bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Experience With Robotic Liver Resection in the United States
Authors: Imai Daisuke , Yokoyama Masaya , Sambommatsu Yuzuru , Khan Aamir A. , Kumaran Vinay , Saeed Muhammad I. , Lee Hannah , Matherly Scott , Cotterell Adrian H. , Levy Marlon F. , Bruno David A. , Lee Seung D. , Sharma Amit 
Published: June 2024

Background This study’s aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). Methods A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. Results The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. Conclusions The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.
The effect of lithium variation coefficient on the risk of attack in patients with bipolar disorder: A pilot study
Authors: Başak Oktay Saniye , Sehlikoğlu Şeyma , Yildiz Sevler , Han Almiş Behice , Çikim İsmail Gürkan 
Published: June 2024

Background This study examines the association between the coefficient of variation (%CV) of lithium levels and episode risk and frequency in bipolar patients maintaining serum lithium levels within the therapeutic range. Methods We retrospectively reviewed patients with bipolar disorder under care from 2018 to 2022. Inclusion criteria were at least 2 years of follow-up, a minimum of three annual lithium level measurements within the therapeutic range. Patients were categorized based on seizure status. We calculated mean lithium levels, standard deviation (SD), and %CV. Results The study included 75 patients (patients with-without episodes, 39–36). Demographic data revealed no significant differences. While mean lithium levels showed no significant disparity between groups, SD and %CV were notably higher in patients with episodes ( P < .05). ROC analysis demonstrated AUC values of 0.722 (95% CI: 0.607–0.836 P = .001) for %CV and 0.709 (95% CI: 0.593–0.826; P = .002) for SD. The optimal %CV cutoff was 17.39, with 67% sensitivity and 69% specificity. A weak correlation was found between %CV and the number of episodes ( P = .001, r = 0.376). The post-hoc power analysis for this study was 0.78. Conclusions Despite acceptable lithium levels, patients with recent episodes exhibited significant lithium level fluctuations. Integrating %CV with real-time lithium measurements during bipolar disorder follow-up may enhance clinical monitoring and seizure prediction.
Picture This: Studying the Effectiveness of Illustrated Instructions
Authors: Gurung Regan A. R. , Herrboldt Paige 
Published: June 2024

BackgroundResearch on multimedia instruction suggests that illustrations aid learning over straight text. Providing students with illustrated instructions may increase comprehension and retention of material.ObjectiveWe tested if students would remember the material better if it was presented as an infographic where the content was supplemented with illustrations versus reading the same content without illustrations.MethodWe randomly assigned students ( N = 114) to either a text-based or an illustrated instruction condition where they learned about three types of study techniques (retrieval practice, spaced practice, and interleaving). After a brief distraction task, all students took a quiz on the material presented.ResultsA multivariate analysis of variance showed a significant main effect for the condition. Students in the illustrated instruction condition scored higher on the quiz than those who were assigned to the text-based condition.ConclusionPresenting complex material as an infographic with illustrations may aid learning.Teaching ImplicationsTeachers and textbook authors should consider the use of illustrated instructions to convey difficult material, especially bottleneck concepts.
Remotely Assessing Motor Function and Activity of the Upper Extremity After Stroke: A Systematic Review of Validity and Clinical Utility of Tele-Assessments
Authors: Sauerzopf Lena , Luft Andreas R. , Baldissera Anna , Frey Sara , Klamroth-Marganska Verena , Spiess Martina R. 
Published: June 2024

Objective The aim of this systematic review is to identify currently available tele-assessments for motor impairments of the upper extremity in adults after a stroke and to assess their psychometric properties and clinical utility. Data sources We searched for studies describing the psychometric properties of tele-assessments for the motor function of the upper extremity. A systematic search was conducted in the Cumulative Index to Nursing and Allied Health Literature, Medline via OVID, Embase, The Cochrane Library, Scopus, Web of Science and Institute of Electrical and Electronics Engineers Xplore from inception until 30 April 2024. Review methods The quality assessment for the included studies and the rating of the psychometric properties were performed using the COSMIN Risk of Bias Checklist for systematic reviews of patient-reported outcome measures. Results A total of 12 studies (N = 3912) describing 11 tele-assessments met the predefined inclusion criteria. The included assessments were heterogeneous in terms of quality and psychometric properties and risk of bias. None of the tele-assessments currently meets the criteria of clinical utility to be recommended for clinical practice without restriction. Conclusion The quality and clinical utility of tele-assessments varied widely, suggesting a cautious consideration for immediate clinical practice application. There is potential for tele-assessments in clinical practice, but the clinical benefits need to be improved by simplifying the complexity of tele-assessments. Registration Number CRD42022335035.
A Retrospective Cohort Analysis of Analgosedation Requirements in COVID-19 Compared to Non-COVID-19 Extracorporeal Membrane Oxygenation Patients
Authors: Schaller Alyssa M. , Feih Joel T. , Juul Janelle J. , Rein Lisa E. , Duewell Brittney E. , Makker Hemanckur 
Published: June 2024

Background Reports have described increased sedation requirements in patients with acute respiratory distress syndrome (ARDS) while on extracorporeal membrane oxygenation (ECMO) and for intubated COVID-19 patients. Thus, the objective of this study was to assess the analgosedation requirements of COVID-19 patients receiving ECMO compared to non-COVID-19 ECMO patients. Methods This retrospective, observational cohort study included adult patients with ARDS requiring venovenous or venopulmonary arterial ECMO admitted to a single intensive care unit from January 2017 to December 2021. Patients were categorized as COVID-19 ECMO or non-COVID-19 ECMO. The primary outcome was median daily dosing of parenteral analgosedative medications. Pertinent secondary outcomes included incidence of extubation or tracheostomy and change in sedation following tracheostomy or addition of oral agents. Results A total of 109 patients were evaluated; 63 COVID-19 ECMO patients and 46 non-COVID ECMO patients. The primary outcome was statistically higher in the COVID-19 compared to non-COVID-19 patients for propofol (4131.0 mg vs 2704.8 mg, P < .001), dexmedetomidine (1581.4 mcg vs 1081.3 mcg, P  =  .016), and parenteral morphine equivalents ([PME], 209.3 mg vs 154.1 mg, P  =  .027), but only propofol remained significant after adjustment for weight (31.1 mcg/kg/day vs 37.7 mcg/kg/day, P  =  .014). COVID-19 was significantly associated with increased propofol and PME requirements after adjustment for confounders on linear regression analysis. COVID-19 patients had more days with non-zero dose for propofol (8 days vs 7 days), dexmedetomidine (13 days vs 8.5 days), and PME (17 days vs 8.5 days). The only interventions that were associated with reductions in propofol dose were tracheostomy and antipsychotics. Conclusions COVID-19 patients on ECMO had significantly longer durations and higher doses of propofol, dexmedetomidine, and parenteral opioids over the first 28 days of cannulation. The only interventions that were associated with statistical reductions in propofol were antipsychotics and tracheostomy.
Ethical challenges in residential care facilities during COVID-19: Leaders’ perspective
Authors: Karlsson Anna-Carin , Edberg Anna-Karin , Sundström Malin , Backman Annica 
Published: June 2024

Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs.
Amlodipine Attenuates Carrageenan-induced Oxidative Stress Targeting Transsynaptic  Neuronal Damage by Promoting Survival of  Retinal Ganglion Cells in Adult Zebrafish  (Danio rerio)
Authors: Nanda Ashirbad , Aparna Sai , Sahoo Rudra Narayan , Patri Manorama 
Published: June 2024

BackgroundTranssynaptic degeneration of retinal ganglion cells (RGCs) likely plays a role in progressive loss of vision in glaucoma. Carrageenan (Carr), obtained from seaweed (Rhodophyceae), a sulphated polysaccharide extracted from a species of red algae ( Chondrus crispus), is a reversible gel mostly used in eye-drop preparation due to its hydrocolloid nature. But Carr-induced inflammation causing oxidative stress in animals has not yet been evaluated. It was reported that amlodipine (AML) can inhibit inflammatory cytokines by lowering intracellular calcium concentration and increasing antioxidant defences.PurposeIn this study, we examined the impact of AML administration on Carr-induced oxidative stress, causing free radial–mediated neurodegeneration and behavioural alteration in zebrafish.MethodsWe aimed to evaluate the behavioural alteration in zebrafish using the novel tank diving test (NTDT) and the light-dark preference test (LDPT) as invaluable tools for analysing visual functions. To understand the role of the antioxidant defence system, oxidative stress biomarkers such as lipid peroxidation and CAT activity were analysed. RGCs of the retina of the eye and neurons of the optical tectum (TeO) in the brain were investigated by histopathological studies.ResultsCarr-treated groups swam in random patterns and showed an increased number of transitions and spent more time in alter zones, whereas controls prefer perceived motion. AML significantly attenuates the increased lipid peroxidation level and decreased CAT activity with Carr administration. Histopathological analysis showed an increase in the percentage of pyknotic cell counts after Carr treatment, whereas AML supplementation significantly reduced the pyknotic RGC cell count in the retina and TeO of the brain.ConclusionFindings showed the effectiveness of AML as an antioxidant and neuroprotective agent by reducing pyckonsis in developmental RGCs and possible repair mechanisms against Carr-induced oxidative stress. This study may be useful to know the underlying mechanisms of weakening and eliminating central neurons for synaptic connections in the visual system of zebrafish.
Cephalometric Pharyngeal Morphology in Adults with Unoperated Cleft Palate
Authors: Cao Congcong , Li Deren , Gong Hanwen , Zheng Qian , Xu Chao , Shi Bing 
Published: June 2024

Objective The aim of this study was to cephalometrically evaluate the pharyngeal morphology in adults with unoperated Submucous Cleft Palate (SMCP), adults with unoperated Overt Cleft Palate (OCP), and adults without clefts. Design This study employed a retrospective cross-sectional design. Lateral cephalometric radiography was performed on three groups of adults: 1) 29 with unrepaired SMCP; 2) 41 with unrepaired OCP; and 3) 39 without clefts, who served as controls. One-way ANOVA and rank-sum tests were used for intergroup comparisons. P value was set at .05. Results The soft palate length and the ratio of soft palate length to pharyngeal depth were significantly lower in subjects with unoperated SMCP and OCP than in non-cleft controls. Significant differences were also observed in pharyngeal depth, nasopharyngeal depth, and posterior pharyngeal wall thickness between subjects with unoperated OCP and non-cleft controls. Conclusions Pharyngeal morphology differs significantly between individuals with and without clefts, particularly in soft palate length and the ratio of soft palate length to pharyngeal depth.
The impact of telehealth care on escalation to emergency care: A systematic review and meta-analysis
Authors: Scott Anna Mae , Sanders Sharon , Atkins Tiffany , van der Merwe Madeleen , Sunner Carla , Clark Justin , Glasziou Paul 
Published: June 2024

Objective We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care. Methods We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes. Results Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores. Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high. Conclusions Telehealth care – delivered by telephone or by video – may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.
Endocrine adverse events in patients with cancer receiving perioperative immune checkpoint blockade: a meta-analysis of randomized controlled trials
Authors: Zhou Susu , Horita Nobuyuki , Shao Theresa , Harrington Matthew , Fujiwara Yu 
Published: June 2024

Background: Perioperative use of immune checkpoint blockade (ICB) improves survival in patients with early-stage cancer. Treatment-related adverse events (AEs), frequently involve the endocrine system which may increase perioperative complications and affect quality of life. Objective: We conducted a meta-analysis to elucidate the impact of adding ICB to conventional neoadjuvant/adjuvant therapy on the incidence of endocrine AEs. Design: A systematic review and meta-analysis of randomize-controlled trials (RCTs). Data sources and methods: A systematic search of PubMed, Embase, Web of Science, and Cochrane library was performed for RCTs comparing groups with and without the addition of ICB to conventional perioperative therapy in patients with cancer. Outcomes included all-grade and grade 3–5 thyroiditis, hyperthyroidism, hypothyroidism, adrenal insufficiency, hypophysitis, type 1 diabetes mellitus, and hyperglycemia. The odds ratios (ORs) of all-grade and grade 3–5 endocrine were pooled using the random-effect model meta-analysis. Results: Twenty-four RCTs comprising 12,199 patients were identified for meta-analysis. The addition of ICB was associated with higher incidence of thyroiditis [all grade: OR = 3.53 (95% confidence interval (CI): 1.88–6.64)], hyperthyroidism [all-grade: 7.18 (4.30–12.01); grade 3–5: 3.93 (1.21–12.82)], hypothyroidism [all-grade: 5.39 (3.68–7.90); grade 3–5: 3.63 (1.18–11.11)], adrenal insufficiency [all-grade: 3.82 (1.88–7.79); grade 3–5: 5.91 (2.36–14.82)], hypophysitis [all-grade: 10.29 (4.97–21.3); grade 3–5: 5.80 (1.99–16.92)], and type 1 diabetes mellitus [all-grade: 2.24 (1.06–4.74); grade 3–5: 3.49 (1.21–10.08)]. The cumulative incidence of each grade 3–5 endocrine AE was low (<1.3%). No grade 5 AEs leading to death were observed. Conclusion: The addition of neoadjuvant/adjuvant ICB to conventional therapy was associated with an increased incidence of several endocrine AEs. Clinicians should be aware of the risk of endocrinopathy from the perioperative ICB use to facilitate risk–benefit discussion with patients with early-stage cancer. Trial registration: The protocol of this research was registered in PROSPERO (CRD42022332624).
Diabetes Technology and Waste: A Real-World Study in a Specialized Practice in Germany
Authors: Petry Sebastian F. , Petry Friedrich W. , Petry Johannes K. , Gäth Stefan , Heinemann Lutz 
Published: June 2024

Background: Diabetes technology is a fundamental part of modern diabetes therapy. Its widespread usage is associated with an increasing amount of “diabetes technology waste.” The aim of this study was to quantify this waste in a real-world situation in a specialized diabetes practice in Germany. Methods: Eighty patients with diabetes and insulin treatment participated and collected all of their therapy-associated waste for three months. Their attitude toward sustainability of antidiabetic therapy, waste generation, and their own waste reduction/separation behavior was surveyed. Results: In total, 23 707 pieces of therapy-associated waste were collected. They comprised 5362 test strips, 630 glucose sensors, 14 619 needles, 519 insulin cartridges, 599 pens, and 1463 pieces of aids for insulin pump therapy. Type and quantity of the collected waste depended on the type of diabetes and the respective therapy, ie, multiple daily injections, usage of glucose sensors, or pump therapy. Most participants (92%) were surprised by the amounts of waste and reported an increased awareness toward the resource consumption of their therapy (87%). The survey indicated an enhanced interest in waste separation (94%) and a demand for the reduction and recycling of devices/aids (93%). Conclusions: Our data revealed the amount and complexity of the waste generated by modern diabetes therapy. Extrapolating these data, it can be estimated that around 1.2 billion pieces of diabetes technology waste are generated in Germany per year. The major concern of the study participants was the limited number of recycling options. A clear demand for improved sustainability of the medical products was expressed.
E-therapists’ views on the acceptability and feasibility of an internet-administered, guided, low-intensity cognitive behavioural therapy intervention for parents of children treated for cancer: A qualitative study
Authors: Reuther Christina , Lundgren Johan , Gottvall Maria , Ljungberg Johan , Woodford Joanne , Essen Louise von 
Published: June 2024

Background Childhood cancer treatment completion can be a period of vulnerability for parents and is associated with mental health difficulties such as depression and anxiety. We developed an internet-administered, guided, low-intensity cognitive behavioural therapy-based self-help intervention (EJDeR) for parents delivered on the U-CARE-portal (Portal). The acceptability and feasibility of EJDeR and study procedures were examined using a single-arm feasibility trial (ENGAGE). Results indicated that EJDeR and ENGAGE study procedures are acceptable and feasible, however, a need for clinical and technical modifications to EJDeR and refinements to ENGAGE study procedures was identified. Objectives This study aimed to explore the acceptability and feasibility of EJDeR and ENGAGE study procedures from the perspective of e-therapists to inform clinical and technical modifications to EJDeR and refinements to study procedures prior to progression to a superiority randomised controlled trial. Methods We conducted semi-structured interviews with 10 e-therapists. Data were analysed using manifest content analysis. Results We identified three categories relating to the acceptability and feasibility of EJDeR: (a) Support to e-therapists (subcategories: Clinical supervision and Technical difficulties); (b) Guidance to parents (subcategories: Support protocols and Synchronous communication); and (c) Content (subcategories: Relevancy of the intervention and Pacing of the intervention). We identified four categories relating to the acceptability and feasibility of study procedures: (a) Recruitment and training of e-therapists (subcategories: Definition of the role and Training program); (b) Retention of parents (subcategories: Parent suitability and screening and Frequency of weekly Portal assessments); (c) Retention of e-therapists (subcategories: Administrative requirements and Communication with the research team); and (d) The Portal. Conclusions EJDeR and study procedures were considered acceptable and feasible, however, clinical and technical modifications and refinements to study procedures were suggested to enhance acceptability and feasibility. Results may also inform implementation considerations for both EJDeR and other similar digital psychological interventions. Trial registration number ISRCTN 57233429