bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 355: A Novel Methodology for Establishing Recommended Threshold Values for MCID, SCB, and PASS for PROMs following ACL Reconstruction
Authors: Yendluri Avanish , Chiang Joshua , Lee Alexander , Parisien Robert 
Published: August 2024

Objectives: An abundance of patient reported outcome measure (PROM) thresholds following ACL reconstruction (ACLR) exist in literature. This frustrates efforts to standardize measures like minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS). While our earlier study identified the most commonly cited threshold values, this paper examines their underlying methodology. We identify the most robust studies from our systematic review, presenting their International Knee Documentation Committee Subjective Knee Form (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds and calculation methods. Methods: Our systematic review evaluated 42 studies from PubMed, Embase, Medline, Google Scholar, and Cochrane reporting MCID, SCB, and PASS thresholds after ACLR between January 1st, 2000 – June 30th, 2022. We extracted each publication’s methodology, noting if it calculated new thresholds or cited existing values. For studies deriving new values, we determined if they used anchor or distribution-based methods. For studies citing existing thresholds from publications not present in our systematic review, we identified the source texts, assessed them using the same criteria as the systematic review (but allowed non-ACLR studies), and included them in our evaluation. We then ranked the literature according to a predetermined hierarchy, prioritizing anchored studies, receiver operating characteristic (ROC) analyses, and those with higher levels of evidence. Results: IKDC and KOOS subscales represented 63% of reported MCID, 70% of SCB, and 94% of PASS thresholds (Table 1). Given their overwhelming representation, we only present threshold recommendations for those PROMs. 32 (76%) of studies in our systematic review referenced thresholds in literature and we included 3 frequently cited publications not originally part of the systematic. Our final ranking of thresholds included 14 studies. 9 studies determined thresholds via anchor-based methodologies and 7 used distribution-based techniques. For anchored studies, 7 calculated thresholds using the Youden Index, 1 used Mean Change, and 1 used Predictive Minimal Important Change (MICpred). 4 studies provided sufficient evidence to recommend their threshold: Irrgang 2006 (MCID: IKDC), Muller 2016 (PASS: IKDC and KOOS), Ingelsrud 2018 (MCID: KOOS), and Forlenza 2020 (MCID: KOOS; SCB: IKDC and KOOS). Their thresholds and derivation methods are found in Table 2. Conclusions: This study is the first to present recommended MCID, SCB, and PASS values for commonly reported PROMs following ACLR. We recommend relying on threshold values from studies utilizing anchor-based methodologies and ROC analysis. For studies establishing new thresholds, we recommend this technique along with multiple anchor questions, in order to reduce single-selection bias and better stratify response cohorts.
Missing topics for a newly established general practice curriculum for medical students in Hesse – a qualitative study
Authors: Kronemann Bibiane , Joson-Teichert Elisabeth , Michiels-Corsten Matthias , Bösner Stefan , Groth Jana 
Published: August 2024

Abstract
Background
To address the declining numbers of general practitioners (GPs) in rural areas and a lack of medical students pursuing a career in primary care, a general practice-based curriculum coupled with additional university admissions for students has been established at three universities in Hesse, Germany. This study aims to analyze potential topics which students striving to become a GP will benefit from. Teaching such topics will prepare them for their chosen career and working in rural areas. We aimed to explore the views of both specialists and GPs on chief topics and necessary skills in primary care.

Methods
In our study we used semi-structured interviews with outpatient specialists and specialists in clinical practice and semi-structured group interviews with GPs in training. The topic guide addressed contents of the curriculum for medical students with an extracurricular focus (addressing additional topics) on primary care. Data analysis was carried out using qualitative content analysis according to Mayring.

Results
GPs in training and specialists agreed on the importance of knowledge in the fields of medical history, physical examination, communication as well as common diseases in primary care. Essential competences mentioned were: inducing medical treatment, decision-making and triage, conducting structured conversations, having patient knowledge (hard skills) as well as an interest in continuous learning, empathy, personal commitment, listening and down-to-earthness (soft skills). Case reports, symptom-based learning, practical training, lessons with simulated patients and the integration of role models were regarded as useful teaching methods.

Conclusions
General practice-based curriculums should not only focus on the transfer of knowledge. Equally important is the training of soft and hard skills to prepare future GPs for their work in primary care. Special teaching methods as well as practical training should be the heart of a newly established curriculum.
Validity of evaluation scales for post-stroke depression: a systematic review and meta-analysis
Authors: Liu Fang , Gong Lei , Zhao Huan , Li Ying-li , Yan Zhiwen , Mu Jun 
Published: August 2024

Abstract
Background
Post-stroke depression (PSD) is closely associated with poor stroke prognosis. However, there are some challenges in identifying and assessing PSD. This study aimed to identify scales for PSD diagnosis, assessment, and follow-up that are straightforward, accurate, efficient, and reproducible.

Methods
A systematic literature search was conducted in 7 electronic databases from January 1985 to December 2023.

Results
Thirty-two studies were included, the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Depression Scale (HDRS) had higher diagnostic accuracy for PSD. The sensitivity, specificity, and diagnostic odds ratio of PHQ-9 or diagnosing any depression were 0.82, 0.87, and 29 respectively. And for HDRS, used for diagnosing major depression, the scores were 0.92, 0.89, and 94. Furthermore, these two scales also had higher diagnostic accuracy in assessing depressive symptoms during both the acute and chronic phases of stroke. In patients with post-stroke aphasia and cognitive impairment, highly diagnostic scales have not been identified for assessing depressive symptoms yet.

Conclusions
The PHQ-9 and HDRS scales are recommended to assess PSD. HDRS, which demonstrates high diagnostic performance, can replace structured interviews based on diagnostic criteria.
Systemic inflammatory response index as a predictor of stroke-associated pneumonia in patients with acute ischemic stroke treated by thrombectomy: a retrospective study
Authors: Zheng Feng , Gao Wen , Xiao Yinfeng , Guo Xiumei , Xiong Yu , Chen Chunhui , Zheng Hanlin , Pan Zhigang , Wang Lingxing , Zheng Shuni , Ke Chuhan , Liu Qiaoling , Liu Aihua , Huang Xinyue , Hu Weipeng 
Published: August 2024

Abstract
Background
The predictive value of systemic inflammatory response index (SIRI) for stroke-associated pneumonia (SAP) risk in patients with acute ischemic stroke (AIS) treated by thrombectomy remains unclear. This study aimed to investigate the predictive value of SIRI for SAP in patients with AIS treated by thrombectomy.

Methods
We included AIS patients treated by thrombectomy between August 2018 and August 2022 at our institute. We used multivariate logistic regression to construct the prediction model and performed a receiver operating characteristic curve analysis to evaluate the ability of SIRI to predict SAP and constructed a calibration curve to evaluate the prediction accuracy of the model. We evaluated the clinical application value of the nomogram using decision curve analysis.

Results
We included 84 eligible patients with AIS in the analysis, among which 56 (66.7%) had SAP. In the univariate analysis, there were significant differences in sex (p = 0.035), National Institute of Health Stroke Scale score at admission ≥ 20 (p = 0.019) and SIRI (p < 0.001). The results of multivariable logistic analysis showed that the risk of SAP increased with the SIRI value (OR = 1.169, 95% CI = 1.049–1.344, p = 0.014). Age ≥ 60 (OR = 4.076, 95% CI = 1.251–14.841, p = 0.024) was also statistically significant. A nomogram with SIRI showed good prediction accuracy for SAP in AIS patients treated by thrombectomy (C-index value = 0.774).

Conclusions
SIRI is an independent predictor for SAP in patients with AIS treated by thrombectomy. A high SIRI value may allow for the early identification of patients with AIS treated by thrombectomy at high risk for SAP.
Evaluating the impact of a trial of labor after cesarean section on labor duration: a retrospective cohort study
Authors: Ooba Hikaru , Maki Jota , Masuyama Hisashi 
Published: August 2024

Abstract
Background
Cesarean section (C-section) rates are increasing globally, and repeated C-sections are associated with increased maternal morbidity. Trial of labor after C-section (TOLAC) is an approach to reduce the recurrence of C-sections. However, limited research exists on the impact of cesarean scars on labor duration in TOLAC, considering the termination of labor through C-section and selection bias. This study aimed to investigate the impact of cesarean scars on labor duration in TOLAC participants, accounting for potential confounding factors and biases.

Methods
This retrospective cohort study included 2,964 women who attempted vaginal birth at a single center in Japan from 2012 to 2021. The study categorized participants into TOLAC (n = 187) and non-TOLAC (n = 2,777) groups. Propensity scores were calculated based on 14 factors that could influence labor duration, and inverse probability of treatment weighting (IPTW) was applied. Cox proportional hazards regression analysis estimated hazard ratios (HRs) for labor duration, with and without IPTW adjustment. Sensitivity analyses used propensity score matching, bootstrapping, and interval censoring to address potential biases, including recall bias in the reported onset of labor.

Results
The unadjusted HR for labor duration in the TOLAC group compared to the non-TOLAC group was 0.83 (95% CI: 0.70–0.98, P = 0.027), indicating a longer labor duration in the TOLAC group. After adjusting for confounding factors using IPTW, the HR was 0.98 (95% CI: 0.74–1.30, P = 0.91), suggesting no significant difference in labor duration between the groups. Sensitivity analyses using propensity score matching, bootstrapping, and interval censoring yielded consistent results. These findings suggested that the apparent association between TOLAC and longer labor duration was because of confounding factors rather than TOLAC itself.

Conclusions
After adjusting for confounding factors and addressing potential biases, cesarean scars had a limited impact on labor duration in TOLAC participants. Maternal and fetal characteristics may have a more substantial influence on labor duration.
The Spinal Instability Neoplastic Score correlates with epidural spinal cord compression -a retrospective cohort of 256 surgically treated patients with spinal metastases
Authors: Bobinski Lukas , Axelsson Joel , Melhus Jonathan , Åkerstedt Josefin , Wänman Johan 
Published: August 2024

Abstract
Background
Bone metastases can compromise the integrity of the spinal canal and cause epidural spinal cord compression (ESCC). The Spinal Instability Neoplastic Score (SINS) was developed in order to evaluate spinal instability due to a neoplastic process. The SINS has reached wide acceptance among clinicans but its prognostic value is still controversial. The aim was to investigate the correlation between the SINS and ESCC and the association between SINS and ambulation before and survival after surgery.

Methods
Correlations were assessed between SINS and grades of ESCC in patients who underwent spine surgery for spinal metastases. CT and MRI were used to calculate SINS and the grades of ESCC respectively. Correlations were analyzed with the Spearman’s correlation test. Postoperative survival was estimated with Kaplan-Meier analysis and survival curves were compared with the log-rank test. The Cox proportional hazard model was used to assess the effect of prognostic variables including age, ambulation before surgery, SINS, and the Karnofsky Performance Status (KPS) as covariates.

Results
The study included 256 patients (196 men and 60 women) with a median age of 70 (24–88) years. The mean SINS was 10. One hundred fifty-two patients (59%) had lost ambulation before surgery. One hundred and one patients had grades 0–2 and 155 patients had grade 3 according to the ESCC-scale. SINS correlated with the grades of ESCC (p = 0.001). The SINS score was not associated with ambulation before surgery (p = 0.63). The median postoperative survival was 10 months, and there was no difference in postoperative survival between the SINS categories (p = 0.25). The ability to walk before surgery and a high KPS were associated with longer postoperative survival.

Conclusion
SINS correlated with grades of ESCC, which implies that higher SINS may be considered as an indicator of risk for developing ESCC. The SINS was not associated with ambulation before or survival after surgery.
Mandibular biomechanics rehabilitated with different prosthetic restorations under normal and impact loading scenarios
Authors: Shash Yomna H. 
Published: August 2024

Abstract
Background
Restorative treatment options for edentulous patients range from traditional dentures to fixed restorations. The proper selection of materials greatly influences the longevity and stability of fixed restorations. Most prosthetic parts are frequently fabricated from titanium. Ceramics (e.g. zirconia) and polymers (e.g. PEEK and BIOHPP) have recently been included in these fabrications. The mandibular movement produces complex patterns of stress and strain. Mandibular fractures may result from these stresses and strains exceeding the critical limits because of the impact force from falls or accidents. Therefore, it is necessary to evaluate the biomechanical behavior of the edentulous mandible with different restorations under different loading situations.

Objective
This study analyzes the biomechanical behavior of mandibles after four prosthetic restorations for rehabilitation under normal and impact loading scenarios.

Material and Methods
The mandibular model was constructed with a fixed restoration, which was simulated using various materials (e.g. Titanium, Zirconia & BIOHPP), under frontal bite force, maximum intercuspation, and chin impact force. From the extraction of tensile and compressive stresses and strains, as well as the total deformation of mandible segments, the biomechanical behavior and clinical situations were studied.

Results
Under frontal bite, the anterior body exhibited the highest tensile (60.34 MPa) and compressive (108.81 MPa) stresses using restoration 4, while the condyles and angles had the lowest tensile (7.12 MPa) and compressive (12.67 MPa) stresses using restoration 3. Under maximum intercuspation, the highest tensile (40.02 MPa) and compressive (98.87 MPa) stresses were generated on the anterior body of the cortical bone using restoration 4. Additionally, the lowest tensile (7.7 MPa) and compressive (10.08 MPa) stresses were generated on the condyles and angles, respectively, using restoration 3. Under chin impact, the highest tensile (374.57 MPa) and compressive (387.3 MPa) stresses were generated on the anterior body using restoration 4. Additionally, the lowest tensile (0.65 MPa) and compressive (0.57 MPa) stresses were generated on the coronoid processes using restoration 3. For all loading scenarios, the anterior body of the mandible had the highest stress and strain values compared with the other segments. Compared to the traditional titanium restoration.2, restoration.1(zirconia) increases the tensile and compressive stresses and strains on the mandibular segments, in contrast to restoration.3 (BIOHPP). In addition, zirconia implants exhibited higher displacements than the other implants.

Conclusion
In the normal loading scenario, the tensile and compressive stresses and strains on the mandible were within the allowable limits when all restorations were used. Under the chin impact loading scenario, the anterior body of the mandible was damaged by restorations 1 and 4.
Nurturing ethical insight: exploring nursing students’ journey to ethical competence
Authors: Hansen Sylvia , Hessevaagbakke Elisabeth , Lindeflaten Katrin , Elvan Kaja , Lillekroken Daniela 
Published: August 2024

AbstractBackgroundEthical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students’ initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes.MethodsThis exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway.ResultsThe naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as ‘Being on a journey towards ethical competence’. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination.ConclusionsNursing students’ ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.
Chronic kidney disease: detect, diagnose, disclose—a UK primary care perspective of barriers and enablers to effective kidney care
Authors: Stewart Stuart , Kalra Philip A. , Blakeman Tom , Kontopantelis Evangelos , Cranmer-Gordon Howard , Sinha Smeeta 
Published: August 2024

AbstractChronic kidney disease (CKD) is a global public health problem with major human and economic consequences. Despite advances in clinical guidelines, classification systems and evidence-based treatments, CKD remains underdiagnosed and undertreated and is predicted to be the fifth leading cause of death globally by 2040. This review aims to identify barriers and enablers to the effective detection, diagnosis, disclosure and management of CKD since the introduction of the Kidney Disease Outcomes Quality Initiative (KDOQI) classification in 2002, advocating for a renewed approach in response to updated Kidney Disease: Improving Global Outcomes (KDIGO) 2024 clinical guidelines. The last two decades of improvements in CKD care in the UK are underpinned by international adoption of the KDIGO classification system, mixed adoption of evidence-based treatments and research informed clinical guidelines and policy. Interpretation of evidence within clinical and academic communities has stimulated significant debate of how best to implement such evidence which has frequently fuelled and frustratingly forestalled progress in CKD care. Key enablers of effective CKD care include clinical classification systems (KDIGO), evidence-based treatments, electronic health record tools, financially incentivised care, medical education and policy changes. Barriers to effective CKD care are extensive; key barriers include clinician concerns regarding overdiagnosis, a lack of financially incentivised care in primary care, complex clinical guidelines, managing CKD in the context of multimorbidity, bureaucratic burden in primary care, underutilisation of sodium-glucose co-transporter-2 inhibitor (SGLT2i) medications, insufficient medical education in CKD, and most recently – a sustained disruption to routine CKD care during and after the COVID-19 pandemic. Future CKD care in UK primary care must be informed by lessons of the last two decades. Making step change, over incremental improvements in CKD care at scale requires a renewed approach that addresses key barriers to detection, diagnosis, disclosure and management across traditional boundaries of healthcare, social care, and public health. Improved coding accuracy in primary care, increased use of SGLT2i medications, and risk-based care offer promising, cost-effective avenues to improve patient and population-level kidney health. Financial incentives generally improve achievement of care quality indicators – a review of financial and non-financial incentives in CKD care is urgently needed.