bluuebunny/crossref_metadata_2025_split huggingface dataset:
PAs' perspective on leadership in medicine
Authors: Roberts Amy Lynn , Rizzolo Denise , Bruza-Augatis Mirela , Pontrelli Gina , Zammit Christine , Banahan Mary 
Published: June 2024

Abstract

Objective:
This study evaluated physician associate/assistant (PA) training and confidence in leadership and leadership skills, as well as where best to incorporate leadership training for the profession.

Methods:
A quantitative survey was administered to assess PAs' perceptions of leadership and degree of leadership training during their primary PA education. The study also solicited where in the career trajectory leadership training is perceived to be most effective. Of the 284 participants who responded to the survey, 207 had complete responses that were used in the analysis.

Results:
Nearly 92% of PAs agreed that they aspire to be leaders, and 93.2% agreed or strongly agreed that leadership training would be beneficial during PA school. Additionally, more than 50% of PAs agreed that they had no training but desired more regarding personal mastery, teaching, administration, ideals of a healthy workforce, vision and goal setting, getting results, coalitions, and system transformation.

Conclusions:
This study demonstrated that PAs desired supplemental training in leadership to cultivate career goals and reported that formal leadership training would be useful to cope with and overcome adversity in clinical practice.
The Physician Is on Campus
Authors: Hutchinson Jennifer C. 
Published: June 2024

Abstract
The purpose of this project was to determine if physician participation in simulation affects students’ perceptions of nurse/physician communication and collaboration. Fifty-five students participated in six groups. Three groups had a physician present and involved during their eight-hour pediatric simulation; the others continued with current practice, which involved phone contact with an individual posing as a physician. There was a statistically significant difference in two items on the Nurse Attitudes About Communicating and Collaborating With Physicians tool when pre- and post-simulation means were compared. Findings are consistent with previous research, indicating simulation-based learning can improve students’ perceptions of nurse-physician collaboration.
Foot Tapping Test as a Simple Quantitative Index of Motor Function for Lumbosacral Radiculopathy
Authors: Kobayashi Hiroshi , Nikaido Takuya , Otani Koji , Watanabe Kazuyuki , Kato Kinshi , Kobayashi Yoshihiro , Hakozaki Michiyuki , Kameda Takuya , Kaneuchi Yoichi , Sekiguchi Miho , Yabuki Shoji , Konno Shin-ichi , Matsumoto Yoshihiro 
Published: June 2024

Study Design.
We conducted a retrospective review of data from patients who underwent surgical treatment for lumbosacral radiculopathy.

Objective.
To assess the effectiveness of the foot tapping test (FTT) in evaluating lower limb motor function in patients with lumbosacral radiculopathy pre and postsurgery.

Background.
Lumbosacral radiculopathy is becoming increasingly common in aging populations. Despite standard treatments, paralysis often leads to incomplete postoperative recovery, necessitating early detection and interventions.

Patients and Methods.
We enrolled individuals who underwent surgery for lumbosacral radiculopathy at our facility between 2009 and 2020. Patients with a history of lumbar surgeries, dialysis, rheumatoid arthritis, and transitional vertebrae were excluded. The FTT score was measured by having the sole of the foot tap as many times as possible for 10 seconds while keeping the heel in contact with the floor. The L4, L5, and S1 groups were assigned using the scores on the side of the radiculopathy, and the control group was assigned using the scores on the intact side. Data were analyzed using the Dunnett test for group comparisons and paired t-tests for pre and postsurgery comparisons.

Results.
Of the 522 eligible patients, 80 (159 nerve roots, 1 patient with hemi-prosthetic leg) were analyzed. The preoperative FTT scores in the L4 and L5 groups were significantly lower than those in the control group, indicating functional impairment. One year postsurgery, all groups showed improvements in FTT scores, with the L5 group exhibiting significant improvements compared with the control; this was supported by the results of sensitivity analyses considering the effects of paralysis and pain.

Conclusion.
The FTT is a valuable tool for the early detection of lower limb motor dysfunction in lumbosacral radiculopathy, particularly for L5 nerve root impairment, where it aids in timely surgical intervention and may improve postoperative outcomes and quality of life.
Characteristics and Outcomes of Prolonged Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery: The Post-Cardiotomy Extracorporeal Life Support (PELS-1) Cohort Study
Authors: Bunge Jeroen J. H. , Mariani Silvia , Meuwese Christiaan , van Bussel Bas C. T. , Di Mauro Michele , Wiedeman Dominik , Saeed Diyar , Pozzi Matteo , Loforte Antonio , Boeken Udo , Samalavicius Robertas , Bounader Karl , Hou Xiaotong , Buscher Hergen , Salazar Leonardo , Meyns Bart , Herr Daniel , Matteucci Sacha , Sponga Sandro , MacLaren Graeme , Russo Claudio , Formica Francesco , Sakiyalak Pranya , Fiore Antonio , Camboni Daniele , Raffa Giuseppe Maria , Diaz Rodrigo , Wang I-wen , Jung Jae-Seung , Belohlavek Jan , Pellegrino Vin , Bianchi Giacomo , Pettinari Matteo , Barbone Alessandro , Garcia José P. , Shekar Kiran , Whitman Glenn J. R. , Gommers Diederik , Dos Reis Miranda Dinis , Lorusso Roberto ,   on behalf of the Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators
Published: June 2024

OBJECTIVES:
Most post-cardiotomy (PC) extracorporeal membrane oxygenation (ECMO) runs last less than 7 days. Studies on the outcomes of longer runs have provided conflicting results. This study investigates patient characteristics and short- and long-term outcomes in relation to PC ECMO duration, with a focus on prolonged (> 7 d) ECMO.

DESIGN:
Retrospective observational cohort study.

SETTING:
Thirty-four centers from 16 countries between January 2000 and December 2020.

PATIENTS:
Adults requiring post PC ECMO between 2000 and 2020.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Characteristics, in-hospital, and post-discharge outcomes were compared among patients categorized by ECMO duration. Survivors and nonsurvivors were compared in the subgroup of patients with ECMO duration greater than 7 days. The primary outcome was in-hospital mortality. Two thousand twenty-one patients were included who required PC ECMO for 0–3 days (n = 649 [32.1%]), 4–7 days (n = 776 [38.3%]), 8–10 days (n = 263 [13.0%]), and greater than 10 days (n = 333 [16.5%]). There were no major differences in the investigated preoperative and procedural characteristics among ECMO duration groups. However, the longer ECMO duration category was associated with multiple complications including bleeding, acute kidney injury, arrhythmias, and sepsis. Hospital mortality followed a U-shape curve, with lowest mortality in patients with ECMO duration of 4–7 days (n = 394, 50.8%) and highest in patients with greater than 10 days ECMO support (n = 242, 72.7%). There was no significant difference in post-discharge survival between ECMO duration groups. In patients with ECMO duration greater than 7 days, age, comorbidities, valvular diseases, and complex procedures were associated with nonsurvival.

CONCLUSIONS:
Nearly 30% of PC ECMO patients were supported for greater than 7 days. In-hospital mortality increased after 7 days of support, especially in patients undergoing valvular and complex surgery, or who had complications, although the long-term post-discharge prognosis was comparable to PC ECMO patients with shorter support duration.
Validation of Math Model Using Porous Media for Determining Alveolar CO2 in Ventilated Patients
Authors: Jiménez-Posada L. D. , Palacio- Sánchez A. F. , Montagut-Ferizzola Y. J. , Ardila-Villegas M. , Maya Juan C. 
Published: June 2024

OBJECTIVES:
To validate a mathematical model using porous media theory for alveolar CO
2 determination in ventilated patients.

DESIGN:
Mathematical modeling study with prospective clinical validation to simulate CO
2 exchange from bloodstream to airway entrance.

SETTING:
ICU.

PATIENTS:
Thirteen critically ill patients without chronic or acute lung disease.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Model outcomes compared with patient data showed correlations for end-tidal CO
2 (EtCO2), area under the CO
2 curve, and PaCO
2 of 0.918, 0.954, and 0.995. Determination coefficients (R
2) were 0.843, 0.910, and 0.990, indicating precision and predictive power.

CONCLUSIONS:
The mathematical model shows potential in pulmonary critical care. Although promising, practical application demands further validation, clinician training, and patient-specific adjustments. The path to clinical use will be iterative, involving validation and education.
Faith Community Nursing
Authors: Burt Susan , Lewis Rosalie , Braithwaite Yvonne 
Published: June 2024

ABSTRACT:
Faith community nurses (FCNs) are well positioned to serve individuals needing community-based healthcare within local healthcare systems, large church denominations, or through the support and resources of nonprofit faith community nursing organizations. This article briefly outlines development of the specialty of faith community nursing and proposes areas of research needed to grow the impact of this nursing specialty. Examples of FCNs working in and collaborating with healthcare systems, educational institutions, and congregations illustrate the value and diversity of FCN services for impacting community-based care. An exhaustive list of national, denominational, and regional organizations supporting FCN practice is included.
Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease
Authors: Farhat Souha , De la Fuente Hagopian Alexa , Andrawes Peter , Dinh Tue A. 
Published: June 2024

Background:
Pilonidal cyst disease is a challenging condition requiring excision and wound management when it is chronic and symptomatic. Primary closure of the excision site can lead to high recurrence rates, necessitating flap-based reconstruction. This article discusses the use of a partial gluteus maximus muscle flap to address recurrent pilonidal disease and reduce its recurrence.

Methods:
From 2014 to 2021, 11 patients aged 14–31 with recurrent pilonidal cysts underwent two-stage surgery involving excision and wound debridement by general surgery, followed by plastic surgery for wound closure using the partial gluteus muscle flap.

Results:
Eleven patients were included in the study (four women and seven men). The mean age was 23 ± 5.2, and the average body mass index was 28.59 (±6.7). The mean number of previous procedures was 2.25 (range, 2–3). Operative time was 158.7 ± 37 minutes. The average length of stay when both procedures were done in the same admission was 8 ± 6 days (range 3–21 days) and when procedures were done separately, the length of hospital stay after the wound closure using a partial gluteus muscle flap was 3 days, and the range for reliable follow-up was 1.6–7 years postoperatively. In our study cohort of 11 patients, the majority, specifically seven individuals, experienced uneventful healing. However, a subset of patients encountered complications. Three patients developed an infection recurrence: one was treated conservatively, and one required reoperation with resolution of symptoms, and one patient also experienced wound dehiscence, which was closed with a small procedure.

Conclusion:
Partial gluteal muscle flap offers a promising approach for treating recalcitrant, difficult-to-treat pilonidal disease in young adults, enhancing wound healing and reducing the risk of recurrence.
Microvascular Thrombosis in Celiac Disease: Is Free Flap an Option? Case Presentation and Literature Review
Authors: Khubrani Abdullah Mohammed , Alobaidi Hussain Amin , Alzahrani Isra’a Abdulaziz , Alelyani Rakan H. , Wani Musaib Shabeer , AlThubaiti Ghazi A. 
Published: June 2024

Summary:
Celiac disease is an autoimmune disease that occurs due to gluten intolerance. The prevalence of breast cancer among celiac disease patients is the same as in the general population. It is of note that breast cancer is the most common type of cancer in women. Following mastectomy, these patients visit plastic surgeons for breast reconstruction. Based on various factors, autologous reconstruction using abdominal-based flaps is the best option. Patients with celiac disease have a high incidence of thromboembolic disorders, which may prevent plastic surgeons from doing breast reconstruction with free flaps. We present a case of a patient with celiac disease who underwent a free flap for breast reconstruction with an uneventful course after using our routine postoperative protocol. This case report highlights that patients with celiac disease cannot be denied the option of breast reconstruction with free flaps.
Using Cognitive Rehearsal to Address Faculty Incivility in Nursing Academe
Authors: M. Clark Cynthia 
Published: June 2024

Background:
Faculty-to-faculty incivility is a national and global problem. Recent studies examining faculty incivility in nursing academe found that respondents expressed emotional and physical distress stemming from workplace incivility, and most avoid dealing with the problem. A top strategy for improving workplace civility includes providing ongoing education to improve communication skills.

Problem:
Faculty and academic nurse leaders require evidence-based strategies to prevent and address the range of uncivil behaviors occurring in academic work environments.

Approach:
Cognitive Rehearsal (CR) is a primary prevention and intervention communication strategy used to address incivility in health care and educational settings. Working with a skilled facilitator, participants practice addressing stressful situations in a non-threatening environment. This is the first known publication using CR to address faculty-to-faculty incivility.

Conclusions:
The author uses real-life situations derived from faculty-to-faculty incivility research studies and in-person conversations to describe each step of the CR process.
Big data study using health insurance claims to predict multidisciplinary low vision service uptake
Authors: Stolwijk Miriam L. , van Nispen Ruth M. A. , van der Pas Stéphanie L. , van Rens Ger H. M. B. 
Published: June 2024

SIGNIFICANCE
There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data.

PURPOSE
This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data.

METHODS
Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping.

RESULTS
Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008).

CONCLUSIONS
Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.
Comparative 3-Dimensional Analysis of Philtral Ridge Projection in Unilateral Cleft Lip Repair Enhanced with Muscle-to-Subdermis Suture
Authors: Kim Tae Hyung , Hong Dae Won , Kim Young Chul , Oh Tae Suk 
Published: June 2024

Background:
Recreating the philtral ridge and restoring orbicularis oris muscle (OOM) continuity in patients with cleft is a challenging task. The muscle-to-subdermis technique introduces an effective method for achieving the desired philtral ridge reconstruction.

Methods:
From August of 2015 to July of 2023, a retrospective study was conducted with a follow-up period of at least 6 months. This procedure involved a suture technique using muscle-to-subdermis sutures. Measurements of philtral projection were taken at 2 distinct points: one above Cupid’s bow and the other at the midphiltral level. In the comparative analysis of philtral ridges between the cleft and noncleft sides, the root mean square projection value was assessed. In addition, an analysis of the restoration of the OOM included the use of color mapping from the midsagittal plane and covered 7 different points across 3 distinct horizontal planes: below subnasale, at the midphiltral level, and above Cupid’s bow.

Results:
A total of 134 patients were included, with a 37.8-month follow-up (SD 9.4). Philtral side projection was well maintained, measuring −0.36 (0.43) mm, −0.24 (0.49) mm in the classic group versus 0.23 (0.29) mm, 0.20 (0.21) mm in the muscle-to-subdermis group (P = 0.001). The root mean square projection value was 0.57 (0.46) versus 0.14 (0.046), indicating greater symmetry in the muscle-to-subdermis group, with no difference in sagittal vector analysis of the OOM between normal and cleft sides.

Conclusions:
A suturing technique using muscle-to-subdermis sutures has shown promising results in philtral projection and dimple formation. This improvement can be attributed to the combined effect of subdermis and fewer muscle sutures.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Skin Color Match in Autologous Breast Reconstruction: Which Donor Site Gives the Best Result?
Authors: Paulus Vera A. A. , van Raay Stephan H. C. , Teunissen Joris S. , Lese Ioana , Ulrich Dietmar J. O. 
Published: June 2024

Background:
Color match of a reconstructed breast with the surrounding area is of importance for the overall aesthetic result. The objective of the authors’ study was to quantify the degree of color match achieved with different autologous breast reconstructions and to analyze the changes in color over time by analyzing digital photographs.

Methods:
A total of 193 patients who underwent a delayed autologous breast reconstruction (deep inferior epigastric perforator [DIEP], profunda artery perforator [PAP], lumbar artery perforator [LAP], latissimus dorsi [LD]) were included. Standardized photographs from 242 flaps at 3 months and 9 to 12 months postoperatively were analyzed, and the L*a*b* values and delta E2000 (dE) values were determined to qualify the color match. The Kruskal-Wallis and Wilcoxon rank sum tests were used for statistical analysis.

Results:
Initially, DIEP flaps had a significant lower dE value compared with LD (P = 0.012) and PAP flaps (P < 0.001), when compared with the natural breast. PAP flaps showed a significant decrease after 9 to 12 months (P = 0.003). Perception of color match was comparable in all flaps. Compared with the cleavage, at late follow-up, DIEP flaps had a significant higher dE value compared with LD (P = 0.017) and PAP flaps (P < 0.001). PAP flaps presented a significant decrease of dE after 9 to 12 months (P = 0.031). Abdominal skin presented no better skin color match in patients with PAP, LD, and LAP flaps.

Conclusions:
All analyzed flaps had a comparable color match with the surrounding tissue and with the contralateral breast approximately 1 year after surgery. The color of PAP flaps changes more, which leads to an improvement at a later follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Nasoorbitofrontal Complex in Facial Feminization Surgery
Authors: Beaufils Tristan , Berkane Yanis , Luca-Pozner Vlad , Watier Éric , Bertheuil Nicolas , Qassemyar Quentin 
Published: June 2024

Background:
With the increasing demand for facial feminization surgery, there is a growing need for reliable and reproducible techniques to enhance outcomes. The authors aimed to evaluate the effectiveness of single-stage nasoorbitofrontal (NOF) complex reshaping in facial feminization surgery. Effectiveness was gauged by computed tomographic assessments and an unvalidated patient satisfaction survey at 6 months postoperatively.

Methods:
The study included 155 transfeminine patients undergoing surgery of the upper third of the face. Outcomes were compared in patients receiving either orbitofrontal (OF) surgery or combined NOF surgery. A comparative analysis of preoperative and postoperative standardized computed tomography sections was performed, focusing on multiple anatomic angles in 2 dimensions. A self-administered satisfaction questionnaire based on 6 FACE-Q items was completed at 6 months.

Results:
Among the 155 patients, 65 underwent OF surgery and 90 underwent NOF surgery. The follow-up period ranged from 6 to 36 months, with an average follow-up of 18 months. Significant changes in craniometric measurements were observed. In the OF group, average changes in nasofrontal, frontal tilt, and metopion angles were +12.3 ± 0.2 degrees, −8.5 ± 2.2 degrees, and +20.0 ± 0.1 degrees, respectively (P < 0.001); in the NOF group, they were +28.5 ± 0.3 degrees, −9.3 ± 2.4 degrees, and +23.9 ± 0.1 degrees, respectively (P < 0.001). The NOF group demonstrated higher overall satisfaction (median, 4 of 5) compared with the OF group (median, 3 of 5). No early complications were reported.

Conclusion:
The NOF complex surgery is an effective approach in gender-affirming surgery of the upper third of the face, yielding predictable results and higher patient satisfaction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.