bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality and Patient Safety Metrics: Developing a Structured Program for Improving Patient Care in the Department of Medicine at The Ottawa Hospital
Authors: Hasimja-Saraqini Delvina , McNeill Kylie , Kuk Hanna , Forster Alan J. , Wells Philip S. , Hamilton Samantha , Gannon Ed , Mielniczuk Lisa M. 
Published: June 2024

Abstract

Problem
Despite increasing recognition of the importance of quality and patient safety in academic medicine, challenges remain with ensuring physician participation in quality assurance and quality improvement efforts, such as lack of compensation and enabling resources. An organizational culture that includes physician leadership and a supportive infrastructure is needed to encourage physician backing of quality and patient safety initiatives.

Approach
The authors describe the development of a robust quality and patient safety program in the Department of Medicine at The Ottawa Hospital over the past 7 years and highlight how the department changed its organizational culture by prioritizing quality and patient safety and establishing the necessary infrastructure to support this program. Program development was characterized by 4 overarching themes: incentives, administrative structure and physician leadership, training and support, and system enhancements.

Outcomes
As a result of the program, the department broadly implemented a standardized framework for conducting quality committee meetings and morbidity and mortality rounds and reviewing patient safety incidents and patient experience across its 16 divisions. This has led to 100% departmental compliance on corporate quality assurance metrics each year (e.g., regular multidisciplinary divisional quality committee meetings), along with physician participation in formal quality improvement initiatives that align with larger corporate goals.

Next Steps
The authors reflect on lessons learned during the implementation of the program and the essential elements that contributed to its success. Next steps for the program include using a centralized repository of quality and patient safety data, including patient safety incident dashboards, to encourage greater divisional collaboration on quality improvement initiatives and continuous institutional learning over time. Another important avenue will be to create an academic hub for excellence in quality and a formal approach to reward and promote physicians for their quality work.
Bias in Observed Assessments in Medical Education: A Scoping Review
Authors: Ismaeel Romaisa , Pusic Luka , Gottlieb Michael , Chan Teresa M. , Oyedokun Taofiq O. , Thoma Brent 
Published: June 2024

Abstract

Purpose
Observed assessments are integral to medical education but may be biased against structurally marginalized communities. Current understanding of assessment bias is limited because studies have focused on single specialties, levels of training, or social identity characteristics (SIDCs). This scoping review maps studies investigating bias in observed assessments in medical education arising from trainees’ observable SIDCs at different medical training levels, with consideration of medical specialties, assessment environments, and assessment tools.

Method
MEDLINE, Embase, ERIC, PsycINFO, Scopus, Web of Science Core Collection, and Cochrane Library were searched for articles published between January 1, 2008, and March 15, 2023, on assessment bias related to 6 observable SIDCs: gender (binary), gender nonconformance, race and ethnicity, religious expression, visible disability, and age. Two authors reviewed the articles, with conflicts resolved by consensus or a third reviewer. Results were interpreted through group review and informed by consultation with experts and stakeholders.

Results
Sixty-six of 2,920 articles (2.3%) were included. These studies most frequently investigated graduate medical education [44 (66.7%)], used quantitative methods [52 (78.8%)], and explored gender bias [63 (95.5%)]. No studies investigated gender nonconformance, religious expression, or visible disability. One evaluated intersectionality. SIDCs were described inconsistently. General surgery [16 (24.2%)] and internal medicine [12 (18.2%)] were the most studied specialties. Simulated environments [37 (56.0%)] were studied more frequently than clinical environments [29 (43.9%)]. Bias favoring men was found more in assessments of intraoperative autonomy [5 of 9 (55.6%)], whereas clinical examination bias often favored women [15 of 19 (78.9%)]. When race and ethnicity bias was identified, it consistently favored White students.

Conclusions
This review mapped studies of gender, race, and ethnicity bias in the medical education assessment literature, finding limited studies on other SIDCs and intersectionality. These findings will guide future research by highlighting the importance of consistent terminology, unexplored SIDCs, and intersectionality.
Special Supplemental Nutrition Program for Women, Infants, and Children Enrollment and Adverse Pregnancy Outcomes Among Nulliparous Individuals
Authors: Venkatesh Kartik K. , Huang Xiaoning , Cameron Natalie A. , Petito Lucia C. , Garner Jennifer , Headings Amy , Hanks Andrew S. , Grobman William A. , Khan Sadiya S. 
Published: June 2024

OBJECTIVE:
To evaluate the relationship between changes in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment during pregnancy from 2016 to 2019 and rates of adverse pregnancy outcomes in U.S. counties in 2019.

METHODS:
We conducted a serial, cross-sectional ecologic study at the county level using National Center for Health Statistics natality data from 2016 to 2019 of nulliparous individuals eligible for WIC. The exposure was the change in county-level WIC enrollment from 2016 to 2019 (increase [more than 0%] vs no change or decrease [0% or less]). Outcomes were adverse pregnancy outcomes assessed in 2019 and included maternal outcomes (ie, gestational diabetes mellitus [GDM], hypertensive disorders of pregnancy, cesarean delivery, intensive care unit [ICU] admission, and transfusion) and neonatal outcomes (ie, large for gestational age [LGA], small for gestational age [SGA], preterm birth, and neonatal intensive care unit [NICU] admission).

RESULTS:
Among 1,945,914 deliveries from 3,120 U.S. counties, the age-standardized rate of WIC enrollment decreased from 73.1 (95% CI, 73.0–73.2) per 100 live births in 2016 to 66.1 (95% CI, 66.0–66.2) per 100 live births in 2019, for a mean annual percent change decrease of 3.2% (95% CI, −3.7% to −2.9%) per year. Compared with individuals in counties in which WIC enrollment decreased or did not change, individuals living in counties in which WIC enrollment increased had lower rates of maternal adverse pregnancy outcomes, including GDM (adjusted odds ratio [aOR] 0.71, 95% CI, 0.57–0.89), ICU admission (aOR 0.47, 95% CI, 0.34–0.65), and transfusion (aOR 0.68, 95% CI, 0.53–0.88), and neonatal adverse pregnancy outcomes, including preterm birth (aOR 0.71, 95% CI, 0.56–0.90) and NICU admission (aOR 0.77, 95% CI, 0.60–0.97), but not cesarean delivery, hypertensive disorders of pregnancy, or LGA or SGA birth.

CONCLUSION:
Increasing WIC enrollment during pregnancy at the county level was associated with a lower risk of adverse pregnancy outcomes. In an era when WIC enrollment has decreased and food and nutrition insecurity has increased, efforts are needed to increase WIC enrollment among eligible individuals in pregnancy.
Impact of Early Depressive Burden on Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Wolf Jacob C. , Anwar Fatima N. , Roca Andrea M. , Loya Alexandra C. , Medakkar Srinath S. , Kaul Aayush , Khosla Ishan , Hartman Timothy J. , Nie James W. , MacGregor Keith R. , Oyetayo Omolabake O. , Zheng Eileen , Federico Vincent P. , Sayari Arash J. , Lopez Gregory D. , Singh Kern 
Published: June 2024

Study Design:
Retrospective review.

Objective:
To evaluate mental health influence on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) patients.

Summary of Background Data:
Poor mental health has been postulated to indicate inferior patient perceptions of surgical outcomes in spine literature. Few studies have assessed mental health as a dynamic metric throughout the perioperative period.

Methods:
A single-surgeon database was retrospectively searched for patients who underwent primary, elective MIS-TLIF for degenerative or isthmic spondylolisthesis. Summative depressive burden (SDB) was defined by the sum of preoperative and 6-week postoperative 9-item Patient Health Questionnaire (PHQ-9), with Lesser Burden (LB, SDB<10) and Greater Burden (GB, SDB≥10) cohorts. Patient-reported outcomes measures (PROMs) were compared preoperatively, at 6 weeks, and at final postoperative follow-up (11.4±10.9 mo), using Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Oswestry disability index (ODI), visual analog scale-back (VAS-B), VAS-leg (VAS-L), and PHQ-9. Improvements at 6-week (∆PROM-6W), final follow-up (∆PROM-FF), and minimum clinically important difference (MCID) achievement were compared.

Results:
The GB cohort consisted of 44 of 105 patients. Demographic variations included older age, higher Charlson comorbidity index, increased hypertension prevalence, and private insurance in the LB cohort (P≤0.018). The LB cohort demonstrated better baseline and 6-week PROMIS-PF/ODI/VAS-L (P≤0.032) and better final PROMIS-PF/ODI/VAS-L/PHQ-9 (P≤0.031). Both cohorts improved in all PROMs at 6 weeks and final follow-up (P≤0.029), except for PROMIS-PF at 6 weeks in the GB cohort. ∆PROM-6W, ∆PROM-FF, and MCID achievement rate for PHQ-9 were greater in the GB cohort (P≤0.001).

Conclusion:
On average, patients undergoing MIS-TLIF for degenerative or isthmic spondylolisthesis improved in all PROMs by final follow-up. Patients with GB suffered inferior perceptions of physical function, disability, and leg pain. MCID rates in mental health were higher for GB cohort. Surgeons are encouraged to adopt a compassionate understanding of depressive burden and educate the patient on possible consequential postoperative outcomes.
Ethylene Oxide Hemoglobin Adducts in Cord Blood and Offspring’s Size at Birth: The NewGeneris European Cohort Study
Authors: Harding Barbara N. , Agramunt Silvia , Pedersen Marie , Knudsen Lisbeth E. , Nielsen Jeanette K. S. , Wright John , Vafeiadi Marina , Merlo Domenico F. , Stayner Leslie , Kelly-Reif Kaitlin , Espinosa Ana , Bustamante Mariona , Gützkow Kristine Bjerve , Granum Berit , von Stedingk Hans , Rydberg Per , Alexander Jan , Törnqvist Margareta , Kogevinas Manolis 
Published: June 2024

Background:
Prenatal ethylene oxide exposure may have adverse effects on fetal development. We examined the relationships between ethylene oxide hemoglobin (Hb) adduct levels and offspring’s size at birth in a prospective European mother–child study.

Methods:
This study included 1106 singletons from the NewGeneris project (2006–2010) with ethylene oxide Hb adducts measured in cord blood. We examined the relationships between adduct levels and offspring’s size at birth among all infants and separately among infants of nonsmokers, using linear regression models for birth weight and birth head circumference and logarithmic binomial regression models for small for gestational age. We examined potential interactions between CYP2E1 single nucleotide polymorphisms in cord blood and the effects of ethylene oxide Hb adduct levels on offspring birth size.

Results:
Higher quartiles of adduct levels as a measure of exposure were associated with decreasing birth weight and head circumference in the overall population. Compared to infants in the lowest quartile, those in the highest quartile exhibited lower birth weight (−70.73 g, 95% confidence interval = −141.16, −0.30) and reduced head circumference (−0.30 cm, 95% confidence interval = −0.58, −0.02). We observed similar, albeit less pronounced, patterns among infants of nonsmokers. There was no evidence of an association between ethylene oxide Hb adducts and risk of small for gestational age, nor consistent evidence of an interaction with CYP2E1 polymorphisms on the association between EO Hb adduct levels and offspring’s size at birth.

Conclusion:
Results suggest that higher ethylene oxide Hb adduct levels in cord blood are associated with a reduction in offspring birth size.
Treating Lows: Management of Orthostatic Hypotension
Authors: Kulkarni Spoorthy , Jenkins Danny , Dhar Arko , Mir Fraz 
Published: June 2024

Abstract:
Orthostatic hypotension is a prevalent clinical condition, caused by heterogenous etiologies and associated with significant morbidity and mortality. Management is particularly challenging in patients with uncontrolled hypertension. A thorough assessment is needed to draw an appropriate management plan. The treatment aims to improve postural symptoms while minimizing side effects and reducing iatrogenic exacerbation of supine hypertension. A personalized management plan including rationalizing medications, patient education, identification, and avoidance of triggers, as well as nonpharmacological therapies such as compression devices, dietary modifications, and postural aids, make the first steps. Among pharmacological therapies, midodrine and fludrocortisone are the most prescribed and best studied; pyridostigmine, atomoxetine, and droxidopa are considered next. Yohimbine remains an investigational agent. A multidisciplinary team may be required in some patients with multiple comorbidities and polypharmacy. However, there is a lack of robust efficacy and safety evidence for all therapies. Building robust real-world and stratified clinical trials based on underlying pathophysiology may pave the way for further drug development and better clinical strategies and in this challenging unmet medical need.
Anthocyanins in Vascular Health and Disease: Mechanisms of Action and Therapeutic Potential
Authors: Zhao Yaping , Wang Li , Huang Yu , Evans Paul C. , Little Peter J. , Tian Xiaoyu , Weng Jianping , Xu Suowen 
Published: June 2024

Abstract:
Unhealthy lifestyles have placed a significant burden on individuals' cardiovascular health. Anthocyanins are water-soluble flavonoid pigments found in a wide array of common foods and fruits. Anthocyanins have the potential to contribute to the prevention and treatment of cardiovascular disease by improving lipid profiles and vascular function, reducing blood glucose levels and blood pressure, and inhibiting inflammation. These actions have been demonstrated in numerous clinical and preclinical studies. At the cellular and molecular level, anthocyanins and their metabolites could protect endothelial cells from senescence, apoptosis, and inflammation by activating the phosphoinositide 3-kinase/protein kinase B/endothelial nitric oxide synthases, silent information regulator 1 (SIRT1), or nuclear factor erythroid2-related factor 2 pathways and inhibiting the nuclear factor kappa B, Bax, or P38 mitogen-activated protein kinase pathways. Furthermore, anthocyanins prevent vascular smooth muscle cell from platelet-derived growth factor -induced or tumor necrosis factor-α–induced proliferation and migration by inhibiting the focal adhesion kinase and extracellular regulated protein kinases signaling pathways. Anthocyanins could also attenuate vascular inflammation by reducing the formation of oxidized lipids, preventing leukocyte adhesion and infiltration of the vessel wall, and macrophage phagocytosis of deposited lipids through reducing the expression of cluster of differentiation 36 and increasing the expression of ATP-binding cassette subfamily A member 1 and ATP-binding cassette subfamily G member 1. At the same time, anthocyanins could lower the risk of thrombosis by inhibiting platelet activation and aggregation through down-regulating P-selectin, transforming growth factor-1, and CD40L. Thus, the development of anthocyanin-based supplements or derivative drugs could provide new therapeutic approaches to the prevention and treatment of vascular diseases.
Severe obesity is associated with worse outcomes than lean metabolic dysfunction–associated steatotic liver disease
Authors: Behari Jaideep , Wang Renwei , Luu Hung N. , McKenzie David , Molinari Michele , Yuan Jian-Min 
Published: June 2024

Background:
Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent in people with obesity. We aimed to study the association of body mass index (BMI) with clinical outcomes in patients with MASLD.

Methods:
A retrospective cohort of 32,900 patients with MASLD, identified through the International Classification of Diseases-9 and 10 codes within the electronic health records of a large US-based health system, with a mean follow-up of 5.5 years (range: 1–15 y), was stratified into 6 BMI categories, <25, 25–<30, 30–<40, 40–<50, and ≥50 kg/m2.

Results:
The risk of liver decompensation and extrahepatic obesity–associated cancers had a J-shaped profile (both ps for linear and quadratic terms <0.05). Compared to patients with BMI 25–<30 kg/m2, the adjusted HRs (95% CIs) for liver decompensation of patients with BMI <25 and BMI ≥50 kg/m2 were 1.44 (1.17–1.77) and 2.27 (1.66–3.00), respectively. The corresponding figures for obesity-associated extrahepatic cancer were 1.15 (0.97–1.36) and 1.29 (1.00–1.76). There was an inverse association for BMI with liver transplantation and non-obesity–associated cancer (both ps for linear terms <0.05), but no association with HCC or all types of cancers combined. A similar J-shaped association between BMI and all-cause mortality was observed; adjusted HRs (95% CIs) for BMI <25 and ≥50 kg/m2 were 1.51 (1.32–1.72) and 3.24 (2.67–3.83), respectively, compared with BMI 25–<30 kg/m2 (both ps for linear and quadratic terms <0.001).

Conclusions:
Patients with MASLD and very severe obesity (BMI ≥50 kg/m2) had the highest risk, exceeding that of patients with lean MASLD, for developing liver decompensation, obesity-associated extrahepatic cancers, or dying from any cause.
EHR Smart Phrases Used as Enrollment Mechanism in Diabetes Self-Management Support Programs: Preliminary Outcomes
Authors: Rhoden Parker A. , Hall Luke , Stancil Michelle , Sherrill Windsor Westbrook 
Published: June 2024

ABSTRACT
Diabetes in the United States is increasing rapidly. Innovative strategies are needed for diabetes prevention and self-management. This study assessed the usability, acceptability, and awareness of an electronic health record (EHR) tool for referring patients to a community-based diabetes self-management support program. Mixed-methods approaches were used, using EHR data and key informant interviews to assess the implementation of this quality improvement (QI) process intervention. The implementation of a smart phrase tool within the EHR led to a substantial increase in referrals (773) to the Health Extension for Diabetes (HED) program. Clinical health care professionals have actively used the referral mechanism; they reported using smart phrases to increase efficiency in patient care. Lack of training and program awareness was identified as a barrier to adoption. Awareness of the HED program and .HEDREF smart phrase was limited, but improved with targeted QI and training interventions. The .HEDREF smart phrase demonstrated effectiveness in increasing patient referrals to the HED program, highlighting the potential of EHR tools to streamline documentation and promote patient engagement in diabetes self-management. Future research should focus on broader health care contexts, patient perspectives, and integration of technology for optimal patient outcomes.
Impact of a Novel Asynchronous Nutrition Course on Knowledge, Attitudes, and Self-Efficacy of Physician Assistant Students
Authors: Bernard Stephanie , Daniel Sarah R. 
Published: June 2024

Introduction
The purpose of this study was to evaluate the impact of a novel asynchronous medical nutrition course on physician assistant (PA) student core nutrition content knowledge, attitudes, self-efficacy about nutrition expertise, and ability to counsel future patients. Evaluating curricular changes and innovations remains imperative as the education landscape has shifted dramatically since the COVID-19 pandemic with many teaching modalities being introduced out of necessity.

Methods
A novel asynchronous medical nutrition course was created. Study participants were PA students enrolled in a nutrition course (n = 43) or a clinical skills course (n = 36). The validated Nutrition in Patient Care Survey and multiple-choice nutrition content questions were deployed at both the beginning and end of the respective courses for data collection for 3 consecutive years. Presurveys and postsurveys captured the impact on knowledge, attitudes, and self-efficacy by using a 2-group pretest post-test, quasiexperimental research design, with a 2 × 2 mixed analysis of variance.

Results
This study demonstrated statistically significant interactions of the medical nutrition course on students' knowledge (F
(1,77) = 14.32, P < .001, ɳ2 = .07), on attitudes (F
(1,77) = 7.52, P = .02, ɳ2 = .02), and on self-efficacy (F
(1,77) = 4.43, P = .04, ɳ2 = .02).

Discussion
Findings from this study provide evidence for the impact that a novel asynchronous course can have on PA students' learning, attitudes, and self-efficacy. As teaching modalities transform and evolve, this study demonstrates reproducible results from an online asynchronous content delivery modality. Future research may seek to repeat this study across many medical programs to confirm similar findings.
The Intersection of Pedagogy and Andragogy in 3 + 2-Modeled Physician Assistant Programs: Five Lessons Learned
Authors: Hoffmann Chelsey 
Published: June 2024

Introduction
Physician associate/assistant (PA) faculty benefit from learning the definitions and applications of pedagogy and andragogy within PA education. However, we are now in an era where PA learners may fall along the continuum between pedagogy and andragogy, particularly in PA programs with a preprofessional phase such as the 3 + 2 model. Given PA programs with a preprofessional phase now make up 12.7% of all PA programs, faculty need to be equipped with effective strategies and techniques for engaging this population of learners.

Methods
PubMed, MEDLINE, and Google Scholar databases were queried to find existing research on the topics of andragogy and pedagogy in 3 + 2-modeled PA programs. The Journal of Physician Assistant Education was also reviewed for articles relevant to these topics.

Results
There is minimal evidence to guide PA faculty on education models, theory, or learning philosophy for students enrolled in 3 + 2 PA programs. As such, this manuscript presents 5 lessons learned from a former faculty member of a 3 + 2-modeled PA program who has experience teaching both traditional PA students in addition to 3 + 2 learners.

Discussion
The 5 lessons learned include the importance of scaffolding, explaining the “why,” emphasizing knowledge acquisition, integrating novel learning experiences, and creating channels for communication. While each of these lessons will apply to all PA students, they may be particularly impactful to those in 3 + 2-modeled PA programs. Moving forward, PA education would benefit from research dedicated to PA programs with a preprofessional phase.