bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midwives’ experience of respectful maternity care (RMC) globally: A meta-synthesis
Authors: Haghdoost Simin , Iravani Mina , Rahmani Ali Hassan , Montazeri Simin 
Published: December 2023

Background Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. Method For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. Result There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives’ conceptualizations of RMC, Midwives commitment to woman’s rights, The value and impact of RMC to midwives, Midwife’s perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives’ recommendations for optimal RMC practice. Conclusion In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required.
“Postponing it Any Later Would not be so Great”: A Cognitive Interview Study of How Physicians Decide to Initiate Goals of Care Discussions in the Hospital
Authors: Chuang Elizabeth , Gugliuzza Sabrina , Ahmad Ammar , Aboodi Michael , Gong Michelle Ng , Barnato Amber E 
Published: December 2023

Background There are missed opportunities to discuss goals and preferences for care with seriously ill patients in the acute care setting. It is unknown which factors most influence clinician decision-making about communication at the point of care. Objective This study utilized a cognitive-interviewing technique to better understand what leads clinicians to decide to have a goals of care (GOC) discussion in the acute care setting. Methods A convenience sample of 15 oncologists, intensivists and hospitalists were recruited from a single academic medical center in a large urban area. Participants completed a cognitive interview describing their thought process when deciding whether to engage in GOC discussions in clinical vignettes. Results 6 interconnected factors emerged as important in determining how likely the physician was to consider engaging in GOC at that time; (1) the participants’ mental model of GOC, (2) timing of GOC related to stability, acuity and reversibility of the patient’s condition, (3) clinical factors such as uncertainty, prognosis and recency of diagnosis, (4) patient factors including age and emotional state, (5) participants’ role on the care team, and (6) clinician factors such as emotion and communication skill level. Conclusion Participants were hesitant to commit to the present moment as the right time for GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.
The Dutch Version of the Orthognathic Quality of Life Questionnaire (OQLQ-NL): Validation for Cleft Patients
Authors: Ploumen Roan L.M. , Jonkman Ronald E.G. , Gilijamse Marjolijn , Baas Erik , Nienhuijs Marloes , Nolte Jitske W. , Becking Alfred G. 
Published: December 2023

Objective The aim of this study is to validate the Dutch version of the Orthognathic Quality of Life Questionnaire (OQLQ-NL) for cleft patients who received orthognathic surgery. Methods To compare the OQLQ-NL with the CLEFT-Q, we used a convenience sample of thirty-two cleft patients. Using the Cronbach's alpha coefficient for multiple item scales, internal reliabilities of the OQLQ-NL were evaluated. The OQLQ-NL was repeated at a two-week interval and the intraclass correlation coefficient was calculated, to establish of the test-retest reliability. The construct validity of the OQLQ-NL was evaluated by using Spearman's correlation to test its correlation with the CLEFT-Q. Results Thirty-two patients filled in the OQLQ-NL and CLEFT-Q. The OQLQ-NL had excellent results in internal reliability and test-retest reliability. The vast majority of the correlations between the domains and scales of the questionnaires were as expected. Data from this study and previous studies confirm the construct validity of the OQLQ-NL. Conclusion Our results suggest the OQLQ-NL is a valid and reliable instrument for measuring quality of life in cleft patients who have received orthognathic surgery in the Netherlands.
Profile of a large cohort of children with persistent fetal vasculature and their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia
Authors: Alawi Abeer , Ahmad Khabir , AlZaben Khawlah , AlOhali Rawa , AlKahtani Abeer , AlBakri Amani 
Published: December 2023

Purpose To present the profile of a large cohort of children with persistent fetal vasculature (PFV) and identify their predictors of poor visual outcome in a tertiary eye hospital in Saudi Arabia. Methods This was a single-center study. Medical records of children diagnosed with persistent fetal vasculature between January 1990 and January 2020 at King Khaled Eye Specialist Hospital (KKESH), Riyadh, were reviewed. Data were collected on PFV type, presenting features, management, and visual acuity. Poisson regression with robust error variance was used to identify the predictors of poor visual outcome. Results Data of 175 eyes of 170 children with PFV were analyzed. Most had unilateral disease (n = 165, 96.2%), and over half of them (57.1%) were males. The main presenting complaints were leukocoria (n = 126, 72.0%), followed by smaller eye (n = 36, 20.6%), poor vision (n = 15, 8.6%), and strabismus (n = 13, 7.4%). Anterior, posterior, and combined PFV were present in 30.9%, 10.9%, and 58.3% eyes, respectively. In eyes with measurable visual acuity (n = 124), BCVA at the last follow-up was ≥20/100, <20/100–20/400, CF/HM and LP/NLP in 11 (8.9%), 32 (25.8%), 43 (34.7%), and 38 (30.6%) eyes, respectively. In the multivariable poisson regression analysis, eyes with posterior PFV were approximately two times more likely to have a BCVA of CF or worse than those with anterior PFV (Adjusted incidence ratio: 1.82 (95%: 1.23, 2.70; P = 0.003). Compared with eyes with primary or secondary IOL implantation, aphakic eyes or those with no cataract surgery were significantly more likely to have BCVA of CF or worse (adjusted incidence ratio: 1.84 [95%: 1.18, 2.86], p = 0.007 and adjusted incidence ratio: 1.64 [95%: 1.08, 2.50], p = 0.020, respectively). Conclusions The prognosis of PFV varies depending on the severity of the disease. Patients with posterior PFV had worse visual outcome than anterior or combined type. Whether primary or secondary, IOL implantation increases the probability of having BCVA better than CF.
Real-World Experience With the Angio-Seal Closure Device: Insights From Manufacturer and User Facility Device Experience Database
Authors: Ahrari Aida , Healy Gerard M. , Min Adam , Alkhalifah Fahd , Oreopoulos George , Teng Tan Kong , Jaberi Arash , Rajan Dheeraj K. , Mafeld Sebastian 
Published: December 2023

Purpose: Angio-Seal (Terumo Medical Corporations, Somerset, New Jersey) device is indicated for femoral arteriotomy closure. Real-world published data on complications are limited. We present 1 year of safety events involving Angio-Seal from the US Food and Drug Administration’s post-market surveillance database of Manufacturer and User Facility Device Experience (MAUDE). Steps for managing frequent device-related problems are discussed. Materials and Methods: Angio-Seal MAUDE data from November 2019 to December 2020 was classified according to (1) mode of device failure, (2) complication, (3) treatment, and (4) Cardiovascular and Interventional Radiological Society of Europe (CIRSE) adverse event classification system. Results: There were 715 safety events, involving Angio-Seal VIP (93.1%), Evolution (5.7%), STS Plus (1.1%), and sizes 6F (62.5%) and 8F (37.5%). Failure mode involved unrecognized use of a damaged device (43.4%), failed deployment (20.1%), failed arterial advancement (6.3%), detachment of device component (4.9%), failed retraction (3.6%), operator error (1.1%), and indeterminate (20.6%). Of total, 44.8% of events were associated with patient harm. Complications involved minor blood loss (34.1%), hematoma (5.6%), significant blood loss (1.4%), and pseudoaneurysm (1.4%). Of total, 43.3% of cases required manual compression (MC), whereas 8.8% required more advanced intervention. Interventions included surgical repair (49.2%), thrombin injection (9.5%), balloon tamponade (6.3%), covered stent (4.8%), and unspecified (30.2%). Majority of safety events were CIRSE grade 1 (92.0%), followed by grades 2 (3.1%), 3 (4.6%), and 6 (deaths, 0.3%). Minority of devices were returned for manufacturer analysis (27.8%). Conclusions: The majority of safety events were associated with minor blood loss or local hematoma and could be addressed with MC alone. Most events were attributed to damaged device; however, very few devices were returned to manufacturer for analysis. This should be encouraged to allow for root cause analysis in order to improve safety profile of devices. System-level strategies for addressing barriers to under-reporting of safety events may also be considered. Clinical Impact Our study highlights important safety events encountered in real-world practice with Angio-Seal closure device. The MAUDE database captures real-world device malfunctions not typically appreciated in conventional clinical trials. Our study provides valuable insight for clinician-users on anticipating and managing the most common device malfunctions. Additionally, our data provide feedback for manufactures to optimize product design and direct manufacturer user training to improve safety. Finally, we hope that the study promotes system-level strategies that foster reporting of safety events and undertaking of root cause analysis.
Robot-Assisted Minimally Invasive Multivessel Coronary Bypass Guided by Computerized Tomography
Authors: Arslanhan Gökhan , Özcan Zeynep Sıla , Şenay Şahin , Baştopçu Murat , Koçyiğit Muharrem , Değirmencioğlu Aleks , Alis Deniz , Alhan Cem 
Published: December 2023

Objective: Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes. Methods: Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated. Results: The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding. Conclusions: Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.
Prediction of difficult laryngoscopy and/or intubation among morbidly obese patients: Upper lip bite test versus modified Mallampati classification
Authors: Richa Freda , El-Hage Christine , Chalhoub Viviane , Yazbeck Patricia 
Published: December 2023

Introduction: We aim to compare the upper lip bite test with the modified Mallampati test as predictors of difficult laryngoscopy and/or difficult intubation among morbidly obese patients. Methods: A total of 500 morbidly obese patients (body mass index > 40 kg/m2) undergoing general anaesthesia with tracheal intubation are included in this prospective single-blinded observational clinical study. The preoperative airway assessment is obtained by the modified Mallampati test and upper lip bite test. The difficulty of laryngoscopy is assessed by an experienced anaesthetist in patients adequately anaesthetised and fully relaxed. The view is classified according to Cormack and Lehane’s classification. Modified Mallampati test III or IV and upper lip bite test III are considered positive tests. Difficult laryngoscopy is defined as Cormack and Lehane’s classification III and IV, whereas difficult endotracheal intubation is defined as an intubation difficulty scale ⩾ 5. Results: The incidences of Cormack and Lehane’s classification III and IV and intubation difficulty scale ⩾ 5 are 9.4% and 11.8% respectively. The specificity, positive predictive value and accuracy are higher with the upper lip bite test. The combination of the upper lip bite test and the modified Mallampati test improved these measures. The likelihood ratio + was significantly higher for the upper lip bite test (6.35 and 9.47) than for the modified Mallampati test (3.21 and 3.16). Conclusion: The upper lip bite test is a test with high sensitivity, specificity, negative predictive value and accuracy making it a favourable test for identifying easy and difficult intubations and laryngoscopies in morbidly obese patients.
Vasculitis in the Central Nervous System: Etiology, Characteristics, and Outcomes in a Large Single-Center Cohort
Authors: Hoshina Yoji , Delic Alen , Wong Ka-Ho , Lyden Stephanie , Kadish Robert , Smith Tammy L. , Wright Melissa A. , Shimura Daisuke , Clardy Stacey L. 
Published: December 2023

Background and Purpose For the management of central nervous system (CNS) vasculitis, it is crucial to differentiate between primary and secondary CNS vasculitis and to understand the respective etiologies. We assessed the etiology, characteristics, and outcomes of patients with CNS vasculitis. Methods A single-center retrospective chart review was conducted at the University of Utah, Department of Neurology, between February 2011 and October 2022. Results The median age of the 44 included patients at diagnosis was 54 years; 25.0% were men. Compared to primary CNS vasculitis, secondary CNS vasculitis exhibits higher fever incidence (observed in infectious and connective tissue disorder [CTD]-associated vasculitis), low glucose levels (mostly in infectious vasculitis) and unique cerebrospinal fluid oligoclonal bands (observed in infectious and CTD-associated vasculitis). Patients with inflammatory cerebral amyloid angiopathy (CAA) were older and more commonly had microhemorrhage than primary angiitis of the CNS (PACNS). All patients with CTD-associated vasculitis had a known history of CTD at presentation. Brain biopsies were performed on 10 of 17 PACNS patients and 4 of 8 inflammatory CAA patients, confirming vasculitis in 7 and 4 patients, respectively. Intravenous methylprednisolone was the predominant induction therapy (63.6%), and cyclophosphamide was the most used adjunctive therapy. Cyclophosphamide, rituximab, azathioprine, and mycophenolate mofetil were utilized as maintenance therapy, often with concurrent prednisone. Patients with inflammatory CAA had a higher tendency for relapse rates than PACNS. Conclusions This study highlights the variations in patients’ characteristics, symptoms, and treatment for CNS vasculitis. Understanding these differences can lead to more efficient diagnostic and management strategies.
Critical analysis of the AI impact on the patient–physician relationship: A multi-stakeholder qualitative study
Authors: Čartolovni Anto , Malešević Anamaria , Poslon Luka 
Published: December 2023

Objective This qualitative study aims to present the aspirations, expectations and critical analysis of the potential for artificial intelligence (AI) to transform patient–physician relationship, according to multi-stakeholder insight. Methods This study was conducted from June to December 2021, using an anticipatory ethics approach and sociology of expectations as the theoretical frameworks. It focused mainly on three groups of stakeholders; namely, physicians (n = 12), patients (n = 15) and healthcare managers (n = 11), all of whom are directly related to the adoption of AI in medicine (n = 38). Results In this study, interviews were conducted with 40% of the patients in the sample (15/38), as well as 31% of the physicians (12/38) and 29% of health managers in the sample (11/38). The findings highlight the following: (1) the impact of AI on fundamental aspects of the patient–physician relationship and the underlying importance of a synergistic relationship between the physician and AI; (2) the potential for AI to alleviate workload and reduce administrative burden by saving time and putting the patient at the centre of the caring process and (3) the potential risk to the holistic approach by neglecting humanness in healthcare. Conclusions This multi-stakeholder qualitative study, which focused on the micro-level of healthcare decision-making, sheds new light on the impact of AI on healthcare and the potential transformation of patient–physician relationship. The results of the current study highlight the need to adopt a critical awareness approach to the implementation of AI in healthcare by applying critical thinking and reasoning. It is important not to rely solely upon the recommendations of AI while neglecting clinical reasoning and physicians’ knowledge of best clinical practices. Instead, it is vital that the core values of the existing patient–physician relationship – such as trust and honesty, conveyed through open and sincere communication – are preserved.
Students’ Interest in Orthopedic Surgery in Saudi Arabia
Authors: Aljuhani Wazzan , Albaiahy Arwa , Alanizy Butoul , Alabdulkarim Aljawhara , Alanazi Abdullah 
Published: December 2023

OBJECTIVES The demand for orthopedic surgery is expected to increase as the Saudi population grows and ages. Therefore, this study aimed to assess the interest of medical students and interns in orthopedic surgery and the factors that influence their interest. METHODS This cross-sectional study was conducted using a structured questionnaire adapted from a similar study and modified by the authors. The questionnaire was distributed via email to more than 500 medical students from the second year to the internship year. The questionnaire was designed to assess knowledge, interest, and students’ perception of orthopedics. RESULTS Five hundred and ten responses were obtained; 382 (74.90%) were from women. Gender, family orientation, private practice, and perceptions of orthopedic surgery as a stressful specialty or a specialty in crisis were variables that did not influence participants’ perceptions of orthopedic surgery. Further, 13% of participants showed early interest in orthopedic surgery, especially during their third year of medical school. Most of the interested participants recognized that having strong level of knowledge, future academic opportunities, a controllable lifestyle, direct patient care, experience during their clerkship, a high salary, immediate satisfaction, and a prestigious specialty were important aspects that determined their interest in considering a future career in orthopedic surgery. Work preferences that had a significant impact on interest included working with patients not requiring long-term care, working only in the hospital, working outside the hospital, and working only during the day. CONCLUSION There was no difference between genders in terms of interest in orthopedic surgery. This study might serve as a basis for future research assessing the interest of medical students in orthopedic surgery as well as identifying and managing the barriers that prevent students from pursuing careers as orthopedic surgeons.
Study on the mechanism of salt relief and growth promotion of Enterobacter cloacae on cotton
Authors: Yue Haitao , Sun Shuwen , Wang Ruiqi , Ma Xiaoyun , Shen Shiwei , Luo Yiqian , Ma Xiaoli , Wu Ting , Li Shuang , Yang Zhengyang , Gong Yuxi 
Published: December 2023

Abstract
Aims
In-depth studies on plant ion uptake and plant growth-promoting rhizobacteria (PGPR) at the molecular level will help to further reveal the effects of PGPR on plants and their interaction mechanisms under salt stress.

Methods
Cotton was inoculated with a PGPR-Enterobacter cloacae Rs-35, and the ion uptake capacity, membrane transporter protein activity, and expression of key genes were determined under salt stress. Changes in the endogenous hormone content of cotton were also determined. Further, the genome-wide metabolic pathway annotation of E. cloacae Rs-35 and its differential enrichment pathway analysis of multi-omics under salinity environments were performed.

Results
In a pot experiment of saline-alkali soil, E. cloacae Rs-35-treated cotton significantly increased its uptake of K+ and Ca2+ and decreased uptake of Na+, elevated the activity of the H+-ATPase, and increased the sensitivity of the Na+/H+ reverse transporter protein on the vesicle membrane. Meanwhile, inoculation with E. cloacae Rs-35 could promote cotton to maintain the indole-3-acetic acid (IAA) content under salt stress. Genome-wide annotation showed that E. cloacae Rs-35 was respectively annotated to 31, 38, and 130 related genes in osmotic stress, phytohormone and organic acid metabolism, and ion uptake metabolic pathway. Multi-omics differences analysis showed that E. cloacae Rs-35 were enriched to tryptophan metabolism, multiple amino acid biosynthesis, carbon and glucose synthesis, and oxidative phosphorylation metabolic pathways at the transcriptome, proteome, and metabolome.

Conclusion
E. cloacae Rs-35 can promote cotton balance cell ion concentration, stabilize intracellular IAA changes, stimulate induction of systemic tolerance, and promote the growth of cotton plants under salt stress.