bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stoma Perceptions of Adults with an Ostomy: A Metaphor Analysis in a Single Center
Authors: Özlü Nazife Gamze Özer , Vural Fatma 
Published: August 2023

ABSTRACTOBJECTIVETo use metaphor to evaluate stoma perceptions among adults with ostomies to conceptualize and portray their lived experiences using a figurative approach.METHODSA qualitative research design was used. Participants were 27 adults with an ostomy who were followed up in the stoma therapy unit. Individuals were included in the study if they had had a temporary or permanent ostomy for at least 2 months and spoke Turkish. Participants were asked to complete the sentence: “Stoma is like…/similar to… because….” The researchers used content analysis to evaluate participants’ responses. Interpretation of the metaphors developed by participants was carried out in five phases: coding, example metaphor compilation, theme development, ensuring trustworthiness, and transferring.RESULTSParticipants expressed a total of 17 unique and 10 repeated metaphors for the concept of “stoma.” These metaphors were grouped under three different themes: positive (lifesaving), negative (punishment/enemy), and neutral (temporary/necessity for life). The most commonly used metaphors were life, savior, comfort, difficulty, fear, punishment, and necessity.CONCLUSIONSIndividuals with an ostomy mostly had negative metaphorical associations with stomas. The authors recommend that hospitals implement multifaceted interventions to bring positive metaphors to individuals with ostomies.
Clinical Phenotypes of Sepsis in a Cohort of Hospitalized Patients According to Infection Site
Authors: Schertz Adam R. , Eisner Ashley E. , Smith Sydney A. , Lenoir Kristin M. , Thomas Karl W. 
Published: August 2023

OBJECTIVES:
Clinical sepsis phenotypes may be defined by a wide range of characteristics such as site of infection, organ dysfunction patterns, laboratory values, and demographics. There is a paucity of literature regarding the impact of site of infection on the timing and pattern of clinical sepsis markers. This study hypothesizes that important phenotypic variation in clinical markers and outcomes of sepsis exists when stratified by infection site.

DESIGN:
Retrospective cohort study.

SETTING:
Five hospitals within the Wake Forest Health System from June 2019 to December 2019.

PATIENTS:
Six thousand seven hundred fifty-three hospitalized adults with a discharge International Classification of Diseases, 10th Revision code for acute infection who met systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA), or Sequential Organ Failure Assessment (SOFA) criteria during the index hospitalization.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome of interest was a composite of 30-day mortality or shock. Infection site was determined by a two-reviewer process. Significant demographic, vital sign, and laboratory result differences were seen across all infection sites. For the composite outcome of shock or 30-day mortality, unknown or unspecified infections had the highest proportion (21.34%) and CNS infections had the lowest proportion (8.11%). Respiratory, vascular, and unknown or unspecified infection sites showed a significantly increased adjusted and unadjusted odds of the composite outcome as compared with the other infection sites except CNS. Hospital time prior to SIRS positivity was shortest in unknown or unspecified infections at a median of 0.88 hours (interquartile range [IQR], 0.22–5.05 hr), and hospital time prior to qSOFA and SOFA positivity was shortest in respiratory infections at a median of 54.83 hours (IQR, 9.55–104.67 hr) and 1.88 hours (IQR, 0.47–17.40 hr), respectively.

CONCLUSIONS:
Phenotypic variation in illness severity and mortality exists when stratified by infection site. There is a significantly higher adjusted and unadjusted odds of the composite outcome of 30-day mortality or shock in respiratory, vascular, and unknown or unspecified infections as compared with other sites.
Whole Blood Metal Levels in the Setting of an Oncologic Endoprosthesis: Is There Cause for Concern?
Authors: Houdek Matthew T. , Couch Cory G. , Wyles Cody C. , Taunton Michael J. , Rose Peter S. , Kremers Hilal Maradit , Lewallen David G. , Berry Daniel J. 
Published: August 2023

Abstract

Background
Massive modular endoprostheses have become a primary means of reconstruction after oncologic resection of a lower extremity tumor. These implants are commonly made with cobalt-chromium alloys that can undergo wear and corrosion, releasing cobalt and chromium ions into the surrounding tissue and blood. However, there are few studies about the blood metal levels in these patients.

Question/purpose
What is the whole blood cobalt and chromium ion level in patients with massive modular endoprostheses?

Methods
We performed a cross-sectional study of our total joints registry to identify patients with a history of an endoprosthetic reconstruction performed at our institution. Patients who were alive at the time of our review in addition to those undergoing an endoprosthetic reconstruction after an oncologic resection were included. Whole blood samples were obtained from 27 (14 male and 13 female) patients with a history of a lower extremity oncologic endoprosthesis. The median time from surgery to blood collection was 8 years (range 6 months to 32 years). Blood samples were collected and stored in metal-free ethylenediaminetetraacetic acid tubes. Samples were analyzed on an inductively coupled plasma mass spectrometer in an International Organization for Standardization seven-class clean room using polytetrafluoroethylene-coated instruments to reduce the risk of metal contamination. The analytical measuring range was 1 to 200 ng/mL for chromium and cobalt. Cobalt and chromium levels were considered elevated when the blood level was ≥ 1 ppb.

Results
Cobalt levels were elevated in 59% (16 of 27) of patients, and chromium levels were elevated in 26% (seven of 27). In patients with elevated metal ion values, 15 of 17 patients had a reconstruction using a Stryker/Howmedica Global Modular Replacement System implant.

Conclusion
Blood metal levels were elevated in patients who received reconstructions using modular oncology endoprostheses Future work is needed to establish appropriate follow-up routines and determine whether and when systemic complications occur because of elevated metal levels and how to potentially address these elevated levels when complications occur. Prospective and retrospective collaboration between multiple centers and specialty societies will be necessary to address these unknown questions in this potentially vulnerable patient group.

Level of Evidence
Level IV, therapeutic study.
Urinary congophilia in pregnancy: a marker of kidney injury rather than preeclampsia
Authors: Younis Dalia , Mosbah Alaa , Zakaria Mahmoud M. , Awadalla Amira , El-kannishy Ghada , Shemies Rasha S. 
Published: August 2023

Background:
The differentiation between preeclampsia and similarly presenting kidney disease in pregnancy is a diagnostic challenge. Although some laboratory tests have been utilized, globally validated tools are yet needed, particularly in resource-limited settings. Congophilic proteins are abundantly detected in the urine of pregnant women who develop preeclampsia that is thought to be a marker of disease process. The present study aimed to assess the diagnostic and predictive utility of urinary congophilia in pregnant women with hypertensive disorders of pregnancy as well as kidney diseases.

Methods:
This cohort study included 157 pregnant women, classified as healthy controls (n = 38), preeclampsia/eclampsia (n = 45), gestational hypertension (n = 9), chronic hypertension (n = 8), chronic kidney disease (CKD) (n = 27), and pregnancy-related acute kidney injury (PR-AKI) (n = 30). Urinary congophilia was assessed by Congo Red Dot Blot assay.

Results:
Congo red retention (CRR) values were significantly higher in women with preeclampsia/eclampsia (P ≤ 0.001), chronic hypertension (P = 0.029), gestational hypertension (P = 0.017), CKD (P ≤ 0.001), PR-AKI secondary to preeclampsia (P ≤ 0.001), and PR-AKI secondary to other causes (P = 0.001), compared with healthy controls. Women with preeclampsia, CKD, and PR-AKI (non-preeclampsia related) exhibited the highest levels of CRR. CRR positively correlated to proteinuria (P = 0.006) and serum creatinine (P = 0.027). CRR did not significantly vary between women who presented antepartum and those presented postpartum after removal of the placenta (P = 0.707). CRR at a cut-off point of at least 1.272 had 91% specificity and 61.1% sensitivity in predicting renal recovery in PR-AKI patients. CRR had a poor specificity in discriminating preeclampsia from the other clinical presentations.

Conclusion:
Urinary congophilia could not discriminate preeclampsia from similarly presenting kidney diseases in pregnancy. Further studies are needed to improve differentiation of these conditions.
Impact of Foveal Status and Timing of Surgery on Visual Outcome in Rhegmatogenous Retinal Detachment
Authors: Haq Zeeshan , Mittra Robert A. , Parke D. Wilkin , Yonekawa Yoshihiro , Hsu Jason , Gupta Omesh , Williams George A. , Shah Gaurav K. , Ryan Edwin H. 
Published: August 2023

Abstract

Purpose:
To investigate the impact of surgical timing on visual acuity (VA) outcomes in retinal detachments (RD) based on preoperative foveal status.

Methods:
A retrospective multicenter cohort study was conducted. Cases were stratified into fovea-on, fovea-split, and fovea-off groups. Days to surgery was defined as the time between the preoperative examination and surgery. The main outcome measure was final postoperative VA.

Results:
1675 cases were studied. More than 80% of fovea-on/fovea-split and fovea-off cases had surgery within 1 and 3 days, respectively. The mean final postoperative VA did not differ significantly between the fovea-on and fovea-split groups (SE 20/33 ± 20/49 and 20/32 ± 20/39, p = 1.000) and did not change significantly based on days to surgery in either group. The mean final postoperative VA was lowest in the fovea-off group (Snellen equivalent [SE] = 20/56 ± 20/76, p < 0.001) and was significantly lower in cases where surgery was performed after 2 or more days when compared to cases performed within 1 day (SE 20/74 ± 20/89 vs 20/46 ± 20/63, p < 0.001).

Conclusions:
Fovea-on and fovea-split RDs demonstrated comparable visual outcomes. Fovea-off RDs demonstrated worse visual outcomes, which declined further when surgery was delayed by 2 or more days.
Photodynamic acute exudative maculopathy in a case series of circumscribed choroidal hemangioma.
Authors: Fernández-Vigo José Ignacio , Valverde-Megías Alicia , García-Caride Sara , Burgos-Blasco Bárbara , Oribio-Quinto Carlos , Donate-López Juan 
Published: August 2023

ABSTRACT

Purpose:
To describe the incidence, features, and clinical outcomes of photodynamic therapy (PDT)-induced acute exudative maculopathy (PAEM) in circumscribed choroidal hemangioma (CCH).

Methods:
Prospective series of 10 patients that underwent standard-fluence PDT for CCH. Best-corrected visual acuity (BCVA) in the Early Treatment Diabetic Retinopathy Score and swept-source optical coherence tomography (SS-OCT) were performed before, 3 days and 1 month after. Central retinal thickness (CRT), CCH retinal thickness and subretinal fluid (SRF) were measured. PAEM was considered as an increase ≥50 µm in SRF or IRF or the appearance of fibrin 3 days after PDT.

Results:
Six males and 4 females were included; median age was 55 years (19 to 69). The incidence rate of PAEM was 7/10. Five PAEM patients showed an increase in IRF, two in SRF and one developed abundant fibrin. Median BCVA at baseline was 57.5 letters (5 to 76) being stable at one month (64 letters; 5 to 80) (p=0.03). Median CRT increased from 516µm (262 to 1265) to 664.5µm 3 days after and diminished to 245µm after one month (156 to 1363) (p≤0.022). In 6/7 of PAEM, a complete resolution of the fluid was obtained.

Conclusion:
PAEM was frequent in CCH, although a favorable prognosis was observed in most cases.
Effect of Keratoconus Stage and Classification Parameters on Deep Anterior Lamellar Keratoplasty Outcomes
Authors: Kemer Atik Burcu , Emul Merve , Kirgiz Ahmet , Cubuk Mehmet Ozgur , Ahmet Sibel , Kandemir Besek Nilay 
Published: August 2023

Purpose:
The aim of this study was to investigate the effect of the keratoconus (KC) stage according to the Amsler–Krumeich classification system and the parameters used in this classification on deep anterior lamellar keratoplasty outcomes.

Methods:
The preoperative KC stage was determined, and the presence of corneal scarring was noted. The preoperative and postoperative best-corrected visual acuity (BCVA), refractive error, mean central keratometry (Kmean) readings, topographic astigmatism, and minimum corneal thickness (CT) values were recorded. Intraoperative and postoperative complications were also noted.

Results:
One hundred thirty-seven eyes (54 eyes in stage 3–83 eyes in stage 4) were included in the study. The mean follow-up period was 42.20 ± 24.36 months. There was no statistically significant difference between stage 3 and 4 KC groups for postoperative BCVA, Kmean, CT, spherical equivalent, and topographic astigmatism values (each P value >0.05). The effect of preoperative BCVA, Kmean, CT, and refractive error values on postoperative BCVA could not be demonstrated (P = 0.264). In addition, no statistically significant correlation was found between postoperative and preoperative values (each P value > 0.05). Although intraoperative Descemet membrane perforation and postoperative early suture loosening were observed more frequently in stage 4 KC than in stage 3 KC, the 2 groups were statistically similar for these and other complications (each P value >0.05).

Conclusions:
The preoperative KC stage and the parameters used in classification are not useful in predicting postoperative deep anterior lamellar keratoplasty outcomes. The timing of the surgery should be planned with the awareness that the progression of the disease will not have a negative effect on outcomes.
Triple Procedure: A Stepwise Combination of Deep Anterior Lamellar Keratoplasty and Cataract Surgery
Authors: Alfonso-Bartolozzi Belén , Fernández-Vega-Cueto Luis , Fernández-Vega Luis , Martínez-Alberquilla Irene , Madrid-Costa David , Alfonso José F. 
Published: August 2023

Purpose:
The aim of this study was to evaluate clinical outcomes of the combined surgery (triple procedure) of deep anterior lamellar keratoplasty (DALK), phacoemulsification, and intraocular lens (IOL) implantation using a new surgical strategy.

Methods:
The study included 43 eyes of 43 patients who underwent a triple procedure. Twenty-six eyes with good visibility through the cornea underwent phacoemulsification before the stromal dissection. Seventeen eyes with bad visibility underwent the DALK procedure first until achieving enough visibility to perform the lensectomy. IOL power calculation was performed for a postoperative estimated flat keratometry of 43.5 and aiming to avoid hyperopic postoperative refraction. The postoperative visual examination included uncorrected and corrected distance visual acuity (CDVA) measurements and manifest refraction.

Results:
The mean follow-up time after suture removal was 3.06 ± 2.14 years. Mean CDVA significantly changed from 0.86 ± 0.56 logMAR preoperatively to 0.37 ± 0.28 logMAR in the last visit (P < 0.0001). The percentage of eyes with CDVA ≤0.3 logMAR changed from 6.9% preoperatively to 62.8%. No eyes lost lines of vision after surgery, and 80% experienced an improvement of 2 or more lines. The safety index was 2.2. The mean postoperative refractive sphere was +0.13 ± 2.04 D, and the postoperative refractive cylinder was −4.02 ± 2.24 D. Only 2 cases (4.65%) obtained postoperative hyperopic astigmatism. No intraoperative complications were found.

Conclusions:
Combined surgery of DALK, phacoemulsification, and IOL implantation is an effective and safe procedure. Depending on the corneal transparency, different surgical strategies can be established to provide more efficacy and safety.
Early oral diet may enhance recovery from benign gynecologic surgery: A single center prospective study
Authors: Yang Szu-Ting , Kuo Shu-Chen , Liu Hung-Hsien , Huang Kuan-Min , Liu Chia-Hao , Chen Shu-Fen , Wang Peng-Hui 
Published: August 2023

Background:
Early dietary intake enhanced recovery after surgery (ERAS). There remains a gap in the recognition and implementation of early diet after surgery in medical institutions in Taiwan. This study aimed to investigate whether early oral intake after benign gynecologic surgery results in favorable outcomes in Taiwanese patients.

Methods:
This was a prospective controlled nonrandomized cohort study. Patients who underwent benign gynecological surgery were included in the early- and conventional-diet groups. The primary outcome was length of hospital stay, and the secondary outcome was postoperative complications.

Results:
Forty and 38 patients were included in the early and conventional-diet groups, respectively. The early-diet group demonstrated significantly reduced length of hospital stay (the early-diet group, 2.58 ± 0.93 days; conventional-diet group, 4.16 ± 1.13 days; p < 0.001). No increase in postoperative complications was observed in the early-diet group. Laparoscopic surgery reduced the length of hospital stay (β, −0.65; 95% confidence interval [CI], −1.22 to −0.08; p = 0.027), while an increased length of hospital stay was associated with higher visual analog scales (VAS, β, 0.21; 95% CI, 0.03-0.39; p = 0.026) and the conventional-diet group (β, 1.13; 95% CI, 0.65-1.61; p < 0.001) as assessed by multivariate regression analysis.

Conclusion:
Patients who underwent benign gynecologic surgery tolerated an early oral diet well without an increase in complications. Laparoscopic surgery and lower pain scores also enhanced postoperative recovery.
Skin tone representation in dermatologic direct-to-consumer advertisements: a cross-sectional analysis and call to action
Authors: Okeke Chidubem A. V. , Tran Joseph , Wright Ixavion , Okoye Ginette A. , Burgess Cheryl M. , Byrd Angel S. 
Published: August 2023

Background:
Direct-to-consumer advertisements (DTCAs) in medical marketing serve as a prominent modality to deliver information to an increasingly diverse audience of consumers and increase prescription sales. In dermatology, advertisements have the potential to shape the public’s opinions, aid in the understanding of skin conditions, and raise awareness of available treatments.

Objective:
To investigate and characterize the representation of skin tones in DTCAs.

Methods:
Nielsen ratings were utilized to identify the networks most watched by Black viewers in 2022. Programming on NBCUniversal, ABC, CBS, and FOX that aired in the District of Columbia, suburban Maryland, and Northern Virginia from June 2022 to July 2022 was reviewed for DTCAs. DTCAs were then analyzed to determine the skin tones of models and skin conditions depicted on models with darkly pigmented skin.

Results:
Of the 106 DTCAs related to dermatologic conditions, there were 13 unique advertisements featuring 32 unique models. Four advertisements depicted the skin condition on darkly pigmented skin tones. Using the Monk Skin Tone (MST) scale to assess the 32 unique individuals, only 25% (n = 8) were rated at an MST 7 or above, and 6.25% (n = 2) were rated at an MST 10.

Limitations:
This study has the limitation of only sampling DTCAs from Washington, District of Columbia which does not fully represent all dermatology-related DTCAs in the United States.

Conclusion:
Results of this content analysis demonstrate that the number of persons of color within dermatologic DTCAs is 23%, whereas there are 13.6% Black individuals in the 2021 US census. This suggests that DTCAs are becoming more diverse since 2018. However, findings also show that the vast majority of DTCAs do not include models with darkly pigmented skin, and there remains a lack of advertisements depicting skin disease among people of color. Given the role of DTCAs in informing and aiding patients’ requests for prescription drugs, representation of all skin tones is essential for this communication to be effective, especially in the field of dermatology.
Protecting the health care workforce from cytotoxic drugs contamination in the hospital wards: the results of the pan-European MASHA-2 project
Authors: Korczowska Ewelina , Crul Mirjam , Wolc Anna , Meier Klaus 
Published: August 2023

Abstract

Background:
A fundamental requirement to ensure the safety of health care workers is to reduce environmental contamination with cytotoxic medicines.

Objectives:
The primary objective of this collaborative project between the European Society of Oncology Pharmacy (ESOP) and the European Society for Medical Oncology (ESMO) was to evaluate cytotoxic medicine contamination on surfaces in European hospital wards. The secondary objectives were (a) to detect possible internal bodily exposure in staff members and (b) to evaluate the impact of teaching safe handling practices.

Materials and methods:
Surface contamination in the chemotherapy administration areas was measured in 28 hospitals from 16 European countries before (part I) and after (part II) staff training through a standardized tutorial. Contamination with four antineoplastic medicines and total platinum was assessed using wipe samples taken from four comparable surfaces in each part of the project. In addition, hospitals that showed a high level of surface contamination, collected 24-hour urine of five staff members (part III). The samples were analyzed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) and inductively coupled plasma-mass spectrometry (ICP-MS).

Results:
In total, 112 and 104 wipe samples (part I and part II) and 32 urine samples (part III) were collected. Surface contamination occurred in all participating hospitals. The most contaminated spot was the floor in the nurses' station. The most frequently found compound was platinum, and the medicine that showed the highest amount of contamination was cyclophosphamide (8.18 ng/cm2 in part I and 0.53 ng/cm2 in part II). Urine samples were positive for gemcitabine and cyclophosphamide in 1 and 2 nurses, respectively. The intervention by tutorial lowered the levels of contamination, both in number (from 48% to 41%) and in amount of contamination.

Conclusion:
The MASHA-2 study shows that contamination of surfaces with cytotoxic medicines in European hospitals is a widespread phenomenon. Bodily exposure of nurses was clearly detected. Surface contamination decreased after training on safe handling practices. Nevertheless, further optimization of occupational safety is warranted.