bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical record-keeping educational interventions for medical students and residents: a systematic review
Authors: Emekli Emre , Coşkun Özlem , Budakoğlu Işıl İrem 
Published: August 2024

Background: Medical records, encompassing patient histories, progress notes, and more, play a crucial role in patient care and treatment, healthcare communication, medico-legal matters, and supporting financial documentation. Objective: Despite their significance, literature suggests inconsistencies in record quality and insufficient formal medical record-keeping education for medical students and residents. The study aimed to identify and evaluate the effectiveness of educational interventions by conducting a systematic review. Method: A literature search covering 2003–2023 and review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken. Results: The literature search identified 44 relevant studies for inclusion. Educational methods, including lectures, feedback, workshops and discussions, addressed different components of the clinical record. The review revealed positive impacts on participant satisfaction, skills and attitudes related to record-keeping. However, some studies reported no significant positive outcomes, emphasising the need for higher-level evidence. Most studies adopted a single-group pretest–posttest design, presenting challenges in control group implementation. The Kirkpatrick evaluation levels were primarily at level 2, with few studies reaching level 3. The absence of studies at level 4 suggested the need for more robust evidence. Studies targeted medical residents more frequently than medical students, with a lack of interventions during the first year of medical education. Conclusion: Despite limitations including language bias and methodological variations, the review revealed diverse educational strategies and highlighted the necessity for more randomised controlled trials and studies providing higher-level evidence to enhance clinical record-keeping skills among medical students and residents. Implications: Medical record-keeping educational interventions can significantly improve the documentation skills of medical students and residents, thereby enhancing patient care, communication and medico-legal compliance.
Characterizing Dysphonia After Pediatric Open Airway Reconstruction: Systematic Review and Meta-Analysis
Authors: Dahan Zachary , Pincivy Alix , Nhan Carol , Bergeron Mathieu 
Published: August 2024

Background Pediatric laryngotracheal stenosis often requires open airway reconstruction. While these surgeries establish an airway for adequate ventilation, many patients develop subsequent dysphonia. Numerous studies have reported outcomes related to voice. Objective This study aims to evaluate dysphonia in pediatric patients following open airway reconstruction, focusing on acoustic parameters, perceptual voice quality, and voice-related quality of life. Methods A comprehensive search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across 6 databases identified articles involving pediatric patients who underwent open airway reconstruction and reported postoperative vocal acoustic parameters, perceptual voice quality, voice-related quality of life, or vocal mechanics. Articles were assessed for bias risk, and common outcomes were synthesized qualitatively and quantitatively using meta-analyses. Results Among 4089 articles, 21 were included, involving 497 pediatric patients. Laryngotracheoplasty was the most common procedure followed by cricotracheal resection. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scale was frequently used to assess voice quality, with a mean score of 55.6 [95% confidence intervals (CIs): 47.9-63.3]. Voice-related quality of life was measured using the pediatric Voice Handicap Index (pVHI) and Pediatric Voice-Related Quality of Life Survey, with mean scores of 35.6 (95% CI: 21.4-49.7) and 83.7 (95% CI: 74.1-93.2), respectively. The fundamental frequency was 210.5 (95% CI: 174.6-246.3). Other common findings included supraglottic phonation, anterior commissure blunting, posterior glottic diastasis, and abnormal vocal cord mobility. Conclusion Pediatric patients experiencing dysphonia after open airway reconstruction exhibited moderately decreased voice quality and reduced voice-related quality of life. However, there was inconsistency in study protocols and outcome measures used. Preserving voice quality during airway reconstruction is crucial to avoid negative impacts on quality of life.
Mechanism of Action of Qingrekasen Granules in Alleviating Nephrotic Syndrome Evaluated by a Multi-Omics Approach
Authors: Wang Shanshan , Dai Wangqiang , Huang Zhuang , Liu Jiajing , Huang Hailing , Ye Yan , Chen Pengyu , Duan Bailu , Jiang Qi , Wen Yuxin , Han Lintao , Li Jingjing 
Published: August 2024

Objectives In this study, the efficacy of and mechanism of Qingrekasen Granules (QRKSG) is evaluated by metabolomics and transcriptomics using adriamycin (ADR)-induced nephrotic syndrome (NS) in rat model. Methods The model, benazepril, and QRKSG group received a single injection of 6.5 mg/kg ADR via the tail vein of the rats. The untreated group received an equal saline injection. The administration of drugs by gavage began after completing the modeling for one week. Benazepril was given at 0.9 mg/kg/d to the benazepril group and QRKSG was given at 1.62 g/kg/d to the QRKSG group. During gavage, 24 h urine was collected weekly. After four weeks of gavage, rats were anesthetized, and we collected the serum, feces, and kidney samples. The protective effect of QRKSG on NS was assessed by the detection of proteins in the urine at 24 h and serum biochemical indexes, as well as histopathological observation, TUNEL assay, and Western Blot of kidney samples. Moreover, gas chromatography-mass spectrometry (GC-MS) metabolomics sequencing of kidney metabolites helped investigate the significant differential metabolites produced by QRKSG that are implicated in ameliorating the pathological damage to the kidneys of NS rats. Subsequently, the significant targets of QRKSG that had an impact on the action of drugs were investigated by a transcriptome sequencing analysis. The correlation between both sets was also investigated. In addition, the effect of QRKSG on the gut microbiota of NS rats was investigated. Finally, the core targets were validated by molecular docking. Results The results indicated that QRKSG possess significant renoprotective effects in NS rats by reversing the abnormal urinary protein content and serum biochemical disorders, as well as improving renal pathological damage. Multiple genes and metabolites were shown to be back-regulated after QRKSG delivery, based on further multi-omics studies. The integrated metabolomics and transcriptomics analysis showed that QRKSG alleviated NS mainly by regulating amino acid metabolic pathways. Gut microbiota analysis demonstrated that QRKSG could alleviate NS by improving gut microbiota. The molecular docking results showed good binding ability of the QRKSG active ingredient to the core target, and among them, the ingredients with the best docking effect were mainly flavonoids and phenolic acid ingredients. The combined metabolomics and transcriptomics study findings were validated through a TUNEL assay and a Western Blot analysis. Conclusion We have concluded that ADR-induced NS in rats can be treated with QRKSG. The mechanisms used by QRKSG to reduce the symptoms of NS are through the multi-component, multi-target, and multi-pathway therapeutic modulation of inflammation, oxidative stress, energy homeostasis, and apoptosis. Additionally, QRKSG could alleviate NS by regulating gut microbiota.
Chronic Adaptation of the Coracohumeral Space and Subscapularis Tendon in Professional Baseball Pitchers
Authors: Schofield Matthew R. , Paul Ryan W. , Buchheit Paul , Rauch Joseph , Thomas Stephen J. 
Published: August 2024

Background: Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers. Hypothesis: The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization. Level of Evidence: Level 4. Methods: Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured. Results: Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions ( P < 0.01), increased scapular protraction (163 vs 156 mm; P < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; P < 0.01). HR was associated with CHD in 30° of external rotation ( R2 = 0.12; P < 0.01), neutral rotation ( R2 = 0.11; P < 0.01), and the crossbody position ( R2 = 0.28; P < 0.01). PCT was associated with CHD in 30° of external rotation ( R2 = 0.16; P = 0.05). HR and CHD in 30° of external rotation was associated most strongly with subscapularis tendon organization ( R2 = 0.11; P = 0.03). Conclusion: The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder. Clinical Relevance: Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.
ChatGPT v4 outperforming v3.5 on cancer treatment recommendations in quality, clinical guideline, and expert opinion concordance
Authors: Tsai Chung-You , Cheng Pai-Yu , Deng Juinn-Horng , Jaw Fu-Shan , Yii Shyi-Chun 
Published: August 2024

Objectives To assess the quality and alignment of ChatGPT's cancer treatment recommendations (RECs) with National Comprehensive Cancer Network (NCCN) guidelines and expert opinions. Methods Three urologists performed quantitative and qualitative assessments in October 2023 analyzing responses from ChatGPT-4 and ChatGPT-3.5 to 108 prostate, kidney, and bladder cancer prompts using two zero-shot prompt templates. Performance evaluation involved calculating five ratios: expert-approved/expert-disagreed and NCCN-aligned RECs against total ChatGPT RECs plus coverage and adherence rates to NCCN. Experts rated the response's quality on a 1-5 scale considering correctness, comprehensiveness, specificity, and appropriateness. Results ChatGPT-4 outperformed ChatGPT-3.5 in prostate cancer inquiries, with an average word count of 317.3 versus 124.4 ( p < 0.001) and 6.1 versus 3.9 RECs ( p < 0.001). Its rater-approved REC ratio (96.1% vs. 89.4%) and alignment with NCCN guidelines (76.8% vs. 49.1%, p = 0.001) were superior and scored significantly better on all quality dimensions. Across 108 prompts covering three cancers, ChatGPT-4 produced an average of 6.0 RECs per case, with an 88.5% approval rate from raters, 86.7% NCCN concordance, and only a 9.5% disagreement rate. It achieved high marks in correctness (4.5), comprehensiveness (4.4), specificity (4.0), and appropriateness (4.4). Subgroup analyses across cancer types, disease statuses, and different prompt templates were reported. Conclusions ChatGPT-4 demonstrated significant improvement in providing accurate and detailed treatment recommendations for urological cancers in line with clinical guidelines and expert opinion. However, it is vital to recognize that AI tools are not without flaws and should be utilized with caution. ChatGPT could supplement, but not replace, personalized advice from healthcare professionals.
Romantic Attachment and Emerging Adults’ Future Expectations: Moderation Role of Self-Regulation
Authors: Reis Joana , Nunes Filipa , Matos Paula Mena , Mota Catarina Pinheiro 
Published: August 2024

The characteristics of Western societies pose significant challenges to how emerging adults view their futures. In the present study, we analyzed the associations between romantic attachment, self-regulation, and future expectations of emerging adults controlling the sex and age of participants. More specifically, we analyzed the moderating role of goal-setting, decision-making, and learning from mistakes (self-regulation dimensions) in the links between trustful, dependent, avoidant, and ambivalent romantic relationships and future expectations. The sample, collected by convenience in Portugal, includes 571 emerging adults (76.2% were female and 23.8% were male) aged between 18 and 30 years ( M = 23.31; SD = 3.35). Our results indicate significant associations between trust, dependent, avoidant, and ambivalent romantic relationships, with different dimensions of future expectations. Findings indicated that goal-setting moderates the association between dependent and avoidant romantic relationships and pessimism. We discuss these findings based on attachment theory, considering the relevance of emotional bonds and self-regulatory processes in future planning.
Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents
Authors: Adkins Sherry , Alta’any Rahaf , Brar Kewaljit , Kauser Humaira , Hughbanks Savannah , Rabah Kelly , Flowers Stacy 
Published: August 2024

I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984: Objectives Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error. Methods Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection. Results Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance. Conclusions Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.
Optimization of a mHealth Physical Activity Promotion Intervention With Mindful Awareness for Young Adult Cancer Survivors: Design and Methods of Opt2Move Full Factorial Trial
Authors: Reading Jean Miki , Solk Payton , Starikovsky Julia , Hasanaj Kristina , Wang Shirlene D , Siddique Juned , Sanford Stacy D , Salsman John , Horowitz Bruriah , Freeman Hannah , Alexander Jacqueline , Sauer Christina , Spring Bonnie , Victorson David , Phillips Siobhan M 
Published: August 2024

BackgroundOpt2Move is a theory-guided moderate and vigorous physical activity (MVPA) promotion trial that uses multiphase optimization strategy (MOST) methodology to evaluate the individual and combined effects of four intervention components in a full factorial experiment among young adult cancer survivors (YACS; N = 304). All participants will receive the core mHealth MVPA intervention, which includes a Fitbit and standard self-monitoring Opt2Move smartphone application. YACS will be randomized to one of 16 conditions to receive between zero and four additional components each with two levels (yes v. no): E-Coach, buddy, general mindfulness, and MVPA-specific mindfulness.ObjectiveThe primary aim is to determine the individual and combined effects of the components on MVPA post-intervention (12-weeks) and at 24-week follow-up. The secondary aim is to examine how changes in MVPA are associated with patient-reported outcomes, light-intensity activity, sedentary time, and sleep duration and quality. Potential mediators and moderators of component effects will also be examined.ResultsResults will support the selection of a package of intervention components optimized to maximize MVPA to be tested in a randomized controlled trial.ConclusionOpt2Move represents the first systematic effort to use MOST to design an optimized, scalable mHealth MVPA intervention for YACS and will lead to an improved understanding of how to effectively change YACS’ MVPA and ultimately, improve health and disease outcomes.
The intestinal microbiota and cellular therapy: implications for impact and mechanisms
Authors: Xie Jiayi , Smith Melody 
Published: August 2024

Abstract
The microbiota, comprising bacteria, fungi, and viruses residing within our bodies, functions as a key modulator in host health and states, including immune responses. Studies have linked microbiota and microbiota-derived metabolites to immune cell functions. In this review, we probe the complex relationship between the human microbiota and clinical outcomes of cellular therapies that leverage immune cells to fight various cancers. With a particular emphasis on hematopoietic cell transplantation and chimeric antigen receptor T-cell therapy, we explore the potential mechanisms underpinning this interaction. We also highlight the interventional applications of the microbiota in cellular therapy while outlining future research directions in the field.
On the evaluation of synthetic longitudinal electronic health records
Authors: Achterberg Jim L. , Haas Marcel R. , Spruit Marco R. 
Published: August 2024

Abstract
Background
Synthetic Electronic Health Records (EHRs) are becoming increasingly popular as a privacy enhancing technology. However, for longitudinal EHRs specifically, little research has been done into how to properly evaluate synthetically generated samples. In this article, we provide a discussion on existing methods and recommendations when evaluating the quality of synthetic longitudinal EHRs.

Methods
We recommend to assess synthetic EHR quality through similarity to real EHRs in low-dimensional projections, accuracy of a classifier discriminating synthetic from real samples, performance of synthetic versus real trained algorithms in clinical tasks, and privacy risk through risk of attribute inference. For each metric we discuss strengths and weaknesses, next to showing how it can be applied on a longitudinal dataset.

Results
To support the discussion on evaluation metrics, we apply discussed metrics on a dataset of synthetic EHRs generated from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) repository.

Conclusions
The discussion on evaluation metrics provide guidance for researchers on how to use and interpret different metrics when evaluating the quality of synthetic longitudinal EHRs.
Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study
Authors: Martin-Misener Ruth , Donald Faith , Rayner Jennifer , Carter Nancy , Kilpatrick Kelley , Ziegler Erin , Bourgeault Ivy , Bryant-Lukosius Denise 
Published: August 2024

Abstract
Background
Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.

Methods
We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.

Results
Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients’ health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it— “a grey area.” Establishing and maintaining a longitudinal relationship that responded holistically to patients’ needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients’ needs. Participants indicated NPs tried to address all of a patient’s concerns at each visit.

Conclusions
Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.