bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reporting on knowledge, attitudes, and behaviours of pharmacists regarding the active offer of French language health services in Ontario: A quantitative survey study
Authors: Timony Patrick , Leone Arielle , Caron Carolanne , Giguère Pierre , Thabet Pierre , Gauthier Alain , Waite Nancy M. , Landry Christine 
Published: January 2025

Background: Patient–provider language discordances can negatively affect the availability, accessibility, acceptability, and quality (AAAQ) of pharmacy services as described by the AAAQ framework. With nearly 600,000 residents of Ontario identifying French as their mother tongue, the active offer (AO) of French language pharmacy services should be provided, yet little is known about pharmacists’ familiarity and use of AO. Methods: Ontario pharmacists completed an online survey measuring their knowledge, attitudes, and behaviours (KAB) regarding the AO for French language services (FLS). Demographics, including ability to converse in French, were collected. KAB AO scores were calculated and compared using descriptive and inferential statistics. Results: A total of 360 pharmacists completed the survey. The majority (65.1%) practiced in a primary care setting, 21.1% spoke French, and 71.8% lived in an area where less than 10% of the population were Francophone. Overall, AO scores were highest for attitude (3.8/5) and lowest for behaviours (2/5) and knowledge (1.8/5). Most pharmacists (62.8%) indicated an interest in AO training. Discussion: Gaps in KAB regarding AO for FLS by Ontario pharmacists resemble those observed throughout the health care system. Further training is suggested to address the lack of knowledge regarding AO, particularly its proactive nature, as well as strategies for its implementation. Conclusion: Although most participating pharmacists demonstrated gaps in AO knowledge and behaviour, many had favourable attitudes toward the importance of AO in the pharmacy setting and agreed that further training would be needed to improve their KAB. Further, the AO can address all 4 elements of the AAAQ framework.
Interest in digital health tools for miscarriage support: A qualitative assessment of Canadian women facing early pregnancy loss
Authors: Flynn Breanna , Sergeant Anjali , Tam Genevieve , Gomes Megan , Gill Roopan 
Published: January 2025

Background: Early pregnancy loss (EPL) occurs in 10%–15% of all pregnancies but remains an underrecognized and undertreated condition. In Canada, resources to support individuals and their partners facing EPL remain scarce despite a high burden of psychosocial sequelae. Digital health tools hold the potential to fill important gaps in reproductive healthcare. Objectives: We sought to better understand the perspectives of individuals who experienced pregnancy loss and explore how digital health tools could offer support. Design: We conducted a qualitative study with grounded theory methodology to address our objectives. Methods: The study was conducted between September 2021 and April 2022 in Ottawa, Canada. Participants between 18 and 45 years of age who resided in Canada and experienced EPL up to 12 + 6 week gestation within the last 2 years were included. Enrolled participants who provided informed consent completed a single in-depth interview. Data were analyzed iteratively by two trained research team members with thematic techniques supported by NVivo software. Results: Interviews were conducted with 14 participants who had experienced EPL. All participants identified as female and resided in Canada, with 28.6% ( n = 4) between 26 and 30 years of age, and the remaining 71.4% ( n = 10) between 31 and 40. Qualitative analysis identified three primary themes centered around participants’ experiences of miscarriage, access to information and support for EPL in Canada, and desires and preferences for a digital miscarriage tool. Conclusion: Miscarriage is an emotionally difficult experience for women and their loved ones, who often do not receive timely and compassionate care within the healthcare system. Participants were highly motivated to co-develop a digital intervention for EPL that is designed to fill gaps in care. The digital companion would assist individuals through their miscarriage journey by providing evidence-based and locally relevant medical information as well as avenues to access both professional and informal forms of psychosocial support.
Pulmonary embolism following bilateral quadriceps tendon repair with unilateral tourniquet use: A case report
Authors: Cedeño-Rodriguez Francis X , Hess Arcelay Hans W , Acosta Julbe José I , Varas-Rodríguez Emil , Cruz Jerry , Otero Francisco , Cintron Kenneth , Girod Julian 
Published: January 2025

Case: An active healthy 68-year-old male sustained a bilateral quadriceps tendon rupture while running. He underwent a simultaneous bilateral quadriceps tendon repair in a dual-surgeon approach. The right quadriceps tendon was repaired with a tourniquet, while the left quadriceps tendon tear was repaired without one. Postoperatively, the patient developed deep vein thrombosis in the right leg, which led to a bilateral pulmonary embolism. This case illustrates a potential complication of tourniquet use in patients undergoing quadriceps tendon repairs. Conclusion: The use of tourniquets in orthopaedic surgeries may be associated with potential risks, such as development of venous thromboembolism including deep vein thrombosis and pulmonary embolism. This case highlights the importance of carefully considering tourniquet use for quadriceps tendon repairs and close postoperative monitoring, early mobility, and thromboprophylaxis to prevent severe complications.
Effect of different doses of oral olanzapine to prevent postoperative nausea and vomiting after laparoscopic surgery in high-risk patients: A randomised controlled trial
Authors: Abdel-Wahab Amani H , Abo Elfad Ghada M , Aboelfadl Ahmed Mohamed , Bahloul Mustafa , Abdel Rady Marwa Mahmoud 
Published: January 2025

Background: We conducted this study to compare the efficacy of oral 10 and 5 mg olanzapine for the prevention of postoperative nausea and vomiting. Methods: Notably, 135 female patients between the ages of 18 and 50 years, classed as American Society of Anaesthesiologists I and II, who underwent elective laparoscopic gynaecological surgery under general anaesthesia were randomly assigned to one of three groups (45 each) to receive perioperative 5 or 10 mg oral olanzapine (OL5 and OL10 groups), or a placebo (in the control group). Postoperation, we recorded the occurrence and severity of postoperative nausea and vomiting within 24 h, the number of patients who received antiemetics and any associated side effects. Results: Postoperative nausea was more prevalent in the control group (23 patients) than in OL5 and OL10 groups (13 and three patients, respectively); Group OL10 had the lowest severity of nausea. There was no incidence of vomiting in the OL10 group, and only one patient required antiemetics; in the OL5 group, three patients required antiemetics and eight patients in the control group needed antiemetics. Conclusion: Olanzapine 10 mg had a higher effect than the lower concentration of 5 mg or control in reducing the incidence of postoperative nausea and vomiting in the first postoperative 24 h.
Association between albumin corrected anion gap and in-hospital mortality in critically ill patients with chronic obstructive pulmonary disease
Authors: Giri Mohan , Puri Anju , Huang Lan , Guo Shuliang 
Published: January 2025

Background: The relationship between albumin-corrected anion gap (ACAG) and in-hospital mortality in critically ill patients with COPD remains unclear. Objective: This study investigated the association between ACAG levels and the risk of in-hospital mortality in critically ill patients with COPD. Design: A retrospective cohort study. Methods: This study uses data from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The receiver operating characteristic (ROC) curve was used to determine the optimal threshold for ACAG, and participants were divided into two categories based on this threshold. The primary outcome was in-hospital mortality. We employed univariable and multivariable logistic regression analyses and Kaplan–Meier (KM) survival curves to assess the relationship between ACAG and the risk of in-hospital mortality. Moreover, subgroup analyses were conducted. Results: A total of 2121 patients (54.7% male) were enrolled in the study. The in-hospital mortality rate was 18.9%. In patients with elevated ACAG levels, the in-hospital mortality rate was significantly higher than in those with lower ACAG levels (27.7% vs 11.3%, p < 0.001). Multivariate logistic regression analysis indicated that even after mitigating for potential confounders, patients in the high ACAG group had significantly greater odds of in-hospital mortality across all models (Model I: OR = 3.000, 95% CI: 2.383–3.777, p < 0.001; Model II: OR = 3.021, 95% CI: 2.397–3.808, p < 0.001; Model III: OR = 1.916, 95% CI: 1.458–2.519, p < 0.001). Patients with elevated ACAG levels have more than twice the risk of in-hospital mortality compared to those with lower levels (hazard ratio (HR): 2.1277, 95% CI: 1.7490–2.5884). Conclusion: This study demonstrates that elevated ACAG levels are strongly associated with an increased risk of in-hospital mortality in critically ill COPD patients, suggesting that ACAG could serve as a potential predictor of adverse outcomes in this patient population.
The association between level IV/V metastasis and the recurrence, distant metastasis, and survival outcomes in hypopharyngeal squamous cell carcinoma
Authors: Li Ruichen , Wang Qi , Ma Siyuan , Li Ji , Zhao Yang , Wang Xiaoshen 
Published: January 2025

Background: The presence of level IV/V metastasis is a significant prognostic factor for patients with oral and oropharyngeal cancer, while level IV lymphadenopathy defines the N3 stage in nasopharyngeal carcinoma. However, the current staging system for hypopharyngeal squamous cell carcinoma (HPSCC) does not consider the location of involved nodes. Objectives: To evaluate the risk factors and prognostic impact of level IV/V metastasis in patients with HPSCC. Methods: The analysis included 2740 HPSCC patients from the SEER (Surveillance, Epidemiology, and End Results) database, followed by a validated study on 232 patients with pathologically positive nodes (pN+) at our center. Results: Of the 2740 patients, 1961 presented with metastatic lymph nodes (LNs), 20.8% and 14.1% had nodal involvement in level IV and level V, respectively. Multivariate analysis revealed that N3 and M1 stages were independently associated with level IV/V metastasis. Level IV metastasis was the sole independent adverse factor for overall survival (OS) among all LN regions ( p < 0.05). Regarding cancer-specific survival (CSS), only level IV and V involvement were independent predictors of prognosis ( p < 0.05). The rate of pN+ at levels IV and V in our center was 35.8% and 16.4%, respectively. The advanced pN stage was independently associated with metastasis to level IV or V. Patients with level IV/V metastasis had significantly higher rates of regional recurrence and distant metastases ( p < 0.001). Multivariate analysis confirmed a significant association regarding OS, CSS, locoregional relapse-free survival (LRFS), or distant metastasis-free survival between patients with and without level IV metastasis ( p < 0.05). Patients with level IV/V disease exhibited decreased survival rates across stages pN1 to pN3. Postoperative chemoradiotherapy improved LRFS in patients with level IV lymphadenopathy and OS/CSS in patients with level V metastasis. Conclusion: Metastasis to level IV/V was associated with a worse prognosis in HPSCC patients. The level IV/V should be considered for future improvements to the staging system. Design: A retrospective study.
Identification of clinical subgroups in anti-SRP positive immune-mediated necrotizing myopathy patients using cluster analysis
Authors: Cui Beibei , Liu Hongjiang , Liu Ruiting , Yin Geng , Xie Qibing 
Published: January 2025

Background: Anti-signal recognition particle immune-mediated necrotizing myopathy (anti-SRP IMNM) is a rare autoimmune disorder characterized by muscle weakness and necrosis. Identifying clinical subgroups within this patient population could facilitate the management of the disease. Objectives: To identify distinct clinical subgroups of anti-SRP IMNM patients. Design: A retrospective study was conducted on anti-SRP IMNM patients treated at West China Hospital of Sichuan University between January 2010 and October 2023. Methods: Clinical data were collected. Unsupervised cluster analysis was conducted to classify patients into distinct subgroups based on their clinical features. Statistical analyses were performed to compare the clinical characteristics and outcomes among the identified clusters. Results: A total of 116 patients were included in the study, and 3 distinct clinical subgroups were identified: Cluster 3 (acute), Cluster 2 (subacute), and Cluster 1 (poor prognosis). Patients in Cluster 3 exhibited a short disease course (median 3 months), severe muscle weakness (78.38% with Medical Research Council (MRC) score ⩽3), high muscle enzyme levels, and a good response to treatment. Cluster 2 patients were younger (mean age 45.83 years), had a longer disease course (median 6.5 months), milder muscle damage, and lower autoantibody titers. Cluster 1 patients were older (mean age 58.10 years), predominantly male (70.97%), and had higher incidences of interstitial lung disease (70.97%) and cardiac injury (45.16%). In Cluster 1, 16.13% of cases were refractory, and the relapse rate was 38.71%, which was significantly higher compared to the other two clusters. Conclusion: This study highlights the clinical heterogeneity among anti-SRP IMNM patients and identifies three distinct clinical subgroups with unique characteristics. These findings provide insights for personalized management.
Alterations in non-REM sleep and EEG spectra precede REM-sleep deficits in a model of synucleinopathy
Authors: Käufer Christopher , Stanojlović Miloš , Schidlitzki Alina , Bonsberger Jana , Storch Alexander , Richter Franziska 
Published: January 2025

Background Sleep disturbances often precede motor symptoms in neurodegenerative diseases like Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Neuroinflammation is implicated in PD pathophysiology and may contribute to non-motor symptoms such as sleep disturbances. The Thy1-αSyn mouse model, overexpressing human alpha-synuclein (αSyn), mimics key aspects of PD and DLB, making it valuable for studying related sleep disturbances and neuroinflammatory changes. Objective To investigate early-stage alterations in sleep architecture, electroencephalographic (EEG) patterns, and neuroinflammation in Thy1-αSyn mice. Methods We used telemetric EEG/electromyography (EMG) with video surveillance to compare sleep patterns and EEG spectral power between 2.5- and 4.5-month-old male Thy1-αSyn transgenic mice and wild-type littermates. Neuroinflammation was assessed by examining microglial (Iba1) and astrocytic (GFAP) activation in key sleep-regulating brain regions. Results Thy1-αSyn mice showed decreased resting wake time and increased non-REM sleep, with altered sleep bout frequency and length, indicating significant sleep architecture changes. Spectral analysis revealed a shift from higher to lower frequency bands, suggesting early neural circuitry disruptions due to αSyn overexpression. Significant microglial activation was observed at 3 months, with astrogliosis progressing by 5 months in key sleep-regulating regions, indicating that neuroinflammation may contribute to the observed sleep disturbances. Conclusions Early-stage Thy1-αSyn mice exhibit significant sleep architecture changes, EEG spectral shifts, and neuroinflammatory alterations. These findings suggest that neuroinflammation may play a role in the initial pathophysiological changes in PD and related synucleinopathies. Sleep, EEG, and neuroinflammatory changes could serve as early biomarkers for these diseases.
Diversity in Medical School, Orthopaedic Surgery Residency, and ACGME-Accredited Foot and Ankle Orthopaedic Surgery Fellowship Training by Gender, Race, and Ethnicity
Authors: Silvestre Jason , George Kola , Nadeau Elizabeth K. , Scott Daniel J. , Gross Christopher E. 
Published: January 2025

Introduction Increasing diversity in the US health care workforce is a topic of increasing scrutiny and interest. This study analyzes the pipeline of demographic diversity for Accreditation Council for Graduate Medical Education (ACGME)-accredited foot and ankle orthopaedic surgery fellowship training. Methods This was a cross-sectional study of medical students, orthopaedic surgery residents, and orthopaedic foot and ankle fellows at US-accredited training programs from 2013 to 2022. Self-reported demographic data were available for trainees and compared with the 2020 US Census according to federal guidelines. Participation-to-prevalence ratios (PPRs) were calculated and analyzed to classify representation of demographic groups in orthopaedic foot and ankle surgery training as overrepresented (PPR > 1.2), equivalent (PPR = 0.8-1.2), and underrepresented (PPR < 0.8). Results Disparities existed in demographic representation among medical students, orthopaedic surgery residents, and ACGME-accredited orthopaedic foot and ankle fellows among women (48.4% vs 16.1% vs 20.1, P < .001), black (6.9% vs 4.6% vs 4.5%, P < .001), Asian (23.9% vs 14.1% vs 23.9%, P < .001), and Hispanic (6.1% vs 4.6% vs 3.0%, P < .001) trainees. There were no self-reported American Indian/Alaska Native and Native Hawaiian/Pacific Islander trainees in orthopaedic foot and ankle fellowship training (PPR = 0). Women (PPR = 0.40), black (PPR = 0.36), and Hispanic (PPR = 0.16) trainees were underrepresented in orthopaedic foot and ankle training relative to the US population. In contrast, Asian (PPR = 3.45), men (PPR = 1.61), and white (PPR = 1.21) trainees were overrepresented in orthopaedic foot and ankle relative to the US population. Discussion There is a lack of gender, racial, and ethnic diversity in orthopaedic foot and ankle training relative to the US patient population and earlier stages of medical training. Increased efforts to recruit underrepresented groups may promote diversity and inclusion in the emerging orthopaedic foot and ankle surgery workforce. Levels of Evidence: III
Determination of Pathogens in Surgical Site Infections in Ankle Fractures and Implications for Empirical Antibiotic Treatment
Authors: Plasmeijer Hannah , Tausendfreund Jasper , Hoogewerf Martine , Penning Diederick , Joosse Pieter , Schepers Tim , Tanis Erik 
Published: January 2025

Surgical site infections (SSIs) are the most common complication after surgery for ankle fractures. This retrospective study aimed to determine the pathogens cultured in SSI and their antimicrobial susceptibility patterns to provide a recommendation for empirical therapy. Patients who underwent surgical treatment for an ankle fracture were included. Cases were screened for the occurrence of SSI and divided into superficial (short course [total of <2 weeks] of oral antibiotics) and deep SSI (surgical debridement and long course [total of >2 weeks] antibiotics). Culture results, antimicrobial susceptibility patterns, empirical antibiotic regimen, type and timing of culture collection, and treatment strategies were collected from electronic health records. In total, 81 (9%) out of 931 patients developed an SSI (39 (48%) superficial SSI and 42 (52%) deep SSI). The most common pathogens in 16 superficial SSI and 37 deep SSI with positive cultures were Staphylococcus aureus, cultured in 11 (69%) superficial SSI and 23 (62%) deep SSI, and Enterobacter cloacae species, cultured in 5 (31%) superficial SSI and 12 (32%) deep SSI. Higher frequencies of gram-negative bacteria and polymicrobial infections were found in deep SSI. It is recommended to aim for empirical treatment at gram-positive and gram-negative microorganisms in the case of both superficial and deep SSI. Level of Evidence: Prognostic, Level 2: Retrospective.
Computerized Tomography for Diagnosing Traumatic Arthrotomies of the Ankle
Authors: Cho Elizabeth , LeDuc Ryan , Castillo Hector , Pinzur Michael S. , Hamid Kamran S. , Schiff Adam P. 
Published: January 2025

Background Owing to the risk for septic arthritis, traumatic arthrotomies are an urgent surgical problem for the treating orthopaedic surgeon. Traditionally, diagnosis is with the saline load test (SLT), although in the awake patient is an invasive and potentially painful procedure. While computerized tomography (CT) has been shown to be a reliable diagnostic tool for traumatic arthrotomies of other joints, its role has only recently been investigated in the setting of ankle arthrotomy. Methods Eight fresh-frozen mid-tibia ankle cadaveric specimens were included for study. Baseline CT scans were performed to confirm intact ankle joint capsules with absence of intra-articular air. Ankle arthrotomies were performed under fluoroscopic guidance with vertical 1 cm incisions made at the anteromedial or anterolateral portals. After arthrotomy, all ankles underwent a second CT scan, and images were evaluated for the presence of intra-articular air. Finally, SLT was performed and the volume of saline required for extravasation was recorded. Results Of 8 ankles, 100% (n = 8) demonstrated intra-articular air on CT scan following arthrotomy. Computerized tomography scan and SLT both demonstrated 100% sensitivity and specificity for diagnosing ankle arthrotomies. Average saline volume necessary for extravasation (and positive SLT) was 4 mL (range: 2-7 mL) and did not differ by foot position. Conclusion In this small cadaveric study, CT scan and SLT were both able to detect 100% (n = 8) of traumatic ankle arthrotomies with 100% sensitivity and specificity. Further comparative study of CT scan and SLT for detection of traumatic ankle arthrotomy in a clinical setting is warranted. Levels of Evidence: Level IV
Efficacy and safety of anti-CD38 monoclonal antibodies-based therapy versus standard therapy in newly diagnosed multiple myeloma patients: a systematic review and meta-analysis
Authors: Osama Muhammad , Khan Muhammad Haris , Khan Safeena , Hussain Amna , Tahir Ammara , Ullah Mehran , Afridi Abdullah , Ullah Ubaid , Rehman Wajeeh Ur 
Published: January 2025

Background: Anti-CD38 monoclonal antibodies (mAbs) have significantly changed the multiple myeloma treatment landscape. This meta-analysis compared the efficacy and safety of anti-CD38 mAb-based therapy versus standard therapy in newly diagnosed multiple myeloma (NDMM) patients. Methods: We performed a comprehensive literature search on PubMed, the Cochrane Database, and ClinicalTrials.gov. The primary outcomes were progression-free survival (PFS) and minimal residual disease (MRD) status. Dichotomous outcomes were pooled using risk ratio (RR) along with the 95% confidence interval (CI) in RevMan 5.4. Subgroup analysis and meta-regression analysis were performed. The RoB 2.0 tool was used to assess the risk of bias. Results: Our meta-analysis included 11 randomized controlled trials. There were 5270 patients; 3040 TEs and 2230 TIEs. Anti-CD38 mAbs significantly improved MRD negativity (RR 1.94, 95% CI: 1.59–2.37; p < 0.00001) and PFS (RR 0.51, 95% CI: 0.45–0.58; p < 0.00001). Subgroup analyses revealed better outcomes for both the TE (MRD: RR 1.52, 95% CI: 1.37–1.68; PFS: RR 0.43, 95% CI: 0.34–0.54) and TIE (MRD: RR 3.49, 95% CI: 2.65–4.61; PFS: RR 0.55, 95% CI: 0.47–0.64) populations. Meta-regression revealed that Eastern Cooperative Oncology Group (ECOG) score 0 significantly influenced MRD status (β = −0.015, p < 0.05), whereas ECOG scores 1 and 2 lacked statistical significance. Subgroup analysis revealed that PFS was significantly different between standard (RR 0.47) and high (RR 0.81) cytogenetic risk groups. Conclusion: In NDMM patients, anti-CD38 mAb-based therapy significantly improved MRD status, and PFS compared with standard therapy alone, in both TE and TIE patients, suggesting a favorable benefit–risk profile.