bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of AbobotulinumtoxinA for Treatment of Moderate-to-Severe Glabellar Lines: A Meta-Analysis
Authors: Han Xiaopan , Bai Jixian , Kuang Jing 
Published: February 2024

Purpose:
This meta-analysis aimed to evaluate the safety and efficacy of abobotulinumtoxinA (ABO) and ABO solution for injection (ASI) for treating moderate-to-severe glabellar lines.

Methods:
The EMBASE, PubMed, and web of science databases were systematically searched. Methodological quality was checked using the Cochrane Risk of Bias tool. We also performed statistical analyses using Stata software to examine the efficacy and safety of ABO.

Results:
Nine randomized controlled trials were included in the meta-analysis. The results showed that at maximum frown, the proportion of responders as measured by the investigator’s live assessment and subject’s self-assessment of moderate-to-severe glabellar lines were significantly higher in the ABO and ASI treatment groups than in the placebo group. In addition, from baseline to maximum frown, the ≥1-grade improvement rate in moderate-to-severe glabellar lines severity was also significantly higher in the ABO and ASI treatment groups than in the placebo group. No significant differences in adverse events were found between ABO, ASI and placebo groups, indicating that ABO and ASI have good safety.

Conclusions:
ABO and ASI are effective and safe options for the treatment of moderate-to-severe glabellar lines. More high-quality studies are needed to verify these conclusions.
Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study
Authors: Wang Yuqing , Jiang Qiao , Long Huizhong , Chen Hu , Wei Jie , Li Xiaoxiao , Wang Haibo , Xie Dongxing , Zeng Chao , Lei Guanghua 
Published: February 2024

Background:
Limited studies have examined the benefits of early arthroplasty within 48 h from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, the authors aimed to investigate the trends in early arthroplasty within 48 h for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns.

Materials and methods:
This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications [i.e. in-hospital death, pulmonary embolism, deep vein thrombosis (DVT), wound infection, and blood transfusion], rates and causes of 30-day readmission between early and delayed arthroplasty.

Results:
During the study period, the rate of early THA increased from 18.0 to 19.9%, and the rate of early HA increased from 14.7 to 18.4% (P<0.001). After matching, 11 731 pairs receiving THA and 13 568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of pulmonary embolism [odds ratio (OR) 0.51, 95% CI: 0.30–0.88], DVT (OR 0.59, 95% CI: 0.50–0.70), blood transfusion (OR 0.62, 95% CI: 0.55–0.70), 30-day readmission (OR 0.82, 95% CI: 0.70–0.95), and venous thromboembolism-related readmission (OR 0.50, 95% CI: 0.34–0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI: 0.61–0.80) and blood transfusion (OR 0.74, 95% CI: 0.68–0.81) than delayed HA.

Conclusion:
Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.
High incidence of gallstones after Roux-en-Y reconstruction gastrectomy in gastric cancer: a multicenter, long-term cohort study
Authors: Zhang Baoping , Nie Peng , Lin Yanyan , Ma Zelong , Ma Guogang , Wang Yongjin , Ma Yuhu , Zhao Jinyu , Zhang Jinduo , Yue Ping , Jiang Ningzu , Zhang Xianzhuo , Tian Liang , Lu Linzhi , Yuan Jinqiu , Meng Wenbo 
Published: February 2024

Background:
Roux-en-Y reconstruction is a common anastomosis technique during gastrectomy in gastric cancer. There is a lack of studies on gallstones after Roux-en-Y reconstruction gastrectomy. This study investigated the incidence and potential risk factors associated with gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer.

Methods:
The study analyzed data from gastric cancer who underwent radical gastrectomy and Roux-en-Y reconstruction at two hospitals between January 2014 and December 2020. The patients fall into distal and total gastrectomy groups based on the extent of gastrectomy. The cumulative event probability curve was plotted using the Kaplan-Meier, and differences in gallstone between groups were evaluated using the Log-Rank. Propensity score matching (PSM) was applied to construct a balanced total versus distal gastrectomies cohort. A Cox regression was employed to analyze the risk factors for gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. Further subgroup analysis was performed.

Results:
531 patients were included in this study, 201 in the distal gastrectomy group and 330 in the total gastrectomy. During the follow-up, there were 170 cases (32.02%) of developed gallstones, 145 cases of gallstones constituting 85.29% of all gallstones within two years after gastrectomy. Then, to reduce the impact of bias, a 1: 1 propensity score matching analysis was performed on the two groups of patients. A total of 344 patients were evaluated, with each subgroup comprising 172 patients. In the matched population, the Cox regression analysis revealed that females, BMI ≥ 23 kg/m2, total gastrectomy, No.12 lymph node dissection, and adjuvant chemotherapy were risk factors for gallstones after Roux-en-Y reconstructive gastrectomy. Subgroup analysis revealed a significantly higher incidence of gallstones after open total gastrectomy than after open distal gastrectomy.

Conclusion:
Significantly higher incidence of gallstones within two years after Roux-en-Y reconstructive gastrectomy for gastric cancer. Patients with these risk factors should be followed closely after gastrectomy to avoid symptomatic gallstones.
Colorectal Cancer Prevention
Authors: Pereyra Lisandro , Schlottmann Francisco , Steinberg Leandro , Lasa Juan 
Published: February 2024

Objective:
To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations.

Background:
Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services.

Methods:
An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app.

Results:
The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001].

Conclusions:
Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.
Biliary stem cells in health and cholangiopathies and cholangiocarcinoma
Authors: Cardinale Vincenzo , Paradiso Savino , Alvaro Domenico 
Published: February 2024

Purpose of review
This review discusses evidence regarding progenitor populations of the biliary tree in the tissue regeneration and homeostasis, and the pathobiology of cholangiopathies and malignancies.

Recent findings
In embryogenesis biliary multipotent progenitor subpopulation contributes cells not only to the pancreas and gall bladder but also to the liver. Cells equipped with a constellation of markers suggestive of the primitive endodermal phenotype exist in the peribiliary glands, the bile duct glands, of the intra- and extrahepatic bile ducts. These cells are able to be isolated and cultured easily, which demonstrates the persistence of a stable phenotype during in vitro expansion, the ability to self-renew in vitro, and the ability to differentiate between hepatocyte and biliary and pancreatic islet fates.

Summary
In normal human livers, stem/progenitors cells are mostly restricted in two distinct niches, which are the bile ductules/canals of Hering and the peribiliary glands (PBGs) present inside the wall of large intrahepatic bile ducts. The existence of a network of stem/progenitor cell niches within the liver and along the entire biliary tree inform a patho-biological-based translational approach to biliary diseases and cholangiocarcinoma since it poses the basis to understand biliary regeneration after extensive or chronic injuries and progression to fibrosis and cancer.
Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods
Authors: Yu Xiao , Meghea Cristian I. , Raffo Jennifer E. , Meng Ran , Vander Meulen Peggy , Lloyd Celeste Sanchez , Roman Lee Anne 
Published: February 2024

Context:
Racial and ethnic disparities in perinatal health remain a public health crisis. Despite improved outcomes from home visiting (HV) participation during pregnancy, most eligible individuals of color do not engage. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible individuals in HV.

Objective:
To examine whether race, ethnicity, and/or language-concordant community health workers (CHWs) increased HV engagement for birthing people in segregated neighborhoods.

Design:
Program evaluation using administrative linked data from birth records, Medicaid claims, and HV program participation. Strong Beginnings (SB), a program with HV provided by CHWs working with nurses and social workers, was compared with the Maternal Infant Health Program (MIHP), a state Medicaid-sponsored HV program without CHW involvement. Data were analyzed using χ2 tests and Poisson regressions.

Participants:
A total of 4560 individuals with a Medicaid-eligible birth between 2016 and 2019, including 1172 from SB and 3388 from the MIHP.

Main Outcome Measures:
Penetration (percentage of participants in HV among all Medicaid-eligible individuals across quintiles of neighborhood segregation) and dosage (the total number of home visits from both CHWs and nurses/social workers, and then restricted to those from nurses/social workers).

Results:
SB penetrated more segregated neighborhoods than the MIHP (58.4% vs 48.3%; P < .001). SB participants received a higher dosage of home visits (mean [SD]: 11.9 [6.1]) than MIHP participants (mean [SD]: 4.4 [2.8], P < .001). Importantly, CHWs did not replace but moderately increased home visits from nurses and social workers (51.1% vs 35.2% with ≥5 intervention visits, P < .001), especially in more segregated neighborhoods.

Policy Implication:
Community-informed HV models intentionally designed for people facing disparities may help facilitate program outreach to segregated neighborhoods with concentrated deprivation and reduce racial and ethnic disparities.

Conclusions:
An HV program provided by CHWs working with nurses and social workers was associated with an increase in penetration and dosage in segregated neighborhoods, compared with HV without CHW involvement. This underscores the value of CHWs partnering with licensed professional workers in improving HV engagement in disadvantaged communities.
Developing an Inclusive Training Environment: Accommodations in Physical Medicine and Rehabilitation Residency Training for Residents with a Disability
Authors: Hall Lauren , Hayano Todd , Morgan Woody , Steere Hannah , Babu Ashwin , Blauwet Cheri 
Published: February 2024

Abstract
This study examines the challenges and accommodations for medical residents with disabilities within physical medicine and rehabilitation (PM&R) training programs. Medical residency presents unique stressors and responsibilities, with the potential for added complexities for residents with disabilities. Few data exist regarding the prevalence and experiences of people with disabilities as medical trainees and the limited studies available highlight an underrepresentation of individuals with disability in medical training and practice. Through cross-sectional surveys administered to PM&R residents, this research assesses disability prevalence, characterizations, barriers to training, and accommodations provided. Out of 140 respondents, 9.3% identified as having disabilities, with varying prevalence among genders and disability types. Results revealed distinct challenges for residents with mobility and non-mobility disabilities, spanning learning environments, standardized testing, procedural skills, and accessibility. Self-provided accommodations exceeded program-provided ones, indicating room for improvement in program support. These findings underscore the need for proactive dialogue between residents and leadership to address barriers, enhance accommodations, and create an inclusive training environment. The study's insights emphasize the importance of advocating for equal opportunities and cultivating supportive conditions to enable individuals with disabilities to thrive in medical residency programs, ultimately contributing to more diverse and inclusive medical communities.
Impact of a Clinical Decision Support Alert on Informed Consent Documentation in the Neonatal Intensive Care Unit
Authors: Sangillo Emily , Jube-Desai Neena , El-Metwally Dina , Hughes Driscoll Colleen 
Published: February 2024

Background:
Informed consent is necessary to preserve patient autonomy and shared decision-making, yet compliant consent documentation is suboptimal in the intensive care unit (ICU). We aimed to increase compliance with bundled consent documentation, which provides consent for a predefined set of common procedures in the neonatal ICU from 0% to 50% over 1 year.

Methods:
We used the Plan-Do-Study-Act model for quality improvement. Interventions included education and performance awareness, delineation of the preferred consenting process, consent form revision, overlay tool creation, and clinical decision support (CDS) alert use within the electronic health record. Monthly audits categorized consent forms as missing, present but noncompliant, or compliant. We analyzed consent compliance on a run chart using standard run chart interpretation rules and obtained feedback on the CDS as a countermeasure.

Results:
We conducted 564 audits over 37 months. Overall, median consent compliance increased from 0% to 86.6%. Upon initiating the CDS alert, we observed the highest monthly compliance of 93.3%, followed by a decrease to 33.3% with an inadvertent discontinuation of the CDS. Compliance subsequently increased to 73.3% after the restoration of the alert. We created a consultant opt-out selection to address negative feedback associated with CDS. There were no missing consent forms within the last 7 months of monitoring.

Conclusions:
A multi-faceted approach led to sustained improvement in bundled consent documentation compliance in our neonatal intensive care unit, with the direct contribution of the CDS observed. A CDS intervention directed at the informed consenting process may similarly benefit other ICUs.
Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language
Authors: Rosen Robert H. , Monuteaux Michael C. , Stack Anne M. , Michelson Kenneth A. , Fine Andrew M. 
Published: February 2024

Background:
Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care.

Methods:
We included all emergency department encounters for patients aged 1–12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012–10/31/2020. We performed retrospective interrupted time series analyses to assess the impact of the clinical pathway by English versus non-English preferred language on the following outcomes: chest radiography (CXR), albuterol use, 7-day return visit, 72-hour return to admission, antibiotic use, and corticosteroid use. Analyses were adjusted for presence of a complex chronic condition.

Results:
There were 1485 encounters in the preperiod (77% English, 14% non-English, 8% missing) and 7840 encounters in the postperiod (79% English, 15% non-English, 6% missing). CXR, antibiotic, and albuterol utilization exhibited sustained decreases over the study period. Pathway impact did not differ by preferred language for any outcome except albuterol utilization. The prepost slope effect of albuterol utilization was 10% greater in the non-English versus the English group (p for the difference by language = 0.022).

Conclusions:
A clinical pathway was associated with improvements in care regardless of preferred language. More extensive studies involving multiple pathways and care settings are needed to assess the impact of clinical pathways on health equity.
Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication
Authors: Gahagen Rachel E. , Gaylord William C. , Drayton Jackson Meghan D. , McCallister Anne E. , Lutfi Riad , Belsky Jennifer A. 
Published: February 2024

Background:
Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass.

Methods:
Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined.

Results:
The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4.

Conclusions:
By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.
The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot
Authors: Bae Yong Chan , Kim Joo Hyoung , Yi Changryul Claud 
Published: February 2024

Background
Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole.

Methods
This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021.

Results
In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm2. Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively.

Conclusions
The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.
Assessing the Readability of Online English and Spanish Language Patient Education Resources Provided by the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and American Society of Reconstructive Microsurgeons
Authors: Sathyanarayanan Sairandri , Paidisetty Praneet , Wang Leonard Kuan-Pei , Gosman Amanda , Williams Steven , Chen Wendy 
Published: February 2024

Introduction
The National Institutes of Health recommends that patient education materials (PEMs) be written at the sixth grade level. However, PEMs online are still generally difficult to read. The usefulness of online PEMs depends on their comprehensibility.

Objectives
This study assessed the readability of PEMs from national Plastic and Reconstructive Surgery (PRS) organization websites.

Methods
Patient education materials were collected from 3 prominent PRS organizations—the American Society of Plastic Surgeons (ASPS), American Society of Aesthetic Plastic Surgeons (ASAPS), and the American Society of Reconstructive Microsurgeons (ASRM). ASPS PEMs were organized into reconstructive and cosmetic groups, and then further subdivided into English and Spanish subgroups. ASAPS and ASRM PEMs provided cosmetic and reconstructive comparison groups to ASPS, respectively. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales.

Results
Overall, all PEMs failed to meet readability guidelines. Within ASPS, Spanish PEMs were easier to read than English PEMs (P < 0.001), and cosmetic PEMs were easier to read than reconstructive PEMs (P < 0.05). There was no significant difference between ASPS cosmetic and ASAPS PEMs (P = 0.36), nor between ASPS reconstructive and ASRM PEMs (P = 0.65). ASAPS and ASRM did not have any Spanish PEMs, and 92% of all ASPS PEMs were in English.

Conclusion
Although PRS societies strive to better educate the public on the scope of PRS, PRS ranks lowly in public understanding of its role in patient care. In addition, Spanish language PEMs from the 3 PRS organizations are severely lacking. Addressing these concerns will make online patient resources more equitable for various patient populations.