bluuebunny/crossref_metadata_2025_split huggingface dataset:
High reliability pediatric heart centers: Always working toward getting better
Authors: Torzone Andrea , Birely Alexandra 
Published: March 2024

Purpose of reviewThe purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, noting that continuous improvement, rather than perfection, should be embraced. Aiming to elevate topics with lesser attention, this review elaborates on key concepts and proposed considerations for maintaining a high reliability heart center.Recent findingsAs provision of care reaches a new complexity, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. Practical application of high reliability enables a shared mental model and aligns teams toward eliminating patient harm. Suggested facilitators of high reliability within heart center teams include interprofessional collaboration, recognition of nursing expertise, psychological safety, and structural empowerment void of hierarchy.SummaryAs the pediatric cardiac population evolves, care becomes more complex with a narrow margin of error. High reliability can guide continuous improvement. Acknowledging culture as the underpinning of all structure and processes allows teams to rebound from failure and supports the mission of rising to exceptional patient challenges.
Scleral fixation of the Smaller-Incision New-Generation Implantable Miniature Telescope (SING IMT ™) using GoreTex suture
Authors: Savastano Alfonso , Sammarco Leonardo Andrea , Francione Giuseppe , Sasso Paola , Rizzo Stanislao 
Published: March 2024

Purpose:
In this case report we describe a surgical technique for scleral fixation of the Smaller-Incision New-Generation Implantable Miniature Telescope (SING-IMT). Using this surgical technique, patient’s eye which receive surgery for the SING-IMT, could still have a safe SING IMT implant despite the anatomical conditions of the capsular bag or in cases of intraoperative complications.

Methods:
The surgery was performed at Policlinico A. Gemelli, Rome, Italy. The patient’s eye underwent a first surgery for artificial intraocular lens (IOL) explant and SING-IMT implant at the same time. We observed SING IMT dislocation into the vitreous chamber 90 days after surgery. We therefore carried out a 23-gauge vitrectomy and after SING IMT recovery from the vitreous chamber, we fixed one of its haptic to the sclera using a 8.0 GoreTex suture.

Conclusion:
Scleral fixation of SING-IMT haptics might be useful in eyes with dislocated or not stable SING IMT. We believe that reporting our experience can help surgeons to fix SING IMT in complicated cases where a capsular bag rupture o disinsertion (like our case) can cause SING IMT decentration or worse its drop into the vitreous chamber. We speculate that GoreTex suture could assure firm fixation of the SING IMT and could reduce the risk of recurrent dislocations.
Predicting intraocular lens tilt using a machine learning concept
Authors: Waser Klemens , Honeder Andreas , Hirnschall Nino , Khalil Haidar , Pomberger Leon , Laubichler Peter , Mariacher Siegfried , Bolz Matthias 
Published: March 2024

Purpose:
To use a combination of partial least squares regression and a machine learning approach to predict intraocular lens (IOL) tilt using preoperative biometry data.

Setting:
Kepler University Clinic Linz, Linz, Austria.

Design:
Prospective single-center study.

Methods:
Optical coherence tomography, autorefraction, and subjective refraction were performed at baseline and 8 weeks after cataract surgery. In analysis I, only 1 eye per patient was included and a tilt prediction model was generated. In analysis II, a pairwise comparison between right and left eyes was performed.

Results:
In analysis I, 50 eyes of 50 patients were analyzed. Difference in amount, orientation, and vector from preoperative to postoperative lens tilt was −0.13 degrees, 2.14 degrees, and 1.20 degrees, respectively. A high predictive power (variable importance for projection [VIP]) for postoperative tilt prediction was found for preoperative tilt (VIP = 2.2), pupil decentration (VIP = 1.5), lens thickness (VIP = 1.1), axial eye length (VIP = 0.9), and preoperative lens decentration (VIP = 0.8). These variables were applied to a machine learning algorithm resulting in an out of bag score of 0.92 degrees. In analysis II, 76 eyes of 38 patients were included. The difference of preoperative to postoperative IOL tilt of right and left eyes of the same individual was statistically relevant.

Conclusions:
Postoperative IOL tilt showed excellent predictability using preoperative biometry data and a combination of partial least squares regression and a machine learning algorithm. Preoperative lens tilt, pupil decentration, lens thickness, axial eye length, and preoperative lens decentration were found to be the most relevant parameters for this prediction model.
Serum 25-Hydroxyvitamin D Level Might Be a Useful Indicator of Disease Severity in Obese Children With Atopic Dermatitis: A Case-Control Study
Authors: Chen Jing-Jing , Fang Xiao-Kai , Liu Xiu-Mei , Liu Xiao-Chun , Yao Xu 
Published: March 2024

Objective:
To assess the relationship between the severity of atopic dermatitis (AD) in children of varying weight categories and their serum 25-hydroxyvitamin D [25(OH)D] levels.

Methods:
The study population comprised 899 patients with AD and 854 age- and sex-matched controls. The Mann-Whitney U test and Kruskal-Wallis H tests were used to assess differences between groups, and Spearman correlation analysis was used to test correlation.

Results:
The 25(OH)D level in the AD group was M (Q
25, Q
75), 24.0 (19.7, 28.4) ng/mL, which was significantly lower than the control group (26.4 [23.6, 29.9] ng/mL; Z = −3.34, P = 0.001). 25(OH)D levels in children with AD were negatively correlated with body mass index (r = −0.30, P < 0.001), Severity scoring of Atopic Dermatitis (SCORAD; r = −0.14, P < 0.001), total immunoglobulin E (r = −0.13, P < 0.001), and eosinophil (r = −0.08, P = 0.017). There were statistically significant differences in 25(OH)D (H = 18.46, P < 0.001), total immunoglobulin E (H = 9.13, P = 0.010), eosinophil (H = 67.17, P < 0.001), and SCORAD (H = 10.49, P = 0.005) among groups with different body mass index classification. The 25(OH)D levels were 22.3 (17.5, 27.1) ng/mL in the overweight AD group and 22.3 (17.6, 25.7) ng/mL in the obese AD group, which were significantly lower than those in the normal-weight AD group (24.7 [20.4, 25.5] ng/mL; P = 0.003, P = 0.004). 25(OH)D levels were negatively correlated with SCORAD in obese AD patients (r = −0.25, P = 0.010).

Conclusion:
Vitamin D insufficient or deficient is obvious in children AD patients. The 25(OH)D levels in the overweight/obese AD group are significantly lower than those in the normal-weight AD group. Vitamin D level is negatively correlated with SCORAD in obese children with AD.
Active TriCROS: A Simultaneous Stimulation With a (Bi)CROS System and a Hearing Aid in the Worst Ear for Severely Asymmetrical Hearing Loss
Authors: Lefeuvre Jérome , Gargula Stéphane , Boulet Marc , Potier Morgan , Ayache Denis , Daval Mary 
Published: March 2024

Objective
Severely asymmetrical hearing loss (SAHL) is characterized by a moderately severe or severe hearing loss in one side and normal or mildly impaired controlateral hearing in the other. The Active tri-CROS combines the Contralateral Routing-of-Signal System (CROS, or BiCROS if the best ear is stimulated) and the stimulation of the worst ear by an in-the-canal hearing aid. This study aims to evaluate the benefit of the Active tri-CROS for SAHL patients.

Study Design
This retrospective study was conducted from September 2019 to December 2020.

Setting
Ambulatory, tertiary care.

Patients
Patients were retrospectively included if they had received the Active tri-CROS system after having used a CROS or BiCROS system for SAHL for at least 3 years.

Main outcome measures
Audiometric gain, signal-to-noise ratio, spatial localization, and the Abbreviated Profile of Hearing Aid Benefit and Tinnitus Handicap Inventory questionnaires were performed before equipment and after a month with the system.

Results
Twenty patients (mean, 62 yr old) with a mean of 74.3 ± 8.7 dB HL on the worst ear were included. The mean tonal hearing gain on the worst ear was 20 ± 6 dB. Signal-to-noise ratio significantly rose from 1.43 ± 3.9 to 0.16 ± 3.4 dB (p = 0.0001). Spatial localization was not significantly improved. The mean Tinnitus Handicap Inventory test score of the eight patients suffering from tinnitus rose from 45.5 ± 18.5 to 31 ± 25.2 (p = 0.016).

Conclusions
The Active tri-CROS system is a promising new therapeutically solution for SAHL.
Microdrill Versus Diode Laser in Endoscopic Stapedotomy: A Comparative Study
Authors: Wang Dan , Peng Fan , Lin Nina , Wang Wuqing 
Published: March 2024

Background
Microdrill and diode laser are two different methods used in endoscopic stapedotomy for otosclerosis. These two methods have not been compared in endoscopic stapedotomy.

Aims/Objectives
To analyze the differences between microdrill and diode laser in endoscopic stapedotomy for otosclerosis.

Materials and Methods
This is a randomized clinical trial; patients with otosclerosis were randomly divided into microdrill group (group A: n = 69) and diode laser group (group B: n = 62). Differences between the two groups were then compared.

Results
The preoperative air–bone gap (ABG) was 25.40 ± 10.88 dBHL in group A and 24.84 ± 12.23 dBHL in group B, with no significant between-group difference (p > 0.05). The postoperative ABG in group A was 13.27 ± 9.91 dBHL versus 11.79 ± 10.82 dBHL in group B, and there was no significant difference between the groups (p > 0.05). The surgical time in group B (64 ± 31.23 minutes) was significantly longer than that in group A (48 ± 25.62 minutes) (p = 0.02). There were no significant between-group differences in basic patient-related data, preoperative air conduction (AC), preoperative bone conduction (BC), postoperative AC, distribution of postoperative ABG, preoperative ABG at different frequencies, and postoperative ABG at different frequencies. There was also no significant between-group difference in the average bleeding volume or number of patients with postoperative dizziness.

Conclusion and Significance
The postoperative improvement in hearing level in the two group was equivalent, but group A had the advantage of a shorter operation time.

Level of evidence
4
Differences in Plasma Fatty Acid Composition Related to Chronic Pancreatitis
Authors: Gumpper-Fedus Kristyn , Crowe Olivia , Hart Phil A. , Pita-Grisanti Valentina , Velez-Bonet Ericka , Belury Martha A. , L. Ramsey Mitchell , Cole Rachel M. , Badi Niharika , Culp Stacey , Hinton Alice , F. Lara Luis , Krishna Somashekar G. , Conwell Darwin L. , Cruz-Monserrate Zobeida 
Published: March 2024

Objectives
Chronic pancreatitis (CP) is an inflammatory disease affecting the absorption of fat-soluble nutrients. Signaling in pancreatic cells that lead to inflammation may be influenced by fatty acids (FAs) through diet and de novo lipogenesis. Here, we investigated the relationship between plasma FA composition in CP with heterogeneity of etiology and complications of CP.

Materials and Methods
Blood and clinical parameters were collected from subjects with CP (n = 47) and controls (n = 22). Plasma was analyzed for FA composition using gas chromatography and compared between controls and CP and within CP.

Results
Palmitic acid increased, and linoleic acid decreased in CP compared with controls. Correlations between age or body mass index and FAs are altered in CP compared with controls. Diabetes, pancreatic calcifications, and substance usage, but not exocrine pancreatic dysfunction, were associated with differences in oleic acid and linoleic acid relative abundance in CP. De novo lipogenesis index was increased in the plasma of subjects with CP compared with controls and in calcific CP compared with noncalcific CP.

Conclusions
Fatty acids that are markers of de novo lipogenesis and linoleic acid are dysregulated in CP depending on the etiology or complication. These results enhance our understanding of CP and highlight potential pathways targeting FAs for treating CP.
Multicenter Prospective Cohort Study of Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer (YPB-001)
Authors: Matsui Hiroto , Ioka Tatsuya , Takahashi Tsuyoshi , Kawaoka Toru , Maeda Yoshinari , Yahara Noboru , Kubo Hidefumi , Nishimura Taku , Inokuchi Toshihiro , Harada Eijiro , Shindo Yoshitaro , Tokumitsu Yukio , Nakajima Masao , Takami Taro , Ito Katsuyoshi , Tanaka Hidekazu , Hamano Kimikazu , Nagano Hiroaki 
Published: March 2024

Objectives
The present multicenter prospective observational study investigated the effectiveness and safety of neoadjuvant chemotherapy (NAC) for patients with borderline resectable pancreatic cancer (BRPC) and those with RPC contacting major vessels, with respect to a historical control of upfront surgery.

Materials and Methods
Patients with BRPC and RPC contacting major vessels were prospectively registered and administered NAC with durations and regimens determined by the corresponding treating physician. Our primary aim was to assess the R0 resection rate, and secondary aim was to evaluate safety, resection rate, time to treatment failure, overall survival, and response rate.

Results
Fifty of 52 enrolled patients were analyzed; 2 with serious comorbidities died during treatment. Thirty-one patients underwent resection, with R0 resection being achieved in 26 (52% of total and 84% of all resected cases). Univariate and multivariate analyses indicated age (≥75 years) as the only independent predictor of nonresection. Median progression-free survival and median survival time were longer in the prospective cohort than in the historical cohort.

Conclusions
Overall, NAC for BRPC in real-world setting might yield R0 resection rates similar to those reported in previous clinical studies. Development of safe regimens and management strategies that can maintain treatment intensity in geriatric patients is warranted.
Design and development of a noninvasive ocular pressure estimator
Authors: Karthikeyan Siddharth K. , Sundaram Swaminathan M. , Ve Ramesh S. , Souza Donson D. , Biswas Sayantan , Shetty Mayur U. 
Published: March 2024

SIGNIFICANCEA snapshot intraocular pressure (IOP) is ineffective in identifying the IOP peak and fluctuation, especially during sleep. Because IOP variability plays a significant role in the progression of glaucoma, monitoring the IOP, especially during sleep, is essential to capture the dynamic nature of IOP.PURPOSEWe aimed to design an ocular pressure estimator (OPE) that can reliably and accurately measure the IOP noninvasively over closed-eyelid condition.METHODSOcular pressure estimator works on the principle that the external pressure applied by raising the IOP of the eyeball is transmitted through a compressible septum to the pressure sensor, thus recording the IOP. A fluid-filled pouch with a pressure sensor was placed over a rubber glove mimicking the eyelid (septum), covering the cornea of enucleated goat eyeballs. A pressure-controlled setup was connected to a goat cadaver eye, which was validated by a rebound tonometer. Cannulation of eyeballs through the lower limbus had the least difference from the control setup values documented using rebound tonometer, compared with cannulation through the optic nerve. Intraocular pressures ranging from 3 to 30 mmHg was induced, and the outputs recorded using OPE were amplified and recorded for 10 minutes (n = 10 eyes). We stratified the randomization of the number of times and the induced pressures.RESULTSThe measurements recorded were found to be linear when measured against an IOP range of 3 to 30 mmHg. The device has excellent reliability (intraclass correlation coefficient, 0.998). The repeatability coefficient and coefficient of variations were 4.24 (3.60 to 4.87) and 8.61% (7.33 to 9.90), respectively. The overall mean difference ± SD between induced IOP and the OPE was 0.22 ± 3.50 (95% confidence interval, −0.35 to 0.79) mmHg across all IOP ranges.CONCLUSIONSOcular pressure estimator offers a promising approach for reliably and accurately measuring IOP and its fluctuation noninvasively under a condition mimicking a closed eye.
The epidemiology of eye illness in Para athletes in the Winter and Summer settings- a systematic review
Authors: Kunorozva Lovemore , Runciman Phoebe , Ganai Ali , Derman Wayne E. 
Published: March 2024

Abstract
The aim of this systematic review was to evaluate eye illnesses in para athletes in the winter and summer settings. A search was conducted using PubMed-Medline, EbscoHost, and Web of Science for full-text original research articles published anytime until November 2022. Studies that reported quantitative data on eye illness in highly active individuals and para athletes, at any level of performance (elite/nonelite/recreational), aged 15–75 yrs were included. Of the eight studies included, two reported eye pathologies in athletes with visual impairment only, and six studies reported specific factors associated with eye illnesses in various impairments. Illnesses in the eye and adnexa were more prevalent in winter (incidence: 1.6–2.2/1000 athlete days) compared to summer (incidence: 0.3–0.5/1000 athlete days) settings. Eye illnesses were reported in athletes with limb deficiency (33.5%), spinal cord injury (29.4%), visual impairment (10.6%), and central neurologic impairment (15.2%). The findings of this review indicate that: (1) eye illness in para athletes is an understudied area; and (2) eye illnesses are present in athletes with impairments other than visual impairment. There is a need for further research on eye illness, particularly in winter sports settings to understand the types and nature of eye illness affecting para athletes during competition and training settings.
Medical Metaphors That May Reinforce Misconceptions Are Associated With Increased Trust in the Clinician
Authors: Chandler Calvin , Azarpey Ali , Brinkman Niels , Ring David , Reichel Lee , Ramtin Sina 
Published: March 2024

Background and Objectives:
This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral?

Methods:
In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor.

Results:
Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort (P < .05).

Conclusion:
The observation that metaphors that validate a person’s understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions.
Effectiveness of Huddles in Improving the Patient Safety Attitudes Among Clinical Team Members
Authors: Lai Yi-Hung , Chang Ching-Wein , Wu Ming-Ju , Chen Hsin-Hua , Lin Shih-Ping , Chin Chun-Shih , Lin Cheng-Hsien , Shiu Sz-Iuan , Wu Chun-Yi , Lin Ying-Cheng , Chen Hui-Chi , Hou Shu-Chin , Lin Hung-Ru 
Published: March 2024

Background and Objectives:
Huddles among members of interdisciplinary medical teams involve short stand-up sessions and allow team members to focus on existing or emerging patient safety issues, thereby facilitating team communication. Hospital managers are able to recognize the current situation of the organization through patient safety attitudes, strengthen team members’ awareness of patient safety, and improve the quality of health care. The purpose of this study was to determine the effects of huddles on improving team members’ attitudes toward patient safety.

Methods:
We used a quasi-experimental design and selected 2 adult wards with similar properties as the experimental and comparison groups by convenience sampling. Data collection was from December 1, 2021, to June 30, 2022, at a teaching hospital in central Taiwan. Team members of the ward performing huddles formed the experimental group, and they participated 2 times per week in 15-minute huddles from 8:15 to 8:30 am for a total of 4 weeks. The comparison group adopted the routine team care process. Both groups completed the Safety Attitudes Questionnaire during the pre- and post-tests of the study.

Results:
The experimental group scored significantly higher in the post-test than in the pre-test in all aspects of safety attitudes, with the exception of stress recognition. These improved aspects were teamwork climate (76.47 ± 15.90 vs 83.29 ± 13.52, P < .001), safety climate (75.94 ± 16.14 vs 82.81 ± 13.74, P < .001), job satisfaction (74.34 ± 20.22 vs 84.40 ± 17.22, P <.001), perceptions of management (78.02 ± 19.99 vs 85.51 ± 15.97, P < .001), and working conditions (78.85 ± 17.87 vs 86.81 ± 14.74, P < .001).

Conclusion:
Through the huddles, clinical team members improved their understanding of different aspects of safety attitudes. Such a study provided ward units with real-time improvement and adjustment in terms of patient safety during their medical work processes with better patient safety.
Transition to Adult Rheumatology Care: A Disease-Specific Guide
Authors: Cintron Dahima , Chang Joyce C. , Sadun Rebecca E. 
Published: March 2024

Abstract
Young adults with childhood-onset rheumatic diseases are more frequently establishing and continuing care with adult rheumatologists. The transfer of care can be challenging for both the young adult patients and their adult rheumatologists, in large part due to differences between pediatric-onset rheumatic diseases and their adult-onset counterparts, or due to the rarity of some pediatric-onset rheumatic conditions. Other challenges are due to cultural differences between pediatric and adult medical care and to the young adult needing to increasingly perform self-management skills that were previously managed by parents or other caregivers. In this review, we will provide a summary of strategies for working effectively with young adults as they transition to adult care. We will then discuss a subset of childhood-onset rheumatic diseases—including juvenile idiopathic arthritis, localized scleroderma, autoinflammatory diseases, pediatric-onset systemic lupus erythematosus, juvenile-onset dermatomyositis, and autoimmune encephalitis—for which clinical manifestations, management, and prognosis frequently differ between pediatric onset and adult onset. Our aim is to highlight differences that make caring for this population of transitioning young adults unique, providing tools and knowledge to empower the adult rheumatologist to care for these young adults in ways that are evidence-based, effective, efficient, and rewarding.