bluuebunny/crossref_metadata_2025_split huggingface dataset:
German Translation and Linguistic Validation of the LIMB‑Q: A Patient-reported Outcome Measure for Lower Extremity Trauma
Authors: Zhu Katherine J. , Njoroge Moreen W. , Zimmermann Stefan M. , Tafrishi Bita , Watson Jennifer , Breitkopf Trisia , Klassen Anne F. , Mundy Lily R. , Besmens Inga S. , Lindenblatt Nicole 
Published: July 2024

Background:
Lower extremity trauma can have a significant impact on a patient’s quality of life. The LIMB-Q is a recently developed and validated patient-reported outcome measure that assesses patient-specific outcomes and experience of health care. The aim of this study was to translate and linguistically validate the LIMB-Q from English to German.

Methods:
The translation was performed by combining World Health Organization and Professional Society for Health Economics and Outcomes Research guidelines. The process consisted of forward translations, a backward translation, expert panel meetings, cognitive debriefing interviews with patients, and several rounds of discussion and reconciliation with the creators of LIMB-Q. The goal was to obtain a culturally and conceptually accurate translation of LIMB-Q into German for use in Switzerland.

Results:
From the two forward translations, there was one primary discrepancy between the two translators that was discussed to determine the most conceptually accurate translation. From the backward translations, there were 63 items that required discussion and re-translation. Nine patients participated in the cognitive debriefing interviews, which led to three items being modified. The translation process led to a linguistically validated and conceptually equivalent German version of the LIMB-Q.

Conclusions:
The German (Switzerland) version of LIMB-Q is now available. This will offer a valuable tool for lower extremity trauma research and clinical care in German-speaking populations.
Post-LASIK Exophiala jeanselmei Keratitis
Authors: Ahmed Adil , Fard Ali Mahdavi , Hsu Hugo Y. 
Published: July 2024

Objective:
To describe a patient diagnosed with Exophiala jeanselmei keratitis.

Methods:
We report a case of a patient who developed infectious keratitis following laser in situ keratomileusis and chronic topical steroid use for approximately six months in both eyes. An atypical infiltrate containing dark pigmentation was noted in the left eye on the initial presentation. During treatment, the infiltrates of the right eye began to exhibit a similar pigmentation.

Results:
Early treatment with topical antifungals was initiated in the left eye and later in the right eye once culture results returned. Both eyes recovered with good vision after approximately one month.

Conclusions:
Patients treated with postoperative topical corticosteroids should be cautioned of potential adverse effects of chronic use and have close follow-up. If infectious keratitis develops, particularly after two weeks, then atypical organisms, such as fungi, should be considered. In addition, our case highlights the significance of recognizing and associating dark-pigmentation with fungal etiologies.
3D X-ray computed tomography in the analyses of intraocular lenses explanted because of postoperative opacification
Authors: Werner Liliana , Wallace-Carrete Christopher , Kelkar Neil , Eid Kevin , Polson Randy 
Published: July 2024

Purpose:
To use X-ray computed tomography (CT) –which describes the acquisition and reconstruction of 2-dimensional X-ray transmission images to create a 3D representation of a specimen –in the analyses of intraocular lenses (IOLs) explanted because of optical opacification occurring postoperatively.

Setting:
John A. Moran Eye Center, and Utah Nanofab, University of Utah, Salt Lake City, Utah.

Design:
Laboratory study.

Methods:
A hydrophilic acrylic and a silicone lens (the latter from an eye with asteroid hyalosis) explanted because of postoperative calcification, as well as a poly(methyl methacrylate) (PMMA) lens explanted because of snowflake degeneration underwent analysis under gross and light microscopy. Then, they were attached to an appropriate support and scanned under a Zeiss Xradia Versa X-ray microscope. After data acquisition, data segmentation was performed with a commercially available program to separate image data into components.

Results:
Morphology, size/volume, and specific location of calcified deposits on the surface or within the substance of explanted IOLs could be demonstrated by X-ray CT within the entire volume of each lens with high contrast and resolution. The PMMA lens showed multiple spaces/fissures in relation to Nd:YAG pitting of the optic, and what appeared to be sheets of delaminated PMMA material at different levels within the optic substance.

Conclusions:
The key benefit of X-ray CT is that it can be performed without physically sectioning the specimen. This preliminary study demonstrates that this technology can be potentially useful in the imaging and analyses of explanted, opacified lenses.
Cost analysis of dropless cataract surgery prophylaxis with intracameral antibiotics and subconjunctival steroids
Authors: Massa Scott , Smits David J. , Nguyen Alexander T. , Patil Sachi A. , Chen Evan M. , Shorstein Neal H. , Friedman Scott , Parikh Ravi 
Published: July 2024

Purpose:
To determine whether dropless, injection-based cataract surgery prophylaxis with intracameral antibiotic and subconjunctival steroid may reduce healthcare system costs and patient out-of-pocket costs compared with topical medication regimens.

Setting:
U.S. national medical expenditures database.

Design:
Retrospective cost analysis.

Methods:
Costs were analyzed for topical ophthalmics from the 2020 Medical Expenditure Panel Survey (MEPS) and for dropless medications from pharmaceutical invoices/catalogs. Main outcomes included system costs, from insurance and patient payments, and out-of-pocket costs for cataract surgery topical and dropless, injection-based prophylactic medication regimens, per eye and nationally. System costs for individual topical medications and same-class dropless, injection-based medications were compared using 2-sided, 1-sample t tests.

Results:
There were 583 prophylactic topical ophthalmic purchases in MEPS. Mean system costs per eye were $76.20 ± SD 39.07 for the lowest cost topical steroid (prednisolone) compared with $4.01 for the lowest cost subconjunctival steroid (triamcinolone acetonide) (P < .001). Per eye, the lowest cost dropless, injection-based regimen, at $15.91, results in an $87.99 (84.7%) reduction in overall healthcare costs and a $43.64 (100%) reduction in patient out-of-pocket costs relative to the lowest cost topical regimen ($103.90 ± 43.14 mean system cost and $43.64 ± 37.32 mean out-of-pocket cost per eye). Use of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce annual national healthcare system and out-of-pocket costs up to $450 000 000 and $225 000 000, respectively.

Conclusions:
An evidence-based cataract surgery prophylactic medication regimen of intracameral moxifloxacin and subconjunctival triamcinolone acetonide can reduce healthcare system and patient out-of-pocket costs in comparison with various topical regimens.
Integrating the Principles of Academic Freedom and Patient-Centered Care to Promote Tolerant Listening Skills in Health Care Providers
Authors: Noller Diana T. , Cain Shannon 
Published: July 2024

Abstract
Collaboration is a vital skill that needs to be developed in health professions students. Developing tolerance for differing viewpoints and valuing an understanding of others' lived experiences are instrumental skills in learning to provide patient-centered care. Fostering the expression of diverse viewpoints and working through uncomfortable and distressful situations are a part of the experience in acquiring these skills. It is the educator's duty to facilitate these encounters in a way that upholds the tenants of academic freedom and civility to create optimal educational outcomes. Doing so creates opportunities for transformative learning and the facilitation of higher cognitive development when compared with the avoidance of exposing students to divergent viewpoints. It is through freedom of discussion that one must teach students that ultimately the pursuit of truth, even when it may be unwelcome, disagreeable, or deeply offensive, greatly outweighs the discomfort the process of discovering it may bring.
Efficacy and safety of intraperitoneal ropivacaine in pain management following laparoscopic digestive surgery: A systematic review and meta-analysis of RCTs
Authors: Daghmouri Mohamed Aziz , Chaouch Mohamed Ali , Deniau Benjamin , Benayoun Laurent , Krimi Bassem , Gouader Amine , Oweira Hani 
Published: July 2024

Background:
Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery.

Methods:
We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates.

Results:
We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = −21.93 95% CI [−27.64, −16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = −0.20 95% CI [−0.36, −0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01).

Conclusion:
Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach.

Registration:
The registration number at PROSPERO was CRD42021279238.
Compensatory strategies of dysphagia after anterior cervical spinal surgery: A case report
Authors: Chung Sung Joon , Lee Jun Ho , Soh Yunsoo 
Published: July 2024

Rationale:
Dysphagia after anterior cervical discectomy and fusion (ACDF) is a common postoperative complication. However, information regarding rehabilitation strategies for postoperative dysphagia is limited. Herein, we report a compensatory strategy for treating dysphagia after ACDF.

Patient concerns:
A 65-year-old Asian male presented with left arm pain and weakness for more than 1 month. Magnetic resonance imaging of the cervical spine revealed degenerative disc lesions and spinal stenosis at the C3 to C7 levels. The patient underwent ACDF at the C3 to C5 levels and artificial disc replacement at the C5 to C7 levels by right side approach. After surgery, the patient complained of difficulty swallowing. A video fluoroscopic swallowing study (VFSS) detected swallowing dysfunction in the pharyngeal phase, revealing an asymmetric pharyngeal residue in the anterior–posterior view.

Diagnosis:
The patient was diagnosed with dysphagia after ACDF.

Interventions:
Based on the VFSS findings, the patient underwent swallowing rehabilitation therapy and compensatory techniques, such as head rotation to the weak right side and head tilting to the robust left side.

Outcomes:
After 2 months of rehabilitation with compensatory techniques, food moved smoothly towards the robust side, and the subjective symptoms of dysphagia improved.

Lessons:
Consequently, swallowing function post-ACDF surgery must be assessed; if unilateral dysphagia is detected, compensatory techniques may prove beneficial. This case study showed that, based on the objective findings of the VFSS, an effective swallowing compensation strategy can be established and applied to patients with postoperative dysphagia.
Comparative evaluation of knee osteoarthritis: radiography vs. ultrasonography in Nepalese population: a cross-sectional study
Authors: Suwal Sundar , K.C. Bibek , Katwal Shailendra , Chataut Dinesh , Lohani Benu 
Published: July 2024

Background and objectives:
Osteoarthritis (OA) is a degenerative and long-term debilitating disease with rising prevalence, predominantly involving larger joints including the knee joint. While radiography has traditionally been the primary modality for joint evaluation, there is a growing trend towards using ultrasonography (USG) for musculoskeletal disorders, including joint assessment. This study aimed to find the role of USG in the evaluation of OA of knee joints with comparison to the radiographs.

Methods:
This was a cross-sectional study done on patients with signs and symptoms of OA of the knee who visited the radiology department for knee radiographs. Kellgren and Lawrence system was used for grading OA in radiographs. USG of knee joints was done with high-frequency probes and searched for joint space width, articular cartilage thickness, marginal osteophytes, meniscal extrusion, and other articular/ extra-articular abnormalities. The USG findings were correlated with findings in anteroposterior and lateral radiographs.

Results:
The mean number of osteophytes was higher in USG compared to the radiographs (P<0.001). Mean joint spaces were comparable in both modalities. Meniscal extrusion was seen with USG, which significantly correlated with joint space width and cartilage thickness (P<0.005). USG also detected synovial changes, effusion, and Baker’s cyst.

Conclusion:
Although radiography is the standard first-line radiological investigation for the diagnosis of OA of the knee joint, USG can be an adjunct as it well correlates with the radiograph findings and can provide more useful information.
Nurse Certification and Test Anxiety
Authors: Stanzo Karen , DeMoss Marinetta , Hollingsworth Bria , Schrah Sherrill Sarah , Cruz Maria Sarah Faye D. , Reynolds Allison , Jackson Tina , Nwawuihe James 
Published: July 2024

OBJECTIVETo determine the relationship between scores on the Westside Test Anxiety Scale (WTAS) and nurse certification rates.BACKGROUNDNurse certification is associated with improved outcomes. Understanding intrinsic factors associated with low certification rates including test anxiety could help nurse leaders improve certification rates.METHODSThis descriptive, correlational study used a convenience sample of 577 RNs with at least 2 years of nursing experience. Participants completed a survey of their demographics and the 10-question WTAS.RESULTSCertified nurses were significantly older and had more years of experience. Noncertified nurses had significantly higher scores on the WTAS.CONCLUSIONSFacilities working to increase their nurse certification rates may consider adding test anxiety reduction interventions to other levels of support.
Evaluation of a Comprehensive Algorithm for PICU Patients With New Fever or Instability: Association of Clinical Decision Support With Testing Practices
Authors: Linz Matthew S. , Booth Lauren D. , Milstone Aaron M. , Stockwell David C. , Sick-Samuels Anna C. 
Published: July 2024

OBJECTIVES:
Previously, we implemented a comprehensive decision support tool, a “New Fever Algorithm,” to support the evaluation of PICU patients with new fever or instability. This tool was associated with a decline in culture rates without safety concerns. We assessed the impact of the algorithm on testing practices by identifying the proportion of cultures pre- vs. post-implementation that were discordant with algorithm guidance and may have been avoidable.

DESIGN:
Retrospective evaluation 12 months pre- vs. post-quality improvement intervention.

SETTING:
Single-center academic PICU and pediatric cardiac ICU.

SUBJECTS:
All admitted patients.

INTERVENTIONS:
Implementing the “New Fever Algorithm” in July 2020.

MEASUREMENTS AND MAIN RESULTS:
Patient medical records were reviewed to categorize indications for all blood, respiratory, and urine cultures. Among cultures obtained for new fever or new clinical instability, we assessed specific testing patterns that were discordant from the algorithm’s guidance such as blood cultures obtained without documented concern for sepsis without initiation of antibiotics, respiratory cultures without respiratory symptoms, urine cultures without a urinalysis or pyuria, and pan-cultures (concurrent blood, respiratory, and urine cultures). Among 2827 cultures, 1950 (69%) were obtained for new fever or instability. The proportion of peripheral blood cultures obtained without clinical concern for sepsis declined from 18.6% to 10.4% (p < 0.0007). Respiratory cultures without respiratory symptoms declined from 41.5% to 27.4% (p = 0.01). Urine cultures without a urinalysis did not decline (from 27.6% to 25.1%). Urine cultures without pyuria declined from 83.0% to 73.7% (p = 0.04). Pan-cultures declined from 22.4% to 10.6% (p < 0.0001). Overall, algorithm-discordant testing declined from 39% to 30% (p < 0.0001).

CONCLUSIONS:
The majority of cultures obtained were for new fever or instability and introduction of the “New Fever Algorithm” was associated with reductions in algorithm-discordant testing practices and pan-cultures. There remain opportunities for improvement and additional strategies are warranted to optimize testing practices for in this complex patient population.
Ethnicity and Observed Oxygen Saturations, Fraction of Inspired Oxygen, and Clinical Outcomes: A Post-Hoc Analysis of the Oxy-PICU Trial of Conservative Oxygenation*
Authors: Jones Gareth A.L. , Wiegand Martin , Ray Samiran , Gould Doug W. , Agbeko Rachel , Giallongo Elisa , Charles Walton N. , Orzol Marzena , O’Neill Lauran , Lampro Lamprini , Lillie Jon , Pappachan John , Ramnarayan Padmanabhan , Harrison David A. , Mouncey Paul R. , Peters Mark J. ,   for the Oxy-PICU Investigators of the Pediatric Critical Care Society Study Group
Published: July 2024

OBJECTIVES:
A conservative oxygenation strategy, targeting peripheral oxygen saturations (Spo
2) between 88% and 92% in mechanically ventilated children in PICU, was associated with a shorter duration of organ support and greater survival compared with Spo
2 greater than 94% in our recent Oxy-PICU trial. Spo
2 monitors may overestimate arterial oxygen saturation (Sao
2) in patients with higher levels of skin pigmentation compared with those with less skin pigmentation. We investigated if ethnicity was associated with changes in distributions of Spo
2 and Fio
2 and outcome.

DESIGN:
Post-hoc analysis of a pragmatic, open-label, multicenter randomized controlled trial.

SETTING:
Fifteen PICUs across the United Kingdom and Scotland.

PATIENTS:
Children aged 38 weeks corrected gestational age to 15 years accepted to a participating PICU as an unplanned admission and receiving invasive mechanical ventilation with supplemental oxygen for abnormal gas exchange.

METHODS:
Hierarchical regression models for Spo
2 and Fio
2, and ordinal models for the primary trial outcome of a composite of the duration of organ support at 30 days and death, were used to examine the effects of ethnicity, accounting for baseline Spo
2, Fio
2, and mean airway pressure and trial allocation.

MEASUREMENTS AND MAIN RESULTS:
Ethnicity data were available for 1577 of 1986 eligible children, 1408 (89.3%) of which were White, Asian, or Black. Spo
2 and Fio
2 distributions did not vary according to Black or Asian ethnicity compared with White children. The trial primary outcome measure also did not vary significantly with ethnicity. The point estimate for the treatment effect of conservative oxygenation in Black children was 0.64 (95% CI, 0.33–1.25) compared with 0.84 (0.68–1.04) in the overall trial population.

CONCLUSIONS:
These data do not suggest that the association between improved outcomes and conservative oxygenation strategy in mechanically ventilated children in PICU is modified by ethnicity.
Pediatric Hematology and Oncology Patients on Extracorporeal Membrane Oxygenation: Outcomes in a Multicenter, Retrospective Cohort, 2009–2021
Authors: Mowrer Michael Colin , Lima Lisa , Nair Rohit , Li Xilong , Sandhu Hitesh , Bridges Brian , Barbaro Ryan P. , Bhar Saleh , Nkwantabisa Raymond , Ghafoor Saad , Reschke Agnes , Olson Taylor , Malone Matthew P. , Shah Neel , Zinter Matt S. , Gehlbach Jon , Hollinger Laura , Scott Briana L. , Lerner Reut Kassif , Brogan Thomas V. , Raman Lakshmi , Potera Renee M. 
Published: July 2024

OBJECTIVE:
To describe characteristics associated with survival for pediatric patients with an oncologic diagnosis or hematopoietic cell transplant (HCT) supported with extracorporeal membrane oxygenation (ECMO).

DESIGN:
Multicenter, retrospective study.

SETTING:
Sixteen PICUs in the United States and Israel.

PATIENTS:
We included patients aged younger than 19 years with an oncologic diagnosis or HCT who required ECMO support between 2009 and 2021.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A total of 149 patients were included in the study cohort. There were 118 patients with an oncologic diagnosis and 31 that received HCT. The indications for ECMO were respiratory failure (46%), combined respiratory and cardiac failure (28%), and cardiac failure (25%). Venovenous (V-V) ECMO was used in 45% of patients, with 53% of patients being placed on venoarterial (V-A) ECMO. For oncologic and HCT groups, survival to ECMO decannulation was 52% (62/118) and 64% (20/31), and survival to hospital discharge was 36% (43/118) and 42% (13/31), respectively. After adjusting for other factors, requiring cardiopulmonary resuscitation was associated with greater odds ratio of mortality (3.0 [95% CI, 1.2–7.7]).

CONCLUSIONS:
Survival to ECMO decannulation of pediatric oncologic and HCT patients in this study was 52–64%, depending upon diagnosis. However, survival to hospital discharge remains poor. Future research should prioritize understanding factors contributing to this survival gap within these patient populations.
Identifying Patients At Risk for Melanoma in an Aesthetic Practice
Authors: Mogle Miranda , Vortman Rebecca , Miller Amy 
Published: July 2024

In the United States, melanoma skin cancer deaths are expected to rise by 4.4% in 2023, reaching 7990. Early detection through visual screening can save lives, but the US Preventive Services Task Force cites insufficient evidence to recommend universal skin screening for all adults. For this reason, the risk for melanoma may be overlooked outside of dermatology settings, leading to delayed diagnoses and poor survival rates. Our project aimed to address this issue by increasing the identification of at-risk individuals visiting a medical aesthetic practice in the Midwest. The literature regarding melanoma risk stratification outside of dermatology settings is deficient. A search yielding 336 articles produced 8 articles for review. Five suggested melanoma risk screenings in general practice are feasible and/or can lead to early detection. Using the Plan-Do-Study-Act model, we executed our project from February through April 2023. Patients visiting the medical aesthetic practice completed a Self-Assessment Melanoma Risk Score questionnaire. We assessed the completed questionnaires and offered visual cancer screenings or dermatology referrals to patients identified as at-risk. A total of 211 patients participated, and 26% (n = 55) were identified as at-risk. This intervention improved the quality of care by identifying patients at risk for melanoma. Future steps include adapting the Self-Assessment of Melanoma Risk Score questionnaire to a new electronic medical record system, incorporating the questionnaire as part of the initial intake and annual patient documentation, and improving patient education and follow-up.