bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis
Authors: Camino-Willhuber Gaston , Schönnagel Lukas , Caffard Thomas , Zhu Jiaqi , Tani Soji , Chiapparelli Erika , Arzani Artine , Shue Jennifer , Duculan Roland , Bendersky Mariana , Zelenty William D. , Sokunbi Gbolabo , Lebl Darren R. , Cammisa Frank P. , Girardi Federico P. , Mancuso Carol A. , Hughes Alexander P. , Sama Andrew A. 
Published: August 2023

Study Design:
Retrospective study of prospective collected data.

Objective:
To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis.

Summary of Background Data:
IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed.

Methods:
We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis.

Results:
A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62–72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12–2.60), P=0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04–3.76), P=0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02–1.35), P=0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery.

Conclusion:
Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.
Developing Mixed-effects Models to Optimize Prediction of Postoperative Outcomes in a Modern Sample of Over 450,000 Patients Undergoing Elective Cervical Spine Fusion Surgery
Authors: Shahrestani Shane , Brown Nolan J. , Yue John K. , Tan Lee A 
Published: August 2023

Study Design:
A retrospective cohort.

Objective:
We utilize big data and modeling techniques to create optimized comorbidity indices for predicting postoperative outcomes following cervical spine fusion surgery.

Summary of Background Data:
Cervical spine decompression and fusion surgery are commonly used to treat degenerative cervical spine pathologies. However, there is a paucity of high-quality data defining the optimal comorbidity indices specifically in patients undergoing cervical spine fusion surgery.

Methods:
Using data from 2016 to 2019, we queried the Nationwide Readmissions Database (NRD) to identify individuals who had received cervical spine fusion surgery. The Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator was used to assess frailty. To measure the level of comorbidity, Elixhauser Comorbidity Index (ECI) scores were queried. Receiver operating characteristic curves were developed utilizing comorbidity indices as predictor variables for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 1-year readmission.

Results:
A total of 453,717 patients were eligible. Nonroutine discharges occurred in 93,961 (20.7%) patients. The mean adjusted all-payer cost for the procedure was $22,573.14±18,274.86 (top quartile: $26,775.80) and the mean length of stay was 2.7±4.4 days (top quartile: 4.7 d). There were 703 (0.15%) mortalities and 58,254 (12.8%) readmissions within 1 year postoperatively. Models using frailty+ECI as primary predictors consistently outperformed the ECI-only model with statistically significant P-values for most of the complications assessed. Cost and mortality were the only outcomes for which this was not the case, as frailty outperformed both ECI and frailty+ECI in cost (P<0.0001 for all) and frailty+ECI performed as well as ECI alone in mortality (P=0.10).

Conclusions:
Our data suggest that frailty+ECI may most accurately predict clinical outcomes in patients receiving cervical spine fusion surgery. These models may be used to identify high-risk populations and patients who may necessitate greater resource utilization following elective cervical spinal fusion.
Ocular Surface Homeostasis After Scleral Lens Usage
Authors: Ballet Brice , Behaegel Joséphine , Reppe Sjur , Consejo Alejandra , Aass Hans Christian , Utheim Tor Paaske , Koppen Carina , Ní Dhubhghaill Sorcha 
Published: August 2023

Objectives:
The aim of this prospective study is to examine the effects of 5 hours of well-fitted, mini–scleral contact lens (mini-SL) wear on the tear film cytokine expression in healthy eyes.

Methods:
Twenty-three healthy participants were included in the study. One eye of each participant was selected at random, and a mini-SL measuring 16.5 mm in diameter was fitted by an experienced contact lens specialist. The contact lens remained in place for 5 hours. Precorneal tear fluid was collected using capillary tubes at three different time points: baseline before SL insertion (T0), after 5 hours of SL wear (T1), and 3 hours after SL removal (T2). The concentration of 40 inflammatory cytokines at the three different time points was determined using multiplex bead assay.

Results:
Mini–scleral lens wear did not result in significant changes in the cytokine-to-protein ratio after 5 hours of wear on a healthy eye.

Conclusions:
Although a well-fitted mini-SL reduces the rate at which the precorneal tear film is refreshed, 5 hours of lens wear did not appear to significantly affect the tears cytokine-to-protein ratio, suggesting that scleral lenses have minimal impact on corneal cytokine expression.
UPDOs Protective Styles, a Multilevel Intervention to Improve Pre-exposure Prophylaxis Uptake Among Black Cisgender Women: Pretest–Posttest Evaluation
Authors: Randolph Schenita D. , Johnson Ragan , Jeter Elizabeth , McGee Kara , Johnson Allison 
Published: August 2023

Abstract
In the United States, Black cisgender women account for one in five new HIV infections with Black Americans, accounting for 57% of new diagnoses in the South. Pre-exposure prophylaxis (PrEP) is 99% effective at preventing HIV. Still, Black women's uptake remains at 2% due to multiple documented barriers, including lack of awareness and knowledge, mistrust, stigma, and low perceived risk. Culturally relevant interventions leveraging trusted venues, such as beauty salons, can overcome these barriers. This article reports preliminary results of an intervention to improve PrEP knowledge and awareness, PrEP stigma, PrEP trust, and uptake among Black cisgender women. This multilevel, mixed-methods study used a community-engagement approach to develop and pilot a salon-based intervention, Using PrEP and Doing it for Ourselves (UPDOs) Protective Styles. The intervention improved knowledge, awareness, and trust around PrEP among Black cisgender women. PrEP use stigma within interpersonal relationships decreased, but low perceived risk and social stigma remained constant. Culturally and socially acceptable interventions like UPDOs Protective Styles can model health care delivery to improve trust, thus improving uptake over time for this population.
Lipoprotein(a) and calcific aortic valve disease: current evidence and future directions
Authors: Lan Nick S.R. , Khan Zahid , Watts Gerald F. 
Published: August 2023

Purpose of review
Calcific aortic valve disease (CAVD), the most common cause of aortic stenosis (AS), is characterized by slowly progressive fibrocalcific remodelling of the valve cusps. Once symptomatic, severe AS is associated with poor survival unless surgical or transcatheter valve replacement is performed. Unfortunately, no pharmacological interventions have been demonstrated to alter the natural history of CAVD. Lipoprotein(a) [Lp(a)], a low-density lipoprotein-like particle, has been implicated in the pathophysiology of CAVD.

Recent findings
The mechanisms by which Lp(a) results in CAVD are not well understood. However, the oxidized phospholipids carried by Lp(a) are considered a crucial mediator of the disease process. An increasing number of studies demonstrate a causal association between plasma Lp(a) levels and frequency of AS and need for aortic valve replacement, which is independent of inflammation, as measured by plasma C-reactive protein levels. However, not all studies show an association between Lp(a) and increased progression of calcification in individuals with established CAVD.

Summary
Epidemiologic, genetic, and Mendelian randomization studies have collectively suggested that Lp(a) is a causal risk factor for CAVD. Whether Lp(a)-lowering can prevent initiation or slow progression of CAVD remains to be demonstrated.
Micronutrient intake to protect against osteoporosis during and after critical illness
Authors: Nair Priya , Orford Neil , Kerschan-Schindl Katharina 
Published: August 2023

Purpose of review
Improved survival from critical illness has enhanced the focus on ways to augment functional outcomes following discharge from the Intensive Care Unit. An area that is gaining increased attention is the effect of critical illness on bone health and fragility fractures following the episode. This review discusses the micronutrients that may play a role in bone metabolism and the potential benefits of their supplementation to prevent osteoporosis. These include calcium, phosphorous, magnesium, vitamin D, vitamin C, vitamin K, and certain trace elements.

Findings
Although there is sound physiological basis for the involvement of these micronutrients in bone health and fracture prevention, there are few clinically relevant publications in this area with calcium and vitamin D being the best studied to date.

Summary
In the absence of high-quality evidence in critically ill populations, attention to measurement and supplementation of these micronutrients as per current guidelines outlining micronutrient requirements in enteral and parenteral nutrition might mitigate bone loss and its sequelae in the recovery phase from critical illness.
Screening for cryptococcal antigen in asymptomatic people with HIV: urgent need in Eastern India
Authors: Chakravarty Jaya , Reddy Sudheer , Gupta Munesh K. , Tilak Ragini , Diwaker Chakra , Sundar Shyam 
Published: August 2023

Objective:
Cryptococcal meningitis (CM) is a leading cause of mortality in people with HIV (PWH). Despite recommendation by the National programme, cryptococcal antigen (CrAg) screening in PWH with CD4+ <200/μl has not been implemented in practice. Therefore, we conducted a prospective study in government funded Antiretroviral treatment centre to determine the prevalence of asymptomatic cryptococcal antigenemia in PWH with CD4+ cell count <200 cells/μl, subclinical cryptococcal meningitis in serum CrAg positive subjects and their outcome.

Method:
Serum CrAg (BIOSYNEX CryptoPS) screening was conducted in newly diagnosed asymptomatic retro-positive adults with CD4+ <200/μl between January 2021 and March 2022. We also conducted cerebrospinal fluid (CSF) CrAg testing in all PWH who were serum CrAg positive and appropriate therapy was instituted. All the enrolled participants were followed up till February 2023.

Result:
Among enrolled 142 PWH patients, 22 (15.49%) were positive for serum CrAg. Among these 22, seven (31.8%) patients had CD4+ cell count between 100 and 199 cells/μl. CSF CrAg was positive in 11 (50%) serum CrAg positive cases. Serum CrAg positivity was significantly associated with low CD4+ cell count, poor clinical stage and concomitant Pneumocystis pneumonia. However, mortality was not significantly different in Serum CrAg positive and negative PWH. None of the deaths in CrAg positive PWH was due to cryptococcal disease.

Conclusion:
Higher prevalence of cryptococcal antigenemia and subclinical CM among PWH with CD4+ cell count <200 cells/μl with good treatment outcomes with therapy reiterates the need for CrAg screening among PWH in Eastern India.
Perception of Health Care Professionals Toward Hospital Accreditation at Johns Hopkins Aramco Healthcare
Authors: Al-Sayedahmed Huda , Al-Qaaneh Ayman , Al-Tawfiq Jaffar , Al-Dossary Basmah , Al-Yami Saeed 
Published: August 2023

Background and Objectives:
The quality of health care relies on achieving the best quality and patient safety goals, and accreditation plays a fundamental role in achieving these goals through compliance with standards that guide excellence. Accreditation also helps streamline operations and supports evidence-based quality improvement plans. This study aims to evaluate the perception of health care professionals on the accreditation process and its impact on the quality of health care and patient safety.

Methods:
This is a cross-sectional questionnaire survey distributed via the SuccessFactors website and made accessible to all hospital staff.

Results:
The online questionnaire was completed by 2047 participants, representing 51% of the entire hospital staff at Johns Hopkins Aramco Healthcare (JHAH). Overall analysis indicated a positive perception of accreditation benefits among health care employees (as indicated by participation in accreditation activities and/or preparation for the survey visits) and reflected on patient health care quality and safety dimensions, with an overall Likert median score of 4.0 (interquartile range = 3.7-5.0; P < .05).

Conclusion:
The outcomes of our study confirm that JHAH employees perceived a positive impact of accreditation on health care quality improvement and patient safety. Also, the study supports considering accreditation as a fundamental requirement to improve health care system processes. However, it is critical to sustain quality of services over time during accreditation cycles.
Quality Objectives in Standardized Quality Management Systems
Authors: Bugdol Marek 
Published: August 2023

Background and Objectives:
The effectiveness of a quality management system consistent with the ISO 9001 standard depends on how quality objectives are established and pursued. The aims of this article are to identify quality objectives in selected certified organizations providing medical services, assess their compliance with the requirements of the ISO 9001 standard, and determine factors influencing such objectives.

Methods:
The first theoretical part of the article is based on a systematic literature review. The empirical part contains an analysis of documentation related to quality management systems and conducted audits. The data were collected during 42 quality management system audits conducted in 16 health care organizations in the years 2015-2020. Uncategorized interviews were conducted with quality management system representatives. The data were verified by interviews with 6 management system auditors having at least 15 years' experience in auditing health care organizations. The assessment of the methodological correctness is based on the ISO 9001:2015 standard criteria.

Results:
The most frequently formulated quality objectives include improving customer satisfaction, task-based objectives related to planned works, improvements, and development of new medical services. The quality objectives fulfill the requirements of the ISO 9001 standard. However, they are not ambitious. The most significant factors influencing the processes of goal setting are economic (financial incentives, available resources for modernization), social (community needs), and managerial (the scope of performed analyses, the quality of the audit process, and the calculation of necessary effort).

Conclusions:
Health care organizations need to pursue more ambitious objectives, intensify the use of performed medical analyses, and integrate quality objectives into management remuneration systems.
Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set
Authors: Tajarernmuang Pattraporn , Valenti David , Gonzalez Anne V. , Artho Giovanni , Tsatoumas Mary , Beaudoin Stéphane 
Published: August 2023

Background and Objectives:
Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse.

Methods:
We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest.

Results:
We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Order-set implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure.

Conclusion:
Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse.
Designing and Evaluating an Emotionally Responsive Virtual Patient Simulation
Authors: Xu Jiayi , Yang Lei , Guo Meng 
Published: August 2023

Introduction
Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact).

Methods
The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital.

Results
A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP.

Conclusions
The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface.
A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education
Authors: Foronda Cynthia L. , Gonzalez Laura , Meese Merrick M. , Slamon Nicholas , Baluyot Mariju , Lee Jiye , Aebersold Michelle 
Published: August 2023

Abstract
With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: (a) research study (of any design), (b) focused on learners in health professions, and (c) compared VR with traditional simulation. Studies were excluded for the following reasons: (a) not a research study, (b) focused on learners outside health professions, (c) used screen-based or computer-based simulation, (d) used a task trainer, and (e) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.