bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of Intra-Articular Hyaluronic Acid Injections in Delaying Total Knee Arthroplasty and Safety Evaluation in Primary Knee Osteoarthritis: Analysis Based on Health Insurance Review and Assessment Service (HIRA) Claim Database in Korea
Authors: Park Jun-Gu , Sim Juho , Han Seung-Beom 
Published: December 2023

Abstract

Background
This retrospective cohort study aimed to evaluate the efficacy of intra-articular hyaluronic acid (IA-HA) injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database.
Methods
The study population included patients aged ≥ 50 years with a first diagnosis of knee osteoarthritis (KOA) between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration.
Results
In all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60–0.62) than non-IA-HA group after adjusting for covariates. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53–0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents and concurrent IA-CS use were associated with higher infection risk.
Conclusion
IA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings support the use of IA-HA as an effective non-operative intervention for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use are important for optimizing outcomes and minimizing complications.
Transitioning from the Emergency Department to a General Internist Outpatient Clinic for Paracentesis: A Qualitative
Authors: Koh Jennifer , Dowlatshahi Shadi , Turner Barbara J 
Published: December 2023

Abstract

Background
Repeated paracentesis for ascites can place significant demands on the emergency department (ED). A new general internist-led outpatient procedure clinic to alleviate this demand required ED staff and patients to accept this transition of care.
Aim:
This qualitative study evaluates barriers and facilitators to implementing the FLuid ASPiration (FLASP) clinic in a safety net hospital.
Methods
The FLASP clinic opened during the COVID-19 pandemic in March 2021. From February to April 2022, semi-structured interviews were conducted with: 10 ED physicians and nurses; 5 FLASP clinic patients; and 4 patients receiving paracentesis in the ED. Interviews were recorded, transcribed, and analyzed using a Grounded Theory approach for themes categorized by Theory of Planned Behavior (TPB) domains including: attitudes/knowledge; social norms; and logistics.
Results
Thematic analysis found that ED staff appreciated reduced demand for paracentesis, but barriers included: lack of knowledge; concerns about unstable patients and patient expectations (norms); and scheduling logistics. FLASP clinic patients had only favorable themes: belief in clinic safety; positive relationship with staff; and clinic efficiency. Patients using the ED for paracentesis expressed only concerns: possible need for testing or hospitalization; care usually in the ED; and unclear clinic scheduling.
Conclusion
This study reveals challenges to transitioning sites of care for paracentesis including the need for greater ED staff education and standardizing methods to triage patients to appropriate site of care. Greater support and education of ED patients about the benefits of an outpatient procedure clinic may also reduce ED burden for paracentesis.
Mortality in Sea Lions is associated with the introduction of the H5N1 clade 2.3.4.4b virus in Brazil, October 2023: Whole genome sequencing and phylogenetic analysis
Authors: Araújo Andreina Carvalho , Cho Andrew Yong , Silva Laura Morais Nascimento , Corrêa Thais Camilo , Souza Gabriela Cristini , Albuquerque Adriana Silva , Macagnan Eduardo , Kolesnikvoas Cristiane K. M. , Meurer Rafael , Vieira Jenyffer Vierheller , Lemos Giulia Gaglianone , Barreto André Silva , Dick Jeferson Luis , Groch Karina Rejane , Castilho Pedro Volkmer , Amgarten Deyvid , Malta Fernanda , Miller Michael , Dorlass Erick G. , Palameta Soledad , Lee Sun-Hak , Arns Clarice Weis , Durigon Edison L. , Pinho João Renato R. , Lee Dong-Hun , Ferreira Helena Lage 
Published: December 2023

Abstract
Clade 2.3.4.4b highly pathogenic avian influenza (HPAI) H5N1 virus was detected in the South American sea lions found dead in Santa Catarina, Brazil, in October 2023. Whole genome sequencing and comparative phylogenetic analysis were conducted to investigate the origin, genetic diversity, and zoonotic potentials of the H5N1 viruses. The H5N1 viruses belonged to the genotype B3.2 of clade 2.3.4.4b H5N1 virus, which was identified in North America and disseminated to South America. They have acquired new amino acid substitutions related to mammalian host affinity. Our study provides insights into the genetic landscape of HPAI H5N1 viruses in Brazil, highlighting the continuous evolutionary processes contributing to their possible adaptation to mammalian hosts.
Beyond the Counter: Navigating the Landscape of Deanxit® Dispensing – Insights from Jordanian Community Pharmacies
Authors: Ahmad Rawand E. , Barakat Muna 
Published: December 2023

Abstract
Background: This study investigates the dispensing patterns and knowledge of community pharmacists regarding Deanxit®, a combination of melitracen and flupentixol approved for depression and anxiety treatment in Jordan.
Methods: Employing a mixed-methods approach, 75 randomly selected pharmacies in two governances of Jordan (Amman and Irbid) underwent simulated patient scenarios and structured interviews using a validated questionnaire.
Results: revealed that 70.6% of pharmacists were willing to dispense Deanxit® based on simulated scenarios, indicating malpractice. The mean practice score was 0.5867 out of 18, underlining a substantial level of malpractice. Pharmacists exhibited poor knowledge, with a median score of 2.0 out of 15, reflecting a lack of awareness about Deanxit®'s labeled indications. Furthermore, 96% reported dispensing without prescriptions, and 62.1% acknowledged encountering cases of improper Deanxit® use.
Conclusion: The findings underscore significant gaps in pharmacists' knowledge and highlight the prevalence of improper Deanxit® use in Jordan, where easy access without prescriptions contributes to the problem. To address these issues, recommendations include implementing comprehensive education and training programs, establishing clear dispensing guidelines, strengthening regulatory measures, launching public awareness campaigns, and promoting collaboration between pharmacists and other healthcare professionals. Urgent interventions are imperative to enhance pharmacist knowledge, improve dispensing practices, and safeguard public health in the context of Deanxit® usage in Jordan.
Challenges Faced by Rural Women in Accessing Credit from Microfinance Institutions- A Case Study of Tengra Morh Village of Varanasi District
Authors: Maurya Jyoti , Jaiswal K.S. 
Published: December 2023

Women always play a dual role in the world which includes family and society both. In the developing country like India, Empowerment for women is an essential part which reveals a key concern topic because their role in decision making and participation in economic activities is pretty low. Apart from traditional beliefs that women are only responsible for the home, women were considered as inferior for many years when compared to men’s, today with improvement in status of the women, they are breaking all boundaries and crossing the challenges and giving active participation independently. The above situation resulted rise of Microfinance or Microcredit that are globally recognised as an effective tool for empowerment among women by eradicating poverty. Microfinance has shown positive sensation result in many of the countries especially in India. At the same time, still there are number of challenges facing by poor people especially rural women while accessing loan from Microfinance Institutions.
In this paper, the study aims to shed light on its challenges and problem facing by rural women from Cash Por Microcredit which is in the small hamlet Tengra Morh of Varanasi District. The instrument for data collection is structured questionnaire on 50 women beneficiaries who are directly and indirectly associated with Cash Por Microfinance Institutions. Secondly Researcher efforted to explore some suggestions to Microfinance Institutions for better exploration so that they can make their life easily and better in terms of income generating and empowerment for obtaining equal opportunities.
Social and Ethical Implications of Digital Crisis Technologies: Case Study of Pandemic Simulation Models During the COVID-19 Pandemic
Authors: Bartl Gabriel 
Published: December 2023

Background
Responses to public health crises are increasingly technological in nature, as the prominence of COVID-19–related statistics and simulations amply demonstrates. However, the use of technologies is preconditional and has various implications. These implications can not only affect acceptance but also challenge the acceptability of these technologies with regard to the ethical and normative dimension.

Objective
This study focuses on pandemic simulation models as algorithmic governance tools that played a central role in political decision-making during the COVID-19 pandemic. To assess the social implications of pandemic simulation models, the premises of data collection, sorting, and evaluation must be disclosed and reflected upon. Consequently, the social construction principles of digital health technologies must be revealed and examined for their effects with regard to social, ethical, and ultimately political issues.

Methods
This case study starts with a systematization of different simulation approaches to create a typology of pandemic simulation models. On the basis of this, various properties, functions, and challenges of these simulation models are revealed and discussed in detail from a socioscientific point of view.

Results
The typology of pandemic simulation methods reveals the diversity of model-driven handling of pandemic threats. However, it is reasonable to assume that the use of simulation models could increasingly shift toward agent-based or artificial intelligence models in the future, thus promoting the logic of algorithmic decision-making in response to public health crises. As algorithmic decision-making focuses more on predicting future dynamics than statistical practices of assessing pandemic events, this study discusses this development in detail, resulting in an operationalized overview of the key social and ethical issues related to pandemic crisis technologies.

Conclusions
This study identifies 3 major recommendations for the future of pandemic crisis technologies.
Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial
Authors: Kearney Lauren E , Jansen Emily , Kathuria Hasmeena , Steiling Katrina , Jones Kayla C , Walkey Allan , Cordella Nicholas 
Published: December 2023

Background
Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear.

Objective
We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message–based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories.

Methods
We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a “helpfulness” message, while the text survey tested frame types informed by behavior economics (“gain,” “loss,” and “helpfulness”) and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated.

Results
Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the “helpfulness” frame compared with the “gain” frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and “loss” frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05).

Conclusions
We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using “gain” or “loss” framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy.
Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry
Authors: Awindaogo Felix , Acheamfour-Akowuah Emmanuel , Doku Alfred , Kokuro Collins , Agyekum Francis , Owusu Isaac Kofi 
Published: December 2023

Background
Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care.

Objective
This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana.

Methods
We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring.

Results
This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024.

Conclusions
This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research.

Trial Registration
ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214

International Registered Report Identifier (IRRID)
DERR1-10.2196/52616
Exploring How Internal Medicine Residents Approach Requests for Medical Assistance in Dying: An Exploratory Qualitative Study at the University of Calgary
Authors: Reich Krista M , Tan Amy , Hui Jacqueline 
Published: December 2023

To develop Medical Assistance in Dying (MAiD) competencies and curricula, we aimed to create a framework outlining how internal medicine (IM) residents approach MAiD requests and identify subsequent learning gaps. We used qualitative descriptive methodology to explore individual participant responses to three clinical vignettes centered on aspects of MAiD, followed by a group discussion. Responses were recorded and transcribed. Codes were reviewed and iteratively organized into themes, highlighting the steps taken for each MAiD scenario. Themes were compared and classified into broader categories within a framework to describe the participants’ overall approach to MAiD requests. Three overarching categories illustrated the approach taken by participants when faced with MAiD requests: 1) Action: the pragmatic steps participants took to respond to requests 2) Decision: the rationale behind how participants decided if MAiD was an option; and 3) Reaction: the emotional reactions that arise from requests; each highlighted significant learning gaps. Participants lacked understanding in concurrent medical and symptom management, MAiD eligibility and referral criteria, roles and responsibilities, and were uncomfortable discussing MAiD. IM residents not only require education on MAiD as a topic but on developing an approach to responding to requests and ways of addressing subsequent personal reactions.
A Large Lithium Overdose with Unusual Pharmacokinetics
Authors: Senecal Justin B , Alhashimalsayed Zaki , Levine Mitchell 
Published: December 2023

Lithium has been used in psychiatry for 50 years and remains a first-line option for bipolar depression and mania. Approximately 7% of patients on lithium will develop toxicity at some point during their treatment. This can often be managed with isotonic crystalloid to promote excretion in the urine, but some patients will require hemodialysis. Here we present the case of a 66-year-old female who presented after ingesting 12 grams of immediate-release lithium. Twenty-eight hours after ingestion, her serum lithium began to rise despite adequate urine output and normal renal function. We hypothesized that this was due to delayed absorption from a pharmacobezoar formation, resulting in pharmacokinetics that mimics what was previously described to occur with sustained release formulations. This case exemplifies the importance of monitoring pharmacokinetic parameters in overdoses, as this can bring attention to issues of prolonged absorption. This has the potential to impact clinical decisions regarding hemodialysis or bowel decontamination.
Admissions for Presumed Social Reasons
Authors: Mah Jasmine Cassy , Searle Samuel , Koller Katalin , Latariya Gali , Nicholls Karen , Freter Susan , Von Maltzahn Maia , Rockwood Kenneth , Andrew Melissa K 
Published: December 2023

“Social admission” is a non-diagnostic label referring to an admission to a hospital for which no medical or health condition is deemed amenable to reversibility or rehabilitation; rather, the patient’s social circumstances are felt to be the sole cause of hospitalization. There is a growing realization that medical facilities are experiencing an increase in socially vulnerable patient presentations. Clinicians also face challenges in caring for this patient population, which may have atypical presentations in which medical and social complexity often align. To better understand individuals admitted for social reasons and to guide future care and research, we review (i) the epidemiology, (ii) risk factors, and (iii) health outcomes associated with being labeled as “social admission.” We draw attention to factors that may improve care for this patient population and offer potential solutions with clinical relevance. Clinicians should remain mindful that patients labelled as “social admissions” often have complex underlying medical problems, which may be acute, and are at high risk of poor outcomes.
RésuméL’« admission sociale » est une étiquette non diagnostique qui fait référence à une admission à l’hôpital pour laquelle aucun trouble médical ou problème de santé n’est jugé réversible ou réadaptable; les circonstances sociales du patient semblent plutôt la seule et unique cause de l’hospitalisation. On se rend de plus en plus compte que les installations de soins de santé connaissent une augmentation du nombre de patients socialement vulnérables. Les cliniciens font également face à des défis dans la prise en charge de cette population de patients qui peuvent présenter des tableaux cliniques atypiques dans lesquels s’aligne souvent une complexité médicale et sociale. Pour mieux comprendre les personnes admises pour des motifs d’ordre social, et pour orienter les soins et les travaux de recherche à venir, nous examinons l’épidémiologie, les facteurs de risque et les résultats en matière de santé associés au port de l’étiquette « admission sociale ». Nous attirons l’attention sur des facteurs susceptibles d’améliorer les soins prodigués à cette population de patients, et proposons des solutions possibles et pertinentes sur le plan clinique. Les cliniciens doivent garder à l’esprit que les patients considérés comme étant des « admissions sociales » ont souvent des problèmes médicaux sous-jacents complexes, qui peuvent être aigus, et présentent un risque élevé de mauvais résultats.
Comparison of serum and plasma taurine values in Bengal tigers with values in taurine-sufficient and -deficient domestic cats
Authors: Pickett J. Phillip , Chesney Russell W. , Beehler Bruce , Moore Cecil P. , Lippincott Shirley , Sturman John , Ketring Kerry L. 
Published: December 2023

Summary
A white Bengal tiger was determined to have a central retinal lesion and a central visual defect. Because of the known association between feline central retinal degeneration (crd) and taurine deficiency in domestic cats, plasma concentrations of taurine were measured in this tiger. Serum concentrations of taurine, methionine, and cystine also were measured in white Bengal tigers, orange Bengal tigers, taurine-sufficient domestic cats, and taurine-deprived and tissue-taurine-depleted visually impaired cats with crd. Hepatic and brain enzymes responsible for taurine synthesis were identified in tissue specimens from an orange Bengal tiger. Serum taurine concentrations were lower in white vs orange tigers, but were not as low as those in cats with crd. Thus, we concluded that taurine depletion did not account for the central retinal lesion in the white Bengal tiger.
Anatomy of the dorsoscapular ligament of horses
Authors: Garrett Phillip D. 
Published: December 2023

Summary
Thoracic limbs from 8 horses were dissected. The dorsoscapular ligament was determined to consist of a collagenous part that fused to the surface of the thoracolumbar fascia and of an elastic part that extended laterally from the collagenous part to attach to the medial surface of the scapula and interdigitate with fibers of the serratus ventralis thoracis muscle.