bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking the Silence: A Workshop for Medical Students on Dealing With Failure in Medicine
Authors: Klasen Jennifer M. , Germann Nicolas , Lutz Sandra , Beck Jimmy , Fourie Lana 
Published: September 2023

Abstract

Problem
Failure is a powerful teacher but an emotionally stressful experience. Before residency, when failure in clinical training is inevitable, medical students should learn to talk about and cope with failure. However, medical school curricula rarely include this topic, and physicians seldom share their mistakes and failures with trainees. This report describes and evaluates a workshop on dealing with failure in medicine.

Approach
Two attending surgical consultants and a life coach facilitated the workshop between February 2021 and February 2022, which consisted of different educational approaches, such as presentations, small group discussions, and journal clubs. The sessions aimed to enable medical learners to identify and analyze actual and potential failure events in everyday clinical practice and learn from them, disclose and communicate medical failures and “speak up,” reflect on failure and develop coping strategies, and understand the moderating role of fear of failure.

Outcomes
Thirty medical students participated in the workshop. Dealing with failure in a productive manner was the medical learners' key learning objective and anticipated takeaway from the workshop. After the workshop, 19 of the 30 participants anonymously completed the standard university evaluation form. The medical students gave the workshop a mean (SD) rating of 8.59 (0.98) on a Likert scale ranging from 1 to 10. They felt better prepared to approach future challenges in a constructive manner after being equipped with strategies to deal with failure. Listening to the failure experiences of faculty and peers in a safe environment helped them accept that failure is inevitable.

Next Steps
The findings suggest that medical students appreciated a safe environment to discuss failure. By promoting a safe learning environment early in the medical career, medical schools could make an important contribution to reducing the stigma of failure and eliminating the shame and blame culture, thus contributing to students' well-being.
Safety and Efficacy of Oral Nalbuphine on Postoperative Pain in Hemorrhoidectomy Patients
Authors: Jao Shu-Wen , Hsiao Koung-Hung , Lin Hua-Ching , Lee Chia-Cheng , Lin Tzu-Chen , Chen Wei-Shone , Lin Chun-Chi , Lee Tsai-Yu , Jiang Jeng-Kai , Wu Chang-Chieh , Hu Oliver Yoa-Pu 
Published: September 2023

Objectives:
Severe postoperative pain requiring opioid treatment has been reported in 20–40% of hemorrhoidectomy patients. Compared to morphine, nalbuphine offers better hemodynamic stability, a lower risk of respiratory depression, and a lower potential for addiction. Nalbuphine was developed from intravenous form into an oral form (PHN131) to alleviate moderate-to-severe pain.

Methods:
A randomized, double-blind, placebo-controlled, multiple-dose, parallel-design trial was conducted to evaluate the safety and efficacy of PHN131 in patients undergoing hemorrhoidectomy. Eligible patients were randomly assigned to receive either PHN131 soft capsules containing nalbuphine hydrochloride 60 mg or placebo capsules. Intramuscular diclofenac was the rescue analgesic. Pain was measured by the area under the curve of mean Visual Analog Scale (VAS) pain intensity scores.

Results:
VAS results in patients receiving PHN131 were significantly lower than placebo group scores through 48 hours postoperatively (149.2±75.52 vs. 179.6±65.97; P=0.0301). According to Brief Pain Inventory Short Form scores, the impact of pain on quality of life was significantly smaller for the PHN131 group than for the placebo group. Time to the first use of diclofenac postoperatively was significantly longer in the PHN131 group than in the placebo group. The cumulative dosage of diclofenac in the PHN131 group was only around half of that in the placebo group (P<0.0001). Drug-related adverse events were mild-to-moderate and resolved by treatment end. No drug-related severe adverse events were observed.

Discussion:
Our findings demonstrate that PHN131 is effective and well-tolerated in the treatment of moderate-to-severe pain and may provide another option for patients to control their pain.
Association of Neighborhood Economic Status and Race With Developing Pelvic Inflammatory Disease After Sexually Transmitted Infections
Authors: Wang Runzhi , Carson Kathryn A. , Sao Saumya S. , Coleman Jenell S. 
Published: September 2023

OBJECTIVE:
To explore the association of neighborhood-level socioeconomic status (SES) and race with developing pelvic inflammatory disease (PID) after sexually transmitted infection (STI) among female adolescents and young adults in Maryland.

METHODS:
We used Maryland statewide hospital claims data (outpatient and inpatient visits) for this retrospective cohort study. Female adolescents and young adults aged 15–24 years who had at least one STI from July 1, 2013, to March 31, 2015, were included. A participant entered the cohort on the date of the first STI diagnosis and was followed up until PID occurrence or 3 years after the first STI. Median household income of the participant’s residential ZIP code tabulation area was used as the neighborhood-level SES. Discrete-time hazard models were used to estimate the hazard of PID.

RESULTS:
Of the 2,873 participants, 88.5% were of Black race, and 67.2% were aged 20–24 years. The hazard of PID after an STI among Black women was 1.40 times that of White women (95% CI 1.06–1.85). After adjustment for age, insurance type, and number of STI events, the hazard ratio (HR) did not change. However, adding neighborhood-level SES to the model attenuated the disparity in PID after STI between Black and White women (HR 1.25, 95% CI 0.94–1.67).

CONCLUSION:
Racial disparities in PID diagnosis are mitigated by neighborhood-level SES.
Census Tracts Are Not Neighborhoods: Addressing Spatial Misalignment in Studies Examining the Impact of Historical Redlining on Present-day Health Outcomes
Authors: Maliniak Maret L. , Moubadder Leah , Nash Rebecca , Lash Timothy L. , Kramer Michael R. , McCullough Lauren E. 
Published: September 2023

Background:
Research examining the effects of historical redlining on present-day health outcomes is often complicated by the misalignment of contemporary census boundaries with the neighborhood boundaries drawn by the US Home Owners’ Loan Corporation (HOLC) in the 1930s. Previous studies have used different approaches to assign historical HOLC grades to contemporary geographies, but how well they capture redlining exposure is unknown.

Methods:
Our analysis included 7711 residences identified in the Multiple Listing Service database in Atlanta, Georgia (2017–2022). We evaluated the classification of HOLC grade assignment (A, B, C, D, or ungraded) when assigning exposure under four area-level approaches (centroid, majority land area, weighted score, and highest HOLC) compared with using complete address data (gold standard). We additionally compared approaches across three 2020 census geographies (tract, block group, and block).

Results:
When comparing the use of census tracts to complete address data, sensitivity was highest for the weighted score approach, which correctly identified 77% of residences in truly A–D graded neighborhoods as compared with the majority land area (44%), centroid (54%), and highest HOLC (59%) approaches. Regarding specificity, the majority land area approach best-classified residences in truly ungraded neighborhoods (93%) as compared with the weighted score (65%), centroid (81%), and highest HOLC (54%) approaches. Classification improved regardless of approach when using census block compared with the census tract.

Conclusions:
Misclassification of historical redlining exposure is inevitable when using contemporary census geographies rather than complete address data. This study provides a framework for assessing spatial misalignment and selecting an approach for classification.
Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction
Authors: Seth Ishith , Lindhardt Joakim , Jakobsen Anders , Bo Thomsen Jørn , Kiil Birgitte Jul , Rozen Warren Matthew , Kenney Peter Sinkjaer 
Published: September 2023

Background:
Augmented reality (AR) technology, exemplified by devices such as the Microsoft HoloLens 2, has gained interest for its potential applications in preoperative guidance. This study explores the use of AR technology for perforator identification during deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods:
A case series of five patients where an AR device was used to identify perforators during DIEP flap breast reconstruction is presented. The device was utilized to recognize preoperative perforators and map their extra- and intramuscular routes. Sound and/or color Doppler confirmation was used to verify the findings.

Results:
In all five cases, the AR device successfully identified preoperative perforators and delineated their extra- and intramuscular routes. AR technology in perioperative visualization of vasculature offers the potential to enhance surgical precision and reduce operative times. By providing an augmented three-dimensional overlay of patients’ vascular structures, AR can facilitate a more comprehensive understanding of individual anatomy, ultimately improving surgical outcomes.

Conclusions:
AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning. Nonetheless, additional research is needed to establish whether the advantages of AR technology warrant its widespread adoption for perforator identification.
Association of subendocardial viability ratio and mortality in the elderly population: results from the CARdiovascular disease, Living and Ageing in Halle study
Authors: Schott Artjom , Kluttig Alexander , Mikolajczyk Rafael , Großkopf Anne , Greiser Karin Halina , Werdan Karl , Sedding Daniel , Nuding Sebastian 
Published: September 2023

Objectives:
The subendocardial viability ratio (SEVR) reflects the balance of myocardial oxygen supply and demand. Low SEVR indicates a reduced subendocardial perfusion and has been shown to predict mortality in patients with kidney disease and diabetes. The aim of this study is to investigate the association of SEVR and mortality in the elderly population.

Methods:
We analysed data from the CARdiovascular disease, Living and Ageing in Halle (CARLA) study. SEVR was estimated noninvasively by radial artery tonometry and brachial blood pressure measurement. The study population was divided into a low (SEVR ≤130%) and normal (SEVR >130%) SEVR group. Cox-regression was used for survival analysis.

Results:
In total, 1414 participants (635 women, 779 men) aged from 50 to 87 years (mean age 67.3 years) were included in the analysis. The all-cause mortality was 22.7% during a median follow-up of 10.5 years. The unadjusted association of SEVR with all-cause mortality decreased from 3.52 (1.31–9.46) [hazard ratio (95% confidence interval) for low SEVR ≤ 130% versus normal SEVR > 130%] among those younger than 60 years to 0.86 (0.50–1.48) among those older than 80 years and from 1.81 (0.22–14.70) to 0.75 (0.30–1.91) for cardiovascular mortality. Sex-specific unadjusted analyses demonstrated an association of SEVR with all-cause and cardiovascular mortality in men [2.32 (1.61–3.34) and 2.24 (1.18–4.24)], but not in women [1.53 (0.87–2.72) and 1.14 (0.34–3.82)].

Conclusion:
Our data suggests that SEVR is an age dependent predictor for all-cause mortality, predominantly in men younger than 60 years.
A Comprehensive Wavefront Assessment of Keratoconus Using an Integrated Scheimpflug Corneal Tomographer/Hartmann–Shack Wavefront Aberrometer
Authors: Koh Shizuka , Matsuo Risako , Inoue Ryota , Miyazato Aoi , Asonuma Sanae , Maeno Sayo , Mihashi Toshifumi , Maeda Naoyuki , Nishida Kohji 
Published: September 2023

Objectives:
To characterize higher-order aberrations (HOAs) in different severities of keratoconus (KC) from the anterior and posterior corneal surfaces and whole eye using an integrated Scheimpflug corneal tomographer/Hartmann–Shack wavefront aberrometer.

Methods:
This study included eyes with clinical KC, topographic KC (no clinical signs), fellow eyes with very asymmetric ectasia with normal topography and no clinical signs (VAE-NT), and control eyes. Corneal and ocular wavefront aberrations were obtained using an integrated Scheimpflug tomographer/Hartmann–Shack wavefront aberrometer. The diagnostic capability of distinguishing VAE-NT from the control was also tested.

Results:
This study included 68 eyes with clinical KC, 44 with topographic KC, 26 with VAE-NT, and 45 controls. Clinical KC had significantly greater total HOAs and coma from the anterior and posterior corneal surfaces and whole eye than the other groups (P<0.05). Although topographic KC had significantly greater values in all wavefront parameters than the control (P<0.05), ocular and corneal HOAs did not differ between the VAE-NT and control groups. The coma from the anterior cornea in topographic KC was significantly greater than that in VAE-NT (P<0.05); the coma from the posterior cornea and whole eye did not differ. Total HOAs from the anterior corneal surface exhibited the highest area under the receiver operating characteristic curve value of 0.774 (sensitivity, 73%; specificity, 78%).

Conclusion:
A comprehensive wavefront assessment can be used to quantitatively evaluate corneal and ocular HOAs across various severity of KC. Total HOAs from the anterior corneal surface exhibited the potential ability in distinguishing VAE-NT from the control eyes.
A Qualitative Study Exploring White-Collar Employee/Manager Experiences of Mental Health and Well-being Initiatives in Corporate Environments
Authors: Young Paul , Chow Vivien , Haslam Cheryl , Barker Jamie 
Published: September 2023

Objective
The aim of the study is to explore white-collar corporate employee/manager experiences of current employer-led mental health and well-being initiatives.

Methods
Twenty-five participants took part in semistructured interviews yielding over 19 hours of data. Thematic analysis of the interview transcripts was undertaken. Participants worked for organizations including investment banks, insurers, asset managers, consultants, public relations, marketing, and legal firms.

Results
Many participants were skeptical of the effectiveness of current company-led mental health and well-being initiatives against a backdrop of high job demands and unsupportive cultures. A commonly expressed view was that organizations were paying lip service to the issue. Participants communicated that more leadership role modeling on mental health and well-being, supportive job designs, and accessible skills-focused psychological support would be beneficial.

Conclusions
Corporate white-collar employees/managers welcome mental health and well-being initiatives but are skeptical about their current effectiveness.
Discrepancies Between Expected and Actual Cochlear Implant–Related Functional Outcomes
Authors: Fabie Joshua E. , Shannon Christian M. , Schvartz-Leyzac Kara , Dubno Judy R. , McRackan Theodore R. 
Published: September 2023

Objective
Previous research has demonstrated that realistic patient expectations are a critical factor in determining cochlear implant (CI) candidacy. The current study uses the validated Cochlear Implant Quality of Life–Expectations (CIQOL-Expectations) instrument to determine expectations of potential CI users and the degree to which their pre-CI expectations are met after implantation.

Study Design
Prospective cohort study.

Setting
Tertiary medical center.

Patients
Sixty adult CI patients.

Interventions/Main Outcome Measures
Pre-CI aided and post-CI consonant-nucleus-consonant word and AzBio sentence scores, pre-CI CIQOL-Expectations, and pre-CI and 3/6/12-month post-CI CIQOL-35 Profile scores.

Results
Mean pre-CI CIQOL-Expectations exceeded 12-month mean CIQOL-35 Profile scores for the global measure and the communication, environment, and listening effort domains (d = 0.65–0.97). The communication and listening effort domain scores had the largest discrepancy between expected and actual post-CI improvement (actual scores, 15.1 and 16.3 points lower than expected [d = 0.93–0.97], respectively). For 42% of patients, pre-CI global expectations exceeded 12-month post-CI CIQOL-35 Profile global scores, 49% met their expectations, and actual scores exceeded expectations for only 10% of patients. Similar patterns were seen for all CIQOL domains except emotional.

Conclusions
Post-CI functional abilities seem to fall short of pre-CI expectations for a substantial percentage of CI users, which was most apparent for the communication and listening effort CIQOL domains. These results may help clinicians direct personalized counseling toward common misconceptions, which can aid shared decision making and potentially minimize the mismatch between expected and realized outcomes.

Level of Evidence: III.
IRB Pro00073019, approved December 20, 2017 (Medical University of South Carolina).
Evaluating Telehealth Uptake Among North Carolina Medicaid Beneficiaries With Musculoskeletal Conditions
Authors: Freed Salama S. , Jones Kelley A. , Whitaker Rebecca G. , Norman Katherine , Carvalho Marissa , Giri Abhigya , Lake Ashley , Tchuisseu Yolande Pokam , Repka Samantha , Vasudeva Karina , Bey Nadia , Bettger Janet Prvu 
Published: September 2023

Background:
The shift from in-person to virtual visits, known as telehealth (TH), during the COVID-19 pandemic was a significant change for North Carolina (NC) Medicaid beneficiaries seeking treatment for musculoskeletal (MSK) conditions, as remote care for these conditions was previously unavailable. We used this policy change to investigate factors associated with TH uptake and whether TH availability mitigated disparities in access to care or affected emergency department (ED) visits among these beneficiaries.

Research Design:
Using 2019–2021 NC Medicaid claims, we identified beneficiaries receiving treatment for MSK conditions before COVID-19 (March 2019–February 2020) and analyzed uptake of newly available TH during COVID-19 (April 2020–March 2021). We used descriptive analysis and Poisson generalized estimating equations to quantify TH uptake, factors associated with TH uptake, and the association with ED visits during COVID-19.

Results:
Black and Hispanic beneficiaries were less likely to use TH compared with White and non-Hispanic counterparts (10%, P<0.001 and 20%, P=0.03, respectively). Adults eligible for Tailored Plans, specialized NC Medicaid plans for those with significant behavioral health needs or intellectual/developmental disabilities, were less likely to use TH [adjusted risk ratio (ARR):0.83, 95% CI (0.78, 0.87)]; youth eligible for Tailored Plans were more likely to use TH [ARR:1.28, 95% CI (1.16, 1.42)]. Lower county-level internet access was associated with lower TH use [ARR: 0.85, 95% CI (0.82, 0.99)]. No statistical difference in ED utilization was observed between TH users and non-users.

Conclusions:
TH has the potential to deliver convenient care to beneficiaries with MSK conditions who can access it. Further research and policy changes should explore and address underlying factors driving disparities and improve equitable access to care for this population.
Effects of a Rehabilitation-at-Home Program Compared to Post-acute Skilled Nursing Facility Care on Safety, Readmission, and Community Dwelling Status
Authors: Augustine Matthew R. , Intrator Orna , Li Jiejin , Lubetsky Sara , Ornstein Katherine A. , DeCherrie Linda V. , Leff Bruce , Siu Albert L. 
Published: September 2023

Objectives:
To evaluate the effectiveness and safety of Rehabilitation-at-Home (RaH), which provides high-frequency, multidisciplinary post-acute rehabilitative services in patients’ homes.

Design:
Comparative effectiveness analysis.

Setting and Participants:
Medicare Fee-For-Service patients who received RaH in a Center for Medicare and Medicaid Innovation Center Demonstration during 2016–2017 (N=173) or who received Medicare Skilled Nursing Facility (SNF) care in 2016–2017 within the same geographic service area with similar inclusion and exclusion criteria (N=5535).

Methods:
We propensity-matched RaH participants to a cohort of SNF patients using clinical and demographic characteristics with exact match on surgical and non-surgical hospitalizations. Outcomes included hospitalization within 30 days of post-acute admission, death within 30 days of post-acute discharge, length of stay, falls, use of antipsychotic medication, and discharge to community.

Results:
The majority of RaH participants were older than or equal to 85 years (57.8%) and non-Hispanic white (72.2%) with mean hospital length of stay of 8.1 (SD 7.6) days. In propensity-matched analyses, 10.1% (95% CI: 0.5%, 19.8) and 4.2% (95% CI: 0.1%, 8.5%) fewer RaH participants experienced hospital readmission and death, respectively. RaH participants had, on average, 2.8 fewer days (95% CI 1.4, 4.3) of post-acute care; 11.4% (95% CI: 5.2%, 17.7%) fewer RaH participants experienced fall; and 25.8% (95% CI: 17.8%, 33.9%) more were discharged to the community. Use of antipsychotic medications was no different.

Conclusions and Implications:
RaH is a promising alternative to delivering SNF-level post-acute RaH. The program seems to be safe, readmissions are lower, and transition back to the community is improved.
Near-Death Experiences and Sleep Disturbance
Authors: Lindsay Nicole , O'Sullivan Laura , Gibson Rosemary , Ladyman Clare , Tassell-Matamua Natasha 
Published: September 2023

Abstract
Near-death experiences (NDEs) are nonordinary states of consciousness typically occurring on the brink of death. Sleep changes after NDEs have been described, including shorter sleep duration, longer sleep latency, and more sleep disturbances; however, objective verification is lacking. In this exploratory research, 57 participants took part in a 14-day actigraphy study and were assigned to three groups: those who have had an NDE (n = 26); those who experienced a near-death event but without NDE (n = 12); and those who had never come close to death (n = 19). No significant differences were found between groups for actigraphy data. Paired samples t tests indicated significant differences between subjective and objective measures of sleep onset latency, sleep duration, and sleep efficiency, notably among the NDE group. Findings are indicative of the phenomenon known as sleep state misperception (SSM), which may have clinical implications for the study of NDEs and SSM.