bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deidentifying Narrative Assessments to Facilitate Data Sharing in Medical Education
Authors: Thoma Brent , Bernard Jason , Wang Shisong , Yilmaz Yusuf , Bandi Venkat , Woods Robert A. , Cheung Warren J. , Choo Eugene , Card Annika , Chan Teresa M. 
Published: April 2024

Abstract

Problem
Narrative assessments are commonly incorporated into competency-based medical education programs. However, efforts to share competency-based medical education assessment data among programs to support the evaluation and improvement of assessment systems have been limited in part because of security concerns. Deidentifying assessment data mitigates these concerns, but deidentifying narrative assessments is time-consuming, resource intensive, and error prone. The authors developed and tested a tool to automate the deidentification of narrative assessments and facilitate their review.

Approach
The authors met throughout 2021 and 2022 to iteratively design, test, and refine the deidentification algorithm and data review interface. Preliminary testing of the prototype deidentification algorithm was performed using narrative assessments from the University of Saskatchewan emergency medicine program. The algorithm’s accuracy was assessed by the authors using the review interface designed for this purpose. Formal testing included 2 rounds of deidentification and review by members of the authorship team. Both the algorithm and data review interface were refined during the testing process.

Outcomes
Authors from 3 institutions, including 3 emergency medicine programs, an anesthesia program, and a surgical program, participated in formal testing. In the final round of review, 99.4% of the narrative assessments were fully deidentified (names, nicknames, and pronouns removed). The results were comparable for each institution and specialty. The data review interface was improved with feedback obtained after each round of review and found to be intuitive.

Next Steps
This innovation has demonstrated viability evidence of an algorithmic approach to the deidentification of assessment narratives while reinforcing that a small number of errors are likely to persist. Future steps include the refinement of both the algorithm to improve its accuracy and the data review interface to support additional data set formats.
Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding
Authors: Marshall Jeanne , Moss Perrin , Raatz Madeline , Ward Elizabeth C. , Frederiksen Nadine , Reilly Claire , Dickinson Corrine , Clarke Sally , Beak Kelly 
Published: April 2024

Introduction:
Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning.

Methods:
This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions.

Results:
Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided.

Discussion:
Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.
Comparative Analysis of Quality of Life of Family Caregivers of Patients With Heart Failure and Cancer Who Receive Palliative Care
Authors: Arias-Rojas Mauricio , Holgín Edith Arredondo , Carreño-Moreno Sonia 
Published: April 2024

Background
Quality of life (QoL) is the criterion-standard outcome in palliative care for patients with various illnesses and their family caregivers. There is a need to determine the factors affecting caregivers' QoL in each population and the differences between groups to design differentiated intervention strategies.

Purpose
The aims of this study were to compare the role adoption, social support, and QoL of family caregivers of patients with heart failure and cancer in palliative care and to examine the determinants of QoL.

Methods
A comparative study was conducted with the family caregivers of patients with cancer (n = 81) and heart failure (n = 80) in palliative care. Quality of life in life-limiting situations, role adoption, and social support questionnaires were also administered. A χ2 test, Student t test, and Mann-Whitney U test were used for between-group comparisons. Multiple linear regression was used to examine the effects of the correlated variables on caregivers' QoL.

Results
Caregivers of patients with heart failure had better QoL (P = .006) and lower tangible social support (P = .007) than caregivers of patients with heart failure. No differences were found in caregiver role adoption between the groups. Linear regression indicated that for caregivers of patients with cancer, social support, role adoption, caregiver age, and patient functional status affect caregiver QoL. For caregivers of patients with heart failure, role adoption and patient functional status are predictors of QoL.

Conclusions
Overall, healthcare professionals should focus on improving social support and caregiver role adoption and provide greater attention to the QoL of caregivers of patients with cancer.
A case study of an acute internal hernia: The complex diagnostic challenges of Roux-en-Y gastric bypass complications
Authors: Irizarry Angela C. 
Published: April 2024

ABSTRACT
Obesity remains a global health challenge linked to several comorbidities, such as obstructive sleep apnea, hypertension, hyperlipidemia, and diabetes. The prevalence of bariatric surgeries being performed is steadily increasing because it is a highly effective surgical tool used to achieve significant permanent weight loss. However, with all weight loss surgeries, several complications may not present for months to years after the initial procedure. In particular, the anatomical changes that occur after the Roux-en-Y gastric bypass (RNYGB) make the risk of internal hernias high. This particular complication is rare but lethal if unrecognized and not treated promptly. This clinical case study aims to provide readers with an overview of diagnosing and recognizing an internal hernia in the setting of previous laparoscopic RNYGB surgical history. Because of the sheer increase in the volume of patients undergoing bariatric surgery worldwide, health care providers must be well educated on the insidious presentations of this late complication and be prepared to act quickly to diagnose and treat these acute abdomen scenarios.
Cross-sectional study: mindset towards Coronavirus in developing countries and lessons learned: the case of Sudan
Authors: Omer Zeinab , Khalid Yousra , Zakaria Goffran , Sabir Shahd , MohamedAbdallah Abrar 
Published: April 2024

Introduction:
People’s mindset towards COVID-19 in developing countries has an impact on how they perceive and react to the preventative measures taken by the governments to contain the virus. Understanding the factors influencing the mindset and identifying lessons learned amidst COVID-19 are critical to inform any future intervention strategy.

Methods:
This was a cross-sectional, community-based study conducted to assess the mindset changes and lessons learned post-COVID-19 in developing countries, focusing on Sudan. The study adopted a sequential mixed approach (SMA), combining qualitative and quantitative methods. The study used a structured questionnaire with 300 respondents and in-depth interviews with two experts. To identify the factors influencing the mindset of the people towards COVID-19, the study employed logistic regression. The data was analyzed using SPSS software.

Results:
Of the total (N = 300) respondents, 59.0% are female, 59.3% are between the ages of 20 and 39, 79.7% have a university education, 25.3% have the Coronavirus, and 42.3% has their family or relative contracted the virus. Further, only 22.7% had taken the vaccine. Reasons for vaccine hesitancy include lack of trust (29.5%), fear of side effects (24.1%), and absence of the need to travel outside the country (25.5%). When the virus first appeared, 77.3% thought it posed a health risk, while 22.7% perceived it as a hoax or conspiracy. After 3 years, 73% still regarded it as a health threat, while 27% believed it was a hoax or conspiracy. The mindset was found to be influenced by age, history of the disease, the extent of trust in foreign media coverage, and the belief in the effectiveness of the vaccination.

Conclusion:
Assessing the mindset towards the virus and identifying the lessons learned from the pandemic could be of vital importance to control the spread of the virus in developing countries. Making use of such lessons and influencing the mindset of the people towards positive attitudes and behaviours are required to enhance the effectiveness of the health precaution measures adopted. Further research is required on the public’s mistrust of foreign media coverage and the contribution of local media to educate the public about the virus, particularly among the elderly.
Electrodiagnostic Findings Using Radial Motor Segmental Conduction Study and Inching Test in Patients With Radial Neuropathy
Authors: Kwon Jeha , Kang Jong Woo , Park Hong Bum , Kim Dong Hwee 
Published: April 2024

Objectives
The aims of this study were to characterize the electrodiagnostic findings of radial neuropathy using motor segmental conduction study and to determine the utility of subsequent inching test in precise lesion localization.

Design
Twenty-three patients with radial neuropathy were evaluated using radial neuropathy using motor segmental conduction study with three-point stimulation. The pathomechanism of the lesions according to the radial neuropathy using motor segmental conduction study was classified into three groups: conduction block, mixed lesion (combination of conduction block and axonal degeneration), and axonal degeneration. Inching test was performed in patients with conduction block to localize the lesion site, and needle electromyography identified the most proximal radial nerve-innervated muscles affected.

Results
Out of 23 cases, the radial neuropathy using motor segmental conduction study demonstrated probable partial conduction block in 10, mixed lesions in 2, and axonal degeneration in 10. One case could not be categorized with radial neuropathy using motor segmental conduction study alone. As determined by radial neuropathy using motor segmental conduction study and inching test, the most common cause of conduction block was compression, while the most common cause of axonal degeneration was iatrogenic. In the conduction block group, the lesion locations identified by radial neuropathy using motor segmental conduction study and inching test were consistent with needle electromyography localization.

Conclusions
The combined radial neuropathy using motor segmental conduction study and inching test technique can precisely localize radial motor nerve injuries and provide detailed information on electrodiagnostic characteristics of radial mononeuropathy.
Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes
Authors: VanDolah Hunter B. , Li Karen R. , Kim Kevin G. , Berger Lauren E. , Tefera Eshetu A. , Acuna Kelly A. , Attinger Christopher E. , Fan Kenneth L. , Evans Karen K. 
Published: April 2024

Background
Complex surgical back wounds represent significant morbidity in patients who have undergone spinal procedures requiring closure or revision by plastic surgeons. This study aimed to assess the utility of bacterial wound culture data for predicting surgical outcomes of wound management.

Methods
This study is a single-institution retrospective review of consecutive patients who required plastic surgery intervention for wound infection following spinal procedures between the years 2010 and 2021 (n = 70). Statistical analysis was performed for demographics, comorbidities, perioperative laboratory studies, and treatment methods. The primary outcomes of interest were rate of postoperative complications after soft tissue reconstruction and reconstructive failure. The secondary outcome of interest was time to healing in number of days.

Results
The overall complication rate after wound closure was 31.4%, with wound infection in 12.9%, seroma in 10%, dehiscence in 12.9%, and hematoma in 1.4%. Increasing number of debridements before wound closure increased the likelihood of a surgical complication of any kind (odds ratio [OR], 1.772; 95% confidence interval [CI], 1.045–3.002). Positive wound cultures before reconstruction were associated with development of seroma only (OR, 0.265; 95% CI, 0.078–0.893). Use of incisional vacuum-assisted closure devices significantly decreased the odds of postoperative wound dehiscence (OR, 0.179; 95% CI, 0.034–0.904) and increased odds of healing (hazard ratio, 3.638; 95% CI, 1.547–8.613).

Conclusions
Positive wound cultures were not significantly associated with negative outcomes after complex closure or reconstruction of infected spinal surgical wounds. This finding emphasizes the importance of clinical judgment with a multidisciplinary approach to complex surgical back wounds over culture data for wound closure timing.
The Application of Reverse Z-Plasty Design in Medial Canthal Skin Redundancy Reconstruction Surgery
Authors: Huahui Zhang , Dan Xue , Jiange Qian , Yuxiang Zhang , Qiming Zhao , Xiaohui Long 
Published: April 2024

Purpose:
To investigate the clinical outcomes of reverse Z-plasty in the reconstruction of epicanthal fold.

Methods:
We conducted a retrospective analysis on clinical data from patients who underwent medial canthal skin redundancy reconstruction surgery from September 2019 to January 2023. The surgical procedure involved a preoperative design for the incision line, suborbicularis oculi dissection to create a muscle flap, and the use of a reverse Z-flap for the reconstruction of the lateral canthal fold. Postoperative follow-up assessments focused on the intercanthal distance, positional changes of the medial canthus point, alterations in the medial canthus angle, and patient satisfaction levels. The statistical evaluation was carried out utilizing paired t-tests, with a P-value of less than 0.05 denoting statistical significance.

Results:
Postsurgery, the lacrimal prominences were less exposed, and inner canthal angles naturally reshaped. Inconspicuous scarring with diminished reverse Z-plasty marks was noted within 3 months. The average ICD has increased by 3 to 6 mm, corresponding to elongation ratios of 9.09% to 28.30%. Preoperatively, the ICD averaged 31.25±2.32 mm, expanding postoperatively to 35.19±2.26 mm. The canthal angle enlarged significantly from 49.031±6.627 to 62.188±6.662. Inner canthal points shifted notably postsurgery, with a decrease in x-value and an increase in y-value, signalling a movement upwards and away from the nose. Patient satisfaction is high.

Conclusion:
The reverse Z-plasty technique has proven to be an effective approach for reconstructing the epicanthal fold. The clarity and precision of the incision design, coupled with the stability of postoperative results, demonstrate that this method can reliably achieve successful epicanthal fold reconstruction.
Mastoid Emissary Foramina in Dry Skulls: Its Morphometry, Topography, and Associated Clinical Implications
Authors: Singh Rajani 
Published: April 2024

Mastoid emissary foramen transmitting mastoid emissary vein connects the posterior auricular vein with the sigmoid sinus. This foramen and so the mastoid emissary vein varies in prevalence, number, size and location, knowledge of which is essential for carrying out uneventful surgeries, especially retrosigmoid, mastoidectomy, and skull base surgeries. There is a paucity of literature on this foramen in the Indian context, so the study was done. The purpose of the study is to elaborate on the prevalence, number, size, and location of mastoid foramen in dry adult skulls. The study was conducted in the Department of Anatomy using 90 dry skulls of unknown age and sex, and prevalence, number, size, and location in these skulls were noted. The mastoid foramen was detected in 27.8% of skulls, with an incidence of 31.1% and 12.2% on right and left sides of skulls, respectively. The number of foramina ranged between 1 and 4. The mean diameter of this foramen was 0.9 mm, and the most frequent location was mastoid process. The detailed morphology and morphometry of mastoid foramen are of utmost use to neurosurgeons, ENT surgeons, radiologists, and vascular surgeons as it transmits mastoid emissary vein and meningeal branch of the occipital artery, which may be injured during various surgical procedures involving mastoid region and skull base causing catastrophic hemorrhage. In addition to this, mastoid emissary vein may be the source of thrombus, causing thrombus of sigmoid sinus creating helm of neurological complications.
Using implementation science to decrease variation and high opioid administration in a surgical ICU
Authors: Kalkwarf Kyle J. , Bailey Brett J. , Wells Allison , Jenkins Allison K. , Smith Rebecca R. , Greer Jordan W. , Yeager Richard , Bruce Nolan , Margolick Joseph , Kost Melissa R. , Kimbrough Mary K. , Roberts Matthew L. , Davis Benjamin L. , Privratsky Anna , Curran Geoffrey M. 
Published: April 2024

BACKGROUND
High doses and prolonged duration of opioids are associated with tolerance, dependence, and increased mortality. Unfortunately, despite recent efforts to curb outpatient opioid prescribing because of the ongoing epidemic, utilization remains high in the intensive care setting, with intubated patients commonly receiving infusions with a potency much higher than doses required to achieve pain control. We attempted to use implementation science techniques to monitor and reduce excessive opioid prescribing in ventilated patients in our surgical intensive care unit (SICU).

METHODS
We conducted a prospective study investigating opioid administration in a closed SICU at an academic medical center over 18 months. Commonly accepted conversions were used to aggregate daily patient opioid use. Patients with a history of chronic opioid use and those being treated with an intracranial pressure monitor/drain, neuromuscular blocker, or extracorporeal membrane oxygenation were excluded. If the patient spent a portion of a day on a ventilator, that day's total was included in the “vent group.” morphine milligram equivalents per patient were collected for each patient and assigned to the on-call intensivist. Intensivists were blinded to the data for the first 7 months. They were then provided with academic detailing followed by audit and feedback over the subsequent 11 months, demonstrating how opioid utilization during their time in the SICU compared with the unit average and a blinded list of the other attendings. Student's t tests were performed to compare opioid utilization before and after initiation of academic detailing and audit and feedback.

RESULTS
Opioid utilization in patients on a ventilator decreased by 20.1% during the feedback period, including less variation among all intensivists and a 30.9% reduction by the highest prescribers.

CONCLUSION
Implementation science approaches can effectively reduce variation in opioid prescribing, especially for high outliers in a SICU. These interventions may reduce the risks associated with prolonged use of high-dose opioids.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
Normothermic Ex Vivo Heart Perfusion With Exosomes From Human Umbilical Cord Mesenchymal Stem Cells Improves Graft Function in Donation After Circulatory Death Hearts
Authors: Zhang Zhong , Ji Jianqiang , Pan Xuan , Niu Chuanjie , Xu Liwei , Lei Wenrui , Zeng Zifeng , Chen Qiong , Peng Qingbao , Zheng Shaoyi , Lu Jun , Zhou Pengyu 
Published: April 2024

Background.
This study aimed to investigate the cardioprotective effect of exosomes derived from human umbilical cord mesenchymal stem cells on donation after circulatory death (DCD) hearts preserved with normothermic ex vivo heart perfusion (EVHP) in a rat heart transplantation model.

Methods.
Thirty-two male Lewis rats were divided into 2 groups: the control group and the exosome group. The donor-heart rats were subjected to the DCD procedure by suffering a 15-min warm ischemia injury, subsequently preserved with EVHP for 90 min, and then transplanted into recipients via abdominal heterotopic heart transplantation. Vehicle or exosome was added into the perfusate of normothermic EVHP in the control or exosome group. We evaluated left ventricular graft function, myocardial inflammation, and myocardial apoptosis of the donor heart 1.5 h after heart transplantation. Furthermore, we investigate the alternation of myocardial gene expression in the donor hearts between both groups by transcriptome sequencing.

Results.
The treatment with exosome significantly enhanced cardiac function through increasing left ventricular developed pressure, dp/dtmax, and dp/dtmin of DCD hearts at 90 min after heart transplantation compared with the control group. The myocardial cells in the exosome group exhibited an orderly arrangement without obvious edema. Furthermore, exosome added into perfusate in the exosome group significantly attenuated the level of inflammatory response and apoptosis. Transcriptome sequencing and RT-qPCR showed the phosphoinositide 3-kinase/protein kinase B pathway was activated after exosome treatment.

Conclusions.
Normothermic EVHP combined with exosome can be a promising and novel DCD heart preservation strategy, alleviating myocardial ischemia–reperfusion injury in the DCD heart.