bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Hemoglobin A1c in the Third-Trimester May Underestimate Maternal Hyperglycemia and Its Impact on Offspring in Perinatal Demise Associated With Gestational Diabetes Mellitus: An Autopsy Case Series
Authors: Chan Elaine S , Chadha Rati , Koning Lawrence de 
Published: September 2023

Introduction: Gestational diabetes mellitus (GDM) is a common metabolic disorder linked to adverse pregnancy outcomes. Recent research indicates that HbA1c is reliable in detecting maternal glycemia during the first trimester but may underestimate glucose intolerance in the late second to third trimesters. Therefore, it is reasonable to hypothesize that mothers with GDM, despite apparently normal HbA1c levels in the third trimester, may give birth to infants displaying characteristic features often seen in infants of diabetic mothers with suboptimal glycemic control. This study aimed to describe a case series of autopsy cases involving stillborn or deceased neonates delivered in the third trimester to mothers diagnosed with GDM and having normal HbA1c levels at or around the time of delivery. The primary focus was on identifying and documenting the characteristic features commonly associated with “infants of diabetic mothers” with suboptimal glycemic control in this series of cases. Materials and Methods: We conducted a retrospective review of autopsy reports from our institution spanning 7.5 years. The study included cases that met the following criteria: (1) stillborn or infants who died in the early neonatal period, delivered in the third trimester; (2) mothers diagnosed with GDM; (3) normal maternal HbA1c levels of ≤6.1% at or around the time of delivery; (4) birthweight or femoral length exceeding the 90th percentile for gestational age; and (5) absence of genetic aberrations. We also examined these cases for other characteristic features associated with “infants of diabetic mothers.” Results: Ten autopsy cases met our inclusion criteria, including 9 stillbirths and 1 neonatal death. Gestational age at delivery ranged from 32 to 39 weeks (mean: 35.7 weeks). Femoral length exceeded the 90th percentile in all cases, and 6 cases had birthweights above the 90th percentile. Puffy facies were observed in 6 cases. Among the 9 cases with complete autopsies including internal examination, 6 exhibited excess adipose tissue, 4 had cardiomegaly, and 3 showed pancreatic islet hyperplasia. Hypoxic-ischemic encephalopathy was detected in 7 cases. No structural abnormalities were noted. Discussion: Our findings demonstrated that fetuses and neonates born to mothers with apparently normal HbA1c levels in the third trimester could still display characteristic features commonly observed in infants of diabetic mothers with poor glycemic control, also known as “infants of diabetic mothers.” This study underscores the potential of third-trimester maternal HbA1c measurements to underestimate maternal glycemia and its consequential impact on fetal development, as well as the subsequent manifestation of features of “infants of diabetic mothers.”
Visual outcome of treating proliferative sickle cell retinopathy in 108 eyes
Authors: Okonkwo Ogugua Ndubuisi , Hassan Adekunle Olubola , Oyekunle Idris , Akanbi Toyin , Agweye Chineze 
Published: September 2023

AimTo report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR).DesignRetrospective interventional.MethodsReview of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed.Results108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05).ConclusionSeveral options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.
Performance of deep learning for detection of chronic kidney disease from retinal fundus photographs: A systematic review and meta-analysis
Authors: Tan Yuhe , Ma Yunxi , Rao Suyun , Sun Xufang 
Published: September 2023

Objective Deep learning has been used to detect chronic kidney disease (CKD) from retinal fundus photographs. We aim to evaluate the performance of deep learning for CKD detection. Methods The original studies in CKD patients detected by deep learning from retinal fundus photographs were eligible for inclusion. PubMed, Embase, the Cochrane Library, and Web of Science were searched up to October 31, 2022. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the risk of bias. Results Four studies enrolled 114,860 subjects were included. The pooled sensitivity and specificity were 87.8% (95% confidence interval (CI): 61.6% to 98.3%), and 62.4% (95% CI: 44.9% to 78.7%). The area under the curve (AUC) was 0.864 (95%CI: 0.769, 0.986). Conclusion Deep learning based on retinal fundus photographs has the ability to detect CKD, but it currently has a lot of room for improvement. It is still a long way from clinical application.
Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months
Authors: Kaiser Dominik , Hoch Armando , Sutter Reto , Zingg Patrick O 
Published: September 2023

Introduction: Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively. Methods: We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months. Results: The mean age of the patients was 69 years, mean follow-up was 35 (26–54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 ( p  = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 ( p  = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up. Conclusions: In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.
The professional agenda and its effect on the implementation of telemedicine among primary care physicians: A qualitative study
Authors: Golan Cohen Avivit , Tal Yossi , Hersh Daniel , Vinker Shlomo , Merzon Eugene , Green Ilan , Isrel Ariel , Tuval Atalia 
Published: September 2023

Introduction Studies show that physicians’ attitudes are a major influential factor in the degree of implementation of telemedicine and that most of them identify much more opportunities in this type of visit than risks. These findings do not explain the observed decrease in the use of telemedicine in primary care with the decline of the COVID-19 pandemic. The aim of our study was to understand the gap between the attitudes that primary care physicians declare towards telemedicine and the extent to which they use it in practice. Methods A qualitative research using a semi-structured phone interview with 33 primary care physicians experienced in telemedicine from Leumit Health Services, a health fund in Israel. A qualitative thematic analysis method was used to extract the main themes from all interviews, and descriptive statistical tests were used to analyze the demographic variables. Results The attitude of the physicians depended on the perception of their professional identity and their sense of control over telemedicine implementation. The more established their professional identity and the stronger the support from the organization in the technology integration, the more positive the physician's attitude towards this type of visit. Discussion Healthcare organizations that wish to improve the use of telemedicine in primary care should understand that this is more than just the implementation of new technology: they must find a way to properly support the profound change that doctors must undergo when defining their new role and professional status.
Going into town or staying home: Rural patient experience and preference with home-based versus clinic-based telehealth
Authors: Eiland Leslie , Wardian Jana , Sayles Harlan , Drincic Andjela 
Published: September 2023

Introduction Telehealth is a model of care with potential to improve access, and in turn outcomes, for people living in rural areas. Since 2013, our endocrine clinic-based telehealth program has provided care at rural community hospitals in Nebraska and Iowa. At the start of the COVID-19 pandemic, when regulations around telehealth were adjusted, patients previously seen via clinic-based telehealth had the option to continue clinic-based visits or have a home-based telehealth visit. There is no literature comparing patient experiences between home-based and clinic-based telehealth. The purpose of this study was to understand rural patient preferences regarding endocrinology home-based versus clinic-based telehealth visits. Methods This was a survey study of adult, rural patients who experienced both a clinic-based and home-based telehealth visit with their established endocrinology provider. Respondents were asked about demographics, their reason for visit, preference for home versus clinic-based telehealth, and how they would have received care if telehealth were not an option. Results Forty-two patients (40.8%) responded to the survey, with 27 patients (64.3%) preferring home-based telehealth. There were no significant differences between the groups. However, 47.5% of patients would not have sought specialty care if telehealth were not an option. Discussion This survey of endocrine patients experienced in both clinic-based and home-based telehealth indicates that, while most respondents preferred home-based telehealth, there are distinct advantages to each model and patients appreciate having options. We believe it is important to maintain both lines of service to provide patient-centered care and improve access to specialty care.
Overdosevarslingssystemer – en kartleggingsoversikt med maskinlæring
Authors: Borge Tiril C. , Muller Ashley E. 
Published: September 2023

Sammendrag Bakgrunn: Helsedirektoratet ønsker å vurdere muligheten for å etablere et nasjonalt overdosevarslingssystem (OVS) for å kunne varsle brukere om økt overdosefare. OVS som system forstås her som et sett med sammenhengende elementer som fungerer som en helhet, der hensikten er tidlig oppdagelse av økt overdoserisiko kombinert med rask varsling til de som står i fare for overdoser. Metode: Vi utførte en kartleggingsoversikt over forskning om varslingssystemer for økt overdosefare. Mål 1 var å kartlegge eksisterende forskning om effekten av et OVS (antall brukere nådd, antall overdoser, varslingshurtighet). Mål 2 var å kartlegge eksisterende forskning som kunne belyse brukeres erfaringer med slike systemer. Resultater: Vi brukte flere maskinlæringsfunksjoner for å identifisere og vurdere totalt 4102 referanser fra litteratursøk gjennomført i mars/april 2022, hvorav 11 studier oppfylte inklusjonskriteriene. Effekt av OVS på antall overdoser var ikke mulig å skille fra eksisterende overdoseforebyggende tiltak. OVS’er varslet skadereduksjonsgrupper eller erfaringskonsulenter så tidlig som fire timer etter innmeldt/oppdaget fare. Antall brukere varslet ble i stor grad ikke rapportert, antageligvis fordi data om dette ikke ble innsamlet. Fra syv kvalitative studier ble mønstre i hovedfunn sett på tvers, som omhandlet preferanser for språkbruk og innhold, hvor varslinger burde komme fra, og prinsippene bak dem. Konklusjon: Vi identifiserte lite empirisk forskning om eksisterende OVS’er, særlig relatert til effekt av slike systemer. Uten tilstrekkelig forskningsgrunnlag om effekt må vi være forsiktige med å trekke konklusjoner om hvilke typer OVS’er som bør og ikke bør innføres i Norge. Opprettelse av et OVS trenger ikke nødvendigvis innebære etablering av en ny infrastruktur, men heller være snakk om at to godt utviklede, eksisterende systemer – systemer for overvåking og skadereduksjonstiltak – kan kobles sammen.
Lebanese pharmacists’ knowledge of generic drugs and factors affecting their use and selection following the pandemic and the economic crisis: A pilot cross-sectional study
Authors: Mansour Maribelle , Hatem Georges , Ballout Souheir , Tarhini Sarah , Henaine Anna-Maria , Awada Sanaa 
Published: September 2023

Background Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-name drugs for generic drugs. They are expected to understand the principles and practices of generic drug substitution for high-quality patient care. Some key areas of knowledge include bioequivalence and therapeutic equivalence, regulatory requirements, drug interchangeability, and adequate patient counseling. Objectives This study aims to assess the knowledge, perception, and practice of generic drug substitution among pharmacists in Lebanon following the crises and the factors affecting the prescription and selection of generic drugs. Methods A pilot descriptive cross-sectional study targeting 80 Lebanese pharmacists was conducted over 2 months (September-October 2022), in which data were collected using a uniform survey. Results Overall, pharmacists had a good knowledge of generic drugs in terms of active ingredients (97.5%), pharmaceutical form (85.0%), lower cost (88.7%), bioequivalence to the brand before (95.0%), and therapeutic equivalence. Nevertheless, 22.5% reported that generic drugs are less safe than brands, and 22.5% said they cause side effects or did not know. Among the possible factors that influence the prescription of generic drugs, 35.0% of pharmacists reported that the financial situation of the patient is among the least important factors, while the lack of possible alternatives (45.0%) and the difference in prices (40.0%) were the most important ones. The price of different generics on the market was among the most important factors (36.3%) affecting the selection of generic drugs, followed by the patient’s. preference (26.3%). Only 11.2% considered the information given by pharmaceutical firms could affect their choice, and 10.0% considered the presence or not of excipients with known effects in the formulation. Conclusion Most pharmacists in Lebanon were familiar with generic drugs and supported generic drug substitution. Factors affecting generic drug use and prescription should be further explored to clarify misconceptions and reduce possible adverse events.
Performance evaluation for medical alliance in China based on a novel multi-attribute group decision-making technique with Archimedean copulas-based Hamy operators and extended best-worst method
Authors: Xing Yuping , Wang Jun 
Published: September 2023

Background Medical alliance plays an important role in promoting resource sharing, optimizing the allocation of medical resources, establishing a hierarchical diagnosis and treatment system featuring primary diagnosis at the grassroots level, a two-way referral system, separated treatment for acute and chronic diseases, and dynamic cooperation. Thus, comprehensive performance evaluation for medical alliance is a necessary research that involves a multi-attribute group decision-making problem. Objective The aim of this paper is to develop a new multi-attribute group decision-making evaluation framework and new weight method to better efficaciously resolve the issues of evaluation for the medical alliance. Methods Firstly, Archimedean copula and co-copula operational rules, called Archimedean co-copula, and the form of q-rung orthopair fuzzy Hamy mean aggregation operator based on Archimedean co-copula operational rules are also developed. Secondly, an extended q-rung orthopair fuzzy extended best-worst method satisfying multiplicative consistency is developed to originate the weight information of the attributes. The new weight method can integrate the membership and non-membership of assessment information, improve constancy for group decision making and get an extremely reliable weight consequence. Finally, a novel multi-attribute group decision-making framework is presented based on the proposed q-rung orthopair fuzzy Archimedean copula and co-copula Hamy mean aggregation operator and q-rung orthopair fuzzy Euclidean best-worst method. Furthermore, the new multi-attribute group decision-making method is applied to comprehensive performance evaluation for medical alliance in Shanghai, and the effectiveness of the new method is also demonstrated. Results The results show that the proposed multi-attribute group decision-making method with Archimedean copulas-based Hamy operators and extended best-worst in this paper outperforms some existing methods and provides support for policymakers seeking the use of patient- and community-centered health evaluations to improve health services. Conclusion The proposed method is a theoretical guidance method and a good reference for the evaluation of medical alliances of other regions in China.
Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift
Authors: Kim Yi-Suk , Koo Seungbum , Kim Jun Ho , Tae Jungyeun , Wang Joon Ho , Ahn Jin Hwan , Jang Ki-Mo , Jeon Jongmin , Lee Do Kyung 
Published: September 2023

Background: For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose: To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design: Controlled laboratory study. Methods: The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results: In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, –0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion ( P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion: Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance: Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.
The Clinical Outcomes of Radiocapitellar Reconstruction With Radiocapitellar Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Sandefur Evan P , Hansen Brian K , Hackley Darren T , Schmitt Mark W , Beck Jadon H , Bravo Cesar J 
Published: September 2023

Background Radiocapitellar arthroplasty fills a treatment void for young patients who experience isolated capitellar fractures or radiocapitellar osteoarthritis who are not candidates for total elbow arthroplasty. The outcomes of this procedure are sparsely reported. We designed a meta-analysis to determine the utility of radiocapitellar arthroplasty with respect to functional and patient reported outcomes. Methods The PubMed database was searched for relevant studies. Only studies published in English language that assessed patient reported outcomes following radiocapitellar arthroplasty were included in this study. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses for 2020. Results The initial review yielded 562 studies that met the criteria. After excluding duplications and confounding factors, eight case series were identified for review. Of the eight studies, seven were eligible for inclusion in the meta-analysis for Mayo Elbow Performance Score, flexion-extension arc, and pronation–supination arc. The pooled standard mean difference was found to be statistically significant between pre-operative and post-operative outcomes for Mayo Elbow Performance Score (SMD = 3.04, 95% CI [2.40, 3.67]), flexion-extension arc (SMD = 1.28, 95% CI [0.73, 1.83]), and pronation–supination arc (SMD = 0.81, 95% CI [0.43, 1.18]). Cochran's Q-test and I2 statistics indicated statistically significant heterogeneity for Mayo Elbow Performance Score ( p = .04, I2 = 54%) and flexion-extension arc ( p < .01, I2 = 67%). Conclusions Patients undergoing radiocapitellar arthroplasty showed statistically significant improvements in flexion-extension arc, pronation–supination arc, and Mayo Elbow Performance Scores compared to pre-operative measures.