bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prescription Opioid Decision-Making and Use Behaviors in Adolescents with Acute Pain
Authors: Kapos Flavia P. , Gordon Grace O. , Groenewald Cornelius B. , Slack Katherine , Wang Vienna , Palermo Tonya M. , Wilson Anna C. , Rabbitts Jennifer A. 
Published: February 2024

Objectives:
Understanding adolescent perspectives on prescribed opioids in the context of medical care for acute pain is needed to prevent opioid-related adverse outcomes. We explored factors that may influence opioid decision-making and use behaviors among adolescents prescribed opioids for acute pain.

Methods:
We conducted semi-structured interviews with nineteen adolescents (63% females, ages 12-17) prescribed opioids upon discharge from surgery or intensive care unit admission. Interview transcripts were coded using inductive thematic analysis.

Results:
Five themes were identified: “Opioid use to reduce extreme pain and facilitate acute recovery”; “Familiarity with risks and negative effects of opioids”; “Assessment of opioid risk based on individual characteristics and use behaviors”; “Careful balance of risks, benefits, and symptoms when taking opioids”; “Importance of trusted adults for adolescent opioid management”. Adolescents commonly believed opioids are only appropriate for severe pain that cannot be managed with other strategies. Most (but not all) adolescents were aware of addiction and other potential opioid harms, and generally disapproved of misuse. However, a few adolescents would consider taking unprescribed opioids for severe pain. Adolescents wanted to be well informed for opioid decision-making, considering guidance from trusted adults.

Discussion:
Adolescents often demonstrated active and sound participation in shared opioid decision-making, influenced by complex integration of inputs and self-reflection. Conversely, potential factors that could contribute to risky behaviors included low personal risk perceptions, uncertainty about what constitutes opioid misuse, and avoidance of prescribed opioids despite extreme pain. Future studies may explore associations of adolescents’ opioid decision-making with longer-term pain and opioid-related outcomes.
The Inhibitory Effect of NSAIDs and Opioids on Spinal Fusion
Authors: Lambrechts Mark J. , D’Antonio Nicholas D. , Heard Jeremy C. , Yalla Goutham , Karamian Brian A. , Markova Dessislava Z. , Kepler Christopher K. 
Published: February 2024

Study Design.
Translational research.

Objective.
To evaluate the relative effects of NSAIDs, opioids, and a combination of the two on spinal fusion inhibition in a rodent model.

Summary of Background Data.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are common postoperative analgesic agents. Since NSAIDs inhibit the cyclooxygenase (COX) pathway, they are seldom prescribed following spinal fusion. Opioids may be given instead, but recent evidence suggests opioids also adversely affect spinal fusion quality and success.

Methods.
Eighty male Sprague-Dawley rats underwent L4-5 posterior lumbar fusion and were given one of the following analgesia regimens: saline, morphine (6 mg/kg), ketorolac (4 mg/kg), or morphine (3 mg/kg) and ketorolac (2 mg/kg). Serum samples were drawn to evaluate systemic pro-osteoblastic cytokines and vascular endothelial growth factor-A (VEGF-A) levels, which were measured through enzyme-linked immunosorbent assays (ELISA). After six weeks, the rats were sacrificed, and the operated spinal segments underwent manual palpation, microCT, and histologic analysis.

Results.
Manual palpation scores were significantly diminished in the opioid, NSAID, and multimodal groups when compared with control (P<0.001). MicroCT fusion scores (P<0.001) and fusion rates (control: 75% vs. NSAID: 35% vs. opioid: 0% vs. combination: 15%, P<0.001) were significantly diminished in the treatment groups. The bone volume (BV) to tissue volume (TV) ratio (BV/TV) (P<0.001) and bone mineral density (BMD) (P<0.001) were all lower in the treatment groups, with the opioid and combined groups having the lowest BMD. Although statistically insignificant (P<0.09), the concentration of VEGF-A was greater in the control group compared with opioids, NSAIDs, and the combined group.

Conclusion.
Opioids and NSAIDs, both independently and combined, inhibited spinal fusion and caused inferior bony callus. Administration of opioids resulted in the lowest rate of spinal fusion. We propose this may be due to the inhibition of VEGF-A, which limits angiogenesis to the burgeoning fusion mass.
Challenging the Chatbot: An Assessment of ChatGPT's Diagnoses and Recommendations for DBP Case Studies
Authors: Kim Rachel , Margolis Alex , Barile Joe , Han Kyle , Kalash Saia , Papaioannou Helen , Krevskaya Anna , Milanaik Ruth 
Published: February 2024

Objective:
Chat Generative Pretrained Transformer-3.5 (ChatGPT) is a publicly available and free artificial intelligence chatbot that logs billions of visits per day; parents may rely on such tools for developmental and behavioral medical consultations. The objective of this study was to determine how ChatGPT evaluates developmental and behavioral pediatrics (DBP) case studies and makes recommendations and diagnoses.

Methods:
ChatGPT was asked to list treatment recommendations and a diagnosis for each of 97 DBP case studies. A panel of 3 DBP physicians evaluated ChatGPT's diagnostic accuracy and scored treatment recommendations on accuracy (5-point Likert scale) and completeness (3-point Likert scale). Physicians also assessed whether ChatGPT's treatment plan correctly addressed cultural and ethical issues for relevant cases. Scores were analyzed using Python, and descriptive statistics were computed.

Results:
The DBP panel agreed with ChatGPT's diagnosis for 66.2% of the case reports. The mean accuracy score of ChatGPT's treatment plan was deemed by physicians to be 4.6 (between entirely correct and more correct than incorrect), and the mean completeness was 2.6 (between complete and adequate). Physicians agreed that ChatGPT addressed relevant cultural issues in 10 out of the 11 appropriate cases and the ethical issues in the single ethical case.

Conclusion:
While ChatGPT can generate a comprehensive and adequate list of recommendations, the diagnosis accuracy rate is still low. Physicians must advise caution to patients when using such online sources.
Autologous Stem Cell-derived Therapies for Androgenetic Alopecia: A Systematic Review of Randomized Control Trials on Efficacy, Safety, and Outcomes
Authors: Gasteratos Konstantinos , Kouzounis Konstantinos , Goverman Jeremy 
Published: February 2024

Background:
Androgenic alopecia (AGA), a prevalent and extensively studied condition characterized by hair loss, presents a significant global issue for both men and women. Stem cell therapy has emerged as a promising therapeutic approach for AGA due to its regenerative and immunomodulatory properties. The primary objective of this systematic review was to assess the current literature on the efficacy and safety of cellular and acellular stem cell–derived therapies in the management of AGA.

Methods:
A computerized literature search was conducted in ClinicalTrials.gov, PubMed, and Cochrane Library in October 2023. The online screening process was performed by three independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research.

Results:
The search yielded 53 articles from 2013 to 2023. Twelve randomized controlled trials were included. Stem cells and their derivatives were isolated from human adipose tissue, hair follicles, bone marrow, umbilical cord blood, and exfoliated deciduous teeth. These trials showed that stem cell–derived treatments can promote hair regeneration and density.

Conclusions:
Both cellular and acellular stem cell–based therapies are safe and effective in improving hair regeneration and density in AGA patients. Although the outcomes may be temporary in some cases, regenerative treatments may become useful adjuncts in combination with traditional methods of hair transplantation. Future research should focus on protocol optimization to enhance long-term patient outcomes.
Relaxing descemetotomy: microscope-integrated OCT-guided technique for acute corneal hydrops
Authors: Kanu Levi N. , Qureshi Sana , Cherny Christina , Ng Veronica , Ciolino Joseph B. 
Published: February 2024

Introduction:
3 cases are used to illustrate the technique of Descemet membrane (DM) relaxing incisions followed by air descemetopexy for the management of patients with acute corneal hydrops.

Patients and Clinical Findings:
In each case, anterior-segment optical coherence tomography (OCT) demonstrated taut DM detachments and hydrops was refractory to conservative medical management and intracameral air injection.

Diagnosis, Intervention, and Outcomes:
To facilitate the reapproximation of DM and potentiate corneal deturgescence, intraoperative OCT-guided descemetotomy was performed with bent surgical scissors and a bent 30-gauge needle. Subsequent air descemetopexy was successful, and DM reattachment was maintained postoperatively. Corneal edema improved in all patients relatively rapidly postoperatively.

Conclusions:
Relaxing descemetotomy with air descemetopexy may be useful in cases of acute corneal hydrops with taut DM detachments that are unresponsive to air tamponade alone.
Visual and refractive outcomes after bilateral implantation of an enhanced monofocal intraocular lens: prospective study
Authors: García-Bella Javier , Burgos-Blasco Bárbara , Vidal-Villegas Beatriz , Garzón Nuria , Villanueva Celia , García-Feijoo Julián 
Published: February 2024

Purpose:
To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction.

Setting:
San Carlos Hospital, Madrid, Spain.

Design:
Prospective, monocentric, noncomparative study.

Methods:
Adults 21 years or older suitable for cataract surgery and with corneal astigmatism <1.50 diopters (D) were bilaterally implanted with the RayOne EMV IOL and followed up for 3 months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity, corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity, distance-corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire.

Results:
50 eyes of 25 patients were included. At month 3, the mean manifest spherical equivalent was −0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤0.0 logMAR and 95% ≤0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤0.2 logMAR. Mean monocular CDVA was −0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤0.2 logMAR over a 2 D range from +1.00 D to −1.25 D. Satisfaction was good in 96% of patients.

Conclusions:
Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction.
Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia
Authors: Zhao Lijuan , Tan Mengjia , Zhang Junfang , Hao Mengyao , Liang Shu , Ji Min , Guan Huaijin 
Published: February 2024

Purpose:
To compare the short-term changes in cornea, retina, and choroid of femtosecond laser–assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract.

Setting:
Affiliated Hospital of Nantong University, Jiangsu Province, China.

Design:
Prospective single-center study.

Methods:
Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded.

Results:
97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group (P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month (P < .05). CDVA and IOP were similar in both groups at the final visit (P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group.

Conclusions:
FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.
The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center
Authors: Wells Chris L. , Frampton Katherine , Horn Linda B. , Gimie Afnan , Falvey Jason R. 
Published: February 2024

Introduction:
Promotion of early mobility is part of an ongoing effort to mitigate the iatrogenic effects of hospitalization. To assist with mobilization efforts, nursing departments hire mobility technicians (MTs). However, little is known about whether hospital units that hire MTs have increased rates of patient mobilization.

Purpose:
The aim of this retrospective study was to determine whether units in an academic medical setting that hired an MT had greater improvements in mobility compared with similar units that did not hire an MT.

Methods:
Two levels of care-matched pairs of hospital units were used for this analysis. Within each pairing, one unit hired an MT. We captured activity days, defined as any documented out-of-bed activity in a 24-hour period, from standardized documentation. A monthly activity rate was calculated for each unit as the average daily percentage of patients who had out-of-bed orders. A difference-in-difference generalized linear model with a time-by-MT interaction, weighted for patient volume, was used to compare the relative improvement in mobility 6 months prior (baseline) to the hiring of an MT to periods 3 and 6 months post-hire.

Results:
There was a 2.3% absolute increase in activity rate from preperiod to the 3-month postperiod for units that hired an MT, as compared with a 5.1% decline in similar units that did not have an MT. This 8.4% difference in activity rates was statistically significant (P = .03). Over 6 months, the effects of the program waned. Control units continued to decline with a 7.1% drop from baseline) compared with a marginal 0.1% increase in activity rates for units with an MT from baseline. This relative 7.6% increase in mobility was not significant (P = .13).

Conclusion:
There was a significant improvement in activity rates associated with MT hire that declined over time. These results may be contributed to a nonstructured MT utilization, variability with nursing education on the role of the MT, and staffing challenges that diverted the use of the MT to nonmobility activities.
Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support
Authors: Mondkar Rajashree S. , Attorri Andrea , Bridges Carolyn , Stawarz-Gugala Agata , Stolboushkin Catherine , Schwing Terrence , Ragsdale Judy , Belarmino Bobby 
Published: February 2024

Purpose:
The primary aim of this pilot study was to propose cutoff scores for the functional outcome measures at which patients with mechanical circulatory support (MCS) device can transition ambulation from a skilled physical therapy service to a nursing-led ambulation program.

Methods:
This was an exploratory pilot study (N = 46) of patients in an intensive care unit (ICU) with MCS devices. Three functional outcome measures were used: Activity Measure for Post-Acute Care (AM-PAC), Perme ICU Mobility Score (Perme Score), and 5-m gait speed test (gait speed). Cutoff scores were identified using area under the curve (AUC) of receiver operating characteristic.

Results:
Twenty-two patients (intra-aortic balloon pump n = 16; Impella n = 6) were transitioned to a nursing-led ambulation program. The proposed cutoff scores to transition to a nursing-led ambulation program were 19.5 raw score (whole number >19) (>45.44 t score) for AM-PAC, 29.5 (whole number >29) for Perme Score, and 0.57 m/s or more for gait speed.

Conclusion:
The proposed cutoff scores for the 3 commonly used outcome measures for patients in the ICU are possibly useful when transitioning the ambulation program safely from skilled physical therapy to nursing service.
Emotional Exhaustion in Healthcare Workers
Authors: Siddique Sundus , Gore Rebecca , Zhang Yuan , Punnett Laura 
Published: February 2024

Objective
Emotional exhaustion (EE)—the first stage of burnout—is related to preventable work environment exposures. We examined the understudied impact of organizational support for safety (OSS) and safety hazards (SH) on EE in a mixed licensed and unlicensed population of healthcare workers (HCWs).

Methods
A work environment exposures survey was conducted in five US public healthcare facilities in 2018–2019. A total of 1059 questionnaires were collected from a predominantly female population of mixed HCWs.

Results
Mean EE scores were higher among women, direct care workers, and younger subjects. In linear regression models, EE was positively associated with SH, emotional labor, psychological demands, physical demands, job strain, assault, and negative acts, while OSS was negatively associated. Safety hazard s both mediated and moderated the relationship between OSS and EE.

Conclusions
When perception of SH is high, OSS has less impact on reducing EE, suggesting a need to effectively put safety policies to practice for improving EE in HCWS.
Preoperative duration of type 2 diabetes mellitus and remission after Roux-en-Y gastric bypass: a single center long-term cohort study
Authors: Hage Karl , Abi Mosleh Kamal , Sample Jack W. , Vierkant Robert A. , Mundi Manpreet S. , Spaniolas Konstantinos , Abu Dayyeh Barham K. , Ghanem Omar M. 
Published: February 2024

Background:
Roux-en-Y gastric bypass (RYGB) has demonstrated excellent glycemic control and type 2 diabetes mellitus (T2DM) remission for patients with obesity and T2DM. Duration of T2DM is a consistent negative predictor of remission after RYGB. However, the exact timing to offer surgical intervention during the course of the disease is not well elucidated.

Material and methods:
The authors performed a retrospective cohort study between 2008 and 2020 to establish the exact association between duration of T2DM and remission after RYGB. The authors divided our cohort into quartiles of preoperative disease duration to quantify the change in remission rates for each year of delay between T2DM diagnosis and RYGB. The authors also compared the average time to remission and changes in glycemic control parameters.

Results:
A total of 519 patients (67.2% female; age 53.4±10.7 year; BMI 46.6±8.4 kg/m2) with a follow-up period of 6.6±3.8 years were included. Remission was demonstrated in 51% of patients. Longer duration of T2DM was a significant negative predictor of remission with an estimated decrease in remission rates of 7% for each year of delay [(OR=0.931 (95% CI: 0.892–0.971); P<0.001)]. Compared to patients with <3 years of T2DM, remission decreased by 37% for patients with 3–6 years, 64% for those with 7–12 years, and 81% for patients with more than 12 years (P<0.001). Half of the patients reached T2DM remission after 0.5 and 1.1 years, respectively, for the first and second quartiles, while patients in the other quartiles never reached 50% remission. Lastly, The authors noted an overall improvement in all glycemic control parameters for all quartiles at last follow-up.

Conclusion:
Patients with a recent history of T2DM who undergo early RYGB experience significantly higher and earlier T2DM remission compared to patients with a prolonged history of preoperative T2DM, suggesting potential benefit of early surgical intervention to manage patients with obesity and T2DM.
Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: a systematic review and meta-analysis
Authors: Liu Liang , Xiao Yu , Yue Xiao , Wang Qiang 
Published: February 2024

Background:
The enhanced recovery after surgery (ERAS) method has been widely used in surgery and anesthesia worldwide and has been applied to a wide range of surgical specialties, including colorectal surgery, gynecology, liver surgery, breast surgery, urology, and spinal surgery. An increasing number of studies have demonstrated its safety and efficacy in various fields. The safety and effectiveness of ERAS for percutaneous nephrolithotomy (PCNL) remain controversial. This study aimed to review the safety and effectiveness of ERAS for PCNL.

Methods:
The Chinese National Knowledge Infrastructure (CNKI), Wan Fang, Chinese Biomedical Literature Service System (SinoMed), Chinese Science and Technology Journal Full Text Database (VIP), Cochrane Library, PubMed, Web of Science, and Embase databases were searched for eligible studies published until 19 September 2022. Outcome measures included postoperative hospital stay, total hospital stay, incidence of postoperative complications, stone-free rate (SFR), operative time, postoperative indwelling nephrostomy tube time, catheter encumbrance time, and nursing satisfaction. All analyses were performed using random-effects or fixed-effects models. Clinical heterogeneity was treated with subgroup, sensitivity, or descriptive analyses only when clinical heterogeneity was not excluded. Publication bias was assessed using funnel plots. Twenty-five studies (1545 observational patients and 1562 controls) were included.

Results:
The ERAS group had a shorter postoperative hospital stay [WMD=−2.59, 95% CI=(−3.04, −2.14), P<0.001], total hospital stay [WMD=−2.59, 95% CI=(−3.04, −2.14), P<0.001], and lower complication rate [RR=0.36, 95% CI=(0.29–0.43), P<0.001] than the control group. The ERAS group had a shorter surgery time [WMD=−3.57, 95% CI=(−5.88, −1.26), P=0.003], postoperative indwelling nephrostomy tube time [WMD=−1.94, 95% CI=(−2.69, −1.19), P<0.001], catheter encumbrance time [WMD=−2.65, 95% CI=(−4.83, −0.46), P=0.02], and higher satisfaction [RR=1.15, 95% CI=(1.05–1.25), P=0.001] than the control group. The difference in the stone-free rate between the two groups was not statistically significant [RR=1.03, 95% CI=(0.97–1.09), P=0.38], but the stone-free rate of the observation group (ERAS group) in each study was higher than that of the control group.

Conclusion:
ERAS not only ensures the safety of PCNL but also promotes postoperative rehabilitation of patients (shorter surgery time, postoperative indwelling nephrostomy tube time, postoperative hospital time, and lower complication rate). At the same time, differences in the stone-free rate were not statistically significant, but the stone-free rate of ERAS in each study was higher than that of the usual care for PCNL patients.