study identified 4 immune-related co-expressed genes (CXCR6, PIK3CB, IL1RAP, and OSMR). Additionally, diagnostic and preterm birth risk prediction models for preeclampsia were constructed based on these genes. GSEA analysis suggested the involvement of these genes in the regulation of galactose metabolism, notch signaling pathway, and RIG-I like receptor signaling pathway. Immune pathway analysis indicated that the activation of T cell co-inhibition could be a potential intervention target for immunotherapy in early-onset preeclampsia.

Conclusion
Our study provides promising insights into immunotherapy and mechanistic research for preeclampsia, discovering novel diagnostic and intervention biomarkers, and offering personalized diagnostic tools for preeclampsia.
Balancing confidentiality and care coordination: challenges in patient privacy
Authors: Ibrahim Ateya Megahed , Abdel-Aziz Hassanat Ramadan , Mohamed Heba Ali Hamed , Zaghamir Donia Elsaid Fathi , Wahba Nadia Mohamed Ibrahim , Hassan Ghada. A. , Shaban Mostafa , EL-Nablaway Mohammad , Aldughmi Ohoud Naif , Aboelola Taghreed Hussien 
Published: August 2024

Abstract
Background
In the digital age, maintaining patient confidentiality while ensuring effective care coordination poses significant challenges for healthcare providers, particularly nurses.

Aim
To investigate the challenges and strategies associated with balancing patient confidentiality and effective care coordination in the digital age.

Methods
A cross-sectional study was conducted in a general hospital in Egypt to collect data from 150 nurses across various departments with at least six months of experience in patient care. Data were collected using six tools: Demographic Form, HIPAA Compliance Checklist, Privacy Impact Assessment (PIA) Tool, Data Sharing Agreement (DSA) Framework, EHR Privacy and Security Assessment Tool, and NIST Cybersecurity Framework. Validity and Reliability were ensured through pilot testing and factor analysis.

Results
Participants were primarily aged 31–40 years (45%), with 75% female and 60% staff nurses. High compliance was observed in the HIPAA Compliance Checklist, especially in Administrative Safeguards (3.8 ± 0.5), indicating strong management and training processes, with an overall score of 85 ± 10. The PIA Tool showed robust privacy management, with Project Descriptions scoring 4.5 ± 0.3 and a total score of 30 ± 3. The DSA Framework had a mean total score of 20 ± 2, with Data Protection Measures scoring highest at 4.0 ± 0.4. The EHR assessments revealed high scores in Access Controls (4.4 ± 0.3) and Data Integrity Measures (4.3 ± 0.3), with an overall score of 22 ± 1.5. The NIST Cybersecurity Framework had a total score of 18 ± 2, with the highest scores in Protect (3.8) and lower in Detect (3.6). Strong positive correlations were found between HIPAA Compliance and EHR Privacy (r = 0.70, p < 0.05) and NIST Cybersecurity (r = 0.55, p < 0.05), reflecting effective data protection practices.

Conclusion
The study suggests that continuous improvement in privacy practices among healthcare providers, through ongoing training and comprehensive privacy frameworks, is vital for enhancing patient confidentiality and supporting effective care coordination.
The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis
Authors: Senaratne Dhaneesha N. S. , Thakkar Bhushan , Smith Blair H. , Hales Tim G. , Marryat Louise , Colvin Lesley A. 
Published: August 2024

Abstract
Background
Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity.

Methods
We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose–response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528).

Results
From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose–response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001).

Conclusions
This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
Circulating interleukin-8 and osteopontin are promising biomarkers of clinical outcomes in advanced melanoma patients treated with targeted therapy
Authors: Levati Lauretta , Tabolacci Claudio , Facchiano Antonio , Facchiano Francesco , Alvino Ester , Antonini Cappellini Gian Carlo , Scala Enrico , Bonmassar Laura , Caporali Simona , Lacal Pedro Miguel , Bresin Antonella , De Galitiis Federica , Russo Giandomenico , D’Atri Stefania 
Published: August 2024

Abstract
Background
Circulating cytokines can represent non-invasive biomarkers to improve prediction of clinical outcomes of cancer patients. Here, plasma levels of IL-8, CCL4, osteopontin, LIF and BDNF were determined at baseline (T0), after 2 months of therapy (T2) and, when feasible, at progression (TP), in 70 melanoma patients treated with BRAF and MEK inhibitors. The association of baseline cytokine levels with clinical response, progression-free survival (PFS) and overall survival (OS) was evaluated.

Methods
Cytokine concentrations were measured using the xMAP technology. Their ability to discriminate between responding (Rs) and non-responding (NRs) patients was assessed by Receiver Operating Characteristics analysis. PFS and OS were estimated with the Kaplan–Meier method. The Cox proportional hazard model was used in the univariate and multivariate analyses to estimate crude and adjusted hazard ratios with 95% confidence intervals.

Results
CCL4 and LIF were undetectable in the majority of samples. The median osteopontin concentration at T0 and T2 was significantly higher in NRs than in Rs. The median T0 and T2 values of IL-8 were also higher in NRs than in Rs, although the statistical significance was not reached. No differences were detected for BDNF. In 39 Rs with matched T0, T2, and TP samples, osteopontin and IL-8 significantly decreased from T0 to T2 and rose again at TP, while BDNF levels remained unchanged. In NRs, none of the cytokines showed a significant decrease at T2. Only osteopontin demonstrated a good ability to discriminate between Rs and NRs. A high IL-8 T0 level was associated with significantly shorter PFS and OS and higher risk of progression and mortality, and remained an independent negative prognostic factor for OS in multivariate analysis. An elevated osteopontin T0 concentration was also significantly associated with worse OS and increased risk of death. Patients with high IL-8 and high osteopontin showed the lowest PFS and OS, and in multivariate analysis this cytokine combination remained independently associated with a three- to six-fold increased risk of mortality.

Conclusion
Circulating IL-8 and osteopontin appear useful biomarkers to refine prognosis evaluation of patients undergoing targeted therapy, and deserve attention as potential targets to improve its clinical efficacy.
Magnesium sulphate to prevent perioperative atrial fibrillation in cardiac surgery: a randomized clinical trial
Authors: Meerman Manon , Buijser Marit , van den Berg Lettie , van den Heuvel Anne-Marthe , Hoohenkerk Gerard , van Driel Vincent , Munsterman Luuk , de Vroege Roel , Bailey Michael , Bellomo Rinaldo , Ludikhuize Jeroen 
Published: August 2024

Abstract
Background
Postoperative atrial fibrillation (POAF) is a common and potentially serious complication post cardiac surgery. Hypomagnesaemia is common after cardiac surgery and recent evidence indicates that supplementation of magnesium may prevent POAF. We aim to investigate the effectiveness of continuous intravenous magnesium sulphate administration in the perioperative period to prevent POAF as compared to placebo.

Methods
The (POMPAE) trial is a phase 2, single-center, double-blinded randomized superiority clinical study. It aims to assess the impact of perioperative continuous intravenous magnesium administration on the occurrence of cardiac surgery-related POAF. A total of 530 patients will be included. Eligible patients will be randomized in 1:1 ratio to the intervention or placebo group with stratification based on the presence of valvular surgery. The objective of the infusion is to maintain ionized magnesium levels between 1.5 and 2.0 mmol/L.

Discussion
The primary outcome measure is the incidence of de novo POAF within the first 7 days following surgery, with censoring at hospital discharge. This trial may generate crucial evidence for the prevention of POAF and reduce clinical adverse events in patients following cardiac surgery.

Trial registration
The POMPAE trial was registered at ClinicalTrials.gov under the following identifier NTC05669417, https://clinicaltrials.gov/ct2/show/NCT05669417. Registered on December 30, 2022.

Protocol version
Version 3.3, dated 13–01-2023.