bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in Medical Students' Attitudes Towards Family Planning After Pregnancy Counseling Panel Intervention [ID 2683614]
Authors: Peipert Leah J. , Brown Lucy , King Carli , Stout Julianne , Caldwell Amy 
Published: May 2024

INTRODUCTION:
Abortion is one of the most commonly performed procedures in the United States, but abortion education is lacking in medical curricula. This study evaluates changes in medical students’ attitudes after a pregnancy counseling panel intervention during preclinical medical education.

METHODS:
Second-year medical students participated in a “Pregnancy Options Panel” with obstetrician–gynecologists, a pediatrician, and a social worker. Using a case study format, panelists guided discussion of appropriate care for a patient diagnosed with an unintended pregnancy. Two identical 19-item surveys were disseminated before and after the panel to assess students’ comfort/beliefs about pregnancy counseling and treatment. Statistical analyses were performed to compare responses. The study was IRB exempt.

RESULTS:
The class was composed of 366 students: 207 (60.5%) completed the pre-survey and 181 (49.5%) completed the post-survey. Students reported increased comfort when contemplating referral to an abortion provider, prescribing medication abortion, and performing a surgical abortion after the panel compared to before the panel (P<.01). Students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% versus 42.3%; P<.01), felt more capable of counseling patients in a neutral manner (86.4% versus 71.6%; P<.01), and had a significant increase in preparedness to pregnancy options counseling (P<.01).

CONCLUSION:
Medical students felt more prepared to counsel patients without bias of their own beliefs after the pregnancy options counseling panel. Expert panels comprised of health professionals with diverse perspectives on pregnancy options can improve preclinical medical curriculum on the often-neglected topic of abortion.
“It Is Challenging to Knowingly Cause Discomfort”: Medical Students' Experiences With Ethical Dilemmas and Professionalism During the Obstetrics and Gynecology Clerkship [ID 2683534]
Authors: Gliwa Catherine , Schmidt Alison , Knapp Frances , Hess Andrea L. , Loder Charisse 
Published: May 2024

INTRODUCTION:
Medical students often encounter ethical dilemmas in obstetrics and gynecology clinical training, yet receive limited directed education to help them interpret and process these situations. We sought to explore students’ described experience with clinical ethical complexities to identify sources of conflict and inform training improvements.

METHODS:
From 2019 to 2022, medical students who submitted an essay assignment to describe an ethical dilemma encountered during their obstetrics and gynecology clerkship were invited to share their work with the study team. We performed thematic analysis of these essays.

RESULTS:
Thirty-nine essays were available for analysis. Prominent themes included patient autonomy, informed consent, approaches to counseling, power differentials, professionalism, and the learning environment and its effect on patient care. The following are sample quotes: “Each time a patient requested that a medical student not be involved in their care they often occupied positions of privilege by title, socioeconomic status, or race.”; “This was a difficult, uncomfortable experience. It is challenging to knowingly cause discomfort.”; “I wondered, and still wonder—should I have intervened? [...] I did not have the courage to speak up, but I wish I did.”

CONCLUSION:
Students bear witness to and learn from ethical conflicts during obstetrics and gynecology training, which can prompt both self-reflection and cognitive dissonance. Topics such as informed consent and patient autonomy are commonly taught in medical schools; in practice, students also identified dilemmas related to their roles as learners navigating team-based health care. Medical students may need additional ethical training or support in processing the hierarchies of academic medicine.
Greater mechanistic understanding of the cutaneous pathogenesis of Stevens–Johnson syndrome/toxic epidermal necrolysis can shed light on novel therapeutic strategies: a comprehensive review
Authors: Ogiji Emeka D. , Aboheimed Nourah , Ross Kehinde , Voller Calum , Siner Ryan , Jensen Rebecca L. , Jolly Carol E. , Carr Daniel F. 
Published: May 2024

Purpose of review
Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse drug reactions (SCARs) characterized by widespread epithelial detachment and blistering, which affects the skin and mucocutaneous membranes. To date, therapeutic interventions for SJS/TEN have focused on systematic suppression of the inflammatory response using high-dose corticosteroids or intravenous immunoglobulin G (IgG), for example. No targeted therapies for SJS/TEN currently exist.

Recent findings
Though our understanding of the pathogenesis of SJS/TEN has advanced from both an immunological and dermatological perspective, this knowledge is yet to translate into the development of new targeted therapies.

Summary
Greater mechanistic insight into SJS/TEN would potentially unlock new opportunities for identifying or repurposing targeted therapies to limit or even prevent epidermal injury and blistering.
Pains Revisited
Authors: Loeser John D. , Ballantyne Jane C. 
Published: May 2024

Objectives:
The management of pain patients has not evolved as rapidly as envisioned when IASP was founded almost 50 years ago. We sought to identify factors that could contribute to this situation, with a focus on concepts of pain and the education of pain physicians.

Methods:
Relevant literature describing new strategies for diagnosing and managing patients with high-impact chronic pain was reviewed.

Results:
It appears that the acute–chronic dichotomy has outlived its usefulness and pains should be identified as of peripheral origin or due to central processing errors. Pains of peripheral origin and those of central processing errors require different diagnostic and therapeutic strategies.

Discussion:
Peripheral treatments and opioids are not effective for central pains. When the cause of the pain lies in the central nervous system, a more centrally focused approach is needed to minimize wasteful pursuit of peripheral causes. The education and training of pain physicians should reflect the skills needed to address these 2 very different clinical problems.
Exposure to Operative Anesthesia in Childhood and Subsequent Neurobehavioral Diagnoses: A Natural Experiment Using Appendectomy
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Reiter Joseph G. , Jain Siddharth , Hill Alexander S. , Hashemi Sean , Brown Sydney , Olfson Mark , Ing Caleb 
Published: May 2024

Background
Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis to determine whether anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes.

Methods
This study identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, attention-deficit hyperactivity disorder) or internalizing or mood or anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001 and 2018. For comparison, this study also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. In addition, this study examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls.

Results
Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (hazard ratio, 1.04; 95% CI, 1.01 to 1.06; P = 0.0010) and mood or anxiety disorders (hazard ratio, 1.15; 95% CI, 1.13 to 1.17; P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (hazard ratio, 1.20; 95% CI, 1.18 to 1.22; P < 0.0001) and mood or anxiety (hazard ratio, 1.25; 95% CI, 1.23 to 1.27; P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients.

Conclusions
Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.

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Assessing the Effectiveness of a Unique Visual Aid in Improving Women's Knowledge of the Hysterectomy Procedure [ID 2683416]
Authors: Fiuza Angelica , Panchal Disha D. , Sproul Wesley A. , Colon Katia M. , Dotterweich Kathryn A. , Howard David L. 
Published: May 2024

INTRODUCTION:
This study aims to determine the efficacy of a visual aid in improving women's knowledge of the hysterectomy procedure. Currently, there is a lack of literature that examines evidence-based hysterectomy patient education, and a recent literature review stated that there is a deficit in education surrounding the different hysterectomy treatment options.

METHODS:
This is IRB study #Pro2021000882. Patients were recruited from the Department of Obstetrics, Gynecology & Reproductive Health at the Ambulatory Care Center at University Hospital in Newark, New Jersey. Participants consented and patient information was de-identified. Participants completed a 28-question pre-test, watched the visual aid in either English or Spanish, and then completed the same 28-question post-test. For both English- and Spanish-speaking participants, the percentage of participants who answered each pre- and post-test question correctly was calculated. Finally, average pre-test scores were compared to average post-test scores for each language.

RESULTS:
After watching the video, average test scores of English-speaking (N=30) participants increased by 19.76 (95% CI: 10.9, 28.6) percentage points, whereas Spanish-speaking (N=20) participants increased by 28.93 (95% CI: 19.7, 38.1) percentage points. From the 28-question knowledge test, there were 15 questions in the English version and 23 questions in the Spanish version where the percent of respondents who answered that question correctly after watching the video improved by 20 percentage points or greater compared to before watching the video.

CONCLUSION:
Our preliminary data provide evidence that the hysterectomy visual aid/video we created significantly improves knowledge of the hysterectomy procedure as measured by a validated hysterectomy knowledge quiz.
Association Between Maternal Age and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683560]
Authors: Mulder Isabelle , Nambiar Anjali , Holloway Steven Blaine , Pruszynski Jessica , Lea Jayanthi , Martin Robert B. 
Published: May 2024

INTRODUCTION:
The incidence of cervical dysplasia in pregnancy is expected to rise as patients delay childbearing. Historical studies have quoted high rates of postpartum regression of lesions diagnosed in pregnancy. We sought to evaluate the relationship between maternal age and postpartum progression, regression, and persistence of high-grade lesions.

METHODS:
This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Institutional review board approval was obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as invasive cervical cancer. Results were stratified by maternal age (≤24, 25–29, 30–34, 35+) and data were analyzed using the Cochran–Armitage test.

RESULTS:
Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. Average age was 28 (±4.2) years. Postpartum regression rate was 44% for patients aged 24 years or younger, 37% in ages 25–29, 33% in ages 30–34, and 33% in ages 35 or older (P=.174). Persistence was common (55%, 63%, 67%, and 64%, respectively) and apparent progression to cancer was rare, occurring in 1% of patients aged 24 years or younger and in 2.8% of patients 35 or older (P=.68).

CONCLUSION:
Persistence occurred in over half of patients, regardless of age. Our findings emphasize the importance of postpartum follow-up, and possible cervical excision, in patients with antepartum high-grade dysplasia.
Maternal Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infection in Otherwise Healthy Preterm and Term Infants: A Systematic Review and Meta-analysis
Authors: Manzoni Paolo , Viora Elsa , Lanari Marcello , Iantomasi Raffaella , Montuori Eva Agostina , Rodgers-Gray Barry , Waghorne Nicola , Masturzo Bianca 
Published: May 2024

Background/objective:
To date, there is no published, formal assessment of all maternal risk factors for respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) in infants. A systematic literature review and meta-analysis were undertaken to ascertain: What maternal risk factors are associated with an increased risk of RSV-LRTI in infants?

Methods:
The systematic literature review used explicit methods to identify, select and analyze relevant data. PubMed, Embase and the Cochrane Library were searched (November 2022) using terms regarding: (1) RSV/LRTI; (2) risk factors; (3) pregnant/postpartum population. Bayesian meta-analysis compared RSV hospitalization (RSVH) risk in infants born to mothers with or without certain risk factors.

Results:
A total of 2353 citations were assessed and 20 were included in the final review (10 individual studies; 10 pooled analyses). In 10 studies examining infants (<1 year) without comorbidities (primary outcome), 10 maternal risk factors were associated with RSV-LRTI/RSVH in multivariate analyses. Meta-analysis revealed smoking while pregnant increased infant RSVH risk by 2.01 (95% credible interval: 1.52–2.64) times, while breast-feeding was protective (0.73, 95% credible interval: 0.58–0.90). Risk scoring tools have reported that maternal risk factors contribute between 9% and 21% of an infant’s total risk score for RSVH.

Conclusions:
A greater understanding of maternal risk factors and their relative contribution to infant RSV-LRTI will enable more accurate assessments of the impact of preventive strategies.
Combination Treatment With Varenicline and Nicotine Patch on Smoking Cessation Outcomes in Heavy Drinkers at 26-Week Follow-up
Authors: Robinson Layne E. , Didier Nathan , Thomas Riya , Vena Ashley , King Andrea 
Published: May 2024

Abstract

Purpose/Background
People who smoke cigarettes and drink alcohol heavily are less likely to quit smoking compared with those who do not drink heavily. The current study examined the effects of a 12-week treatment phase of combination varenicline and nicotine patch compared with placebo and nicotine patch on smoking cessation (primary outcome) and alcohol consumption (secondary outcome) in heavy drinking smokers at 26-week follow-up.

Methods/Procedures
Participants were daily smokers who met heavy drinking criteria. They were randomly assigned to receive either varenicline and nicotine patch (n = 61) or placebo and nicotine patch (n = 61) for 12 weeks. At week 26, self-reports of point prevalence cigarette abstinence were biochemically confirmed, and past-month alcohol drinking days and heavy drinking days were assessed.

Findings/Results
At week 26, smoking quit rates did not differ by treatment group (25% varenicline and 26% placebo). Relative to week 12 outcomes, week 26 quit rates significantly dropped off in the varenicline group but not in the placebo group. Alcohol drinking reductions for the whole sample that were previously observed from baseline to week 12 were sustained at week 26, although they did not differ between treatment groups.

Implications/Conclusions
In heavy drinking smokers, smoking cessation success was evident in a quarter of the total sample at 3 months postmedication discontinuation. At this time, quit rates were the same between those who received varenicline and nicotine patch and those who received nicotine patch alone. Future research is warranted to examine what may aid in longer-term smoking quit rates in heavy drinking smokers.
Assessing Justice, Equity, Diversity, and Inclusion Best Practices for Test Item Writing at a Physician Assistant Program: A Retrospective Analysis
Authors: Wright Hannah R. , Nelson Courtney E. , Toussaint Michele , Ip Eric J. 
Published: May 2024

Introduction
Outcomes for specific racial and ethnic groups during the COVID-19 pandemic and the widespread protests demanding racial justice in 2020 renewed a focus on health equity practices and bias in medical education. Routine inclusion of sociodemographic identifiers such as sex/gender, age, race, and/or ethnicity in test items risks perpetuation of implicit bias and race-based practices in medical education.

Methods
A retrospective review was conducted of test items in a pathophysiology course series at an academic medical center in the Western United States. Sociodemographic identifiers in multiple choice test items were reviewed to determine clinical relevance.

Results
Of 795 test items, 475 referred to sociodemographic information (gender, race/ethnicity, age, sexual orientation) and in only 27.5% of questions, this inclusion was clinically relevant (131/475).

Discussion
Current evidence suggests that routine inclusion of sociodemographic information in test items infrequently supports the clinical diagnosis and perpetuates implicit bias and race-based practices in medical education. Thoughtful inclusion of sociodemographic information in assessment offers an opportunity to address sociostructural determinants of health.
Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation
Authors: Fischer Fielding S. , Shahzad Hania , Khan Safdar N. , Quatman Carmen E. 
Published: May 2024

Abstract

Objectives:
To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery.

Design:
Retrospective cohort study.

Setting:
Mariner claims database.

Patients/Participants:
Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study.

Intervention:
Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing.

Main Outcome Measures:
One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation.

Results:
Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08–2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08–1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00–1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59–0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63–1.18, P = 0.41).

Conclusions:
Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population.

Level of Evidence:
Prognostic Level III.
Cell Cycle Checkpoints p16 and p21—Strong Predictors of Clinicopathologic Outcomes in High-Grade Osteosarcoma
Authors: Nasri Elham , Torrence Dianne E. , Vasilopoulos Terrie , Knapik Jacquelyn A. , Lagmay Joanne P. , Reith John D. , Gibbs Charles Parker 
Published: May 2024

Osteosarcoma is the most common primary malignant neoplasm of bone. Despite recent advances in the management of the disease, the overall survival of patients has failed to improve in the past 30 years due to the biological and genetic complexities of the disease and the lack of reliable prognostic and predictive markers to guide the treatments. Histologic tumor necrosis in response to chemotherapy has served as the most reliable predictor of disease outcome for years. Patients with a good histologic response (greater than 90% tumor necrosis) to chemotherapy had better disease outcomes compared with patients with a poor histologic response (less than 90% tumor necrosis). With the changes in the intensity of chemotherapeutic regimens, the prognostic value of histologic measurement of tumor necrosis has been questioned in recent studies.

Purpose
In this study, we used a series of immunohistochemical measurements of 2 cell cycle regulators, p16 and p21, to evaluate their prognostic value, separately and in combination, for the disease outcomes.

Method
A total of 101 patients with high-grade osteosarcoma were included in this study. Clinicopathologic data were collected, and immunohistochemistry for p16 and p21 was performed and interpreted by 3 independent pathologists. Statistical analysis was performed to assess the strength of each of these markers relative to disease outcome.

Results
Our results indicate that more than 90% expression (high) of p16 by immunohistochemistry on the initial biopsy has a strong predictive value for good histologic response to chemotherapy. The patients are also more likely to survive the past 5 years and less likely to develop metastasis than patients with less than 90% p16 (low) expression. The results for p21, on the other hand, show a unique pattern of relationship to the clinicopathologic outcomes of the disease. Patients with less than 1% (low) or more than 50% (high) expression of p21 by immunohistochemistry show a higher chance of metastasis, poor necrotic response to chemotherapy, and an overall decreased survival rate when compared with p21 expression between 1% and 50% (moderate). Our results also showed that the expression of p16 and combined p16 and p21 demonstrates a stronger predictive relationship to 5-year survival than tumor histologic necrosis and p21 alone.

Discussion
The results of this study, once proven to be reproducible by a larger number of patients, will be valuable in the initial assessment and risk stratification of the patients for treatment and possibly the clinical trials.