bluuebunny/crossref_metadata_2025_split huggingface dataset:
So You Want to Do Trauma Research? A Practical Guide to Creating a Research Program at Your Home Institution
Authors: Larson Nicholas J. , Altamirano Heidi M. , Dries David J. , Blondeau Benoit , Rogers Frederick B. 
Published: March 2024

BACKGROUND:
There are 3 pillars upon which the foundation of a teaching program in health care is founded: research, education, and clinical care. However, in a busy academic trauma practice, the unfortunate reality is that research is often a low priority in the frenzy of mandates for clinical productivity.

OBJECTIVE:
The purpose of this report is to advise hospitals on how to create a modest trauma research program that supports research interests without significantly impacting the overall clinical productivity of the department.

METHODS:
Relevant literature related to the development of an academic trauma research department was reviewed. Relevant articles were then compared to this manuscript to assess the novelty of the topic.

RESULTS:
There are 4 essential components of a trauma research program: (1) a zealot, (2) institutional commitment and support, (3) a statistician, and (4) registry data access.

CONCLUSION:
The creation of a trauma research program may seem like a herculean effort, but this work is necessary for institutions hoping to achieve status as a Level I/II trauma center. Following the steps outlined in this report, trauma providers can create a robust research program at their institution without sacrificing clinical productivity.
Trauma Registry Professionals’ Perspectives on the Secondary Traumatic Stress Component of Compassion Fatigue: A Qualitative Study
Authors: Truelove Amanda L. , Arcipowski Erin , Herndon Michele , McCormack Jane , Steurer Lisa M. , Broeder Jennifer Lee , Newcomb Anna B. 
Published: March 2024

BACKGROUND:
Secondary traumatic stress and compassion fatigue have been studied among trauma clinicians yet have not been explored in trauma registry professionals (TRPs).

OBJECTIVE:
The purpose of this study is to describe the secondary traumatic stress component of compassion fatigue among TRPs.

METHODS:
A qualitative, phenomenological study was conducted to examine TRPs’ experiences with the secondary traumatic stress component of compassion fatigue. The primary investigator assembled a multidisciplinary team of researchers, including nursing leadership, registry educators, mental health experts, and qualitative researchers. Two focus groups were held virtually in January 2021, using an interview guide designed by the research team. Participants were recruited via an email sent to a list of colleagues known to the research team from training classes held nationally and selected for their diverse clinical experiences, years in the role, demographic background, and trauma center representation. The recorded sessions were independently transcribed and analyzed by a five-member subgroup of the research team; the analysis concluded in December 2022.

RESULTS:
Nine TRPs participated in the focus groups. Participants came from Level I, II, and III adult and pediatric trauma centers and military centers. Four themes emerged from the data: disquieting and rewarding work, reactions and emotional responses, the influence of personal histories and background, and coping strategies.

CONCLUSION:
A qualitative analysis of focus group discussions revealed the secondary traumatic stress component of compassion fatigue is present in the TRP.
Traumatic Brain Injury, Psychological Trauma Exposure, and Anxious and Depressive Symptoms in a Clinical Population
Authors: Clausen Ashley N. , Meyers Katherine R. , Stamey Heather M. , Spilman Sarah K. 
Published: March 2024

BACKGROUND:
Approximately 90% of adults endorse psychological trauma exposure. However, barriers to assessment of psychological trauma and sequelae include limited access to care, lack of standardized assessments in nonpsychiatric settings, and comorbid diagnoses, such as traumatic brain injury (TBI), that may mimic psychiatric syndromes.

OBJECTIVES:
This study aims to assess the prevalence rates of psychological trauma exposure and TBI to understand the relationship of these experiences with current psychiatric symptoms.

METHODS:
This is a cross-sectional study of a convenience sample of adult patients (age 18 years and older) referred for outpatient evaluation at a neuropsychology clinic in the Western United States between September 2021 and October 2022. Patients completed a clinical interview to assess their history of psychological trauma, TBI, and current psychiatric symptoms.

RESULTS:
A total of 118 patients met inclusion criteria. Patients in the TBI group (n = 83) endorsed significantly higher rates of childhood trauma and prior physical, emotional, and sexual abuse compared with the No TBI group (n = 35). Psychological trauma exposure and TBI significantly predicted current anxiety and depressive symptoms, but there was no interaction between these experiences in predicting current psychiatric symptoms.

CONCLUSIONS:
Individuals with prior TBI experienced psychological trauma, particularly childhood trauma, at a significantly higher rate than those without TBI. Psychological trauma exposure and TBI independently predicted anxious and depressive symptoms, suggesting both may be viable treatment targets. Evaluation of prior psychological trauma exposure during evaluation of TBI may provide opportunities for trauma-informed care and may allow for improved outpatient treatment planning.
Integration of Substance Use Screening Into the Electronic Health Record for Adolescent Trauma Patients: A Quality Improvement Project
Authors: Troncoso-Munoz Samantha , Davis Khalil D. 
Published: March 2024

BACKGROUND:
Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers.

OBJECTIVE:
This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma.

METHODS:
This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12–21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12 months of preintervention data (January 2021 through January 2022) to 15 months of postintervention data (February 2022 through May 2023).

RESULTS:
A total of N = 241 patients met inclusion criteria, of which most were male, n = 168 (69.7%), White n = 185 (76.8%), and Hispanic n = 179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%.

CONCLUSION:
Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.
Normothermic machine perfusion for liver transplantation: current state and future directions
Authors: Lindemann Jessica , Yu Jennifer , Doyle MB Majella 
Published: March 2024

Purpose of review
The number of patients on the liver transplant waitlist continues to grow and far exceeds the number of livers available for transplantation. Normothermic machine perfusion (NMP) allows for ex-vivo perfusion under physiologic conditions with the potential to significantly increase organ yield and expand the donor pool.

Recent findings
Several studies have found increased utilization of donation after cardiac death and extended criteria brain-dead donor livers with implementation of NMP, largely due to the ability to perform viability testing during machine perfusion. Recently, proposed viability criteria include lactate clearance, maintenance of perfusate pH more than 7.2, ALT less than 6000 u/l, evidence of glucose metabolism and bile production. Optimization of liver grafts during NMP is an active area of research and includes interventions for defatting steatotic livers, preventing ischemic cholangiopathy and rejection, and minimizing ischemia reperfusion injury.

Summary
NMP has resulted in increased organ utilization from marginal donors with acceptable outcomes. The added flexibility of prolonged organ storage times has the potential to improve time constraints and transplant logistics. Further research to determine ideal viability criteria and investigate ways to optimize marginal and otherwise nontransplantable liver grafts during NMP is warranted.
Expanding MELD exceptions for colorectal liver metastasis: data and policy
Authors: Whitrock Jenna N. , Pratt Catherine G. , Shah Shimul A. 
Published: March 2024

Purpose of review
While liver transplant for unresectable colorectal cancer liver metastases (CRLM) has been demonstrated to be a promising treatment in selected patients, the typically low MELD score of these patients and lack of exception points may lead to challenges in receiving a deceased donor liver for transplant.

Recent findings
Several studies have shown improved outcomes in select patients with CRLM who undergo liver transplant, and several trials are ongoing and will conclude in the next several years. MELD exception points have recently been proposed in qualifying patients with CRLM to help this group obtain more timely quality allografts. Under the current proposal, patients with CRLM would receive a score of the median MELD at transplant (MMaT) for their center minus 20 with a minimum score of 15 in cases where MMaT minus 20 would be less than 15. This would allow them to receive transplants faster without competing unnecessarily with those with greater medical need.

Summary
Giving MELD exception points to patients with colorectal cancer liver metastases in need of transplant may decrease time on the waitlist and improve outcomes for these patients.
Interfacility Referral Communication for PICU Transfer*
Authors: Thirnbeck Caitlin K. , Espinoza Elizabeth T. , Beaman Elizabeth A. , Rozen Alexis L. , Dukes Kimberly C. , Singh Hardeep , Herwaldt Loreen A. , Landrigan Christopher P. , Reisinger Heather Schacht , Cifra Christina L. 
Published: March 2024

OBJECTIVES:
For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was to characterize verbal handoffs for urgent interfacility transfers of children to the PICU and compare these characteristics with known elements of high-quality intrahospital shift-to-shift handoffs.

DESIGN:
Mixed methods retrospective study of audio-recorded referral calls between referring clinicians and receiving PICU physicians for urgent interfacility PICU transfers.

SETTING:
Academic tertiary referral PICU.

PATIENTS:
Children 0–18 years old admitted to a single PICU following interfacility transfer over a 4-month period (October 2019 to January 2020).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We reviewed interfacility referral phone calls for 49 patients. Referral calls between clinicians lasted a median of 9.7 minutes (interquartile range, 6.8–14.5 min). Most referring clinicians provided information on history (96%), physical examination (94%), test results (94%), and interventions (98%). Fewer clinicians provided assessments of illness severity (87%) or code status (19%). Seventy-seven percent of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis. Only 9% of PICU physicians summarized information received. Interfacility handoffs usually involved: 1) indirect references to illness severity and diagnosis rather than explicit discussions, 2) justifications for PICU admission, 3) statements communicating and addressing uncertainty, and 4) statements indicating the referring hospital’s reliance on PICU resources. Interfacility referral communication was similar to intrahospital shift-to-shift handoffs with some key differences: 1) use of contextual information for appropriate PICU triage, 2) difference in expertise between communicating clinicians, and 3) reliance of referring clinicians and PICU physicians on each other for accurate information and medical/transport guidance.

CONCLUSIONS:
Interfacility PICU referral communication shared characteristics with intrahospital shift-to-shift handoffs; however, communication did not adhere to known elements of high-quality handovers. Structured tools specific to PICU interfacility referral communication must be developed and investigated for effectiveness in improving communication and patient outcomes.
Evaluation of ChatGPT for Pelvic Floor Surgery Counseling
Authors: Johnson Colin M. , Bradley Catherine S. , Kenne Kimberly A. , Rabice Sarah , Takacs Elizabeth , Vollstedt Annah , Kowalski Joseph T. 
Published: March 2024

Importance
Large language models are artificial intelligence applications that can comprehend and produce human-like text and language. ChatGPT is one such model. Recent advances have increased interest in the utility of large language models in medicine. Urogynecology counseling is complex and time-consuming. Therefore, we evaluated ChatGPT as a potential adjunct for patient counseling.

Objective
Our primary objective was to compare the accuracy and completeness of ChatGPT responses to information in standard patient counseling leaflets regarding common urogynecological procedures.

Study Design
Seven urogynecologists compared the accuracy and completeness of ChatGPT responses to standard patient leaflets using 5-point Likert scales with a score of 3 being “equally accurate” and “equally complete,” and a score of 5 being “much more accurate” and much more complete, respectively. This was repeated 3 months later to evaluate the consistency of ChatGPT. Additional analysis of the understandability and actionability was completed by 2 authors using the Patient Education Materials Assessment Tool. Analysis was primarily descriptive. First and second ChatGPT queries were compared with the Wilcoxon signed rank test.

Results
The median (interquartile range) accuracy was 3 (2–3) and completeness 3 (2–4) for the first ChatGPT query and 3 (3–3) and 4 (3–4), respectively, for the second query. Accuracy and completeness were significantly higher in the second query (P < 0.01). Understandability and actionability of ChatGPT responses were lower than the standard leaflets.

Conclusions
ChatGPT is similarly accurate and complete when compared with standard patient information leaflets for common urogynecological procedures. Large language models may be a helpful adjunct to direct patient-provider counseling. Further research to determine the efficacy and patient satisfaction of ChatGPT for patient counseling is needed.
Antibiotic Switches in Urinary Tract Infection Are Associated With Atypical Symptoms and Emergent Care
Authors: Khalfay Nuha , Murray Kristen , Shimabukuro Julianna , Chiang Jeffrey N. , Ackerman A. Lenore 
Published: March 2024

Importance
Given worsening global antibiotic resistance, antimicrobial stewardship aims to use the shortest effective duration of the most narrow-spectrum, effective antibiotic for patients with specific urinary symptoms and laboratory testing consistent with urinary tract infection (UTI). Inappropriate treatment and unnecessary antibiotic switching for UTIs harms patients in a multitude of ways.

Objective
This study sought to analyze antibiotic treatment failures as measured by antibiotic switching for treatment of UTI in emergent and ambulatory care.

Study Design
For this retrospective cohort study, 908 encounters during July 2019 bearing a diagnostic code for UTI/cystitis in a single health care system were reviewed. Urinary and microbiological testing, symptoms endorsed at presentation, and treatments prescribed were extracted from the medical record.

Results
Of 908 patients diagnosed with UTI, 64% of patients (579/908) received antibiotics, 86% of which were empiric. All patients evaluated in emergent care settings were prescribed antibiotics empirically in contrast to 71% of patients in ambulatory settings (P < 0.001). Of patients given antibiotics, 89 of 579 patients (15%, 10% of all 908 patients) were switched to alternative antibiotics within 28 days. Emergent care settings and positive urine cultures were significantly associated with increased antibiotic switching. Patients subjected to switching tended to have higher rates of presenting symptoms inconsistent with UTI.

Conclusions
Empiric treatment, particularly in an emergent care setting, was frequently inappropriate and associated with increasing rates of antibiotic switching. Given the profound potential contribution to antibiotic resistance, these findings highlight the need for improved diagnostic and prescribing accuracy for UTI.
Obesity and Reconstructive Pelvic Surgery: An ACS NSQIP Study
Authors: Ashmore Sarah , Kenton Kimberly , Das Deepanjana , Bretschneider C. Emi 
Published: March 2024

Importance
Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS).

Objective
This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS.

Study Design
This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared).

Results
A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery.

Conclusion
Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.
No-Show Rates in a Urogynecology Clinic
Authors: Melnyk Alexandra I. , Pollard Aja , Matten Nathan , Napoe Gnankang Sarah 
Published: March 2024

Importance
No-show appointments, or scheduled appointments that patients do not attend without giving notice of cancellation, are a prevalent problem in the outpatient setting.

Objective
The objective of this study was to compare the proportion of patients by decades of life who “no-show” to their urogynecology appointments.

Study Design
This retrospective cohort included women 20 years and older who did not show to their urogynecologic clinical encounters at an academic practice between January 1, 2022, and December 31, 2022. Demographics and visit history were recorded. The primary outcome was the proportion of patients by decade of age who were a “no-show” to their appointments. All decades were compared with women in their 70s, the decade with the most patients seen. Secondary outcomes included descriptive data of patients. Descriptive statistics and χ2 analyses were used.

Results
The cohort of 450 no-show encounters (composed of 391 patients), out of 6729 encounters, demonstrated an overall no-show rate of 6.7%. Baseline demographics of “no-show” patients were 67.3% White and 27.4% Black. The odds of women in their 20s–50s who no-show was 2–3 times higher than women in their 70s (P < 0.01). The highest no-show rates occurred in 20s (12.6%) and 40s (11.8%). Forty-six patients missed multiple appointments. The odds of a Black patient having multiple no-shows was 3.15 times higher than the odds of a White patient.

Conclusions
No-show rates are low in this urogynecology practice. Younger women are more likely to no-show. This knowledge can facilitate potential double bookings necessary for urgent appointments and to maximize resource utilization.
Impact of the Duration of the Second Stage of Labor on Postpartum Pelvic Floor Symptoms
Authors: McKenzie Collin M. , Woolfolk Candice L. , Rieger Mary M. , White Amanda B. , Tuuli Methodius G. , Srinivas Sindhu K. , Caughey Aaron B. , Tita Alan , Gregory W. Thomas , Richter Holly E. , Cahill Alison G. 
Published: March 2024

Importance
The associated effect of duration of the second stage of labor (SSL) on pelvic floor symptoms development is not well studied.

Objective
This study aimed to examine the association between duration of SSL and pelvic floor symptoms at 6 months postpartum among primiparous women.

Study Design
A planned secondary analysis of a multicenter randomized trial evaluating the impact of immediate versus delayed pushing on vaginal delivery rates, maternal morbidity, and neonatal outcomes was conducted between 2014 and 2018. For pelvic floor arm participants, demographic, pelvic examination, and validated questionnaire data were collected postpartum. Primary outcome was change in Pelvic Floor Distress Inventory 20 (PFDI-20) score from immediate to 6 months postpartum. Secondary outcomes included changes in the Pelvic Floor Impact Questionnaire, Fecal Incontinence Severity Index, Modified Manchester Health Questionnaire scores, and Pelvic Organ Prolapse Quantification measurements at 6 months postpartum. Participants were analyzed by SSL duration ≤60 minutes or >60 minutes.

Results
Of the 2,414 trial participants, 767 (32%) completed pelvic floor assessments at 6 months. Pelvic Floor Distress Inventory 20 scores significantly improved at 6 months in the ≤60 minutes SSL group compared with >60 minutes SSL (−14.3 ± 48.0 and −3.2 ± 45.3, respectively; P = 0.04). Changes from immediate postpartum in total and subscale scores for other questionnaires at 6 months did not differ between groups. Prolapse stage did not differ between groups. Perineal body was significantly shorter in the >60 minutes SSL group (3.7 ± 0.7, 3.5 ± 0.8; P = 0.03).

Conclusions
Women with SSL >60 minutes experience less improvement in PFDI-20 scores at 6 months. Greater tissue and innervation trauma in those with SSL >60 minutes may explain persistently less improvement in PFDI-20 scores.