bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Nurse Practitioners Deliver? A Retrospective Self-audit Comparing Nurse Practitioner Care for People With HIV in Australia to Screening and Monitoring Guidelines
Authors: Woodward Shannon , Tilley Donna , Spinks Adam , Thompson El , Collins Danielle 
Published: February 2025

Abstract
In Australia, nurse practitioners (NPs) provide care to people with HIV (PWH) in hospital and community settings. We describe a national audit evaluating NP care for PWH, assessing adherence to 2 HIV monitoring guidelines. Five NPs conducted a retrospective case note self-audit. Deidentified data were collected, pooled, and analyzed using Microsoft Excel and compared with HIV monitoring guideline targets. The review was undertaken for 212 NP patients, the majority being cisgendered men (86%), ages 45–49 years, identifying as gay (65%). The majority (95%) of PWH were on an appropriate HIV treatment, meeting the United Nations Programme on HIV/AIDS target of 95%. HIV viral load testing was current for 211 (99%) individuals. Of 138 individuals eligible for cardiovascular screening, 84 (60%) were screened, below a guideline target of 90%. Compliance with HIV monitoring guidelines exceeded targets in most areas. Our audit demonstrates that NPs provide effective and guideline compliant HIV care to PWH in Australia.
ChatGPT’s role in alleviating anxiety in total knee arthroplasty consent process: a randomized controlled trial pilot study
Authors: Gan Wenyi , Ouyang Jianfeng , She Guorong , Xue Zhaowen , Zhu Lingxuan , Lin Anqi , Mou Weiming , Jiang Aimin , Qi Chang , Cheng Quan , Luo Peng , Li Hua , Zheng Xiaofei 
Published: February 2025

Background:
Recent advancements in artificial intelligence (AI) like ChatGPT have expanded possibilities for patient education, yet its impact on perioperative anxiety in total knee arthroplasty (TKA) patients remains unexplored.

Methods:
In this single-blind, randomized controlled pilot study from April to July 2023, 60 patients were randomly allocated using sealed envelopes to either ChatGPT-assisted or traditional surgeon-led informed consent groups. In the ChatGPT group, physicians used ChatGPT 4.0 to provide standardized, comprehensive responses to patient queries during the consent process, while maintaining their role in interpreting and contextualizing the information. Outcomes were measured using Hospital Anxiety and Depression Scales (HADS), Perioperative Apprehension Scale-7 (PAS-7), Visual Analogue Scales for Anxiety and Pain (VAS-A, VAS-P), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and satisfaction questionnaires.

Results:
Of 55 patients completing the study, the ChatGPT group showed significantly lower anxiety scores after informed consent (HADS-A: 10.48 ± 3.84 vs 12.75 ± 4.12, P = .04, Power = .67; PAS-7: 12.44 ± 3.70 vs 14.64 ± 2.11, P = .01, Power = .85; VAS-A: 5.40 ± 1.89 vs 6.71 ± 2.27, P = .02, Power = .75) and on the fifth postoperative day (HADS-A: 8.33 ± 3.20 vs 10.71 ± 3.83, P = .01, Power = .79; VAS-A: 3.41 ± 1.58 vs 4.64 ± 1.70, P = .008, Power = .85). The ChatGPT group also reported higher satisfaction with preoperative education (4.22 ± 0.51 vs 3.43 ± 0.84, P<.001, Power = .99) and overall hospitalization experience (4.11 ± 0.65 vs 3.46 ± 0.69, P = .001, Power = .97). No significant differences were found in depression scores, knee function, or pain levels.

Conclusions:
ChatGPT-assisted informed consent effectively reduced perioperative anxiety and improved patient satisfaction in TKA patients. While these preliminary findings are promising, larger studies are needed to validate these results and explore broader applications of AI in preoperative patient education.
Daily physical activity habits influence surgeons’ stress in the operating room: a prospective cohort study
Authors: Skinner Sarah C , Awtry Jake A. , Pascal Léa , Polazzi Stéphanie , Lifante Jean-Christophe , Duclos Antoine 
Published: February 2025

Background:
Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons’ physical activity habits and their stress, assessed as heart rate variability, at the start of surgery.

Materials and methods:
This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons.

Results:
We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42–55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Senior surgeons presented lower lnRMSSD (−0.437, −0.749 to −0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (−0.337, −0.646 to −0.027, P = 0.033), compared to their counterparts.

Conclusions:
Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons’ stress in the operating room.
Intra- and early postoperative predictors of delirium risk in cardiac surgery: results from the prospective observational FINDERI study
Authors: Itting Paul T. , Sadlonova Monika , Santander Manuel J. , Knierim Maria , Derad Carlotta , Asendorf Thomas , Celano Christopher M. , Hansen Niels , Esselmann Hermann , Heinemann Stephanie , Eberhard Charlotte , Hoteit Melanie , Schröder Mirjam F. , Kutschka Ingo , Wiltfang Jens , von Arnim Christine A.F. , Baraki Hassina 
Published: February 2025

Background:
Postoperative delirium (POD) is a severe complication following cardiac surgery and is associated with increased morbidity and mortality. The impact of intra- and early postoperative factors on the occurrence of POD following cardiac surgery remains controversial. To close this gap, we investigated intra- and early postoperative factors and their predictive values for POD.

Methods:
We performed a prospective observational study that aimed to FIND DElirium RIsk factors (FINDERI) for patients undergoing elective cardiac surgery. POD was assessed using the Confusion Assessment Method (CAM) algorithm. Intra- and early postoperative factors were extracted from electronic medical records and reviewed by cardiac surgeons. To identify potential predictors of POD, we used univariate and multivariate logistic regression along with machine learning (ML) with tenfold cross-validation.

Results:
In our study cohort of 490 patients, 106 screened positive for POD (21.6%). In the multivariate analysis, we found a positive association between POD occurrence and age (p<0.001), duration of surgery (p = 0.027), combined (versus isolated) surgical procedures (p = 0.024), opening of the cardiac chambers (p = 0.046), and ventilation time (p<0.001). The ML-based decision tree identified a two level-algorithm including ventilation time and aortic cross-clamping time, with an AUC of 0.7116 (p = 0.0002) in the validation set. In the ML-based LASSO regression analysis, we identified ventilation time, administration of erythrocyte concentrates (EC), and usage of cardiopulmonary bypass (CPB) as predictors of POD, with an AUC of 0.7407 (p<0.0001) in the validation set.

Conclusion:
The results of this analysis highlight the associations between ventilation time, aortic cross-clamping time, administration of EC, and usage of CPB and POD. Additionally, they suggest that the optimization of surgical protocols has the potential to reduce POD risk in individuals undergoing cardiac surgery.
Artificial intelligence-assisted precise preoperative prediction of lateral cervical lymph nodes metastasis in papillary thyroid carcinoma via a clinical-CT radiomic combined model
Authors: Du Junze , He Xinyun , Fan Rui , Zhang Yi , Liu Hao , Liu Haoxi , Liu Shangqing , Li Shichao 
Published: February 2025

Objectives:
This study aimed to develop an artificial intelligence-assisted model for the preoperative prediction of lateral cervical lymph node metastasis (LCLNM) in papillary thyroid carcinoma (PTC) using computed tomography (CT) radiomics, providing a new noninvasive and accurate diagnostic tool for PTC patients with LCLNM.

Methods:
This retrospective study included 389 confirmed PTC patients, randomly divided into a training set (n = 272) and an internal validation set (n = 117), with an additional 40 patients from another hospital as an external validation set. Patient demographics were evaluated to establish a clinical model. Radiomic features were extracted from preoperative contrast-enhanced CT images (venous phase) for each patient. Feature selection was performed using analysis of variance and the least absolute shrinkage and selection operator algorithm. We employed support vector machine, random forest (RF), logistic regression, and XGBoost algorithms to build CT radiomic models for predicting LCLNM. A radiomics score (Rad-score) was calculated using a radiomic signature-based formula. A combined clinical-radiomic model was then developed. The performance of the combined model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results:
A total of 1724 radiomic features were extracted from each patient’s CT images, with 13 features selected based on nonzero coefficients related to LCLNM. Four clinically relevant factors (age, tumor location, thyroid capsule invasion, and central cervical lymph node metastasis) were significantly associated with LCLNM. Among the algorithms tested, the RF algorithm outperformed the others with five-fold cross-validation on the training set. After integrating the best algorithm with clinical factors, the areas under the ROC curves for the training, internal validation, and external validation sets were 0.910 (95% confidence interval [CI]: 0.729–0.851), 0.876 (95% CI: 0.747–0.911), and 0.821 (95% CI: 0.555–0.802), respectively, with DCA demonstrating the clinical utility of the combined radiomic model.

Conclusions:
This study successfully established a clinical-CT radiomic combined model for predicting LCLNM, which may significantly enhance surgical decision-making for lateral cervical lymph node dissection in patients with PTC.
Prehabilitation in surgery – an update with a focus on nutrition
Authors: Gillis Chelsia , Weimann Arved 
Published: February 2025

Purpose of the review
Since the introduction of the prehabilitation concept for optimizing functional capacity before surgery 20 years ago, evidence and interest has grown considerably. This review summarizes the recent evidence and proposes questions for prehabilitation with special regard to the nutritional component.

Recent findings
Several meta-analyses of multimodal prehabilitation (exercise, nutrition, and psychological support) have been published recently. These reviews suggest that preoperative conditioning can improve functional capacity and reduce the complication rate for many patient groups (risk of bias: moderate to low). A prerequisite is the identification of high-risk patients using suitable screening and assessment tools. Additionally, there are currently no standardized, clear recommendations for the organization and implementation of prehabilitation programs. The programs vary greatly in duration, content, and outcome measurement. Although the preoperative nutrition interventions enhanced outcomes consistently, there was no clear evidence for which nutritional intervention should be applied to whom over consistent time frame four to six weeks (timeframe consistent with most prehabilitation programs).

Summary
To advance our understanding of which prehabilitation interventions work best, how they work, and for whom they work best, additional low risk of bias and adequately powered trials are required. Nevertheless, our review presents evidence that prehabilitation should be offered before major surgery on a risk-stratified basis.
Skull base osteoradionecrosis: from pathogenesis to treatment
Authors: Rampinelli Vittorio , Testa Gabriele , Arosio Alberto Daniele , Piazza Cesare 
Published: February 2025

Purpose of review
This review aims to provide a comprehensive analysis of skull base osteoradionecrosis (ORN), a severe and rare complication of radiotherapy for head and neck malignancies. It explores pathogenesis, clinical presentation, diagnostic strategies, and management approaches, emphasizing the importance of multidisciplinary care in addressing this challenging condition.

Recent findings
Skull base ORN results from radiotherapy-induced tissue damage, characterized by hypovascularity, hypoxia, and necrosis, often compounded by secondary infections. Advances in radiotherapy techniques, such as intensity-modulated radiotherapy and heavy particles, have reduced ORN incidence, though cases persist, particularly in high-dose radiotherapy fields. Emerging treatments, including hyperbaric oxygen therapy and the pentoxifylline–tocopherol protocol, show promise but lack robust evidence for standardized use. Surgical interventions, especially those incorporating vascularized tissue reconstruction, have demonstrated favorable outcomes in refractory cases. Recent studies underscore the utility of multimodal imaging techniques, including MRI and PET/CT, for distinguishing ORN from tumor recurrence.

Summary
Skull base ORN represents a complex and potentially life-threatening condition requiring tailored, multidisciplinary management. Although advancements in diagnostics and therapeutics have improved outcomes, significant challenges remain, particularly in developing standardized protocols. Further research is needed to refine treatment strategies and improve evidence-based practices for this entity.
Antiviral activity of contact lens care solutions and rub-and-rinse regimen against adenovirus
Authors: Lourenco Nogueira Christiane , Boegel Scott Joseph , Shukla Manish , Ngo William , Hui Alex , Jones Lyndon W. , Aucoin Marc G. 
Published: February 2025

SIGNIFICANCE
Although human adenoviruses are the leading cause of acute viral conjunctivitis, there is a lack of data surrounding the efficacy of contact lens care products against these viruses.

PURPOSE
This study investigates the antiviral activity of several commercially available contact lens care solutions against human adenovirus type 5 (Ad5).

METHODS
Six contact lens care solutions (Biotrue, Boston Simplus, OPTI-FREE Puremoist, Clear Care, cleadew, and cleadew GP) were investigated. Quantitative suspensions tests were conducted on Ad5 solutions after interaction with the different contact lens care solutions for 4 or 6 hours. For the hydrogen peroxide solution (Clear Care), interaction times of 0, 2, 4, and 6 hours prior to neutralization were also investigated. Finally, the impact of rubbing and rinsing of Ad5 contaminated contact lenses with the solutions was studied.

RESULTS
Solutions based on povidone-iodine demonstrated a more than 3-log reduction in virus after 4 and 6 hours of incubation. In contrast, hydrogen peroxide only demonstrated a 0.52-log reduction after 6 hours of incubation. Increasing the contact time with hydrogen peroxide increased Ad5 inactivation, with a 2.18-log reduction after 6 hours of incubation with the solution prior to neutralization. Nonoxidative systems did not demonstrate a significant log reduction after 4 hours of incubation. However, rubbing and rinsing of contact lenses using the nonoxidative systems reduced the virus counts from contaminated contact lenses to below the limit of quantification.

CONCLUSIONS
Povidone-iodine solutions have a significant effect on reducing the viability of Ad5. Hydrogen peroxide care solutions are effective only if unneutralized contact time is increased. Nonoxidative systems can be effective in combating contaminated lenses only with the addition of a rub-and-rinse step.
Single-stage reconstruction of congenital multi-finger syndactyly with contiguous cross-shaped advancement flaps
Authors: Yang Guang , Yin Fei , Yin Chunhua , Liu Wei , Yu Wentao , Yu Qinyuan , Shen Xiaofang 
Published: February 2025

Purpose:
The purpose of this paper is to report the techniques and results of contiguous dorsal cross-shaped advancement flaps for reconstruction of the three- or four-finger syndactyly in a single-stage operation for congenital syndactyly.

Methods:
Thirty-five patients with multiple-finger syndactyly for web-space reconstruction using the contiguous dorsal cross-shaped advancement flaps in a single operation were retrospectively studied. The patients were treated between January 2019 and October 2022. There were 20 patients with Poland syndrome, nine with constriction ring sequence, and six with synpolydactyly. One patient had bilateral hands involved. Twenty-three hands had three-finger syndactyly, and 13 hands had four-finger syndactyly. The patients’ ages ranged from 5 to 96 months, with an average age of 29.6 months. The contiguous dorsal cross-shaped flaps were advanced to reconstruct both web space and lateral walls of the bases of the conjoined fingers. Withey grading was used for postoperative evaluation of web creep of each reconstructed web. Scar hyperplasia was assessed using the Vancouver Scar Scale (VSS). Visual Analogue Scale (VAS) of 0 to 10 was applied to evaluate the subjective satisfaction of the parents with the overall appearance and function.

Results:
In all cases the syndactyly was successfully released in a single operation. There were no perioperative complications such as finger necrosis, incision infection, or skin graft failure in this group. During a 12-to-58-month follow-up period, all the reconstructed web spaces exhibited satisfactory appearance, and there was no obvious web creep. The scars on the dorsal side of the hand were acceptable. Revision surgery was not needed in any patients. Web creep averaged 0.45, and the VSS score averaged 1.6. The average VAS score of appearance was 1.2, and that of function was 2.5.

Conclusions:
Multiple syndactyly release in one stage is feasible and safe. The contiguous cross-shaped flaps can be used to reconstruct two or more web spaces simultaneously after releasing.
Utility of Preoperative Hypoalbuminemia as Independent Predictor of Post-Conversion and Revisional Bariatric Surgery Outcomes: MBSAQIP Registry Analysis
Authors: Medhati Pourya , Dang Jerry , Sheu Eric G , Tavakkoli Ali , Nimeri Abdelrahman , Shin Thomas H 
Published: February 2025

Background:
Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS).

Study Design:
A retrospective cohort analysis was performed on 58,327 MBS revisions and anastomotic conversions from the 2020-2022 MBSAQIP registry. Approximately all cases studied were performed laparoscopically (98.8%). A preoperative albumin level of 3.5 g/dL was used as a threshold to identify patients with hypoalbuminemia. We utilized descriptive statistics, univariate and multivariable logistic regression, and 1:1 nearest neighbor matching in complete-case analyses to explore the relationship between albumin levels and postoperative outcomes.

Results:
While univariate analyses illustrate an association between hypoalbuminemia and postoperative morbidity, multivariable regression and 1:1 matched analysis showed hypoalbuminemia is not an independently significant driver of 30-day overall postoperative complications (including leaks), reoperation, or reintervention. However, 1:1 matched analysis demonstrated significantly increased odds of 30-day postoperative superficial surgical site infection (SSI) (OR 8.138, p=0.049) and readmission (OR 1.75, p=0.045) associated with albumin levels lower than 3.5 g/dL.

Conclusions:
Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.
Is There an Optimal Electrode Placement for Patients With Schizophrenia Undergoing Electroconvulsive Therapy?
Authors: Tan Weng Jun , Choo Kimberly Wan Xin , Foo Jenies Hui Xin , Tor Phern Chern 
Published: February 2025

Abstract
Electroconvulsive therapy (ECT) is a recognized treatment option for patients with schizophrenia, especially when patients do not respond adequately to antipsychotic medication or when rapid response is needed in severe cases. The 3 common electrode placements, namely, bitemporal, bifrontal and right unilateral (RUL) modalities, have all been described by various studies to be efficacious in symptom reduction. However, the optimal electrode placement with the greatest success rate in the treatment of schizophrenia has yet to be ascertained. Furthermore, the benefit of switching ECT modalities after poor response to the initial electrode placement has not been well studied. Hence, to illustrate the twin issues of the optimal ECT modality as well as the effect of switching ECT modalities after initial nonresponse in patients with schizophrenia, we describe 2 distinct patients who underwent multiple courses of bifrontal and RUL ECT, but only responded well to bifrontal ECT. This is possibly due to the patients' anatomical differences as well as varying brain stimulation patterns produced by the different electrode placements. Thus, we believe that the prescription of ECT in patients with schizophrenia should be individualized, and a switch to a different ECT modality should be strongly considered if there is a lack of response to a particular modality.