bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Clinical, Economic, and Health Resource Utilization Impacts of Prefilled Syringes Versus Conventional Medication Administration Methods: Results From a Systematic Literature Review
Authors: Benhamou Dan , Weiss Mia , Borms Matthias , Lucaci Julia , Girgis Haymen , Frolet Cecile , Baisley Wesley T. , Shoushi Gio , Cribbs Kristen A. , Wenk Manuel 
Published: November 2023

Objective: The objective of this systematic review was to assess the clinical, economic, and health resource utilization outcomes associated with the use of prefilled syringes in medication administration compared with traditional preparation methods. Data Sources: We conducted a systematic literature review to evaluate outcomes such as medication errors, wastage, time savings, and contamination in prefilled syringes. Our search encompassed multiple databases, including PubMed and Embase, for studies published between January 1, 2017, and November 1, 2022. Study selection and data extraction: Peer-reviewed publications meeting our inclusion criteria underwent rigorous screening, including title, abstract, and full-text article assessments, performed by two reviewers. Data synthesis: Among reviewed articles, 24 met our eligibility criteria. Selected studies were primarily observational (46%) and conducted in Europe (46%). Our findings indicated that prefilled syringes consistently reduced medication errors (by 10%-73%), adverse events (from 1.1 to 0.275 per 100 administrations), wastage (by up to 80% of drug), and preparation time (from 4.0 to 338.0 seconds) (ranges varied by drug type, setting, and dosage). However, there was limited data on contamination. Economically, prefilled syringes reduced waste and error rates, which may translate into overall savings. Relevance to patient care and clinical practice: This review highlights the value of prefilled syringes, which can streamline medication delivery, save nursing time, and reduce preventable medication errors. Moreover, prefilled syringes have the potential to minimize medication wastage, optimizing resource utilization and efficiency in health care settings. Conclusion and relevance: Our findings provide new insights into clinical and economic benefits of prefilled syringe adoption. These benefits include improved medication delivery and safety, which can lead to time and cost reductions for health care departments, hospitals, and health systems. However, further real-world research on clinical and economic outcomes, especially in contamination, is needed to better understand the benefits of prefilled syringes.
Evaluating a new supported employment internship programme for autistic young adults without intellectual disability
Authors: Ashworth Maria , Heasman Brett , Crane Laura , Remington Anna 
Published: November 2023

Supported employment initiatives have been shown to increase employment rates for autistic people who want to enter the workforce. Despite the success of supported employment initiatives in increasing employment rates, little is known about the first-hand experiences and views of those involved. In the current study, we examined the experiences and views of autistic young adults without intellectual disability (‘interns’), employers and parents regarding a previously unevaluated paid internship scheme that offers tailored support for interns and employers before, during and after the internship, the Employ Autism network. In total, 51 participants (19 interns, 22 employers, 10 parents), across eight internships, engaged in semi-structured interviews. Reflexive thematic analysis was used to identify three themes, shared across participant groups: (1) the internship was ‘an invaluable experience’, (2) the internship helped break down autism-specific barriers to employment and (3) stakeholder groups had some unmet expectations. Drawing on this multi-informant qualitative evaluation of a novel supported employment scheme, we derive recommendations of best practice for supported employment initiatives for autistic young adults without intellectual disability. Lay abstract Internships designed for autistic people can help them to find employment, but there is little research about the experiences of those involved with internship schemes. To learn more about a new paid internship scheme in the United Kingdom, the Employ Autism network, we interviewed 19 interns, who were autistic young adults without intellectual disability taking part in one of eight different internships. We also interviewed 22 employers (who worked with the interns), and 10 parents (who supported their children in the internship). The interns, employers and parents told us that the Employ Autism network was a valuable experience that helped the interns become more confident. Also, the parents said it helped the interns become more independent. All the groups said the Employ Autism network removed common barriers to employment, and interns and parents said it would help interns get a job in future. Employers and interns said they understood each other better during the internship, and employers said the internship made them think about how their organisations might have accidentally had barriers in place that could stop autistic people getting employed (barriers that they wanted to address in future). However, all groups said some expectations of the internship were not met. These findings suggest the Employ Autism network is helpful for autistic young adults without intellectual disability and employers, but that there are ways that the internships could be improved in future. We discuss the lessons we can learn from the Employ Autism network that might help others who are thinking about setting up, or getting involved in, similar internship schemes.
Intraoperative Bivalirudin Use in Patient Undergoing Femoral Endarterectomy with Heparin-Induced Thrombocytopenia: Case Report and Review of the Literature
Authors: Haffler Zachary J. , Hughes Travis G. , Yeager Lauren S. 
Published: November 2023

Purpose To describe the intraoperative use of bivalirudin during lower extremity revascularization in the setting of heparin-induced thrombocytopenia (HIT). Case Summary A 65 year-old man presented with left common iliac, external iliac, and femoral artery occlusion necessitating revascularization with left femoral endarterectomy and common and external iliac stent angioplasty. Three months before the femoral endarterectomy, the patient was hospitalized for a coronary artery bypass procedure. During this admission, the patient tested positive for the presence of heparin-PF4 antibody complexes. With the patient’s recent history of HIT, bivalirudin was selected as the optimal agent for intraoperative anticoagulation. Bivalirudin was administered as a 50 mg bolus, followed by a continuous infusion initiated at 1.75 mg/kg/hr. Repeated bivalirudin boluses were necessary to maintain an activated clotting time (ACT) necessary for the revascularization procedures and recurrent subacute thrombi despite appropriate ACT values. Discussion Bivalirudin has been utilized for cardiopulmonary bypass and carotid endarterectomy (CEA), but data for dosing in lower extremity revascularization are lacking. As the risk for thrombosis with HIT continues for months after diagnosis, it is important to elucidate optimal dosing of non-heparin anticoagulant options, such as the direct thrombin inhibitor, bivalirudin. The absence of validated dosing strategies for bivalirudin can result in prolonged operative times, increased risk of bleeding, and inadequate anticoagulation. Conclusion Bivalirudin is an appropriate agent for intraoperative anticoagulation in lower extremity revascularization. However, further investigation into the optimal intraoperative bivalirudin dosing regimen is necessary.
Evaluation of the impact of redeployment during the COVID-19 pandemic: results from a multi-centre survey
Authors: Taylor Rachel M , Hughes Luke , Fern Lorna A , Hogg Julie , Petrella Anika 
Published: November 2023

Background: The COVID-19 pandemic brought unprecedented upheaval for healthcare systems globally. Rapid changes in the way nurses were asked to work brought about many challenges, especially with the requirement for nurses to move into intensive care and high dependency areas to deliver care for the increasing number of critically ill patients. Aim: The purpose of this evaluation was to assess the impact of these changes on nurses who were redeployed during the first acute phase of the pandemic and explore factors associated with burnout. Methods: A redeployment survey, containing 42 items in four domains (preparation for redeployment, safety and support, perceived competence, reflections and emotional impact) was administered online to nurses who had been redeployed in two hospitals in England, one urban and one rural. Bivariate correlations and a multiple linear regression model were conducted to explore associations between perceptions of leadership, training, communication and feeling valued with levels of emotional exhaustion. Results: Valid responses were received from 240/618 (39%) nurses. The majority of respondents felt it was their duty to work where they were asked (79%), were prepared to work where needed (72%) and were consulted on changes to their working hours (55%). However, nurses were nervous about the new role (75%) and felt they had a lack of choice regarding redeployment (66%) and the way it was implemented (50%). Multiple regression analysis showed that lack of training (β = 0.18) and feeling undervalued (β = 0.48) was positively associated with emotional exhaustion, which accounted for 38% of the variance among redeployed nurses. Conclusions: To mitigate the risk of nurses developing burnout as a result of redeployment, there is a need for training to upskill them so they feel competent in doing the changed role. Additionally, nursing leadership needs to support nurses feeling valued as individuals in their role.
Return to Sports Activity After Reverse Total Shoulder Arthroplasty
Authors: Kim Hyun Gon , Kim Seung-Ho , Kim Su Cheol , Park Jong Hun , Kim Jae Soo , Kim Bo Taek , Lee Sang Min , Yoo Jae Chul 
Published: November 2023

Background: There are little published data on return to sports (RTS) after reverse total shoulder arthroplasty (RTSA). Purpose: To (1) determine the rate and timing of RTS after RTSA in an Asian population, (2) analyze predictive factors for RTS, and (3) determine the relationship between RTS after RTSA and clinical/radiological outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was performed on consecutive patients with diagnosis of irreparable rotator cuff tear (RCT), cuff tear arthropathy (CTA), or degenerative osteoarthritis who underwent RTSA between May 2017 and May 2020. Included were patients who played sports preoperatively in ≤3 years and had ≥2-year follow-up. Patients were divided into 2 groups based on responses to a telephone survey about RTS after RTSA: those who returned to sports (group A) and those who did not (group B). Patient characteristics, pre- and postoperative clinical features and functional scores, and radiologic outcomes (acromial fracture, scapular notching, heterotopic ossification, and loosening of humeral and glenoid component) were compared between the groups. Results: Of 59 eligible patients, 44 patients (28 in group A, 16 in group B) were included. The RTS rate after RTSA was 63.6%, and the mean RTS time was 9.1 months (range, 3-36 months). There was a significant group difference in body mass index (BMI) (group A, 24.3 ± 2.1; group B, 27.1 ± 4.4; P = .01) and preoperative diagnosis (CTA/irreparable RCT/degenerative osteoarthritis diagnoses: group A, 13/12/3; group B, 3/6/7; P = .03). Patients in group A showed significantly higher forward flexion ( P = .03) and higher Simple Shoulder Test score ( P = .02) than group B at final clinical follow-up. No significant difference in radiological outcomes was found between the groups. Conclusion: Patients with a low BMI and those diagnosed with CTA or irreparable RCT were found to have better RTS rates after undergoing RTSA, and forward flexion and Simple Shoulder Test scores at final follow-up were significantly higher in the RTS group, with no significant differences in complications.
Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability
Authors: Delgado Cristina , Luengo-Alonso Gonzalo , Valencia Maria , Martínez-Catalán Natalia , Calvo Emilio 
Published: November 2023

Background: The glenoid track concept is now widely accepted, and its evaluation is considered essential for making decisions about surgery. Purpose: To define preoperative descriptive data and clinical and functional features in patients with anterior glenohumeral instability according to glenoid track status and to analyze the influence of off-track Hill-Sachs (HS) lesions on preoperative shoulder function. Study Design: Case-control study; Level of evidence, 3. Methods: Preoperative magnetic resonance imaging or computed tomography scans were used to measure the glenoid track. Descriptive data and preoperative objective and subjective clinical and functional features were compared between patients with on-track HS lesions versus off-track HS lesions. Multivariate regression analysis was conducted to identify potential risk factors for off-track HS lesion development. Results: A total of 235 patients (201 men, 34 women; mean age, 29.6 ± 8.6 years) were included— 134 shoulders (57%) with on-track HS lesions and 101 shoulders (43%) with off-track HS lesions. Age <20 years at first dislocation, number of dislocations, and ≥2 years between first dislocation and surgery were significantly different between the study groups ( P = .005, P = .0001, and P = .01, respectively). Regarding these characteristics, the odds ratios for the risk of developing an off-track lesion were 2.67 (95% CI, 1.2-5.99)—1.2 times higher for each additional instability episode (95% CI, 1.025-1.14) and 2.42 times higher (95% CI, 1.176-4.608) for patients whose first dislocation was ≥2 years before surgery, respectively. Patients with off-track HS lesions had a significantly greater degree of instability ( P = .04), worse Rowe scores (48.8 ± 15.3 vs 54.8 ± 28.3 for on-track HS lesions; P = .04), and lower Western Ontario Shoulder Instability scores (975 ± 454 vs 1179 ± 428 for on-track HS lesions; P = .01). Conclusion: Characteristics related to a history of instability (age <20 years at first instability episode, larger number of dislocations, ≥2 years between first dislocation and surgery) were found to be risk factors for the development of an off-track HS lesion in this study. Off-track lesions led to a higher degree of instability and worse objective and subjective preoperative shoulder function versus on-track HS lesions.
U-shaped association between serum Klotho and accelerated aging among the middle-aged and elderly US population: a cross-sectional study
Authors: Li Heng , Miao Shuai , Zhang Min , Zhang Peng , Li Yan-Bin , Duan Rui-Sheng 
Published: November 2023

Abstract
Background
Phenotypic age acceleration, which reflects the difference between phenotypic age and chronological age, is an assessment to measure accelerated aging. Klotho is a protein related to slower aging, but its association with accelerated aging remains unclear.

Methods
Based on data from the 2007–2010 National Health and Nutrition Examination Survey, phenotypic age was calculated using chronological age and 9 aging-related biomarkers. A total of 4388 participants aged 40 to 79 years with measured serum Klotho and calculated phenotypic age were enrolled. The association between serum Klotho and phenotypic age acceleration was estimated using multivariable linear regression models. The possible nonlinear relationship was examined with smooth curve fitting. We also conducted a segmented regression model to examine the threshold effect.

Results
The association between serum Klotho and phenotypic age acceleration followed a U-shaped curve (p for nonlinearity < 0.001), with the inflection point at 870.7 pg/ml. The phenotypic age acceleration significantly decreased with the increment of serum Klotho (per SD increment: β -1.77; 95% CI, -2.57 ~ -0.98) in participants with serum Klotho < 870.7 pg/ml, and increased with the increment of serum Klotho (per SD increment:β, 1.03; 95% CI: 0.53 ~ 1.54) in participants with serum Klotho ≥ 870.7 pg/ml.

Conclusion
There was a U-shaped association between serum Klotho and accelerated aging among the middle-aged and elderly US population.
Accuracy of biomicroscopy, ultrasonography and spectral-domain OCT in detection of complete posterior vitreous detachment
Authors: Zvorničanin Jasmin , Zvorničanin Edita , Popović Maja 
Published: November 2023

Abstract
Background
To evaluate the accuracy of preoperative biomicroscopy (BM), ultrasonography (US), and spectral domain optical coherence tomography (SD-OCT) to determine complete posterior vitreous detachment (PVD) confirmed by intraoperative findings of triamcinolone acetonide-assisted pars plana vitrectomy (PPV).

Methods
This prospective study included all consecutive patients admitted for surgical treatment of the epiretinal membrane (ERM) and macular hole (MH). The presence of complete PVD was determined one day before PPV using BM, US, SD-OCT. The preoperative findings were compared to the PVD status determined during PPV.

Results
A total of 123 eyes from 123 patients were included in the study. Indications for PPV included ERM in 57 (46.3%), full thickness macular hole in 57 (46.3%) and lamellar macular hole in 9 (7.3%) patients. Complete PVD during PPV was observed in 18 (31.6%; 95%CI:18.7–49.9) patients with ERM and 13 (19.7%; 95%CI:10.4–33.7) patients with MH. The sensitivity of preoperative BM, US, SD-OCT was 48.4% (95%CI:30.2–66.9), 61.3% (95%CI:42.2–78.2) and 54.8% (95%CI:36.0–72.7) respectively. The specificity of preoperative BM, US, SD-OCT was 81.5% (95%CI:72.1–88.9), 90.2% (95%CI:82.2–95.4) and 85.9% (95%CI:77.0–92.3) respectively. With a prevalence of 25.2% of PVD in our sample the positive predictive value of preoperative BM, US, SD-OCT was 46.9% (95%CI:29.1–65.3), 67.9% (95%CI:47.6–84.1) and 56.7% (95%CI:37.4–74.5) respectively.

Conclusion
Preoperative BM, US, and SD-OCT showed relatively low sensitivity but also good specificity in assessing complete PVD. A combination of all three diagnostic methods can provide a good assessment of the vitreoretinal interface state.
Clinical characteristics and management of autoimmune enteropathy in children: case reports and literature review
Authors: Jin Meng , Gong Youzhe , Liu Wenwen , Zhong Xuemei 
Published: November 2023

Summary
Background
Autoimmune enteropathy (AIE) defined by intractable diarrhoea and nonceliac enteropathy with villous atrophy, is a rare digestive disease. Case reports of this disease are sporadic and the clinical characteristics of AIE is seldom discussed.

Purpose
We evaluate the clinical, laboratory, histopathological features, response to therapy and outcome of AIE in children.

Method
We conducted a retrospective analysis of five children with AIE in our hospital. A comprehensive search of MEDLINE was performed using PubMed, through keywords of “autoimmune enteropathy, pediatric or children”. The clinical manifestations, endoscopic results, pathological results, and medication therapy of these children were collected and the cases were divided into two groups, infants (≤ 1 year old) and children (> 1 year old).

Results
Five cases treated in our department: one case took eight years to make the final diagnosis; one case was positive for anti-intestinal epithelial cell (AE) antibody; three cases showed crypt apoptosis in histopathology; and two cases showed celiac-like changes. All cases were responsive to glucocorticoid therapy in the early stage of treatment, while three cases required immunosuppressant maintenance. After reviewing the literature, we performed a statistical analysis of 50 cases with a male-to-female ratio of 31:19. Among them, 35 patients (70%) were within 1 year of age, and their clinical manifestations were mainly watery stool (43 cases, 86%), weight loss (28 cases, 56%), abdominal distension (3 cases, 6%), serum AE or anti-goblet cell (AG) antibody positivity (32 cases, 64%), other immune-related antibodies (21 cases, 42%), gene mutations (9 cases, 18%), and family history (21 cases, 42%). All the children showed different degrees of intestinal villous atrophy. Thirty-seven (74%) of the children were treated early, and their clinical symptoms were relieved. Comparing the cases between different age groups, it was found that the mortality rate of children with onset in infancy was higher (P < 0.05), and there was no difference in other autoimmune diseases, AE antibody positivity rates, and other antibodies between the two groups. In addition to survival rate between different age group (P = 0. 005), there was no difference in sex, autoantibody positivity rate, single gene mutation, or family history between the two groups (P > 0.05) through analysis of mortality and clinical remission cases.

Conclusion
Endoscopic examination and mucosal pathological examination should be performed to diagnose AIE in children with watery stool and weight loss who fail to be treated with diet therapy. Immunotherapy is the core of medical management of AIE and can improve prognosis. Children with a poor prognosis in infancy should be actively treated to reduce mortality rates associated with AIE.
Relationship of sleep-quality and social-anxiety in patients with breast cancer: a network analysis
Authors: He Chunyan , He Yang , Yang Tianqi , Wu Chao , Lin Yawei , Yan Jiaran , Chang Wei , Chang Fenxia , Wang Yameng , Wu Shengjun , Cao Baohua 
Published: November 2023

AbstractBackgroundThere is a complex relationship between social anxiety and sleep quality. However, network analysis studies of associations between social anxiety and sleep quality are lacking, particularly among patients with breast cancer. The current study aimed to extend this research to a sample of patients with breast cancer and to examine symptom-level associations between social anxiety and sleep quality using network analysis.MethodsNetwork analysis was conducted to explore their associations and identify bridge items of social anxiety and sleep quality.ResultsThe network structure revealed 9 important edges between social anxiety and sleep quality. “Subjective sleep quality” had the highest EI value in the network. “Working difficulty under watching” and “Sleep disorders” had the highest BEI values in their own communities.ConclusionThere are complex pathological correlation pathways between social anxiety and sleep quality in breast cancer patients. “Subjective sleep quality”, “Working difficulty under watching” and “Sleep disorders” have the potential to be intervention targets for sleep disorder-social anxiety comorbidity. Medical staff can take corresponding interventions according to the the centrality indices and bridge centrality indicators identified in this study, which is likely to effectively reduce the comorbidity of sleep disorders and social anxiety.