bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Aging Care 5Ms Competencies: A Modified Delphi Study to Revise Medical Student Competencies for the Care of Older Adults
Authors: Yogaparan Thirumagal , Burrell Alishya , Talbot-Hamon Catherine , Sadowski Cheryl A. , Grief Cindy , MacDonald Elizabeth , Thain Jenny , Ng Karen A. , Khoury Lara , Moran Martin , Feldman Sid , Lustgarten Sylvia , Bach Tammy V. 
Published: February 2024

Abstract

Purpose
To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process.

Method
The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation.

Results
Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%–93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%–97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%–95%.

Conclusions
The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties.
A Case Series of Patients With Complex Airway Disease and Large Thyroid Tumors Anterior to the Trachea Precluding Tracheostomy
Authors: Imran Saira , Chen Leon L. , Rausen Michelle , Morris Luc G.T. , Patel Snehal , Halpern Neil A. 
Published: February 2024

BACKGROUND:
This case series explores the management of respiratory failure in patients with large anterior tracheal thyroid tumors where tracheostomy is not an option. To our knowledge, this study is the first to address the challenges associated with caring for such patients.

CASE SUMMARY:
We present the clinical courses of four intubated adults with advanced thyroid cancer and complex airway issues that preclude surgical tracheostomy. Interventions included custom airway stents, long-term intubation, and oncological therapies. Ethical quandaries around patient autonomy and capacity emerged, exacerbated by the absence of viable exit strategies for prolonged intubation, notably the performance of a tracheostomy, causing emotional distress in patients, families, and staff.

CONCLUSIONS:
This study showcases the multifaceted challenges in medical, ethical, and emotional domains associated with managing intubated patients with complex disease precluding tracheotomies. We advocate for a nuanced, multidisciplinary, and personalized approach to confront unique issues in airway management, ethical considerations, and disposition.
Liver Elastography in Acute Liver Failure: A Pilot Study
Authors: Trovato Francesca M. , Artru Florent , Miquel Rosa , Pirani Tasneem , McPhail Mark J.W. 
Published: February 2024

OBJECTIVES:
We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF).

DESIGN:
Observational study.

SETTING:
ALF is a rare, life-threatening disease that requires intensive care admission and often liver transplant, where the accurate selection of patients is crucial. Liver elastography is a noninvasive tool that can measure hepatic stiffness, but previous results have been inconclusive in ALF.

PATIENTS:
Patients admitted between October 2021 and March 2023 to the Liver Intensive Therapy Unit at King’s College Hospital with ALF were recruited, with healthy control (HC) individuals and acute-on-chronic liver failure (ACLF) used as controls.

INTERVENTION:
None.

MEASUREMENTS:
Average shear wave velocity was recorded with ElastPQ on the right and left liver lobes and the spleen. Portal vein flow, hepatic artery resistive index, and peak systolic velocity were also recorded. Physiologic and histologic data were used for comparison.

MAIN RESULTS:
Forty patients with ALF, 22 patients with ACLF, and 9 HC individuals were included in the study. At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.6 ± 2 kPa), ALF (31.7 ± 17 kPa), and ACLF (76.3 ± 71 kPa) patients (ALF vs. ACLF, p = 0.0301). Spleen size and stiffness discriminated between ALF (10.4 ± 2 cm and 21.4 ± 16.6 kPa) and ACLF (14 ± 2.3 cm and 42.6 ± 26 kPa). At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM.

CONCLUSIONS:
In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.
Assessing Fuchs Corneal Endothelial Dystrophy Using Artificial Intelligence–Derived Morphometric Parameters From Specular Microscopy Images
Authors: Prada Angelica M. , Quintero Fernando , Mendoza Kevin , Galvis Virgilio , Tello Alejandro , Romero Lenny A. , Marrugo Andres G. 
Published: February 2024

Purpose:
The aim of this study was to evaluate the efficacy of artificial intelligence–derived morphometric parameters in characterizing Fuchs corneal endothelial dystrophy (FECD) from specular microscopy images.

Methods:
This cross-sectional study recruited patients diagnosed with FECD, who underwent ophthalmologic evaluations, including slit-lamp examinations and corneal endothelial assessments using specular microscopy. The modified Krachmer grading scale was used for clinical FECD classification. The images were processed using a convolutional neural network for segmentation and morphometric parameter estimation, including effective endothelial cell density, guttae area ratio, coefficient of variation of size, and hexagonality. A mixed-effects model was used to assess relationships between the FECD clinical classification and measured parameters.

Results:
Of 52 patients (104 eyes) recruited, 76 eyes were analyzed because of the exclusion of 26 eyes for poor quality retroillumination photographs. The study revealed significant discrepancies between artificial intelligence–based and built-in microscope software cell density measurements (1322 ± 489 cells/mm2 vs. 2216 ± 509 cells/mm2, P < 0.001). In the central region, guttae area ratio showed the strongest correlation with modified Krachmer grades (0.60, P < 0.001). In peripheral areas, only guttae area ratio in the inferior region exhibited a marginally significant positive correlation (0.29, P < 0.05).

Conclusions:
This study confirms the utility of CNNs for precise FECD evaluation through specular microscopy. Guttae area ratio emerges as a compelling morphometric parameter aligning closely with modified Krachmer clinical grading. These findings set the stage for future large-scale studies, with potential applications in the assessment of irreversible corneal edema risk after phacoemulsification in FECD patients, as well as in monitoring novel FECD therapies.
Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain
Authors: Burns John W. , Gerhart James , Smith David A. , Porter Laura , Rye Bonny , Keefe Francis 
Published: February 2024

Abstract
People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances—even when not opioid-based—can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
Bilateral deficiency of Meissner corpuscles and papillary microvessels in patients with acute complex regional pain syndrome
Authors: Mehling Katharina , Becker Juliane , Chen Jeremy , Scriba Sabrina , Kindl Gudrun , Jakubietz Rafael , Sommer Claudia , Hartmannsberger Beate , Rittner Heike L. 
Published: February 2024

Abstract
Complex regional pain syndrome (CRPS) presents postinjury with disproportionate pain and neuropathic, autonomic, motor symptoms, and skin texture affection. However, the origin of these multiplex changes is unclear. Skin biopsies offer a window to analyze the somatosensory and vascular system as well as skin trophicity with their protecting barriers. In previous studies, barrier-protective exosomal microRNAs were altered in CRPS. We here postulated that tissue architecture and barrier proteins are already altered at the beginning of CRPS. We analyzed ipsilateral and contralateral skin biopsies of 20 fully phenotyped early CRPS patients compared with 20 age- and sex-matched healthy controls. We established several automated unbiased methods to comprehensively analyze microvessels and somatosensory receptors as well as barrier proteins, including claudin-1, claudin-5, and claudin-19. Meissner corpuscles in the skin were bilaterally reduced in acute CRPS patients with some of them lacking these completely. The number of Merkel cells and the intraepidermal nerve fiber density were not different between the groups. Dermal papillary microvessels were bilaterally less abundant in CRPS, especially in patients with allodynia. Barrier proteins in keratinocytes, perineurium of dermal nerves, Schwann cells, and papillary microvessels were not affected in early CRPS. Bilateral changes in the tissue architecture in early CRPS might indicate a predisposition for CRPS that manifests after injury. Further studies should evaluate whether these changes might be used to identify risk patients for CRPS after trauma and as biomarkers for outcome.
Inability to Access Needed Medical Care Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees
Authors: Nguyen Kevin H. , Oronce Carlos Irwin A. , Adia Alexander C. , Yeh Jih-Cheng , Ponce Ninez 
Published: February 2024

We examined self-reported inability to access to needed medical care and reasons for not accessing medical care among US-representative adult Medicaid enrollees, disaggregated across 10 Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Chinese (−4.54 percentage points [PP], P < .001), Other Asian (−4.42 PP, P < .001), and Native Hawaiian (−4.36 PP, P < .001) enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason reported was that a health plan would not approve, cover, or pay for care. Mitigating inequities may require different interventions specific to certain ethnic groups.
Effects of kidney tonic herbs for primary osteoporosis: A systematic review and meta-analysis
Authors: Li Wei , Ye Baisheng , Huang Zhen , Zhou Hang , Feng Jie , Chen Qi , Huang Hai , Meng Shilong , Qie Fengqing , Shi Xiaolin 
Published: February 2024

Background:
Primary osteoporosis (POP) is one of the most common orthopedic conditions with a high risk of fractures. Effective treatment of POP is crucial for reducing disability rates and improving quality of life. Kidney tonic therapy is a classical traditional Chinese medicine approach for treating POP. This study aims to provide a comprehensive and reliable assessment of the clinical evidence of kidney tonic herbs (KTH) in treating POP patients.

Methods:
An extensive literature search was conducted in 8 electronic databases from their inception through September 30, 2022, to evaluate the efficacy and safety of KTH for POP. We included 43 randomized controlled trials with 4349 participants. The qualified studies will be chosen and evaluated separately by 2 researchers. The primary outcome measure was bone mineral density (BMD) of lumbar. RevMan 5.3 and Stata 16 were used to carry out the meta-analyses.

Results:
Our meta-analysis showed 29 studies with significantly increased lumbar BMD (mean difference [MD] = 0.06; 95% confidence interval [CI]; I
2 = 98%, P = .003), 18 studies with noticeably higher femoral neck BMD (MD = 0.08; 95% CI; I
2 = 98%, P = .0005), 6 studies with significantly increased femoral trochanter BMD (MD = 0.10; 95% CI; I
2 = 97%, P = .002), 4 studies with noticeably higher ward’s triangle BMD (MD = 0.13; 95% CI; I
2 = 100%, P = .04), and 3 studies with noticeably higher distal radius BMD (MD = 0.06; 95% CI; I
2 = 86%, P = .009). One study showed 12 falls and 8 fallers in the intervention group, 28 falls and 17 fallers in the control group at 36 months. 3 studies showed a significant difference in fracture incidence between the intervention group and the control group (95% CI: 0.15-0.81; I
2 = 0%, P = .01). Additionally, the meta-analysis demonstrated that KTH offered superior pain relief (8 trials, n = 980; 95% CI: −1.05 to −0.74; I
2 = 94%, P < .00001). Besides, KTH found no serious harmful effects.

Discussion:
KTH may increase BMD and decrease the likelihood of fractures in POP patients. However, further research is necessary to investigate the effectiveness of KTH in reducing falls and fractures.
Hot spots and trends in PCI prognostic research: A bibliometric analysis with CiteSpace
Authors: Guo Shuli , Luo Xiandao , Huang Liu , Wang Changmin , Yang Yining , Yang Lei 
Published: February 2024

Background:The number of patients undergoing percutaneous coronary intervention (PCI) procedures is increasing along with the number of studies involving guidelines, prognostic assessments, and cardiac rehabilitation related to PCI strategies. However, fewer studies have reported the mapping of knowledge structure and hotspot analysis in this field. Our goal was to discuss and analyze the current status, hot spots and developmental trends associated with research into the prognosis of patients undergoing PCI, and to provide reference for PCI-related research.Methods:The Web of Science Core Collection and China Knowledge Network were searched for relevant literature from January 2003 to October 2022, and CiteSpace 6.1. R3 software was used to analyze the co-occurrence, clustering, and emerging authors, institutions, and keywords.Results:A total of 2666 English and 2010 Chinese publications were included. The number of publications showed a growing trend. The author with the maximum number of articles was Xu Bo. The institutions with high productivity were Peking Union Medical College and Capital Medical University. Although the number of Chinese articles was high, the cooperation between institutions was low and the impact was small. The results of the analysis suggest a shift in the focus of keywords from coronary artery disease and PCI to studies involving the assessment and intervention of risk factors associated with poor prognosis of PCI. Traditional Chinese Medicine and anxiety represent the emerging direction of PCI prognosis. The assessment of major adverse cardiovascular events and cardiac rehabilitation require careful analysis in post-PCI research.Conclusion:The findings of this bibliometric study present a comprehensive and systematic overview of the PCI prognosis, based on the analysis of the current status and trends in research, which may facilitate the identification of hot topics and new directions for future research.
The predictive value of infrared thermal imaging (IRT) for peripheral artery disease: A systematic review
Authors: Djajakusumah Teguh Marfen , Candrawinata Valeska Siulinda , Ho Jackie Pei , Herman Herry , Lukman Kiki , Lesmana Ronny 
Published: February 2024

Background:
Medical infrared thermal imaging (IRT) has been applied to research blood flow, breast cancer detection, and human body muscle performance. The benefits of IRT include the fact that it is noninvasive, quick, dependable, non-contact, capable of creating several recordings in a short period of time, and secure for both patients and medical professionals. We aimed to determine the predictive value of IRT for identifying and evaluating any interventional procedure in patients affected by peripheral artery disease (PAD) of any severity.

Methods:
We searched the Cochrane Library, EMBASE, and PubMed on the topic of IRT and PAD until January 20,2023. We excluded gray literature as it is lacking credibility for not undergoing a peer-reviewed process. The search strategy includes the medical topic headings for “infrared thermal imaging” and “peripheral vascular disorders.” The primary outcome of this systematic review was the variation in tissue perfusion in PAD patients. Each technique’s technical characteristics and therapeutic use within PAD must be described in each included study.

Results:
This systematic review included 2 case reports and 3 observational studies. By comparing the temperatures of PAD patients hands, legs, and feet, IRT might prove to be an unduly valuable tool for treating vascular illnesses, especially in light of the knowledge gained from the temperature distribution maps.

Conclusion:
This noninvasive method demonstrated encouraging results in the detection of various areas of foot perfusion and the screening of PAD, and it gave good findings in gauging the effects of any type of intervention.
Network meta-analysis of 7 acupuncture therapies for knee osteoarthritis
Authors: Ma Weiwei , Zhang Chao Yang , Huang Xin , Cheng Wei 
Published: February 2024

Objective:
With the progression of society aging demographic, the prevalence of knee osteoarthritis (KOA) continues to rise steadily, exerting a significant impact on individuals’ quality of life. Acupuncture therapy has garnered extensive utilization in the management of osteoarthritis; however, a comprehensive systematic review integrating acupuncture with traditional Chinese medicine remains absent. This study compared the clinical efficacy of 7 acupuncture methods (electroacupuncture, conventional acupuncture, warm needle, floating needle, fire needle, needle knife, and silver needle) for the treatment of KOA through a network meta-analysis.

Methods:
This study examined the databases—PubMed, EMbase, The Cochrane Library, the China Biology Medicine, Chinese Journal Full-text Database, Wanfang Database, and VIP Database—for randomized controlled trials of the 7 methods for KOA treatment. The search time spanned from the database establishment to March 5, 2022. The primary outcome indicator was the total effective rate, and the secondary outcome indicator was the visual analog scale. After the layer-by-layer screening, the quality of the literature was assessed using the Cochrane systematic reviewer manual 5.1.0 bias risk assessment tool for randomized controlled trials. After data extraction, the R4.0.1 software was used for network meta-analysis.

Results:
Based on the network meta-analysis, the ranking of interventions based on the surface under the cumulative ranking curve for the total effective rate is as follows: silver needle (0.99) > floating needle (0.97) > needle knife (0.66) > fire needle (0.56) > warm needle (0.44) > conventional acupuncture (0.35) > electroacupuncture (0.13). Regarding the improvement in visual analog scale scores, the surface under the cumulative ranking curve ranking is as follows: silver needle (0.97) > conventional acupuncture (0.67) > needle knife (0.64) > floating needle (0.51) > warm needle (0.44) > fire needle (0.14) > electroacupuncture (0.09).

Conclusion:
Based on the network meta-analysis, silver needle therapy emerged as the most efficacious and analgesic intervention for KOA. Nevertheless, given the notable variations in the quality and quantity of studies encompassing diverse treatment modalities, the findings of this research necessitate further substantiation through forthcoming high-quality multicenter, large-sample, randomized double-blind trials.