bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Health Literacy in Plastic Surgery Using a Crowdsourced Patient Survey
Authors: Bustos Valeria P. , Haddad Anthony , Kinney JacqueLyn R. , Xun Helen , Nassar Amer H. , Lee Theodore , Lin Samuel J. , Lee Bernard T. 
Published: February 2023

Background:
Little is known about the levels of health literacy (HL) among plastic and reconstructive surgery (PRS) patients compared with the general population. This study aimed to characterize HL levels in patients interested in plastic surgery and identify potential risk factors associated with inadequate levels of HL among this population.

Methods:
Amazon’s Mechanical Turk was used to distribute a survey. The Chew’s Brief Health Literacy Screener was used to evaluate the level of HL. The cohort was divided into two groups: non-PRS and PRS groups. Four subgroups were created: cosmetic, noncosmetic, reconstructive, and nonreconstructive groups. A multivariable logistic regression model was constructed to assess associations between levels of HL and sociodemographic characteristics.

Results:
A total of 510 responses were analyzed in this study. Of those, 34% of participants belong to the PRS group and 66% to the non-PRS group. Inadequate levels of HL were evidenced in 52% and 50% of the participants in the non-PRS and PRS groups, respectively (P = 0.780). No difference in HL levels was found in the noncosmetic versus cosmetic groups (P = 0.783). A statistically significant difference in HL levels was evidenced between nonreconstructive versus reconstructive groups after holding other sociodemographic factors constant (0.29, OR; 95% CI, 0.15–0.58; P < 0.001).

Conclusions:
Inadequate levels of HL were present in almost half of the cohort, which highlights the importance of adequately assessing HL levels in all patients. It is of utmost importance to evaluate HL in clinical practice using evidence-based criteria to better inform and educate patients interested in plastic surgery.
Lessons Learned After Integrating the Five Steps of Evidence-Based Practice Into a Doctor of Physical Therapy Curriculum
Authors: Lis Angela , Snowdon Lauren , Downey Kyle 
Published: February 2023

Background and Purpose.
Teaching evidence-based practice (EBP) has become a standard curricular goal for Doctor of Physical Therapy (DPT) education programs. In 2014, the American Physical Therapy Association published a consensus document to provide guidance on curricular objectives for teaching EBP in entry-level DPT programs. The document reinforced the need to promote skills related to the efficient and critical consumption of published evidence. The purpose of this case report is to describe the collaborative process of integrating the EBP guidelines in one university's DPT curriculum.

Case Description.
Faculty of EBP courses, in collaboration with a health sciences librarian, worked collaboratively to review and redesign the courses that teach and promote the skills required for an efficient EBP entry-level clinician, using the EBP guidelines as a reference document. Integrating the guidelines, specifically the five steps of teaching EBP, required creating a curricular thread for both the didactic and the clinical portions of the program, the development of standardized tools to optimize the students’ learning, promotion of literature search and appraisal skills, and designing instructional activities, assignments, and standardized rubrics.

Outcomes.
The effectiveness of the curricular integration process was evaluated using students’ self-efficacy with the acquired EBP skills. Data indicated students who participated in the modified curriculum perceived to have achieved all terminal objectives for each of the EBP steps.

Discussion.
This case study highlights the benefits of progressive and early exposure to EBP to facilitate integration into clinical practice. Additionally, it reinforced the idea of EBP as a learnable skill that requires practice and experiential learning.

Conclusion.
It is feasible to successfully integrate EBP guidelines into a physical therapist program.
Defining the Learning Curve for Endoscopic Ear Skills Using a Modular Trainer: A Multi-Institutional Study
Authors: Wong Kevin , Gorthey Scott , Arrighi-Allisan Annie E. , Fan Caleb J. , Barber Samuel R. , Schwam Zachary G. , Wanna George B. , Cosetti Maura K. 
Published: February 2023

Objective
Quantify the learning curve for endoscopic ear skills acquisition in otolaryngology residents using a simulator. The secondary objective was to determine if demographic factors or previous endoscopic experience influenced skill development.

Study Design
Prospective, multicenter study. Resident participants each completed 10 amassed trials using a validated endoscopic ear skill trainer.

Setting
Two academic teaching hospitals.

Subjects
Otolaryngology residents.

Main Outcome Measures
Trial completion times; rate of improvement over time.

Results
Thirty-eight residents completed the study, 26 from program A and 12 from program B. Fifteen participants were women and 23 were men. Mean age was 30 years old (range 26 to 34 years). Previous experience with otoendoscopy (B = −16.7, p = 0.005) and sinus endoscopy (B = −23.4, p = 0.001) independently correlated with lower overall trial times. Age, gender, postgraduate year, handedness, interest in otology, and video gaming were not associated with trial times. On multivariate logistic regression, resident completion times improved with trial number, and residents without previous endoscopy experience improved at a faster rate than those with experience (p < 0.001).

Conclusions
Novice surgeons may acquire basic endoscopic ear experience with self-directed simulation training. The learning curve for transcanal endoscopic ear surgery is comparable to those demonstrated for other otologic surgeries, and specific task competencies can be achieved within 10 trials, suggesting that previous experiences, or lack thereof, may not dictate the ability to acquire new skills. There may be a translational value to previous endoscopic sinus experience on learning transcanal endoscopic ear surgery.
A new approach of estimating insertion length for intermittent orogastric tube feeding in adult patients
Authors: Gan Ting , Luo Yuan , LE Meixian , Sheng Lijuan , Zhao Liping 
Published: February 2023

Abstract

Objective:
To determine the association between human external anthropometry and the in vivo length between the incisor and cardia and develop a new approach for estimating the insertion length of the orogastric tube in adult patients.

Methods:
A cross-sectional study was conducted among participants from the digestive endoscopy department of a tertiary hospital in China. The in vivo length between the incisor and cardia was measured through a digestive endoscopy examination. External anthropometric data were obtained using a weighing scale and a soft ruler. The univariate analysis, correlation analysis, and multiple regression analysis were performed to establish a prediction model of the in vivo length between the incisor and cardia.

Results:
A total of 327 participants were recruited in this study. The in vivo length between the incisor and cardia ranged from 35 to 46 cm (average 40.57 cm). The highest correlation coefficient was observed for height (r=0.71, P<0.001). Multiple regression analysis showed that weight, sex, height, sitting height, and the nose-umbilicus distance could predict the in vivo length between the incisor and cardia and the prediction equation was as follows: 6.990 – 0.066×weight – 1.049×sex + 0.124×height + 0.135×sitting height + 0.128×nose-umbilicus distance (sex=0 if the participant was male; sex=1 if the participant was female).

Conclusion:
The prediction equation for the in vivo length between the incisor and cardia proposed in this study can provide an evidence-based approach for estimating the insertion length of the orogastric tube.
Validity, reliability, and Rasch analysis of the orthotics and prosthetics users' survey: Turkish version of the lower-extremity functional status
Authors: Soyer Kardem , Demirdel Senem , Erol Çelik Seher , Topuz Semra , Karahan Sevilay 
Published: February 2023

Background:
It is well known that questionnaires and scales are easy to use, cheap, and provide fast results. In the clinical setting, it will be easier and more comfortable to evaluate lower-extremity functions in both prosthesis and orthosis users with a single questionnaire.

Objectives:
To study the Turkish version of the orthotics and prosthetics users' survey lower-extremity functional status (OPUS-LEFS) and investigate its reliability and validity in the Turkish prosthesis and orthosis users.

Study design:
After forward and backward translation process, test–retest, internal consistency, validity, dimensionality, and Rasch analysis were done for 139 participants.

Methods:
Participants with a lower-limb prosthesis or orthosis were recruited in this study. Test and retest of the survey was done 1–3 days apart. For convergent validity, Nottingham Health Profile was used. Pearson correlation coefficient was used to analyze test–retest reliability; Cronbach's alpha for internal consistency, Spearman's correlation coefficient for validity, exploratory factor analysis by means of Kaiser–Meyer–Olkin and Bartlett's value of sphericity for dimensionality, and Rasch analysis were used.

Results:
Test–retest reliability of OPUS-LEFS showed very strong correlation (0.994) and for internal consistency with Cronbach's alpha value 0.71 of the Turkish version of OPUS-LEFS. Analyses showed that OPUS-LEFS is valid (p < 0.001) and significant (p < 0.001).

Conclusions:
The Turkish version of the OPUS-LEFS has been shown to be a valid and reliable tool in evaluating both orthosis and prosthesis users with a self-administered questionnaire for LEFS.
Second Primary Cancers in People With HIV/AIDS: A National Data Linkage Study of Incidence and Risk Factors
Authors: Di Ciaccio Pietro R. , Van Leeuwen Marina T. , Amin Janaki , Vajdic Claire M. , McGregor Skye , Poynten Isobel M. , Templeton David J. , Law Matthew , Grulich Andrew E. , Polizzotto Mark N. , Jin Fengyi 
Published: February 2023

Background:
Evidence regarding the characteristics of second primary cancer (SPC) in people living with HIV (PLWHIV) is limited.

Setting:
We performed a national population-based data linkage study to determine the incidence and risk factors of SPC in PLWHIV in Australia between 1982 and 2012.

Methods:
We conducted a probabilistic data linkage study to compare the incidence of SPC over time, defined using HIV treatment eras, for SPCs related to oncogenic viral infection in comparison with non–infection-related SPCs. Risk factors considered included age at diagnosis of cancer, sex, HIV exposure modality, and CD4+ count.

Results:
Of 29,383 individuals diagnosed with HIV, 3123 individuals who developed a first primary cancer were included in the analysis. Among them, 229 cases of SPC were identified across 27,398 person-years of follow-up. The most common SPCs were non-Hodgkin lymphomas (n = 71, 31%). The incidence of SPC overall did not change over time; however, there was an increase in individuals diagnosed with HIV in later eras (P trend =0.001). The incidence of non–infection-related SPC increased over time and was associated with older age (P trend = 0.005) and the acquisition of HIV in later eras (P trend <0.001). Conversely, the incidence of infection-related SPC decreased (P trend <0.001), but this was no longer significant after adjustment for age (P trend = 0.14).

Conclusions:
The risk of SPC in PLWHIV in Australia remains high, with a temporal increase observed in non–infection-related cancer, likely due to aging of the population. Optimal screening and prevention strategies for SPC in PLWHIV are increasingly important.
Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States
Authors: Elbur Abubaker Ibrahim , Ghebremichael Musie , Konkle-Parker Deborah , Jones Deborah L. , Collins Shelby , Adimora Adaora A. , Schneider Michael F. , Cohen Mardge H. , Tamraz Bani , Plankey Michael , Wilson Tracey , Adedimeji Adebola , Haberer Jessica , Jacobson Denise L. 
Published: February 2023

Background:
Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure.

Methods:
We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association.

Main Outcome Measure:
Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits.

Results:
We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely “consistently high” (26.3%), “moderate increasing” (9.5%), “moderate decreasing” (30.6%), and “consistently low” (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the “consistently high” trajectory, the risk of virologic failure was higher among women with “consistently low” [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and “moderate decreasing” adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with “moderate increasing” adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94).

Conclusions:
Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.
A Quality Improvement Approach to Decrease the Utilization of Docusate in Hospitalized Patients
Authors: Shair Kamal A. , Espinosa Samantha M. , Kwon Joshua Y. , Gococo-Benore Denise A. , McCormick Benjamin J. , Heckman Michael G. , Seim Lynsey A. , Cowdell J. Colt 
Published: February 2023

Background and Objectives:
Docusate sodium is a commonly prescribed medication to relieve constipation, but several studies have demonstrated its ineffectiveness. Its continued use in the hospital setting adds unnecessary cost and risk to patients. At the Mayo Clinic Florida campus, docusate was ordered for 9.7% of patients admitted to the internal medicine resident (IMED) teaching services during the month of January 2020, and the average hospital length of stay (LOS) was 3.1 days.

Methods:
A multidisciplinary team of internal medicine resident physicians and pharmacists collaborated to address this quality gap through a quality improvement project. It sought to reduce the number of patients admitted to the IMED teaching services who had an order placed for docusate by 50% in less than 6 months without adversely impacting hospital LOS. Two separate interventions were devised using Six Sigma methodology and implemented to reduce the frequency of docusate orders, which involved educating internal medicine residents and hospital pharmacists, and creating an additional process-related barrier to docusate orders.

Results:
The percentage of docusate orders decreased from 9.7% to 2.4% (P = .004) with a grossly unchanged LOS of 3.1 days to 2.7 days (P = .12) after 5 weeks.

Conclusion:
The implementation of a dual-pronged intervention successfully decreased the use of an ineffective medication in hospitalized patients without impacting the balancing measure, and serves as a model that can be adopted at other institutions with the hope of promoting evidence-based medical care.
Association Between Naloxone Coprescription Mandates and Postoperative Outcomes
Authors: Du Austin L. , Rishel Chris A. , Sun Eric C. 
Published: February 2023

Introduction:
The opioid epidemic is a public health issue in the United States. The objective of this study was to evaluate the association between naloxone coprescription mandates and postoperative outcomes.

Background:
Data on naloxone coprescription mandates show mixed evidence for fatal overdoses in the broader population. How these mandates have impacted surgical patients has not been fully explored.

Methods:
Healthcare claims data were used to identify all patients undergoing 1 of 50 common procedures between January 1, 2004, and June 30, 2019, and categorized as high risk for opioid overdose. The primary outcomes were an emergency department visit or hospital admission within 30 postoperative days. To reduce confounding, the association between this outcome and the implementation of naloxone coprescription mandates was estimated using a difference-in-differences approach.

Results:
The study included 429,878 surgical patients with an average age of 54.8 years (SD=15.9 years) and with 257,728 females (60.0%). There was no significant association between naloxone prescribing mandates and the primary outcomes. After adjustment for potential confounders, the incidence of hospital admission was 3.26% after implementation of a naloxone coprescription mandate compared with 3.33% before (difference change: −0.08%, 95% CI: −0.44% to 0.29%, P=0.68). The incidence of an emergency department visit was 7.06% after implementation of a naloxone coprescription mandate compared with 7.73% before (difference: −0.67%, 95% CI: −1.39% to 0.05%, P=0.07). These results were robust to a variety of sensitivity and subgroup analyses.

Conclusions:
Naloxone coprescription mandates were not associated with a statistically or clinically significant change in emergency department visits or hospital admissions within 30 postoperative days.
Financial vulnerability of trauma centers: A national analysis
Authors: Marrotte Alexander , Calvo Richard Y. , Capacio Benedict , Goljan Christopher , Rooney Alexandra S. , Carroll Alyssa N. , Krzyzaniak Andrea , Bansal Vishal , Sise Michael J. , Martin Matthew J. 
Published: February 2023

OBJECTIVE
Trauma centers function as an essential safeguard in the United States health care system. However, there has been minimal study of their financial health or vulnerability. We sought to perform a nationwide analysis of trauma centers using detailed financial data and a recently developed Financial Vulnerability Score (FVS) metric.

METHODS
The RAND Hospital Financial Database was used to evaluate all American College of Surgeons–verified trauma centers nationwide. The composite FVS was calculated for each center using six metrics. Financial Vulnerability Score tertiles were used to classify centers as high, medium, or low vulnerability, and hospital characteristics were analyzed and compared. Hospitals were also compared by US Census region and teaching versus nonteaching hospitals.

RESULTS
A total of 311 American College of Surgeons–verified trauma centers were included in the analysis, with 100 (32%) Level I, 140 (45%) Level II, and 71 (23%) Level III. The largest share of the high FVS tier was consisted of Level III centers (62%), with the majority of Level I (40%) and Level II (42%) in the middle and low FVS tier, respectively. The most vulnerable centers had fewer beds, negative operating margins, and significantly less cash on hand. Lower FVS centers had greater asset/liability ratios, lower outpatient shares, and three times less uncompensated care. Nonteaching centers were statistically significantly more likely to have high vulnerability compared with teaching centers (46% vs. 29%). Statewide analysis showed high discrepancy among individual states.

CONCLUSION
With approximately 25% of Levels I and II trauma centers at high risk for financial vulnerability, disparities in characteristics, including payer mix and outpatient status, should be targeted to reduce vulnerabilities and bolster the health care safety net.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
The females have spoken. A patient-centered national survey on the administration of emergent transfusions with the potential for future fetal harm
Authors: Uhlich Rindi , Hu Parker , Yazer Mark , Jansen Jan O. , Patrician Patricia , Marques Marisa B. , Reynolds Lindy , Fifolt Matthew , Stephens Shannon W. , Gelbard Rondi B. , Kerby Jeffrey , Holcomb John B. 
Published: February 2023

Abstract

Background
Traumatic hemorrhage is the leading cause of preventable death. Early in the resuscitation, only RhD-positive red blood cells are likely to be available, which poses a small risk of causing harm to a future fetus if transfused to an RhD-negative females of childbearing age (CBA), i.e., 15-49 years old. We sought to characterize how the population, in particular females of CBA, felt about emergency blood administration vis-a-vis potential future fetal harm.

Methods
National survey using Facebook advertisements in three waves from 01/2021 to 01/2022. The advertisements directed users to the survey site with 7 demographic questions and 4 questions on accepting transfusion with differing probabilities for future fetal harm (none/any/1:100/1:10,000). Acceptance of transfusion questions scored on 3-point Likert scale (likely/neutral/unlikely). Only completed responses by females were analyzed.

Results
Advertisements were viewed 16,600,430 times by 2,169,805 people with 15,396 advertisement clicks and 2,873 surveys initiated. Most (79%; 2,256/2,873) were fully completed. Majority (90%; 2,049/2,256) of respondents were female. 80% of females (1,645/2,049) were of CBA. Most females responded “likely” or “neutral” when asked whether they would accept a lifesaving transfusion if the following risk of fetal harm were present: no risk (99%); any risk (83%); 1:100 risk (85%); 1:10,000 risk (92%). There were no differences between females of CBA versus non-CBA with respect to the likelihood of accepting lifesaving transfusion with any potential for future fetal harm (p = 0.24).

Conclusion
This national survey suggests that most females would accept lifesaving transfusion even with the potential low risk of future fetal harm.

Level of Evidence
Prognostic and Epidemiological; Level 1