bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association of ICU Acuity and Organizational Factors With Outcomes of Low-Risk Patients
Authors: Salgueiro Emmanuel S. , Kurtz Pedro , Borges Lunna P. , Bastos Leonardo S.L. , Zampieri Fernando G. , Burghi Gaston , Melo Ulisses O. , Corrêa Thiago D. , de Almeida Samantha L.S. , de Marco Fernando V.C. , Maia Marcelo O. , Cravo Victor S. , Pastore Laerte , de Freitas Flávio G.R. , Santino Marcelo S. , Saturnino Saulo F. , Lisboa Thiago C. , de Azevedo José R.A. , Varaschin Pedro A. , Veiga Viviane C. , Ferez Marcus A. , Boniatti Márcio M. , Rabahi Marcelo F. , Machado Flavia R. , Antunes Aline R.S. , Ramos Grazielle V. , Bozza Fernando A. , Salluh Jorge I.F. , Spector Nelson , Soares Marcio ,   for the Organizational CHaractEriSTics in cRitical cAre (ORCHESTRA) Study Investigators
Published: February 2025

Objective:
Outcomes of low-risk patients may be affected by the overall acuity of the ICU to which they were admitted. Studies addressing this topic are very scarce and the underlying mechanisms supporting this association remain incompletely understood. Here, we investigated the effects of ICU acuity (defined as the mean Simplified Acute Physiology Score 3 of all admitted patients in the bimester in which a given patient was admitted) and organizational factors on the outcomes of patients with a low risk of dying admitted to ICUs.

Design:
Retrospective cohort study.

Setting:
One hundred and thirty-four ICUs from Brazil and Uruguay.

Patients:
All low-risk (defined as a Simplified Acute Physiology Score 3 probability of death < 3%) patients admitted between 2016 and 2018.

Interventions:
None.

Measurements and Main Results:
The primary outcome was hospital mortality; secondary outcomes were ICU mortality, and ICU and hospital lengths of stay (LOS). ICU acuity was evaluated as a continuous variable. Multilevel multivariable regression analyses were used to explore the association between ICU acuity, organizational characteristics, and outcomes. Of 285,553 patients, 69,675 (24.4%) were considered low risk. Elective surgeries (66.2%) were the main admission reason. In the models adjusted for patient- and ICU-level characteristics, ICU acuity was not associated with hospital mortality (odds ratio [OR] = 1.095 [0.942–1.274]) and all secondary outcomes. These results were consistent in sensitivity analyses. The presence of dedicated pharmacists in the ICU (OR = 0.531 [0.365–0.773]) and the number of implemented clinical protocols (OR = 0.817 [0.688–0.970]) were independently associated with lower hospital mortality. Clinical protocols were also associated with shorter ICU and hospital LOS.

Conclusions:
ICU acuity was not associated with outcomes in low-risk patients. Appropriate multidisciplinary staffing coupled with adherence to best clinical practices are essential to optimize efficiency and minimize variability of care for this population.
Bone Changes With Silicone Chin Implants: Clinical Case, Review, and Considerations for Technique Modification
Authors: Madorsky Simon J. , Meltzer Orr A. 
Published: February 2025

Background:
Bone resorption has been imputed to silicone chin implants as the cause of the reported bone changes with chin augmentation. Bone remodeling is complex. Both neo-ossification and bone resorption can occur.

Methods:
A literature review was performed on bone complications of silicone chin implants and bone remodeling with periosteal manipulation. Available data from plastic surgical and dental literature, alongside a case observation showing neo-ossification 10 years after implantation, were analyzed and used to explain patterns of bone changes around chin implants.

Results:
Periosteal elevation induces bone formation. Spur-like neo-ossification with silicone chin implants is caused by subperiosteal implant placement. Our case describes such neo-ossification 10 years after silicone chin implantation. The pressure of an implant on bone can cause limited bone resorption. The pressure of an implant trapped under a forming bone shelf can cause significant bone resorption in rare cases.

Conclusions:
Previously reported mandibular bone resorption ascribed to silicone chin implants has been overwrought. Bone formation is more common with silicone chin augmentation. We propose surgical modifications to limit bone complications of chin implants based on the reviewed literature. Surgical approaches to periosteal elevation and implant insertion and consideration of alternate biomaterials to silicone chin implants may improve outcomes of chin augmentation.
Demographic Data of Orbital Fat Removal for Dark Circles Under Eyes in Nationwide Cosmetic Surgery Group
Authors: Tamura Takahiko , Funakoshi Yusuke , Okuma Hiromichi , Furuichi Yoshimasa , Tamura Taichi , Fuse Takashi , Toma Miku , Okumura Koki , Teranishi Hiroo 
Published: February 2025

Background:
Transconjunctival orbital fat removal has exhibited an increasing trend in Japan. This study, conducted in more than 100 clinics in Japan, aimed to contribute to the evolving body of evidence guiding surgical procedures.

Methods:
We analyzed data from our institutional database of 127,505 patients who underwent orbital fat removal for dark circles under the eyes at our clinic. Parameters evaluated included age, sex, occupation, number of debridement sites, medications, and comorbidities.

Results:
The number of procedures has been increasing annually, surpassing 70,000 in 2023. A total of 86.5% of patients were women and 13% were men. The top 3 occupations of patients included company employees (46.2%), housewives (10.4%), and others (9.9%). The median age of patients was 43 (range 33–51) years, showing a trend toward older age. Nearly all excess orbital fatty areas were removed via total resection. Patients undergoing total resection were significantly older on average compared with those undergoing partial resection. Comorbidities, including hypertension, glaucoma, and retinal disease, tended to increase annually. Both steroids and antiplatelet/anticoagulant medications were increasingly used, with the former accounting for 26.5 patients per month and the latter for 10.8 patients per month in the last year.

Conclusions:
The number of middle-aged and older patients is increasing, suggesting a future increase in procedures. The aging demographic will likely lead to a higher prevalence of comorbidities and high-risk medications in the patient population. Surgeons must be aware of these risk factors and possess the skills to manage them safely and effectively.
Arteriovenous Loops for Free Flaps to the Abdomen and Pelvis: Case Reports and Pearls
Authors: Jagasia Puja , Shah Shivani A. , Bagdady Kazimir , Dumanian Gregory A. , Fracol Megan E. 
Published: February 2025

Summary:
Arteriovenous (AV) loops formed from the greater saphenous vein and femoral artery can facilitate free tissue transfer to the abdomen or pelvis when adequate recipient vessels are not available. Here, we present the application of this technique in 3 cases where patients had significant abdominal or pelvic defects due to oncological resection or trauma. AV loops were successfully created using a saphenous vein turned up into the femoral artery at the level of the groin. These loops were then tunneled through the groin and cut back to form recipient vessels for anterolateral thigh (ALT) flaps in a single-stage procedure. In all 3 cases, AV loops constructed with this technique served as reliable conduits for free ALT flaps. Only 1 complication occurred. Following a drop in tissue oximetry, 1 patient was taken back to the operating room. A stitch was found to be compressing the pedicle. Following release, no further complications were observed and all patients achieved complete wound healing. In this article, we highlight key surgical techniques to maintain the orientation of the vein during AV loop anastomosis, which prevents kinking. We provide technical insights regarding tunneling the AV loop through the groin without compression, anchoring the pedicle appropriately, and positioning the ALT flap anastomosis. Our success with this technique underscores its potential in facilitating complex pelvic and abdominal reconstruction.
Association of Frailty, Comorbidities and Muscularity With GOS and 30-Day Mortality After TBI in Elderly Patients—A Retrospective Study in 1104 Patients
Authors: Niedermeyer Sebastian , Weig Thomas , Leiber Mathias , Gencer Aylin , Stöcklein Sophia , Terpolilli Nicole A. 
Published: February 2025

Objective:
This study aimed to assess the prognostic value of various frailty assessment tools in predicting 30-day mortality and Glasgow outcome scale (GOS) at discharge in elderly patients with traumatic brain injury (TBI). Additionally, the study evaluated the role of muscularity as surrogate for frailty in the context of TBI.

Setting:
Data were collected from patients treated as inpatients in a single hospital.

Participants:
All patients aged 60 years or older who were admitted for TBI between 1/2010 and 12/2020.

Design:
A single-center study, with retrospective analysis of clinical notes and computed tomography (CT) imaging at admission.

Mean Measures:
Assessment of frailty by different frailty grading scales, comorbidities by the Charlson Comorbidity Index (CCI), assessment of muscularity by muscle area measurements and their association with outcome of TBI.

Results:
A total of 1104 patients with a median age of 78 years (IQR 72-84) were identified. The overall mortality rate was 12.9% (n = 137). Multivariate regression models identified frailty measured by the Clinical Frailty Scale (CFS) (P < .0001) as predictive variable for short-term mortality and the CCI as predictive variable for GOS at discharge (P = .009); muscle area measurements as surrogate markers of sarcopenia were not associated with outcome in our cohort. Implementing frailty as measured by CFS and CCI into prognostic models for short-term mortality increased their predictive power (increase of area under the ROC curve from 0.897 to 0.919).

Conclusions:
Geriatric-specific models are necessary for a more accurate prognosis estimation of elderly patients with TBI. Our findings suggest that frailty measured by CFS and assessment of comorbidities by CCI adds prognostic value, while muscularity at various locations (as assessed in CT imaging) had no effect on 30-day mortality after TBI.
Evaluating the Implementation of an Occupational Therapy-Led Concussion Clinic Model Into Usual Practice: A Mixed Methods Study
Authors: Natoli Adrianne , Hunt Ethan , Hays Emma , Thompson Eloise , Ioannidis Samantha , Read David J , Withiel Toni D , Marston Celia 
Published: February 2025

Objectives: (1) To evaluate the implementation of Australia’s first occupational therapy-led concussion clinic model into usual practice by examining acceptability and fidelity among clinicians and service users, and (2) to explore the feasibility of embedding outcome measures into the service to facilitate longer-term clinic evaluation. Setting and Participants: A large tertiary trauma hospital service in Melbourne, Australia. Participants were patients referred to the concussion clinic and occupational therapists working in the service. Design: Prospective, single-site, mixed methods design. Main Measures: Acceptability outcomes were evaluated using clinician interviews and the Client Satisfaction Questionnaire-8. Clinic fidelity was assessed by service usage data. Long-term patient outcomes assessed concussion (Rivermead Post-Concussive Questionnaire), mood symptoms (Patient Health Questionnaire-9), and participation in activities of daily living (Community Integration Questionnaire-Revised). Results: Over 18 months, 73% (n = 177) of patients were referred to the clinic, and 75% attended. Adherence to protocol was achieved; however, the completion rate of post-treatment measures was low. Almost half of the patients required specialist referrals beyond the clinic model for persistent symptoms. The interviewed occupational therapists (n = 6) viewed the clinic as a “safety net for patients,” believed they were “learning as we go,” recognized that the “clinic had potential to grow,” but admitted, “we could be doing more.” High attendance rates and patient satisfaction further supported clinic acceptance at an end-user level. Conclusion: An occupational therapy-led concussion clinic is accepted by patients and clinicians to capture the immediate needs of people with concussions after discharge. However, coordinated pathways to multidisciplinary care are needed to address the long-term needs of people with persistent concussion symptoms and problems returning to daily activities.
A New Holistic Theoretical Framework to Inform Opioid Use Disorder Management
Authors: Coffee Zhanette , Taylor-Piliae Ruth , Badger Terry , Gordon Judith , Reed Pamela 
Published: February 2025

Abstract
Opioid use disorders (OUDs) are a public health crisis. Individuals with OUD often have coexisting symptoms: smoking, chronic pain, and anxiety. These coexisting symptoms increase the prevalence and severity of OUD. To inform OUD management, a new holistic theoretical framework (Complexity of Opioid Use Disorder Model [COUDM]) is proposed by combining two theories: Theory of Unpleasant Symptoms and Self-Determination Theory (SDT). TOUS and SDT comprehensively represent the complexity of the OUD experience, including influencing factors, interconnected conditions, and the motivation of individuals based on psychological needs that impact overall outcomes. Individuals receiving OUD treatment informed by SDT are more engaged and experience lower occurrences of drug relapse when they are intrinsically and autonomously motivated. COUDM encompasses the multidimensional aspects of OUD. To acquire a healthier and better future for OUD patients, novel frameworks to guide new approaches are needed. COUDM is a new theoretical framework, incorporating biopsychosocial factors and symptom clusters associated with OUD to improve treatment strategies.
“It Needs to Become a Norm Again and Not Make It Feel Like It’s Something so Foreign”: (Re)normalizing and Reclaiming Breastfeeding in African American Families
Authors: Woods Barr Alexis 
Published: February 2025

Purpose:
To explore the lived experiences and perspectives of 3 generations of African American women regarding breastfeeding within their historical and cultural contexts, and to identify factors influencing their breastfeeding decisions and practices.

Background:
African American communities have a rich cultural heritage that includes infant nurturing. However, breastfeeding rates among African American mothers are comparatively low due to various societal factors, despite well-established health benefits. This disparity stems from historical trauma, socioeconomic inequities, and systemic barriers that disrupt community breastfeeding norms.

Methods:
This study presents a secondary analysis of data from an original qualitative study. Semi-structured interviews were conducted with 35 African American women from 15 family dyads/triads across 3 generations. Data were reexamined using deductive thematic analysis, allowing for emergent themes.

Results:
Six main themes emerged: intergenerational dynamics, tenacity/grit, self-empowerment, Blactivism, overcoming guilt, and a supportive breastfeeding ecosystem. These themes collectively form the framework of “(Re)Normalizing and Reclaiming Breastfeeding in African American Families,” highlighting patients’ resilience and agency in reclaiming breastfeeding practices.

Conclusions:
This study provides valuable insights into the complex factors influencing breastfeeding decisions and experiences among African American women. Findings underscore the importance of intergenerational support, self-empowerment, community activism, and a nurturing ecosystem in renormalizing breastfeeding within the African American community.

Implications:
Results can inform the development of culturally relevant interventions, policies, and support systems that promote breastfeeding equity and empowerment. Future research could focus on implementing and evaluating these strategies while addressing historical trauma and ongoing systemic barriers faced by African American women.
Urology Residency Program Directors’ Criteria for Evaluating Applicants
Authors: Bushweller Leila , Alvarez-Suarez Armando , Munoz-Lopez Carlos , Miranda Andre F. , Hudak Steven J. , Campbell Steven C. , DeWitt-Foy Molly E. , Han Justin S. , Nowacki Amy S. , Khouri Roger K. 
Published: February 2025

Objective:
To evaluate how the recent changes to the urology residency application process affect program directors' (PD) criteria for evaluating applicants.

Methods:
All 148 urology PDs were invited to participate in an anonymous survey administered by REDCap in 2024.

Results:
Forty-eight of 148 PDs (32.4%) responded to the survey. When evaluating whether to interview an applicant, the highest ranked criterion of the 9 options listed was sub-internship (sub-I) performance at the PD’s institution, followed by letters of recommendation (LORs), preference signal (PS) sent to institution, and grades on surgery clerkships. The differences between these top 4 criteria were not statistically significant. Only 23% of PDs were likely to interview applicants who did not complete a sub-I with or send a PS to their program; 23% were neutral. However, 51% of PDs were likely to interview an applicant who sent them a PS, even if the applicant did not complete any sub-Is in their geographic region or send a geographic preference signal to their region; 31% were neutral. Only 21% of PDs were likely to interview applicants who did not submit a Step 2 score with their application; 44% were neutral.

Conclusions:
Sub-I performance is the most important factor for urology PDs, highlighting the importance of away rotations. LOR and PS continue to have a strong influence on interview invitations, but geographic signaling and geographic location of sub-Is do not. Having a Step 2 score at the time of application has become critical for many PDs. These findings will help guide future applicants in navigating the match.
Stool Antigen Test for Helicobacter Pylori Infection in Adults
Authors: Silva Luz Marcel , Tianeze de Castro Caroline , Bueno Lemos Fabian Fellipe , Reis Rocha Gabriel , Lima Correa Santos Gabriel , Rocha Pinheiro Samuel Luca , de Oliveira Silva Luis Guilherme , Santos Calmon Mariana , Vasconcelos Oliveira Márcio , Teixeira Kádima Nayara , de Magalhães Queiroz Dulciene Maria , Freire de Melo Fabrício 
Published: February 2025

Objective:
The stool antigen test (SAT) is a convenient noninvasive option for the diagnosis of Helicobacter pylori (H. pylori) infection. However, despite having been previously evaluated, there is currently a lack of evidence regarding the comparative accuracy of conventional and rapid SATs utilizing monoclonal or polyclonal antibodies in adults. Here, we perform a thorough statistical synthesis to determine and compare the diagnostic accuracy of conventional and rapid SATs for the diagnosis of H. pylori infection in adults.

Materials and Methods:
We conducted independent searches through July 25, 2023, for studies evaluating the accuracy of SAT against a reference standard. We assessed methodological quality using Quality Assessment of Diagnostic Accuracy Studies-2 and calculated overall accuracy measures using the bivariate random-effect model. We also conducted subgroup analyses based on model and assessment technique, and Spearman correlation analysis to investigate a possible threshold effect. We generated summary receiver operating characteristic curves to assess heterogeneity and evaluated publication bias.

Results:
Conventional SAT demonstrated superior sensitivity (92.19% vs 85.79%), specificity (92.93% vs 91.18%), likelihood ratios (LR+ 9.68 vs 8.16; LR- 0.10 vs 0.15), and area under the curve (0.958 vs 0.940) compared with rapid SAT. Notably, the diagnostic odds ratio for conventional SAT (114.70) significantly outperformed rapid SAT (diagnostic odds ratio: 57.72). Correlation analysis revealed no threshold effect and summary receiver operating characteristic curves showed consistent accuracy for both tests.

Conclusion:
Our study establishes evidence of the superior diagnostic accuracy of conventional SATs over rapid SATs for detecting H. pylori infection in adults. Also, we provide valuable insights into the impact of using monoclonal or polyclonal antibodies and different assessment techniques on diagnostic accuracy measures.
Accuracy of Single-dose Transcatheter Aortic Valve Replacement Planning CT Angiography for the Detection of Coronary Artery Disease
Authors: Gassert Florian T. , Brismar Torkel B. , Durukan Taha , Themudo Raquel , Svensson-Marcial Anders 
Published: February 2025

Purpose:
To assess the accuracy of transaortic valve replacement (TAVR) planning CT examinations with a broad detector and a single dose of contrast media to diagnose CAD in a large patient cohort.

Materials and Methods:
In this retrospective study, consecutive patients who underwent a dedicated TAVR planning CT examination with a single contrast media dose and a 320-detector row between November 2017 and March 2021 were screened for inclusion. Inclusion criteria were a complete and correctly performed CT exam as well as an invasive coronary angiography (ICA). The scan consisted of 3 series: (1) ECG-triggered calcium score series over the heart. (2) ECG triggered i.v. CM scanning over the heart covering the entire cardiac cycle (0% to 100%). (3) non-ECG triggered scanning over the thoracic-abdominal area including subclavian and femoral arteries. For 2 and 3, a single i.v. CM bolus was used (300 mg iodine per kg total body weight of iodixanol, minimum 47 mL, maximum 75 mL at 100 kVp; 90 mL at 120 kVp). CT-derived CAD was defined as either free of obstructive CAD (<50%) or showing obstructive disease (>50%), further subclassified in moderate stenosis (50%–70%), or severe stenosis (>70%) for each vessel. ICA data were used as standard of reference.

Results:
We studied 599 patients (78.6±7.5 y, 358 men). In ICA, 428 of 2396 coronary vessels (17.8%) demonstrated stenosis of 50% or more. In a per-patient analysis, CTA had a sensitivity of 97.6% and specificity of 84.3% for the detection of patients with at least one vessel with stenosis of 50% or more as well as a NPV and PPV of 97.8% and 82.2%, respectively. In a per-vessel analysis, CTA had 80.8% sensitivity and 88.1% specificity for the detection of stenosis of 50% or more, as well as an NPV and PPV of 95.5% and 59.6%, respectively.

Conclusions:
Single-dose TAVR planning CT imaging with a wide detector has high sensitivity and NPV to exclude at least moderate CAD in TAVR candidates.