bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates
Authors: Rodriguez-Unda Nelson A. , Mehta Ishan , Chopra Shiv , Vicente-Ruiz Miriam , Navia Alfonso , Fernandez-Diaz Oscar F. 
Published: April 2023

Background:
Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees.

Methods:
A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire.

Results:
One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout.

Conclusions:
Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were “protective.” Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.
Procedure Costs of Peripheral Nerve Graft Reconstruction
Authors: Raizman Noah M. , Endress Ryan D. , Styron Joseph F. , Emont Seth L. , Cao Zhun , Park Lawrence I. , Greenberg Jeffery A. 
Published: April 2023

Background:
Peripheral nerve injuries not repaired in an effective and timely manner may lead to permanent functional loss and/or pain. For gaps greater than 5 mm, autograft has been the gold standard. Allograft has recently emerged as an attractive alternative, delivering comparable functional recovery without risk of second surgical site morbidities. Cost is an important factor when considering surgical options, and with a paucity of nerve repair cost data, this study aimed to compare allograft and autograft procedure costs.

Methods:
A retrospective cross-sectional observational study using the US all-payer PINC AI Healthcare Database examined facility procedure costs and cost drivers in patients undergoing allograft or autograft repair of an isolated single peripheral nerve injury between January 2018 and August 2020. Inpatient repairs were limited to nerve-specific DRGs. Multivariable regression evaluated risk-adjusted procedure cost differences.

Results:
Peripheral nerve graft repairs (n = 1363) were more frequent in the outpatient setting, and more than half involved the use of allograft nerve. Procedure costs for allograft and autograft repair were not significantly different in the outpatient (P = 0.43) or inpatient (P = 0.71) setting even after controlling for other risk factors. Operating room cost was significantly higher for autograft in outpatient (P < 0.0001) but not inpatient (P = 0.46), whereas allograft implant cost was significantly higher in both settings (P < 0.0001).

Conclusions:
No significant differences in procedure costs for autograft and allograft repair in inpatient and outpatient settings were found using real-world data. Future research should explore longer-term costs.
PRIMARY VITREORETINAL LYMPHOMA MASQUERADING AS POSTOPERATIVE ENDOPHTHALMITIS IN A PREGNANT PATIENT WITH LONG-STANDING IDIOPATHIC PANUVEITIS
Authors: Konda Sri Meghana , Deaner Jordan D. , Proia Alan D. , Jaffe Glenn J. 
Published: April 2023

Purpose:
To report primary vitreoretinal lymphoma after surgical 0.59 mg fluocinolone acetonide implant (FAi) exchange in a patient treated with adalimumab for idiopathic bilateral panuveitis.

Methods:
Retrospective case review.

Results:
A 37-year-old woman with bilateral idiopathic panuveitis, who had favorable responses to previous FAi surgical implants, presented with right eye recurrent intraocular inflammation and cystoid macular edema that partially responded to systemic adalimumab. Her FAi was replaced, given her previous favorable response. She developed postoperative ocular inflammation transiently responsive to two serial vitreous taps and injections of intravitreal antimicrobials and then worsening inflammation and new layered flocculant material. Diagnostic vitrectomy showed a few atypical lymphocytes and cultures were negative. At postdiagnostic vitrectomy Month 1, flocculant material recurred. Aqueous cytology and flow cytometry revealed large CD45-positive B cells suspicious for lymphoma. Postoperatively, she revealed that she was pregnant. She was treated with eight monthly intravitreal methotrexate injections and postpartum consolidation radiotherapy. Subsequent repeat cytology, flow cytometry, and corneal pathologic examination revealed large B cells that were CD20 positive, and next-generation sequencing detected a dominant monoclonal B-cell population, diagnostic of PVRL. Nineteen months after FAi exchange, she developed an area of enhancement in the lateral aspect of the right frontal lobe on brain MRI, consistent with central nervous system involvement.

Conclusion:
The authors present a unique case of PVRL masquerading as postoperative endophthalmitis after FAi exchange in an eye with chronic panuveitis treated with adalimumab immunosuppressive therapy. The authors hypothesize that there may be a causal relationship between adalimumab and PVRL.
Psychological burden in Portuguese university students during the COVID-19 pandemic
Authors: Tavares-Almeida Sofia , Moura Diana , Madeira Nuno , Figueiredo-Braga Margarida 
Published: April 2023

Abstract

Background:
University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators.

Methods:
We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated.

Results:
From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses.

Conclusions:
Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.
Impact of COVID-19 on adolescent health and use of social media
Authors: Ramsey Natasha , Obeidallah Malik , Abraham Anisha 
Published: April 2023

Purpose of reviewThe coronavirus disease 2019 (COVID-19) pandemic changed access to healthcare and decreased mental and physical wellbeing. It also significantly altered teens’ relationship with social media. This article is a current review of the literature on the impact of COVID-19 on adolescent health overall. In addition, how social media use has both improved and worsened the impact of COVID-19, along with strategies providers should consider in wanting to address social media use with teens.Recent findingsThe COVID-19 pandemic has affected adolescents through increased social isolation and decreased access to healthcare resources. Social media use has both positive and negative effects on adolescent health. Positive effects include sustained connection to friends, family and community while negative effects include lower self-esteem and increased incidence of eating disorders.SummaryOur findings underscore the multifaceted impact of social media on adolescent mental health, physical wellbeing, and healthcare access. Of particular relevance to the physician is the potential of leveraging social media to promote healthy behaviors in vulnerable age groups and populations. Social media can be used to connect teens with reputable websites where they can seek medical or health information that would otherwise not readily be available.
Health literacy in pediatric dermatology: challenges and opportunities
Authors: Williams Kendrick J. , Housten Ashley J. , Coughlin Carrie C. 
Published: April 2023

Purpose of review
Health literacy influences how children and families participate in their medical care, use health services, and overall health outcomes. Health literacy is underexplored in pediatric dermatology. In this scoping review, we provide examples of how limited health literacy can be a barrier to patient care in pediatric dermatology and how to mitigate its effects.

Recent findings
Limited health literacy is associated with worse health outcomes, decreased medication adherence, and decreased use of the healthcare system versus those with adequate health literacy. Materials created to help patients understand their medical conditions and treatment options often are written at a reading level far above that of the average patient and caregiver. Given the reading level of patient-facing materials, those with limited health literacy are more susceptible to medication administration errors, with omissions or incorrect dosing being most frequent to occur. There is limited research about how skills related to health literacy, including numeracy and electronic health literacy, can be addressed in pediatric dermatology.

Summary
Health literacy impacts patient care, treatment, and adherence in pediatric dermatology. This article gives examples of how to address common challenges in the pediatric dermatology clinic and presents areas for further research and improvement.
Timely Recognition of Abusive Injuries (TRAIN): Results from a Statewide Quality Improvement Collaborative
Authors: Crichton Kristin Garton , Spencer Sandra , Shapiro Robert , McPherson Paul , Izsak Eugene , McDavid Lolita M. , Baker Carrie , Thackeray Jonathan D. ,   for the TRAIN Collaborative
Published: April 2023

Introduction:
Early recognition of physical abuse is critical as children often experience recurrent abuse if their environment remains unchanged. The Timely Recognition of Abusive Injuries (TRAIN) Collaborative was a quality improvement network of 6 Ohio children’s hospitals created in 2015 to improve the management of injuries concerning for abuse in infants. TRAIN’s first phase sought to reduce recurrent abuse by recognizing and responding to injured infants. This study aimed to reduce reinjury rate among infants ≤6 months by 10% at 1 year and 50% by 2 years and sustain improvement for 1 year as reflected in 3- and 12-month reinjury rates.

Methods:
The TRAIN Collaborative adopted the Institute for Healthcare Improvement’s Breakthrough Series Collaborative Model, where partnerships between organizations facilitate learning from each other and experts. Collaborative members identified opportunities to improve injury recognition, implemented changes, responded to data, and reconvened to share successes and obstacles. As a result, institutions implemented different interventions, including education for clinical staff, increased social work involvement, and scripting for providers.

Results:
Data collected over 3 years were compared to a 12-month baseline. The number of injuries increased from 51 children with concerning injuries identified monthly to 76 children sustained throughout the collaborative. However, within 2 years, the 3- and 12-month reinjury rates ultimately significantly decreased from 5.7% to 2.1% and 6.5% to 3.7%, respectively.

Conclusion:
Our data suggest the Institute for Healthcare Improvement’s Breakthrough Series model can be applied across large populations to improve secondary injury prevention in infants.
Soft tissue response following genioplasty combined with anterior segmental osteotomy
Authors: Kim Huy-Young , Han Sang-Baek 
Published: April 2023

Background:
Our main aim was to analyze soft tissue response of the chin following genioplasty with anterior segmental osteotomy, which enables optimal surgical planning of genioplasty.

Methods:
Sixty-two patients who underwent genioplasty with concomitant anterior segmental osteotomy were divided into three groups depending on the direction of pogonion movement: G1 (without sagittal change), G2 (advancement genioplasty), and G3 (setback genioplasty). All genioplasties included height reduction. Hard and soft tissue measurements with cephalometry were performed at T1 (before surgery), T2 (after surgery), and T3 (after orthodontic treatment) for the analysis of sagittal and vertical changes. Correlation and regression analyses were conducted to analyze soft-to-hard tissue movement and soft tissue thickness changes.

Results:
During the T1–T2 period, the horizontal soft-to-hard tissue ratio at pogonion was 0.85 in G2 and 0.80 in G3, and the vertical ratio at menton was 0.9 for all groups. The correlation coefficients were 0.64 (G2) and 0.83 (G3) at pogonion and 0.9 (all), 0.85 (G1), 0.95 (G3) at menton. There was no significant correlation between initial soft tissue thickness and soft tissue response ratio. During the T2–T3 period, no significant relapses were observed, which demonstrates the stability of anterior segmental osteotomy-combined genioplasty.

Conclusions:
Clinically and statistically significant soft tissue responses were demonstrated at pogonion and menton. The higher values in G3 in particular suggest that setback genioplasty with anterior segmental osteotomy is an an effective treatment alternative to conventional two-jaw surgery in some patients with bimaxillary prognathism with macrogenia.
Single Oral Z-plasty: A Clinical Validation of a Technique for Palatal Lengthening in Primary and Secondary Cleft Palate Repair
Authors: Lerner Julia , Vishwanath Neel , Crozier Joseph , Rao Vinay , Woo Albert 
Published: April 2023

PURPOSE:
In cleft palate repair, palate length is associated with improved speech outcomes. While direct closure offers poor palatal lengthening, utilization of two opposing Z-plasties may reorient palatal musculature and lengthen the velum. We previously described a novel overlapping intravelar veloplasty to achieve longitudinal closure of the nasal mucosa with a single oral Z-plasty (1ZP), lengthening the palate in cadaver studies. This study aims to corroborate this finding in clinical cases.

METHODS:
A retrospective comparative study of patients with a cleft palate was conducted. Patients underwent cleft palate closure with 1ZP or IVV with straight line closure. Pre- and post-operative measurements of the palate along four dimensions were recorded. Analysis was conducted on pre-and-post operative measurements within and between groups using the Mann-Whitney-Wilcoxon or Chi Squared test.

RESULTS:
85 patients were included (1ZP=65, Straight line closure = 20). 1ZP increased soft palate length (SPL) by 33% (p<0.001) and total palate length (TPL) by 10% (p<0.001). Primary 1ZP increased SPL by 33% (p<0.001) and TPL by 10% (p<0.001). Secondary 1ZP increased SPL by 28% (p<0.001) and TPL by 8% (p<0.001). When comparing between primary and secondary 1ZP, 1ZP was equal percent lengthening in SPL(p > 0.9) and TPL (p > 0.3). When compared to straight line closure, 1ZP showed superior percent lengthening in SPL (p<0.001), and TPL (p=0.038).

CONCLUSION:
1ZP results in a statistically significant increase in palate length in both primary and secondary cleft palate repair. This technique provides an effective alternative in patients for whom 2ZP is not feasible.
CHANGES IN VASOACTIVE DRUG REQUIREMENTS AND MORTALITY IN CARDIAC INTENSIVE CARE UNIT PATIENTS
Authors: Jentzer Jacob C. , Patel Parag C. , Van Diepen Sean , Morrow David A. , Barsness Gregory W. , Kashani Kianoush B. 
Published: April 2023

ABSTRACT

Background: The Society for Cardiovascular Angiography and Intervention (SCAI) Shock Classification can define shock severity. We evaluated the vasoactive-inotropic score (VIS) combined with the SCAI Shock Classification for mortality risk stratification. Methods: This was a single-center retrospective cohort analysis including Mayo Clinic cardiac intensive care unit patients from 2007 to 2015. The peak VIS was calculated at 1 and 24 h after cardiac intensive care unit admission. In-hospital mortality was evaluated using multivariable logistic regression. Results: Of 9,916 included patients, vasoactive drugs were used in 875 (8.8%) within 1 h and 2,196 (22.1%) within 24 h. A total of 888 patients (9.0%) died during hospitalization. Patients who required vasoactive drugs within 1 h had higher in-hospital mortality (adjusted odds ratio [OR], 1.30; 95% confidence interval [CI], 1.03–1.65; P = 0.03) and in-hospital mortality rose with the VIS during the first 1 h (adjusted OR per 10 units, 1.22; 95% CI, 1.12–1.33; P < 0.001). The increase in VIS from 1 to 24 h was associated with higher in-hospital mortality (adjusted OR per 10 units, 1.16; 95% CI, 1.10–1.21; P < 0.001). These results were consistent in the 1,067 patients (10.9%) with cardiogenic shock. A gradient of in-hospital mortality was observed according to the VIS at 1 h and the increase in VIS from 1 to 24 h. Conclusions: Higher vasoactive drug requirements portend a higher risk of mortality, particularly a high VIS early after admission. The VIS provides incremental prognostic information beyond the SCAI Shock Classification, emphasizing the continuum of risk that exists across the spectrum of shock severity.
Precision Medicine in Epilepsy Management; GET Application (Gene, Epilepsy, Treatment)
Authors: Asadi-Pooya Ali A. 
Published: April 2023

Objectives
The aim was to develop a prototype of an application (app) that identifies the significance of discovered genes for further consideration in the treatment plan of patients with epilepsy (precision medicine).

Methods
MEDLINE was systematically searched for related publications from inception to April 1, 2022. The following search strategy was implemented (title/abstract): “epilepsy” AND “precision” AND “medicine.” The following data were extracted: genes, phenotypes associated with those genes, and the recommended treatments. Two other databases were searched to cross-check the retrieved data and add to the data: https://www.genecards.org and https://medlineplus.gov/genetics. Also, the original articles of the identified genes were retrieved. Genes with specific treatment strategies (ie, any specific drug to be selected or to be avoided and also any other specific therapies [eg, diets, supplements, etc]) were selected.

Results
A database of 93 genes, which are associated with various epilepsy syndromes and for which specific treatment strategies have been suggested, was developed.

Conclusions
A Web-based app (a search engine) was developed accordingly that is freely available at http://get.yektaparnian.ir/, GET (Gene, Epilepsy, Treatment). When a patient comes to the clinic with a genetic diagnosis and a specific gene is identified, the physician enters the gene name into the search box, and the app shows whether this genetic epilepsy needs a specific treatment. This endeavor would benefit from input by experts in the field, and the Web site should be developed more comprehensively.
COVID-19 Vaccine Uptake And Its’ Associated Factors among general population In Basmaia City in Baghdad 2022
Authors: Saber Hussein Abdalrahim , Albayaty Mohammed Asaad 
Published: April 2023

AbstractObjectiveVaccination is a vital cornerstone of public health, which has saved countless lives throughout history. Therefore, achieving high vaccination uptake rates is essential for successful vaccination programs. Unfortunately, vaccine uptake has been hindered by deferent factors and challenges. The objective of this study is to assess COVID-19 vaccine uptake and associated factors among the general population.MethodsThis study is a descriptive cross-sectional study conducted in Basmaia city, Baghdad from June to October 2022. Data were collected through a semi-structured questionnaire using multi-stage random sampling. Statistical analysis was performed using descriptive statistics, chi-square analysis, Mann-Whitney test, and binary and multivariable logistic regression.ResultsThe prevalence of COVID-19 vaccine uptake was 70.4%. The most common reason for getting vaccinated was protection from the disease, while fear of side effects and not needing the vaccine were the main reasons for refusal.The study found that gender, age, education level, job title, risk perception, knowledge, and attitude towards the vaccine were significantly associated with COVID-19 vaccine uptake. Males were 2.273 times more likely to get vaccinated than females, and older age groups had higher odds of vaccination than younger age groups. Those with higher education levels were also more likely to receive the vaccine. Participants with higher risk perception, knowledge, and positive attitude towards the vaccine were more likely to get vaccinated.And found that mandatory vaccination policies may negatively impact uptake of subsequent vaccine doses.ConclusionThe study found a high prevalence of COVID-19 vaccine uptake, with gender, age, education level, and job title being significant factors associated with vaccine uptake. Additionally, mandatory vaccination policies may have a negative impact on the uptake of subsequent vaccine doses. Public health efforts should prioritize addressing these factors to increase vaccine uptake.