bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effectiveness of Endovascular Thrombectomy in M2 Occlusion Stroke: Real-World Experience Versus Clinical Trials
Authors: Gao Lan , Tan Elise , Chen Chushuang , Kleinig Timothy , Yan Bernard , Cheung Andrew , Levi Chris , Garcia-Esperon Carlos , Cordato Dennis , Blair Chris , Lin Longting , Parsons Mark , Bivard Andrew 
Published: October 2023

Objectives: This study sought to establish the cost-effectiveness of endovascular thrombectomy (EVT) in M2 occlusions compared with patients who did not have EVT using both real-world and clinical trial evidence. Methods: The effectiveness of EVT in M2 occlusions was informed by the International Stroke Perfusion Imaging Registry (INSPIRE, real-world data for a wide range of strokes) and HERMES collaboration, trial data. Patients who received EVT and non-EVT treatment from INSPIRE were matched according to baseline characteristics. A Markov model with 7 health states defined by the 3-month modified Rankin scale (mRS) was constructed. Endovascular thrombectomy and non-EVT-treated patients in real-world, and clinical trials were run through the Markov model separately to generate the results from a limited societal perspective. National statistics and published literature informed the long-term probability of recurrent stroke, mortality, costs of management post-stroke, non-medical care, and nursing home care. Results: A total of 83 (42 EVT and 41 non-EVT) patients were matched of 278 (45 EVT and 233 non-EVT) patients in INSPIRE who had M2 occlusion stroke at presentation. The long-term simulation estimated that offering EVT to M2 occlusion stroke patients was associated with greater benefits (5.48 EVT vs 5.24 non-EVT quality-adjusted life year [QALY]) and higher costs (A$133 457 EVT vs A$126 127 non-EVT) compared with non-EVT treatment in real-world from a limited societal perspective. The incremental cost-effectiveness ratio (ICER) of EVT in real-world was A$29 981 (€19 488)/QALY. The analysis using the data from HERMES collaboration yielded consistent results for the EVT patients. Comparison with real-world cost-effectiveness analyses of EVT in internal carotid artery/middle cerebral artery-M1 (ICA/MCA-M1) occlusion suggested a potential reduced QALY gains and increased ICER in M2 occlusions. Conclusions: Our study suggested that the benefits gained from EVT in M2 occlusion stroke in the real-world were similar to that derived from the clinical trials. The clinical and cost benefits from EVT appeared to be reduced in M2 compared with that from the ICA/MCA-M1 occlusions. Clinical Impact Our study has provided valuable insights into the clinical significance of endovascular therapy (EVT) in the context of M2 occlusion stroke within a real-world setting. It is noteworthy that our findings indicate that the benefits obtained from EVT in M2 occlusion stroke closely align with those observed in controlled clinical trials. However, it is essential to recognize that there is a reduction in the clinical and cost-related advantages when comparing M2 occlusions to more proximal ICA/MCA-M1 occlusions.
Do Computerized Tomography Scans Change Management in Carpometacarpal Dislocations and Fracture-Dislocations?
Authors: Sendek Gabriela , Reghunathan Meera , Beeson Summer , Ewing Emily , Hinchcliff Katharine M. 
Published: October 2023

Background: Concomitant carpal injuries with dislocations and fracture-dislocations of the carpometacarpal joints (CMCD/FD) are often hard to see on plain radiographs, making advanced imaging a useful diagnostic adjunct. We aim to: (1) characterize bony injury patterns with CMCD/FD; and (2) determine the frequency that preoperative computed tomography (CT) scans change surgical management. Methods: A retrospective review was performed of patients who underwent operative fixation of CMCD/FD from 2006 to 2021. X-ray and CT scan diagnoses were reviewed and correlated to intraoperative findings and procedures performed. Statistical analyses were performed to evaluate the frequency in which CT scans changed management and the frequency of new intraoperative diagnoses. Results: Seventy-five patients were identified. All patients had a preoperative x-ray, and 27 patients (36%) additionally had a CT scan. Patients who sustained high-velocity trauma were significantly more likely to obtain a CT scan than patients with low-velocity trauma ( P = .019); however, the number of additional diagnoses was not significantly associated with trauma velocity ( P = .35). Computed tomography scans significantly increased the number of diagnoses ( P < .001) and changed operative management in 58% of cases. Six of the 48 patients (12.5%) that did not receive a CT scan had new intraoperative diagnoses, which changed the procedure for five of these patients. New intraoperative diagnoses were identified significantly more when patients did not have a CT scan ( P = .04). Conclusions: Obtaining a CT scan in CMCD/FD patients changed the patient’s diagnosis at a significant rate and changed operative management roughly half of the time. The authors recommend routine CT scans be obtained in patients with CMCD/FD.
The impact of the COVID-19 pandemic on children’s occupations
Authors: Blanta Maria , Karathanasi Anetta , Tzonichaki Ioanna 
Published: October 2023

Background The COVID-19 pandemic changed the daily lives and limited everyday activities of children worldwide. Objectives To document the impact of the COVID-19 pandemic on children’s occupations, the associated factors, and the impact on children’s health, wellbeing, and development. Methods A narrative review was conducted by searching four databases (Scopus, MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews). Results A total of 35 articles met the inclusion criteria. Out of the 34 articles, 23 were relevant to the impact of the COVID-19 pandemic on occupations related to leisure ( n = 17), productivity ( n = 11), and self-care ( n = 9). Ten articles highlighted specific factors that had been linked to changes in occupational engagement and child behavior. Ten articles focused on the impact of occupational disruption during COVID-19 on health, wellbeing, and general development. Conclusion The COVID-19 pandemic seems to have had a negative impact on children’s occupations, while the restrictions were still in effect. Further research is needed to establish reliable conclusions.
General medication adherence scale in patients with chronic illnesses: Persian translation and psychometric evaluation
Authors: Jalali Amir , Mohammadi Mohammad Mehdi , Ghasemi Hooman , Darvishi Niloufar , Khodamorovati Mahbod , Moradi Khalil 
Published: October 2023

Objectives This study was conducted with the aim of determining the validity and reliability of the Persian version of “General Medication Adherence Scale (GMAS)” in chronic patients in Iran. Methodology The study was conducted among patients with chronic diseases in five hospitals of Iran. In this study, after cultural validation, using the steps of Content, Response Reaction, and Internal structure evaluations, the research sample was increased to 150 individuals for exploratory factor analysis (EFA) and 313 chronic patients for confirmatory factor analysis (CFA) to confirm the construct validity. Cronbach's alpha coefficient was used to assess internal consistency, and test-retest method was used to evaluate the reliability of the tool. Findings The results of EFA and CFA confirmed the tool with three factors and 11 items. The R2 index in the above model was estimated at 0.99, indicating that 99% of the variation in medication adherence scores in research units was explained by GMAS with 11 items. The main indices of the model in factor analysis were all above 0.9, indicating a good fit for the model. Discussion Overall, the study results showed that the Persian version of GMAS has acceptable and practical characteristics for evaluating medication adherence, and it can be used as a valid tool in various related fields.
An infodemiology study on exploring the quality and reliability of colorectal cancer immunotherapy information
Authors: Mohamed Hind , O’Malley Laura , Kelly Dervla 
Published: October 2023

Background Immunotherapy is a new treatment modality which promises hope for advanced colorectal cancer patients. To our knowledge, no previous studies have evaluated the quality of patient information available on this topic online. Objective This study will explore the quality and reliability of colorectal cancer immunotherapy information using the Journal of the American Medical Association (JAMA) and DISCERN tools. Methods Design thinking methodology was integrated with systematic scoping reviews framework to inform our descriptive observational media analysis study. Google Chrome was used to run four searches using prespecified search terms selected according to the top patient concerns about immunotherapy. The first 20 relevant results were identified (n = 80) and then duplicates were removed. Descriptive narrative univariate and bivariate analysis was done for the relevant variables. Results The total of included websites was 17. Most websites score <3 points on JAMA and fair/poor on DISCERN. Most of the websites that score ≥3 points on JAMA and excellent/good on DISCERN have a charity affiliation. A total of 58.8% of the websites present the date, 41.2% demonstrate authorship, and sources are mentioned in 29.4% of the websites. Lack of content was noticed in providing the prognosis of patients if no treatment is given, clear aim and the effect of treatments on patient's quality of life. Conclusion Assessing the reliability of information about cancer treatments online remains a challenge. Further research is required to understand the patient perceptions and use of online information and whether it has an impact on their behavioural health outcomes.
Anatomy of a km-scale fault zone controlling the Oligo-Miocene bending of the Ligurian Alps (NW Italy): integration of field and 3D high-resolution digital outcrop model data
Authors: Manna Ludovico , Perozzo Michele , Menegoni Niccolò , Tamburelli Silvia , Crispini Laura , Federico Laura , Seno Silvio , Maino Matteo 
Published: October 2023

AbstractWe report the first description of a ~ 15 km long NE-SW-striking transtensive fault network crosscutting the metamorphic units of the Ligurian Alps. The main fault zone, hereby named Horse Head Fault Zone, is up to 250 m thick, involves quarzite, metarhyolite, marble and alternation of dolostone and limestone and minor pelite. Relatively narrow (~ 1–3 m-thick) fault cores are characterized by gouge and cataclasites, surrounded by brecciated damage zones as thick as tens to hundreds of meters. Damage zones show widespread evidence for dilation in the form of dilation breccia, large calcite crystals and aggregates, and centimeter- to meter-thick veins. Moreover, the fault zone contains a multitude of polished slip surfaces with multiple sets of slickensides and slickenfibers. Oblique to strike-slip kinematics dominates over the large part of the fault mirrors and both overprint and are overprinted by down-dip slip surfaces. The fault network includes dominant NE-SW right-lateral faults with a minor normal component and NW–SE left-lateral steep faults with a negligible reverse component, consistent with a km-size dextral NE-SW-striking Riedel shear zone, in turn representing an antithetic R’ of the regional sinistral shear zone constituted by the Ligurian Alps after the nappe stacking. The Horse Head Fault Zone accommodated km-scale displacement before the Early Miocene, as it is sealed by the sedimentary deposits of the Finale Ligure Basin, thus predating the Corsica-Sardinia drifting. Results of this work constraint the bending of the Ligurian Alps as part of the Western Alpine arc as accomplished through two consecutive, late Oligocene and Early Miocene, stages driven by the combination of Adria rotation and the rollback of the Apennine subduction.
Effect of the COVID-19 pandemic on advanced life support units’ prehospital management of the stroke code in four Spanish regions: an observational study
Authors: Riera-López Nicolás , Aranda-Aguilar Francisco , Gorchs-Molist Montse , Iglesias-Vázquez Jose Antonio 
Published: October 2023

Abstract
Introduction
Stroke is the most common time-dependent pathology that pre-hospital emergency medical services (EMS) are confronted with. Prioritisation of ambulance dispatch, initial actions and early pre-notification have a major impact on mortality and disability. The COVID-19 pandemic has led to disruptions in the operation of EMS due to the implementation of self-protection measures and increased demand for care. It is crucial to evaluate what has happened to draw the necessary conclusions and propose changes to improve the system’s strength for the future. The study aims to compare prehospital time and neuroprotective care metrics for acute stroke patients during the first wave of COVID-19 and the same periods in the years before and after.

Methods
Analytical, observational, multicentre study conducted in the autonomous communities of Andalusia, Catalonia, Galicia, and Madrid in the pre-COVID-19 (2019), “first wave” of COVID-19 (2020) and post-COVID-19 (2021) periods. Consecutive non-randomized sampling. Descriptive statistical analysis and hypothesis testing to compare the three time periods, with two by two post-hoc comparisons, and multivariate analysis.

Results
A total of 1,709 patients were analysed. During 2020 there was a significant increase in attendance time of 1.8 min compared to 2019, which was not recovered in 2021. The time of symptom onset was recorded in 82.8% of cases, and 83.3% of patients were referred to specialized stroke centres. Neuroprotective measures (airway, blood glucose, temperature, and blood pressure) were performed in 43.6% of patients.

Conclusion
During the first wave of COVID-19, the on-scene times of pre-hospital emergency teams increased while keeping the same levels of neuroprotection measures as in the previous and subsequent years. It shows the resilience of EMS under challenging circumstances such as those experienced during the pandemic.
Increasing C-reactive protein levels in a patient with glioblastoma with lymph node metastasis: a case report
Authors: Kanemitsu Takuya , Furuse Motomasa , Kuwabara Hiroko , Yagi Ryokichi , Hiramatsu Ryo , Kameda Masahiro , Nonoguchi Naosuke , Kawabata Shinji , Takami Toshihiro , Arai Motohiro , Wanibuchi Masahiko 
Published: October 2023

Abstract
Background
Glioblastoma usually recurs locally and extracranial metastases are rare. Most patients with extracranial metastases experience recurrence of the primary intracranial tumor. Lymph node metastases are often detected based on lymphadenopathy or symptoms caused by other metastatic sites.

Case presentation
Herein, we report a case of glioblastoma with lymph node metastasis in which the patient was asymptomatic but exhibited gradually increasing C-reactive protein levels prior to becoming febrile 9 months after the initial C-reactive protein increase. Diagnosis of lymph node metastasis that was delayed because the patient had a fever of unknown origin, no signs of infection, and the primary intracranial tumor did not recur. Chest computed tomography indicated supraclavicular, mediastinal, and hilar lymphadenopathy, and biopsy identified lymph node metastasis of glioblastoma. This is the fifth reported case of lymph node metastasis without intracranial recurrence.

Conclusions
C-reactive protein levels may be a diagnostic marker for lymph node metastasis in patients with glioblastoma. Further evaluation is needed to elucidate the role of CRP in glioblastoma with lymph node metastasis.
Integrated bioinformatics analysis for the identification of idiopathic pulmonary fibrosis–related genes and potential therapeutic drugs
Authors: Zhang Zhenzhen , Guan Qingzhou , Tian Yange , Shao Xuejie , Zhao Peng , Huang Lidong , Li Jiansheng 
Published: October 2023

Abstract
Objective
The pathogenesis of idiopathic pulmonary fibrosis (IPF) remains unclear. We sought to identify IPF-related genes that may participate in the pathogenesis and predict potential targeted traditional Chinese medicines (TCMs).

Methods
Using IPF gene-expression data, Wilcoxon rank-sum tests were performed to identify differentially expressed genes (DEGs). Protein–protein interaction (PPI) networks, hub genes, and competitive endogenous RNA (ceRNA) networks were constructed or identified by Cytoscape. Quantitative polymerase chain reaction (qPCR) experiments in TGF-β1-induced human fetal lung (HFL) fibroblast cells and a pulmonary fibrosis mouse model verified gene reliability. The SymMap database predicted potential TCMs targeting IPF. The reliability of TCMs was verified in TGF-β1-induced MRC-5 cells.

Materials
Multiple gene-expression profile data of normal lung and IPF tissues were downloaded from the Gene Expression Omnibus database. HFL fibroblast cells and MRC-5 cells were purchased from Wuhan Procell Life Science and Technology Co., Ltd. (Wuhan, China). C57BL/12 mice were purchased from Beijing Vital River Laboratory Animal Technology Co., Ltd. (Beijing, China).

Results
In datasets GSE134692 and GSE15197, DEGs were identified using Wilcoxon rank-sum tests (both p < 0.05). Among them, 1885 DEGs were commonly identified, and 87% (1640 genes) had identical dysregulation directions (binomial test, p < 1.00E-16). A PPI network with 1623 nodes and 8159 edges was constructed, and 18 hub genes were identified using the Analyze Network plugin in Cytoscape. Of 18 genes, CAV1, PECAM1, BMP4, VEGFA, FYN, SPP1, and COL1A1 were further validated in the GeneCards database and independent dataset GSE24206. ceRNA networks of VEGFA, SPP1, and COL1A1 were constructed. The genes were verified by qPCR in samples of TGF-β1-induced HFL fibroblast cells and pulmonary fibrosis mice. Finally, Sea Buckthorn and Gnaphalium Affine were predicted as potential TCMs for IPF. The TCMs were verified by qPCR in TGF-β1-induced MRC-5 cells.

Conclusion
This analysis strategy may be useful for elucidating novel mechanisms underlying IPF at the transcriptome level. The identified hub genes may play key roles in IPF pathogenesis and therapy.
When theory meets reality- a mismatch in communication: a qualitative study of clinical transition from communication skills training to the surgical ward
Authors: Berglund Leif , von Knorring Johanna , McGrath Aleksandra 
Published: October 2023

Abstract
Background
Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication.

Methods
Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews.

Results
The analysis resulted in a theme ‘When theory meets reality- a mismatch in communication’. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students’ wishes and perceived needs.

Conclusions
We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.
Use of simulation scenarios and vote cards in teaching critical appraisal concepts in evidence-based medicine
Authors: Lin Ashleigh Peng , Chou Yun-Yun , Tam Ka-Wai 
Published: October 2023

Abstract
Background
The most effective method of teaching critical appraisal concepts remains unclear. We used simulation scenarios in a Risk-of-Bias (RoB) 2.0 framework to teach the various biases that may affect randomized controlled trials and assessed whether including this interactive session in an evidence-based medicine (EBM) course for third-year preclinical medical students can optimize their understanding of critical appraisal concepts.

Methods
The session had 13 modules, each corresponding to a particular risk of bias in RoB 2.0. Each module included a simulated scenario, followed by data presentation and a generalized conclusion. The students were subsequently asked to use colored vote cards to indicate whether they agreed, had some concern, or disagreed with the conclusion and to justify their answers. On the basis of the students’ answers, the facilitator debriefed the scenario and addressed the specific bias. In each module, the students were required to demonstrate critical thinking in analyzing the claims and quality of the supporting evidence and in justifying their decisions, thus conceptualizing their understanding of research biases.

Results
We included 306 students across two pilot sessions in spring 2020 and 2021, and the response rate was 97.4%. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging.

Conclusion
Preclinical medical students generally appreciated the inclusion of simulation scenarios and vote cards in an EBM course. The use of vote cards facilitated medical students’ understanding of critical appraisal concepts, uncovered areas that they found challenging to understand, and encouraged their active participation. Such interactive sessions should be increasingly included in medical education.