bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Implantation of 3D Anatomically Tailored Polypropylene Mesh for Laparoscopic Inguinal Hernia Repair Designed on the Basis of CT Images (the ILAM Study)
Authors: Śmietański Maciej , Zamkowski Mateusz , Karbowski Krzysztof , Kujawa Mariusz J. 
Published: October 2023

Objective The aim of the ILAM (Individualized Laparoscopic Anatomical Mesh) study was to create and implant a fully individualized mesh based on CT scans, taking into account the published body of knowledge about the material and mechanical behavior of the implant for laparoscopic inguinal hernia repair. Summary Background Data The team creating and conducting this study consisted of surgeons and engineers. A specific project was made and divided into 4 phases. Methods The process of development and implantation was divided into 4 milestones: CT scans and modeling based on predefined subgroups, mesh manufacture, certification and clinical evaluation. Results The result of the study was the first individually designed hernia mesh to have been implanted in a human subject. After 12 months of follow-up, no recurrences or other complications were reported. Conclusions The new mesh provides a better anatomic fit to the patients’ inguinal region geometry. Mechanical stability is ensured by the multiple contact points between the implant and the tissues, which generate friction forces. Together with the possibility of shape design (proper overlap), the authors believe that there is no need for mesh fixation. If so, the use of such design meshes can change the guidelines in laparoendoscopic hernia repair in the future.
Mobile-based program improves healthy eating of ulcerative colitis patients: A pilot study
Authors: Tu Wenjing , Yan Shuxia , Yin Tingting , Zhang Sumin , Xu Wenjing , Zhang Ping , Xu Guihua 
Published: October 2023

Background Dietary management plays a crucial role in the treatment of patients with ulcerative colitis (UC). While various e-services provide dietary advice, the long-term dietary management requires continuous monitoring and dynamic adjustment to accommodate the evolving nature of the disease and meet the patients’ nutritional needs. Consequently, the development of a novel dietary management tool that incorporates diet tracking, personalized nutritional feedback, and evidence-based advice becomes imperative. This study aims to address this need by developing a WeChat applet called “HealthyGut” specifically designed for the dietary management of UC patients, and evaluate its feasibility, acceptability, and preliminary efficacy. Methods A total of 134 UC patients were equally allocated into the intervention group (receiving a 12-week mobile-based dietary management via HealthyGut) and control group (receiving a paper-based food diary and routine advice). The feasibility outcomes were recruitment, retention, engagement, satisfaction, and acceptability in the intervention group. Dietary intakes were effective outcomes. Results Both groups had satisfactory retention rates (89.6% and 77.6%, respectively). The System Usability Scale in the intervention group yielded “good usability” with a mean score of 79.63 (SD 7.39), and all participants reported good user experiences and perceived benefits after using HealthyGut. At week 12, intervention responders reported significantly higher daily energy intake than control group (Z = −3.089, p = 0.002). Conclusions and Implications The results display that HealthyGut as a dietary management tool is feasible and accepted by UC patients, and it may help them make healthier food choices. Larger sample studies should be considered in the future.
Ethical considerations in implementing AI for mortality prediction in the emergency department: Linking theory and practice
Authors: Petersson Lena , Vincent Kalista , Svedberg Petra , Nygren Jens M , Larsson Ingrid 
Published: October 2023

Background Artificial intelligence (AI) is predicted to be a solution for improving healthcare, increasing efficiency, and saving time and recourses. A lack of ethical principles for the use of AI in practice has been highlighted by several stakeholders due to the recent attention given to it. Research has shown an urgent need for more knowledge regarding the ethical implications of AI applications in healthcare. However, fundamental ethical principles may not be sufficient to describe ethical concerns associated with implementing AI applications. Objective The aim of this study is twofold, (1) to use the implementation of AI applications to predict patient mortality in emergency departments as a setting to explore healthcare professionals’ perspectives on ethical issues in relation to ethical principles and (2) to develop a model to guide ethical considerations in AI implementation in healthcare based on ethical theory. Methods Semi-structured interviews were conducted with 18 participants. The abductive approach used to analyze the empirical data consisted of four steps alternating between inductive and deductive analyses. Results Our findings provide an ethical model demonstrating the need to address six ethical principles (autonomy, beneficence, non-maleficence, justice, explicability, and professional governance) in relation to ethical theories defined as virtue, deontology, and consequentialism when AI applications are to be implemented in clinical practice. Conclusions Ethical aspects of AI applications are broader than the prima facie principles of medical ethics and the principle of explicability. Ethical aspects thus need to be viewed from a broader perspective to cover different situations that healthcare professionals, in general, and physicians, in particular, may face when using AI applications in clinical practice.
Tolerability of subcutaneous ofatumumab with long-term exposure in relapsing multiple sclerosis
Authors: Kramer John , Linker Ralf , Paling David , Czaplinski Adam , Hoffmann Olaf , Yong V Wee , Barker Noreen , Ross Amy Perrin , Lucassen Elisabeth , Gufran Mohammad , Hu Xixi , Zielman Ronald , Seifer Gustavo , Vermersch Patrick 
Published: October 2023

Background Ofatumumab is approved for treating relapsing multiple sclerosis (RMS). Examining tolerability will enable understanding of its risk–benefit profile. Objective Report the tolerability profile of ofatumumab in RMS during treatment of up to 4 years and the effect of pre-medication. Methods Cumulative data from the overall safety population included patients taking continuous ofatumumab or being newly switched from teriflunomide. Injection-related reactions (IRRs) by incidence and severity, and post-marketing surveillance data, with an exposure of 18,530 patient-years, were analyzed. Results Systemic IRRs affected 24.7% of patients (487/1969) in the overall safety population; most (99.2% [483/487]) were mild (333/487) to moderate (150/487) in Common Terminology Criteria for Adverse Events severity; most systemic IRRs occurred after first injection. Local-site IRRs affected 11.8% (233/1969) and most (99.6% [232/233]) were mild/moderate. Incidence and severity of systemic and localized IRRs were similar between continuous and newly switched patients across repeated injections. Systemic IRR incidence and severity were not substantially affected by steroidal or non-steroidal pre-medication. Post-marketing surveillance identified no new tolerability issues. Conclusion Ofatumumab is well tolerated, displays a consistent safety profile during continuous use or after switching from teriflunomide and does not require pre-medication. This enables home management of RMS with a high-efficacy treatment.
The influence of methylphenidate on auditory brainstem response patients with attention deficit hyperactivity disorder; an exploratory study
Authors: Claesdotter-Knutsson Emma , Källstrand Johan , Niklasson Katalin , Andersson Mitchell , Lindvall Magnus 
Published: October 2023

Background: Attention-deficit hyperactivity disorder (ADHD), characterized by periods of inattention, overactivity, and impulsiveness, is the most prevalent neurodevelopmental disorder among children. Auditory Brainstem Response (ABR) is a technique in which clickshaped sounds elicit potentials that are recorded from electrodes placed on a patient’s skull. Extant research indicates that ABR is frequently affected in neurodevelopmental disorders such as ADHD. Methylphenidate (MPH), a psychostimulant, is often prescribed to children with ADHD as a first-line pharmacological treatment. The aim of this study was to explore the effects of Methylphenidate treatment on previously observed amplitude alterations in the ABR of patients with ADHD. Methods: We recruited 32 drug-naïve children and adolescents (19 males and 13 females; mean age 11 years) diagnosed with ADHD and 35 health controls (15 males and 20 females; mean age 12 years). The ADHD group was treated with Methylphenidate, and ABR was recorded before treatment and at a steady state of medical treatment. Results: Medicated ADHD patients exhibited increased activity in the right side ABR in Wave VI. Conclusions: A significant increase in activity was found in a part of the ABR thought to correspond to the thalamic area in medicated ADHD patients compared to the same area of non-medicated ADHD patients. The results add to the growing body of research suggesting that specific ABR peaks correlate to certain psychiatric symptoms.
Assessment of Coracoclavicular Ligament Healing on MRI After Arthroscopic TightRope Fixation for Acute Acromioclavicular Joint Dislocation
Authors: Elhalawany Mohamed Fathy , Abdalla Usama Gaber , Shwitter Lotfy , ElAttar Mohammed Said , Fahmy Fahmy Samir 
Published: October 2023

Background: Arthroscopic-assisted fixation of acute high-grade acromioclavicular (AC) joint dislocation has gained popularity in the last decade. Coracoclavicular (CC) fixation using the TightRope device is a less invasive technique. Purpose: To investigate CC ligament healing and functional outcomes after arthroscopic fixation using the TightRope device for acute AC joint disruption. Study Design: Case series; Level of evidence, 4. Methods: The study retrospectively analyzed the data of patients admitted for arthroscopic surgical treatment of acute AC joint injury using a single TightRope device. The data collection commenced in October 2021. The Constant-Murley (CM) score and University of California, Los Angeles (UCLA) shoulder score were used for functional evaluation. The CC distance (CCD) was measured on plain radiographs, whereas healing of the CC ligament was evaluated on magnetic resonance imaging (MRI). Statistical analyses were conducted with the Mann-Whitney U test, independent t test, or paired t test, as appropriate. Results: The analysis included 33 patients with a mean age of 37.7 years (range, 24-49 years) and a minimum follow-up of 24 months. Significant preoperative to postoperative increases were noted in both the CM and UCLA scores (from 34.1 ± 7.6 to 93.3 ± 3.6 and from 8.7 ± 2.1 to 32.9 ± 1.7, respectively; P < .0001 for both). The CCD decreased from 21.8 ± 3.02 mm preoperatively to 10.6 ± 1.2 mm postoperatively ( P < .0001). All patients displayed CC ligament healing on MRI. Two patients with superficial infection and 1 case of partial reduction loss were confirmed at the end of this study. Conclusion: The arthroscopic TightRope technique was found to be a reliable and less invasive method of fixation for acute AC joint disruptions. The CC ligament healed adequately based on MRI evaluation, and the patients regained their preinjury activities, with favorable functional outcomes and minor comorbidities.
Comparable Injury to the Indirect Head of the Rectus Femoris During Interportal and Periportal Capsulotomy: A Cadaveric Study
Authors: Patel Urvi J. , Anderson Devon E. , Yen Yi-Meng , Giordano Brian D. 
Published: October 2023

Background: There is concern for maintaining the integrity of the reflected head of the rectus femoris during arthroscopic hip joint access. Because of the proximity to the indirect head of the rectus femoris (IHRF), capsulotomy technique and capsular closure during routine hip arthroscopy may play a role in postoperative tendinitis. Purpose: To quantify the extent of injury sustained to the IHRF during interportal versus periportal capsulotomy for routine arthroscopic hip joint access. Study Design: Controlled laboratory study. Methods: A cadaveric study was conducted using 20 fresh-frozen cadaveric hips, in which hip joint access through a periportal capsulotomy (n = 10) or interportal capsulotomy (n = 10) was performed. Capsular closure followed by a layered dissection to the capsuloligamentous complex of the hip joint was then performed to localize the IHRF. Suture proximity to the tendon, tendon disruption, and the IHRF footprint was documented to the nearest 0.01 mm using digital calipers. Statistical analysis was performed using unpaired Student t tests. Results: The mean capsulotomy length for the interportal specimens was 19.27 ± 3.25 mm, and the mean medial and lateral capsulotomy length for the periportal specimens was 4.47 ± 1.60 and 4.26 ± 0.89 mm, respectively. There was violation of the tendon in 3 of 10 interportal specimens and 4 of 10 periportal specimens. There was no significant difference in the closest suture measured to the IHRF for specimens with versus without tendon violation, for either interportal or periportal capsulotomy. Conclusion: We found comparable outcomes with regard to violation of the IHRF between interportal and periportal capsulotomy, with no significant difference in suture proximity to the IHRF in specimens with or without tendon violation. There remains no consensus on the ideal method by which to avoid iatrogenic damage to the IHRF. Clinical Relevance: Our findings provide insight that may lead to future advances in surgical care, such that protection of the tendon during routine hip arthroscopy may allow for improved postoperative rehabilitation and strength.
Critical Care Nursing in a Resource-Constrained Setting: A Qualitative Study of Critical Care Nurses’ Experiences Caring for Patients on Mechanical Ventilation
Authors: Mukuve Paulus , Nuuyoma Vistolina 
Published: October 2023

Introduction Managing a patient on mechanical ventilation is a vital aspect of clinical scope in intensive and critical care units. In addition, it is a highly technical, intricate, dynamic task requiring extensive knowledge and skills. Little is known about critical care nurses’ experiences caring for patients on mechanical ventilation in contexts where resources are constrained, creating an empirical gap in the available body of knowledge. Objective This study explored critical care nurses’ experiences caring for patients on mechanical ventilators at an intermediate hospital in northeastern Namibia. Method The study followed qualitative descriptive and explorative designs. The purposive sample included 13 critical care nurses who had cared for patients on mechanical ventilation for more than 6 months. Data were collected via individual unstructured interviews and analyzed using a reflexive thematic analysis approach. Results Four themes and eight subthemes emerged. Varied personal feelings, such as feeling proud, competent, exhausted, traumatized, overwhelmed, and concerns for patients’ well-being were experienced by critical care nurses. Participants described learning from colleagues in the unit and expressed concerns about not having postbasic training in critical care nursing. Negative experiences included concerns about community members’ misconceptions about critical care units and mechanical ventilators, and challenges with resources, personnel, and admission procedures. Conclusion Critical care nurses in resource-constrained settings have positive and negative experiences caring for patients on mechanical ventilators. The findings have implications for the development of support systems for critical care nurses, including induction programs, competence enhancement, psychological support, the development of guiding documents for admission, patient preparation and sensitization of community members. There is a need for this study to be replicated in other resource-constrained contexts where specialized critical care nurses are available.
Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study
Authors: Asumah Mubarick Nungbaso , Abubakari Abdulai , Abdulai Abdul Malik , Nukpezah Ruth Nimota , Adomako-Boateng Fred , Faridu Abdul-Wadudu , Kubio Chrysantus , Padhi Bijaya Kumar , Kabir Russell 
Published: October 2023

Introduction Postnatal care (PNC) is critical for the newborn and the mother, as it offers the opportunity to examine the mother and child to ensure early and timely intervention of any obstetric anomalies that might have gone unnoticed during delivery. However, there is a lack of data on PNC utilization and associated determinants in Ghana. Meanwhile, it is suspected that the PNC service should be more patronized by mothers, particularly within the first 2 days after delivery; therefore, investigating PNC utilization and associated factors could inform policies to enhance PNC uptake. Objective The objective is to determine the level of utilization of PNC service and associated factors in the Savannah region of Ghana. Methods The study used a facility-based analytical cross-sectional study design. The study was carried out in 311 postnatal mothers using consecutive sampling. Data collection was carried out using a questionnaire. Univariate and multiple logistic regression was performed to establish the determinants of PNC. Variables/variable categories with P < .05 were significantly associated with PNC. The significance level is anchored at P < .05. Results The study showed that almost all respondents (98.7%) have heard about PNC services through health workers (39.7%), media (13.0%), and friends and relatives (47.2%). Most of the respondents (88.7%) have used PNC services within 48 h. Mothers aged 25–39 years were about seven times more likely to utilize PNC compared to those who were less than 25 years old (AOR [adjusted odds ratio] = 7.41, 95% CI [confidence interval]: 1.98–7.71); mothers with high school education (SHS) and above were also approximately four times more likely to use PNC compared to those who had no formal education (AOR = 3.65, 95% CI 1.97–13.66). In the same vein, married mothers were 10 times more likely to use PNC compared to those who are single mothers (AOR = 10.34, 95% CI: 3.69–28.97), whereas mothers who had at least four antenatal care (ANC) visits during pregnancy were approximately seven times more likely to use PNC compared to those who had less than four ANC visits (AOR = 6.92, 95% CI: 1.46–32.78). Reasons for not attending PNC include waiting time (40.5%), health workers’ attitude (32.4%), being attended by a student (16.2%), being busy (27.0%), inadequate information on PNC (24.3%), and no family support (18.9%). Conclusion All mothers knew about the PNC services, with a higher proportion patronizing the services. The increasing age, the level of mothers, marital status, and participation in ANC were significant determinants of the use of PNC. More education during ANC on the importance of PNC service is required to achieve universal coverage of PNC.
Modeling as Visioning: Exploring the Impact of Criminal Justice Reform on Health of Populations with Substance Use Disorders
Authors: Martin Natasha K. , Beletsky Leo , Linas Benjamin P. , Bayoumi Ahmed , Pollack Harold , Larney Sarah 
Published: October 2023

In the context of historic reckoning with the role of the criminal-legal system as a structural driver of health harms, there is mounting evidence that punitive drug policies have failed to prevent problematic drug use while fueling societal harms. In this explainer article, we discuss how simulation modeling provides a methodological framework to explore the potential outcomes (beneficial and harmful) of various drug policy alternatives, from incremental to radical. We discuss potential simulation modeling opportunities while calling for a more active role of simulation modeling in visioning and operationalizing transformative change. Highlights This article discusses opportunities for simulation modeling in projecting health and economic impacts (beneficial and harmful) of drug-related criminal justice reforms. We call on modelers to explore radical interventions to reduce drug-related harm and model grand alternative futures in addition to more probable scenarios, with a goal of opening up policy discourse to these options.
Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting
Authors: Coombs Demetrius M. , Patel Viren , Kochenour Nicholas , Patel Niyant , Murthy Ananth S. 
Published: October 2023

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.