bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Implementation of an Experiential Longitudinal Health Systems Science Thread Into an Existing Medical School Curriculum
Authors: Dagher Tanios , Oyler Julie , Press Valerie G. , Kostas Tia , Tang Joyce , Hight Robert , Saathoff Mark , McKinnon Marie , Jackson Jenna Ford , McGinty Michael , Schwanz Korry , Farnan Jeanne , Arora Vineet , Anderson Irsk 
Published: June 2024

Abstract

Problem
Medical school graduates enter a complex health care delivery system involving interprofessional teamwork and multifaceted value-based patient care decisions. However, current curricula on health systems science (HSS) are piecemeal, lecture based, and confined to preclinical training.

Approach
The VISTA program is a longitudinal, immersive learning curriculum integrated into the University of Chicago Pritzker School of Medicine curriculum between 2016 and 2018. Key components include a unit-based nursing interprofessional team experience, a discharge objective structured clinical examination (OSCE), a patient safety simulation, and the implementation of a Choosing Wisely SmartPhrase. Graduates before 2016–2017 and after 2018–2020 VISTA implementation completed a Likert-style survey assessing attitudes, knowledge, and behaviors on HSS topics. A free response question solicited improvement areas. The Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) was also examined.

Outcomes
The overall VISTA survey response rate was 59%, with 126 fourth-year medical student respondents before VISTA and 120 after VISTA. Compared with pre-VISTA graduates, post-VISTA graduates reported a significantly higher rate of competence on the HSS questions, with the greatest increases seen in effective communication at discharge (n = 73/126 [57.9%] to 116/120 [96.7%], P < .001), knowledge on safety event reporting (n = 53/126 [42.1%] to 96/120 [79.8%], P < .001), and considering costs in making health care decisions (n = 76/126 [60.3%] to 117/120 [97.5%], P < .001). All were directly addressed through experiential learning interventions, and 2 were intended practice behaviors. VISTA graduate responses to free-text questions demonstrated a more nuanced understanding of HSS compared with pre-VISTA responses. The AAMC GQ data showed increased agreement with an item that mapped to HSS understanding.

Next Steps
The VISTA program provides a model for institutions to enhance HSS education between curricular overhauls. Next steps include implementing value-added roles and additional immersive learning exercises.
A pattern of admission and outcome of patients admitted to the intensive care unit of a tertiary hospital in a low resource setting: a cohort study
Authors: Bime Aman E. , Bayissa Badhaasaa B. 
Published: June 2024

Background:
ICU is a specialized department designed to serve critical care for severely ill patients. It needs an adequate number of highly trained and skilled human power and costly materials, which has limited its number and functionality in low resource settings. As a result, intensive care medicine or critical care services are poorly developed, or at most, still in the infancy stage. Due to the multifactorial limitations, ICU treatment outcomes were lower compared to high-income countries from the limited available literature. The objective of this study was to depict ICU treatment patterns and patient outcomes at low resources and limited setup.

Methods:
A retrospective cohort study was conducted on patients admitted to ICU from January 2017 to 31 December 2020, on a sample of 420 cases using a systematic sampling technique. Patient data were collected from the medical record and filled into a prevalidated checklist from admission to discharge or death. Data were analyzed using a statistical package for social sciences version 25.0.

Result:
A total of 419 patients’ data was qualified for analysis with ICU mortality being 40.8%. The majority of the admissions to the ICU were from the surgical department followed by trauma admissions. Some of the factors significantly associated with ICU mortality were: vasopressor use during the course of ICU follow up adjusted odd ratio (aOR)=4.3 with 95% CI: 1.83–10.03, P-value <0.001, patients who were put on mechanical ventilator aOR=3.6 with 95% CI: 1.90–6.63, P-value <0.001, enteral feeding aOR=0.31 at 95% CI: 0.16–0.59, P-value <0.001and admissions from internal medicine aOR=4.2, 95% CI: 1.66–10.41, P-value=0.01.

Conclusion:
The pattern of ICU admissions in developing countries were characterized by surgical and trauma related, younger patients, and high mortality rate. Hypotension, being on mechanical ventilator, vasopressor use, and enteral feeding were some of the factors associated with ICU outcome.
Prevalence of Computer Vision Syndrome and Its Risk Factors in a Spanish University Population
Authors: Ortiz-Toquero Sara , Sanchez Irene , Serrano Alicia , Martin Raul 
Published: June 2024

Objectives:
To determine the prevalence of digital eye strain or computer vision syndrome (CVS) and its risk factors in a university population (University of Valladolid, Spain).

Methods:
An anonymous cross-sectional online survey was conducted in a university population [staff (lecturers and administrative employees) and students (undergraduate, master's, and PhD)], including two validated questionnaires (Ocular Surface Disease Index [OSDI] and the 17-item Computer-Vision Symptom Scale questionnaire [CVSS17]) and questions about sociodemographic data and visual display terminal use. The prevalence and risk factors for CVS (CVSS17≥29) (multivariate logistic regression model) were calculated.

Results:
One thousand nine participants responded to the survey (35.2±15.2 years; 64.1% women). The mean OSDI and CVSS17 questionnaire scores were 18.9±15.6 and 31.5±6.4, respectively, and 35.4% of the respondents had dry eye symptoms (OSDI>22). The total prevalence of CVS was 65.4% (95% CI 62.1–68.3). Undergraduate students showed the highest CVS prevalence (72.6%; P<0.01), which was significant. In addition, women, participants younger than 36 years old, contact lens wearers, and subjects with dry eye symptoms reported a statistically higher CVSS17 score (P≤0.01). In the multivariate model, significant factors associated with the presence of CVS (P≤0.03) were female sex (OR=2.10; 95% CI 1.54–2.88), dry eye symptoms (OSDI>22) (OR=16.98; 95% CI 10.36–27.84), VTD use ≥6 hr daily (OR=1.96; 95% CI 1.09–3.52), and being an undergraduate student (OR=2.23; 95% CI 1.54–3.24).

Conclusion:
A high prevalence (65.4%) of CVS was found among the Spanish university population, with the undergraduate student group having the highest prevalence (72.6%). Female sex, more than 6 hr/day of visual display terminal use, being an undergraduate student, and dry eye symptoms significantly increased the risk of CVS in the university population.
Sonographic Assessment of Asymptomatic Patellar and Achilles Tendons to Predict Future Pain: A Systematic Review and Meta-analysis
Authors: Cushman Daniel M. , Vomer Rock , Teramoto Masaru , O'Sullivan Maddie , Mulvey Jade , Eby Sarah F. , McAuliffe Sean 
Published: June 2024

Objective:
Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain.

Design:
Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder.

Setting:
N/A.

Patients:
Athletes without Achilles or patellar tendon pain at baseline.

Interventions:
N/A.

Main Outcome Measures:
Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities.

Results:
This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively.

Conclusions:
This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.
Successful second kidney transplantation following cured metastatic rectal cancer after first kidney transplantation, 20-year history: A case report
Authors: Lee Chang-Hoon , Lee Na-Ri , Song Eun-Kee , Jeon So-Yeon 
Published: June 2024

Rationale:
Solid organ transplant recipients face an elevated risk of malignancies due to immunosuppressive drugs and viral infections. Colorectal cancer is a common malignancy in kidney transplant (KT) recipients, with liver metastasis associated with worse. This case report highlights the successful resolution of colorectal cancer with liver metastasis following KT and subsequent triumph in a second KT after the cancer cure.

Patient concerns:
A man who had undergone KT 10 years earlier presented with rectal bleeding. He was diagnosed with rectal cancer with no distant metastasis and recurrence of renal failure, with a creatinine level of 2 mg/dL.

Diagnosis:
He underwent an anterior resection of a pathologic T3N0M0 tumor without risk features. Three months after surgery, a liver metastasis was detected, and a metastasectomy was performed. After the metastasectomy, the patient’s renal function further declined, and his creatinine levels increased from 5 mg/dL to over 12 mg/dL.

Interventions:
A consultation to discuss adjuvant chemotherapy was postponed in favor of discussions regarding dialysis. He visited the oncologic clinic to discuss adjuvant treatment options 7 months post-metastasectomy. The decision was made to monitor for cancer recurrence without adjuvant therapy.

Outcomes:
The patient remained cancer-free for 5 years, and was declared cured. Another 6 years passed, and he achieved renal recovery through a second KT and maintained good health for the subsequent 2 years.

Lessons:
Despite the poor prognosis for posttransplant malignancies, this case underscores the significance of early detection and tailored intervention in achieving successful outcomes for posttransplant malignancies and advocates for considering a second transplantation for cancer-cured patients experiencing organ function loss.
The Effect of Perceived Social Support and Spiritual Care Needs in Predicting Hope in Oncology Patients
Authors: Budak Simay Ezgi , Ay Kaatsız Melike Ayça 
Published: June 2024

Background
Hope has an influential role in oncology patients and is related to perceived social support and spirituality. However, studies on the extent to which the concepts of perceived social support and spiritual care needs affect hope are still limited.

Objective
To examine the effect of perceived social support and spiritual care needs in predicting hope in adult oncology patients.

Methods
Study questionnaires, a demographic form, the Herth Hope Scale, the Multidimensional Perceived Social Support Scale, and the Spiritual Care Needs Scale were administered to participants. Correlation and regression analyses were conducted.

Results
A total of 134 oncology patients completed the study questionnaires. Significant correlations were found between hope and perceived social support and between hope and spiritual care needs (P < .05). Perceived support explained 11.7% of the variance in hope scores. A 1-unit increase in the support score was associated with a 0.344-unit increase in the hope score. Spiritual care needs did not significantly predict hope.

Conclusion
In line with the results, interventions that promote social support may increase hope in oncology patients.

Implications for Practice
Nurses could incorporate interventions into their care to improve social support as one way to enhance hope levels among oncology patients. Further studies are required to understand more about the impact of spiritual care needs on hope.
Do All Patients Benefit From the Soothing Properties of a Conversational Nursing Intervention to Reduce Symptom Burden During Outpatient Chemotherapy?
Authors: Arbour Caroline , Lapierre Alexandra , Hjeij Danny , Bilodeau Karine 
Published: June 2024

BackgroundSoothing conversation (SC) is particularly promising for symptom management during outpatient chemotherapy. However, we know little about the profile of patients who are most likely to benefit from this intervention.ObjectiveTo gain a better understanding of the profile of patients most likely to benefit from SC to reduce symptom burden during outpatient chemotherapy.MethodsWe performed a multimethod secondary analysis of 2 data sets: the first gathered during a quantitative pilot trial investigating the impact of SC on patients’ symptom fluctuations during chemotherapy perfusion (n = 24); the second derived from qualitative interviews about nurses’ experiences with SC in this context (n = 6).ResultsSecondary quantitative analysis suggests that symptom control with SC is more effective in older patients, reporting lower education, widowed status, work incapacity, advanced cancer, and undergoing chemotherapy perfusion for less than 1 hour. According to nurses’ interviews, SC could best benefit patients (1) prone to anxiety and fear, (2) with unalleviated pain, (3) who are unaccompanied during treatment, and contrary to what was shown with quantitative data, (4) undergoing longer perfusion duration.ConclusionAlthough this study provides valuable insights, much work remains to be done to fully understand the factors that predispose patients to respond positively to SC during outpatient chemotherapy.Implications for PracticeThis study extends previous research on the effectiveness of SC for symptom management during outpatient chemotherapy by comparing nurses’ experience with the intervention to patients’ results. Results could be used to inform the assignment and delivery of supportive communication-based interventions during chemotherapy protocols.
Clinicopathological Impact of FOXM1 and MMP-9 Immunohistochemical Expression in Different Grades of Intracranial Meningioma
Authors: Ibrahim Hanaa M. , Abdelrahman Aziza E. , Elwan Amira , Gharieb Shimaa A. , Refaat Mohammed , Elmesallamy Wael , Salem Amira A. 
Published: June 2024

Objectives:
To find predictive biomarkers for recurrence and progression of meningioma.

Background:
Despite great advances in meningioma treatment, the prognosis remained unfavorable due to the high recurrence rate.

Methods:
In this study, we evaluated the immunohistochemical expression of FOXM1, MMP-9, and Ki67 in 50 cases of intracranial meningioma to detect its potential role in meningioma progression, recurrence, and patients’ survival.

Results:
Strong FOXM1 expression was detected in 20% of the cases and was significantly associated with meningioma grade (P= 0.002) and peritumoral brain edema (PTBE; P<0.001). Strong MMP-9 expression was noted in 32% of the cases and was significantly associated with meningioma grade and PTBE (P<0.001, P<0.001, respectively). High Ki67 was noted in 50% and significantly associated with tumor grade and PTBE (P<0.001, P= 0.002, respectively). The follow-up period revealed that meningiomas with strong FOXM1, strong MMP-9, and high Ki67 expression were associated with tumor recurrence, shorter OS, and recurrence-free survival. Furthermore, up-regulation of FOXM1 and MMP-9 expression had a significant relation with poor clinical response to the therapy (P= 0.010, P= 0. 001, respectively). However, high Ki67 cases were more sensitive to clinical therapy (P= 0.005).

Conclusion:
Strong FOXM1, strong MMP-9, and high Ki67 in meningiomas indicate highly aggressive tumors with a shortened survival rate, dismal outcome, and high risk of recurrence after the standard protocol of therapy.
Comparison of Laws that Impact Volunteer Response in Three Disaster-Prone Southeastern States
Authors: Malmin Natasha Prudent , Nostrand Elizabeth Van 
Published: June 2024

Objective:
As natural disasters become more frequent and severe, the ability of impacted states to rapidly scale up their capacity to respond and facilitate recovery through volunteers is ever more crucial. However, the legal landscape that may facilitate or hamper augmentation through volunteers has yet to be fully explored.

Design:
This study utilized policy surveillance methodology to code relevant laws identified in searches using the Emergency Law Inventory database and Westlaw.

Setting:
We assessed laws in three natural disaster-prone states: North Carolina, South Carolina, and Georgia.

Main Outcome Measures:
We assessed the presence of liability protection, license reciprocity, and scope of practice laws for health care volunteers.

Results:
Of the three assessed legal domains, liability protection for health care volunteers across all states contained the most robust language. Liability protections apply unless the health care volunteers act with reckless disregard, willful misconduct, or gross negligence. However, nuance exists based on which organizations (state vs charitable) volunteers are affiliated with to qualify for coverage. License reciprocity for out-of-state specific health care professions entering the impacted states was available across all three states. However, only Georgia enacted federal model legislation that provides additional flexibility regarding credentialing and liability protections. Lastly, very few laws addressed the scope of practice in impacted states.

Conclusions:
Comparisons of laws that impact the ability of health care volunteers to respond and recover from disasters are scarce. More research needs to be performed to better understand the laws that impact volunteers in emergencies, particularly as the public health system is overtasked when providing services to impacted communities.
Shifting the Curve
Authors: Rydberg Leslie , Roy Vivian , Roy Ishan , Neal Jacqueline 
Published: June 2024

Abstract
Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.
Randomized, placebo-controlled, pilot clinical study evaluating acute Niagen®+ IV and NAD+ IV in healthy adults
Authors: Hawkins Jessie , Idoine Rebecca , Kwon Jun , Shao Andrew , Dunne Elizabeth , Hawkins Elizabeth , Dawson Kayla , Nkrumah-Elie Yasmeen 
Published: June 2024

AbstractBackgroundNicotinamide riboside (NR) is a promising compound for augmenting the intracellular NAD+ pool, potentially mitigating age-related decline and associated conditions. While oral NR supplementation has demonstrated safety and bioavailability in multiple animal and human studies, the effects of intravenous NR (NR IV) are far less understood. Until now, pharmaceutical grade NR was not available for injection research.ObjectivesGiven that intravenous administration may offer advantages in certain conditions and contexts, a systematic investigation of the clinical effects of NR IV is warranted.MethodsThe present randomized, double-blinded, placebo-controlled, pilot clinical study was initiated with the primary aim of investigating the safety, tolerability, and the blood NAD+-boosting efficacy of an acute, single dose of NR IV (500 mg, test), NAD+ IV (500 mg, active comparator), oral NR (500 mg, bridge), and saline IV (placebo control) in generally healthy adult participants. The study consisted of two parts; data from 37 and 16 participants in the first and second phases, respectively, were analyzed.ResultsNo significant differences in vital signs were detected across groups. In comparison to NAD+ IV, NR IV was associated with fewer and less severe adverse experiences during the infusion; no attributable adverse events were reported through the 14-day follow-up period for any treatment groups. Further, the mean tolerable infusion time for NR IV was 75% less than that of NAD+ IV. No clinically meaningful changes in blood chemistry markers were described in the NR IV condition, whereas an increase in white blood cell counts and neutrophils was observed in the NAD+ IV condition, suggesting the presence of an inflammatory response. Finally, NR IV appeared to promote the most robust increases in NAD+ concentration as measured by dried blood spot analyses, with peak NAD+ levels increasing by 20.7% relative to baseline, and acutely outperforming NAD+ IV (p <0.01) and oral NR (p<0.01) at the 3-hr timepoint.ConclusionThis is the first study to clinically evaluate NR IV. Overall, acute intravenous infusions of 500 mg NR were safe in the study participants with no attributable adverse events and only minor and transient infusion-related experiences. In comparison to NAD+ IV, NR IV had a faster infusion time with superior tolerability. At 3 hours post-infusion, blood NAD+ levels were significantly higher in the NR IV group compared to the NAD+ IV group. Future studies in larger populations are needed to validate these results.