bluuebunny/crossref_metadata_2025_split huggingface dataset:
ChatGPT in private practice: The opportunities and pitfalls of novel technology
Authors: Lehman Kirk , Aroney Emeil , Wu Isabella 
Published: March 2024

Objective This article explores the transformative impact of OpenAI and ChatGPT on Australian medical practitioners, particularly psychiatrists in the private practice setting. It delves into the extensive benefits and limitations associated with integrating ChatGPT into medical practice, summarising current policies and scrutinising medicolegal implications. Conclusion A careful assessment is imperative to determine whether the benefits of AI integration outweigh the associated risks. Practitioners are urged to review AI-generated content to ensure its accuracy, recognising that liability likely resides with them rather than with AI platforms, despite the lack of case law specific to negligence and AI in the Australian context at present. It is important to employ measures that ensure patient confidentiality is not breached and practitioners are encouraged to seek counsel from their professional indemnity insurer. There is considerable potential for future development of specialised AI software tailored specifically for the medical profession, making the use of AI more suitable for the medical field in the Australian legal landscape. Moving forward, it is essential to embrace technology and actively address its challenges rather than dismissing AI integration into medical practice. It is becoming increasingly essential that both the psychiatric community, medical community at large and policy makers develop comprehensive guidelines to fill existing policy gaps and adapt to the evolving landscape of AI technologies in healthcare.
Eyeing Risks: A Critical Analysis of the Use of Periorbital Steroids in Fronto-orbital Advancement
Authors: Cho Daniel Y. , Blum Jessica D. , Kurnik Nicole , Swanson Jordan W. , Susarla Srinivas M. , Taylor Jesse A. , Hopper Richard A. , Bartlett Scott , Birgfeld Craig B. 
Published: March 2024

Objective To evaluate the outcomes associated with two techniques of periorbital steroid administration in bilateral fronto-orbital advancement (FOA). Design Multi-institutional retrospective chart review Setting Two high volume, tertiary US craniofacial centers Patients, Participants Patients who underwent FOA between 2012 and 2021 Interventions Patients were divided into three cohorts based on method of steroid administration. Groups GEL and INJ represent those who received steroids in the form of triamcinolone soaked gelfoam or direct injection of dilute triamcinolone to the frontal/periorbital region, respectively. Group NON did not receive any periorbital steroids. Main Outcome Measure(s) Peri-operative outcomes including hospital length of stay and complications were evaluated based on method of periorbital steroid administration. Variables predictive of infectious complications were assessed using stepwise logistic regression. Results Four hundred and twelve patients were included in our sample (INJ:249, GEL:87, NON:76). Patients in the INJ group had a higher ASA class ( P < .001) while patients in the NON group were significantly more likely to be syndromic ( P < .001) and have multisuture craniosynostosis ( P < .001). Rate of infectious complications for each cohort were NON: 2.6%, INJ: 4.4%, and GEL: 10.3%. There was no significant difference between groups in hospital length of stay ( P = .654) or rate of post-operative infectious complications ( P = .061). Increased ASA class ( P = .021), increased length of stay ( P = .016), and increased intraoperative narcotics ( P = .011) were independent predictors of infectious complications. Conclusions We identified a dose-dependent relationship between periorbital steroids and rate of postoperative infections, with key contributions from ASA class, hospital length of stay, and dose of intraoperative narcotics.
Comparison of analgesic efficacy of tramadol, morphine and methadone in cats undergoing ovariohysterectomy
Authors: Goich Mariela , Bascuñán Alejandra , Faúndez Patricio , Siel Daniela 
Published: March 2024

Objectives The aim of this study was to compare the analgesic efficacy and the effect on physiological variables and behavior of the use of tramadol, methadone and morphine as preoperative analgesia in healthy cats undergoing elective ovariohysterectomy. Methods Cats undergoing ovariohysterectomy were randomly assigned to receive one of the following premedication treatments intramuscularly: methadone (0.2 mg/kg; n = 10); morphine (0.2 mg/kg; n = 10); or tramadol (3 mg/kg; n = 10). Induction of anesthesia was done with propofol, and maintenance of anesthesia was done with isoflurane. Intraoperative heart rate, arterial blood pressure, respiratory rate, end-tidal isoflurane concentration and frequency of rescue analgesia (fentanyl 2.5 µg/kg) were compared between groups. Postoperative analgesia was assessed using the UNESP-Botucatu Multidimensional Composite Pain Scale, and perioperative serum glucose, cortisol concentrations and postoperative rescue analgesia were evaluated. Results Intraoperative rescue analgesia was required in 76.5% of cats at some time during surgery, and 27% of cats required postoperative rescue analgesia up to 6 h after extubation. There were no significant differences between groups with respect to intraoperative and postoperative rescue analgesia, pain scale scores and end-tidal isoflurane concentrations. In the immediate postoperative period, after extubation, most of the patients presented with hypothermia; however, 1–6 h postoperatively, hyperthermia was observed in most of the patients, and was most common in the tramadol group. Conclusions and clinical relevance Under the conditions of this study, methadone, morphine and tramadol produced satisfactory postoperative analgesia in most of the cats undergoing ovariohysterectomy, and the effects lasted up to 6 h postoperatively. Intraoperative analgesia was not sufficient in most cases. Significant cardiovascular or respiratory effects contraindicating the use of these drugs were not found. Postanesthetic hyperthermia occurred with all opioids studied and was more frequent in the tramadol group.
Comparison of Doppler ultrasonic sphygmomanometry, oscillometry and high-definition oscillometry for non-invasive blood pressure measurement in conscious cats
Authors: Knies Marieke , Teske Erik , Kooistra Hans 
Published: March 2024

Objectives Systemic arterial hypertension is a common occurrence and can have serious adverse consequences in cats. Therefore, measuring blood pressure is very important. There are many indirect blood pressure measurement devices available. This study compared Doppler, oscillometric (petMAP Graphic II, SunTech Vet20, the Cardell Insight-X0000) and high-definition oscillometry devices for the non-invasive measurement of blood pressure in conscious cats. Methods In this prospective study, blood pressure was measured in 32 cats using the different devices according to the recommendations of the American College of Veterinary Internal Medicine Consensus Statement. Blood pressures (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), time to complete measurements, number of attempts needed, coefficient of variation (CV) between the blood pressure measurements of the different devices, ease of completing measurements and apparent stress level of the cat were assessed. Results There was a significant difference between devices in the time taken to obtain blood pressure readings and the number of attempts necessary to obtain six reliable measurements. The CV of the Doppler device was significantly smaller than that of the rest of the devices, but there were no other differences between the devices. The mean SBP, DBP and MAP measured by the petMAP device were significantly higher than the measurements from the other devices. The perceived ease of measurement was not significantly different between the various machines. The perceived level of stress of measurement with the Doppler device was significantly higher compared with the other devices but did not lead to an increased SBP. Conclusions and relevance Using a Doppler device to measure blood pressure in conscious cats is fast, relatively easy and gives reliable results. A disadvantage is that the Doppler device can only measure SBP, while oscillometric devices also provide DBP and MAP. However, in veterinary medicine, systolic hypertension is considered the most relevant.
Incidental AVF creation during unrelated hospitalization is associated with worse outcomes compared with outpatient AVF creation
Authors: Hafeez Muhammad Saad , Abdul-Malak Othman M , Reitz Katherine M , Go Catherine , Eslami Mohammad H , Chaer Rabih A , Yuo Theodore H 
Published: March 2024

Introduction: Arteriovenous fistula (AVF) creation during an inpatient hospitalization is often performed for patient convenience and to ensure compliance. We sought to evaluate whether this approach has comparable outcomes to outpatient AVF creation. Methods: We identified patients undergoing index AVF creation from the United States Renal Data System dataset (2012–2017). Patients were grouped into outpatient and inpatient. Outpatient included patients that were operated in either an outpatient setting, ambulatory surgical center or were admitted inpatient on the day of AVF creation. Inpatient included only patients with claims for an inpatient visit before access creation. Multiple safety outcomes were compared between groups using unadjusted and adjusted logistic regression methods generating odds ratios and 95% confidence intervals (95% CI). One-year maturation rates were compared using competing-risks regression methods generating sub-hazard ratios (sHR) and 95% CI. Outcomes were also compared after 1:1 propensity score matching. Results: We identified 68,872 patients undergoing AVF creation, 4855 (7.1%) of which were created during inpatient hospitalization. Patients in the inpatient group were older (65.8 ± 13.8 vs 65.2 ± 13.8, p = 0.002), more likely to be of Black race (28.1% vs 26.8%, p = 0.02), and have cardiovascular comorbidities (all p < 0.05). Patients in the inpatient groups were more likely to be dialyzed at for-profit (88.1% vs 85.9%, p < 0.01) and freestanding (94.8% vs 92.9%, p < 0.01) dialysis centers. On both unadjusted and adjusted analysis, inpatient group was more likely to experience 30-day adverse events (e.g. pneumonia, COPD exacerbation, stroke, myocardial infarction), any complication, and all-cause mortality. On competing risks analysis, successful two-needle cannulation at 1 year was significantly less likely in the inpatient group (68.1% vs 76.8%, p < 0.01; sHR = 0.68 [95% CI, 0.65–0.71], p < 0.01). These trends were robust on 1:1 propensity matching. Conclusion: Incidental AVF creation in hospitalized patients is associated with worse outcomes, ranging from mortality to postoperative complications to fistula maturation, compared with outpatient AVF creation.
Cardiac Morbidity and Mortality in Patients with Sarcoma: A Population-Based Study
Authors: Alanazi Rakan , Aljizeeri Ahmed , Alsaileek Ahmed , Alrashid Azzam , Alolayan Ashwaq , Alkaiyat Mohammad , Alenazy Basel , Shehata Hussam , Alqahtani Joud , Ardah Husam , Alshammari Kanan 
Published: March 2024

Background: Soft tissue sarcoma (STS) is a rare malignancy that affects soft tissues. It encompasses various subtypes and requires different treatment strategies. Doxorubicin is a commonly used anthracycline in the management of localized and metastatic STS. However, high doses of doxorubicin are associated with cardiotoxicity, which can significantly impact patients’ long-term outcomes. This study aimed to evaluate doxorubicin’s effect on cardiac function in patients with sarcoma and to correlate the frequency of cardiotoxicity with potential risk factors. Methods: A retrospective analysis was conducted on patients with sarcoma who were treated with doxorubicin between 2016 and 2022 at King Abdulaziz Medical City in Saudi Arabia. Patient demographic information, comorbidities, cardiac measurements, laboratory values, systemic therapy, and treatment outcomes were collected from electronic medical records. A statistical analysis was performed to assess the association between cardiotoxicity and various factors. Results: A total of 133 patients were included in the study, with a median age of 30 years. Cardiotoxicity was observed in 9% of the patients. Female patients had a significantly higher risk of developing cardiotoxicity. Patients with a higher Eastern Cooperative Oncology Group (ECOG) performance status and lower troponin I levels also had an increased risk of cardiotoxicity. However, there was no significant association between cardiotoxicity and the number of chemotherapy cycles, total cumulative dose of doxorubicin, or history of radiation. Furthermore, patients with cardiotoxicity had a higher risk of mortality. The overall survival of the patients was 18 months. Conclusion: Doxorubicin-associated cardiotoxicity is a concern for patients with sarcoma. Female patients and patients with a higher ECOG performance status are at an increased risk of developing cardiotoxicity. Careful monitoring and risk assessment are crucial for mitigating the adverse effects of doxorubicin treatment in patients with sarcoma. Future studies are warranted to validate these findings and explore preventive strategies for doxorubicin-induced cardiotoxicity in patients with sarcoma.
Investments in Innovations and Market Structure: A Semi-parametric Approach
Authors: Singh Sukhdeep 
Published: March 2024

The economic literature suggests that there is an inverted-U type of relationship between innovation and product market competition. Existing empirical studies assume a quadratic functional form while estimating the relationship between the two variables. Using data on the Indian manufacturing industry, this article contributes by using a semi-parametric approach to test the ‘Inverted-U’ hypothesis without assuming a priori functional form. The estimation results suggest that the functional form of the relationship is contingent upon the choice of product market competition indicator in the model. When product market competition is defined as overall price competition, the empirical evidence confirms the inverted-U hypothesis. This implies that both escape competition and the Schumpeterian effect are observed as price competition increases. However, when product market competition is defined as domestic competition, only the escape competition effect is observed. JEL Codes: L10, L60, O30, O33, F10
The impact on thirty day readmissions for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease admitted to an observation unit versus an inpatient medical unit: A retrospective observational study
Authors: Bell Jacob , Lim Steven , Mikami Takahisa , Bahk Jeeyune , Argiro Stephen , Steiger David 
Published: March 2024

Objectives We aimed to evaluate the utility of an Observation Unit (OU) in management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and to identify the clinical characteristics of patients readmitted within 30-days for AECOPD following index admission to the OU or inpatient floor from the OU. Methods This is a retrospective observational study of patients admitted from January to December 2017 for AECOPD to an OU in an urban-based tertiary care hospital. Primary outcome was rate of 30-day readmission after admission for AECOPD for patients discharged from the OU versus inpatient service after failing OU management. Regression analyses were used to define risk factors. Results 163 OU encounters from 92 unique patients were included. There was a lower readmission rate (33%) for patients converted from OU to inpatient care versus patients readmitted after direct discharge from the OU (44%). Patients with 30-day readmissions were more likely to be undomiciled, with history of congestive heart failure (CHF), pulmonary embolism (PE), or had previous admissions for AECOPD. Patients with >6 annual OU visits for AECOPD had higher rates of substance abuse, psychiatric diagnosis, and prior PE; when these patients were excluded, the 30-day readmission rate decreased to 13.5%. Conclusion Patients admitted for AECOPD with a history of PE, CHF, prior AECOPD admissions, and socioeconomic deprivation are at higher risk of readmission and should be prioritized for direct inpatient admission. Further prospective studies should be conducted to determine the clinical impact of this approach on readmission rates.
Single nucleotide polymorphisms in the Dicer gene modify the risk of systemic lupus erythematosus
Authors: Zhang Jingjing , Zhao Yufei , Wang Song , Zhang Shasha , Zhang Xiaoyun , Peng Chenxing , Liu Qingyi 
Published: March 2024

Objective MicroRNA-related single-nucleotide polymorphisms (miR-SNPs) can alter microRNA (miRNA) expression profiles, thereby influencing the risk of rheumatic diseases. Herrin a case control study, six miR-SNPs in miRNA processing machinery genes, namely RAN (rs14035), XPO5 (rs11077), Dicer (rs3742330), GEMIN3 (rs197412), GEMIN4 (rs2740348), and TNRC6B (rs9623117), were genotyped to assess their correlation with the risk of systemic lupus erythematosus (SLE). Methods We included 119 patients with SLE and 130 healthy controls. The genotypes of the six miR-SNPs were determined using polymerase chain reaction (PCR). Serum cytokine levels were assessed using a cytometric bead array, and fluorescent probe technology was used to determine plasma reactive oxygen species (ROS) levels. Results The AA genotype of Dicer was correlated with a 0.566-fold decreased risk of SLE compared with that of the AG + GG genotype (odds ratio, 0.566; 95% CI, 0.342–0.935; p = .026), and the rs3742330 A allele was associated with a significantly decreased risk of SLE ( p = .035) compared with that of the rs3742330G allele. Additionally, AA genotype carriers exhibited lower levels of interleukin-6 (IL-6) in the blood ( p = .013). Subsequent analysis revealed increased ROS production in patients with SLE than that in the controls (621.042 ± 425.285 vs 499.966 ± 302.273, p = .011). Conclusion Our findings suggest that ROS generation participates in SLE pathogenesis. The identification of Dicer gene SNP rs3742330 as a potential modifier of SLE risk via mediating IL-6 overproduction suggests a potential avenue for targeted interventions to manage SLE and its associated immune dysregulation.
Evolutionary relationship between antimitochondrial antibody positivity and primary biliary cholangitis in Taiwan: a 16-year hospital cohort study
Authors: Chang Ming-Ling , Cheng Jur-Shan , Le Puo-Hsien , Chen Wei-Ting , Ku Hsin-Ping , Chien Rong-Nan 
Published: March 2024

Background: How antimitochondrial antibody (AMA)-positive patients evolve to have primary biliary cholangitis (PBC) in viral hepatitis–endemic areas is unknown. Objectives: We aimed to investigate this evolution in Taiwan. Design/methods: A 16-year medical center-based cohort study of 2,095,628 subjects was conducted in Taiwan, an Asian country endemic to viral hepatitis. AMA-positive subjects were those with positive AMA with alkaline phosphatase (ALP) ⩽1.5 times the upper limit of normal (ULN), and PBC was defined as positive AMA with ALP >1.5 × ULN. Results: AMA-positive subjects had a lower average age- and sex-adjusted prevalence than PBC patients (4.68/105 versus 11.61/105, p = 0.0002), but their incidence was comparable (0.99/105 versus 1.12/105, p = 0.36). The former group had a borderline significantly lower mean age (56.59 years versus 58.10 years, p = 0.06) and a lower female-to-male ratio (2.85:1 versus 5.44:1, p < 0.0001). Both AMA-positive subjects (prevalence change: 20.0%, p < 0.01; incidence change: −9.2%, p < 0.01) and PBC patients (prevalence change: 14.6%, p < 0.01; incidence change: −4.7%, p  < 0.01) prevalence rate increased but the incidence rate decreased. Among the 423 AMA-positive subjects, 77 (18.2%) developed PBC, for a mean duration of 1.757 years. Compared with AMA-positive subjects, PBC patients had similar concurrent chronic hepatitis B (CHB) rates (2.7% versus 4.3%, p = 0.197) but lower chronic hepatitis C (CHC) rates (3.69% versus 15.60%, p < 0.01). Conclusion: PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects.
Time to Confirmed Neuroinfectious Diagnoses: Diagnostic Testing and Resource Allocation
Authors: Dugue Rachelle , Kim Carla , Boruah Abhilasha , Harrigan Eileen , Sun Yifei , Thakur Kiran T. 
Published: March 2024

Background and Objectives In a retrospective study evaluating the diagnostic approach of definitive neurological infections at a tertiary referral center, we assessed the time to diagnosis from presentation, number of diagnostic tests ordered, and modality of etiologic diagnosis. Methods A total of 111 confirmed clinical cases of neurological infections from 2010-2018 were reviewed. Definitive neuroinfectious diagnoses were defined by positive cerebrospinal (CSF) polymerase chain reaction (PCR)/antigen, CSF culture, CSF antibody, serology, or pathology tests. Results An etiologic diagnosis was determined at an average (SD) of 3.1 (5.9) days after presentation with an average (SD) of 27.7 (15.6) diagnostic tests ordered per workup. Viral neuro-infections were associated with lower intensive care unit (ICU) admission rates, shorter length of hospitalization, and fewer diagnostic tests ordered, as well as shorter time to definitive diagnosis ( P < .05). Longer hospitalizations were associated with immunosuppression status regardless of infectious etiology ( P < .001). Discussion Given the high morbidity and mortality of neuroinfectious disease, specifically meningitis and encephalitis, efficient diagnostic testing is imperative to facilitate the most appropriate clinical course of action with special attention to the specific patient population.
Comparison of dynamic susceptibility contrast (DSC) using gadolinium and iron-based contrast agents in high-grade glioma at high-field MRI
Authors: Wongsawaeng Doonyaporn , Schwartz Daniel , Li Xin , Muldoon Leslie L , Stoller Jared , Stateler Cooper , Holland Samantha , Szidonya Laszlo , Rooney William D , Wyatt Cory , Ambady Prakash , Fu Rongwei , Neuwelt Edward A , Barajas Ramon F 
Published: March 2024

Purpose To compare DSC-MRI using Gadolinium (GBCA) and Ferumoxytol (FBCA) in high-grade glioma at 3T and 7T MRI field strengths. We hypothesized that using FBCA at 7T would enhance the performance of DSC, as measured by contrast-to-noise ratio (CNR). Methods Ten patients (13 lesions) were assigned to 3T (6 patients, 6 lesions) or 7T (4 patients, 7 lesions). All lesions received 0.1 mmol/kg of GBCA on day 1. Ten lesions (4 at 3T and 6 at 7T) received a lower dose (0.6 mg/kg) of FBCA, followed by a higher dose (1.0-1.2 mg/kg), while 3 lesions (2 at 3T and 1 at 7T) received only a higher dose on Day 2. CBV maps with leakage correction for GBCA but not for FBCA were generated. The CNR and normalized CBV (nCBV) were analyzed on enhancing and non-enhancing high T2W lesions. Results Regardless of FBCA dose, GBCA showed higher CNR than FBCA at 7T, which was significant for high-dose FBCA ( p < .05). Comparable CNR between GBCA and high-dose FBCA was observed at 3T. There was a trend toward higher CNR for FBCA at 3T than 7T. GBCA also showed nCBV twice that of FBCA at both MRI field strengths with significance at 7T. Conclusion GBCA demonstrated higher image conspicuity, as measured by CNR, than FBCA on 7T. The stronger T2* weighting realized with higher magnetic field strength, combined with FBCA, likely results in more signal loss rather than enhanced performance on DSC. However, at clinical 3T, both GBCA and FBCA, particularly a dosage of 1.0–1.2 mg/kg (optimal for perfusion imaging), yielded comparable CNR.