bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Body Weight and Estimated Circulating Blood Volume: A Review and Practical Nonlinear Approach
Authors: Kennedy H. , Haynes S.L. , Shelton C.L. 
Published: September 2023

(Br J Anaesth 2022;129:716e725)
Postpartum hemorrhage is a leading cause of maternal morbidity and mortality. The volume of blood loss is an important measure in assessing the severity of hemorrhage and determining appropriate treatment. Maternal circulating blood volume (CBV) also requires accurate estimation to determine necessary interventions and management strategies. CBV does not increase at a proportional rate to body composition, yet linear calculations are utilized to estimate maternal CBV. While the current linear model can adequately estimate CBV for many patients, it can lead to miscalculations for patients with higher or lower body mass. The overestimation of CBV can result in inappropriate thresholds for intervention. This review describes physiological changes during pregnancy relevant to blood volume and proposes a tool for a more accurate estimation of CBV.
Maternal Pregnancy Outcomes in Women With Cardiomyopathy: A Systematic Review and Meta-analysis
Authors: Eggleton E.J. , McMurrugh K.J. , Aiken C.E. 
Published: September 2023

(Am J Obstet Gynecol. 2022;227:582–592)
Pregnancy adds increased stress to the cardiovascular system of pregnant women. As a result, 1% to 4% of pregnancies are complicated by maternal cardiac disease, which increases the risk of adverse outcomes. Cardiac disease is a leading cause of indirect maternal mortality worldwide. Despite its prevalence and outcomes, a lack of systematic evidence exists that specify risks. The aim of this study was to determine the impact of cardiomyopathy on maternal pregnancy outcomes.
Trends of Neonatal Hypoxic-ischemic Encephalopathy Prevalence and Associated Risk Factors in the United States, 2010-2018
Authors: Acun C. , Karnati S. , Padiyar S. , Puthuraya S. , Aly H. , Mohamed M. 
Published: September 2023

(Am J Obstet Gynecol 2022;227:751e1–10)
Incidence of neonatal hypoxic-ischemic encephalopathy (HIE) is 1 to 3 in 1000 live births in developed countries, and ~10 times higher in resource-limited countries, making it one of the most common causes of infant morbidity and mortality. The overall mortality rate for HIE is 15% to 25%, and 40% to 50% of infants that survive develop long-term neurological disabilities. Therapeutic hypothermia (TH) is currently the only effective treatment for infants with moderate to severe HIE shortly after birth, but up to 29% continue to experience poor outcomes related to HIE. Trends of HIE and its treatment, TH, have not been studied carefully at different gestational ages in the United States. Thus, the purpose of this study was to analyze trends of HIE prevalence, use of TH, mortality associated with HIE, and HIE-associated confounding variables in a US national dataset.
A Novel Ultrasound Software System for Lumbar Level Identification in Obstetric Patients
Authors: Hetherington J. , Brohan J. , Rohling R. , Gunka V. , Abolmaesumi P. , Albert A. , Chau A. 
Published: September 2023

(Can J Anaesth. 2022;69:1211–1219)
Manual palpation is the primary method that obstetric anesthesiologists use to identify the optimal point of neuraxial anesthesia placement. As it is unreliable, especially when performed in patients with a higher body mass index (BMI), lumbar ultrasound (LUS) is an intriguing option. LUS for neuraxial labor anesthesia and analgesia has improved accuracy in lumbar vertebral level identification and improved first-pass success rate. Despite potential LUS benefits, many physicians continue using manual palpation because they are not proficient in the technical skills required to perform or interpret LUS images. To make LUS simpler and more user-friendly, automated ultrasound software known as Spine Level Identification (SLIDE) system was developed. SLIDE automatically identifies vertebral landmarks in real-time as the ultrasound transducer moves over the skin. This study aimed to determine whether SLIDE accurately identifies the L3-L4 intervertebral space in healthy term parturient women compared with the manual palpation method.
Cerebrospinal Fluid and Arterial Acid-base Equilibria in Spontaneously Breathing Third-trimester Pregnant Women
Authors: Zadek F. , Giudici G. , Fusarini C.F. , Ambrosini M.T. , di Modugno A. , Scaravilli V. , Zanella A. , Fumagalli R. , Stocchetti N. , Calderini E. , Langer T. 
Published: September 2023

(Br J Anaesth. 2022;129:726–733)
The acid-base regulation of the choroid plexus is critical to spontaneous breathing. Minute ventilation while at rest is increased during the first trimester, which results in the development of hypocapnia and respiratory alkalosis. This study aimed to describe the acid-base status of the cerebrospinal fluid (CSF) and arterial plasma in resting, spontaneously breathing third-trimester pregnant women. The study also aimed to discuss the physiological adaptations to hypocapnic alkalosis (HA) in pregnancy.
Intermediate-dose Versus Low-dose Low–molecular-weight Heparin in Pregnant and Postpartum Women With a History of Venous Thromboembolism (Highleow study): An Open-label, Multicenter, Randomized, Controlled Trial
Authors: Bistervels I.M. , Buchmüller A. , Wiegers H.M.G. , Ní Áinle F. , Tardy B. , Donnelly J. , Verhamme P. , Jacobsen A.F. , Hansen A.T. , Rodger M.A. , DeSancho M.T. , Shmakov R.G. , van Es N. , Prins M.H. , Chauleur C. , Middeldorp S. ,   Highlow Block writing committee; Highlow Investigators
Published: September 2023

(Lancet. 2022;400:1777–1787)
Venous thromboembolism (VTE) and subsequent major bleeding are leading causes of maternal morbidity and mortality worldwide, and the risk for recurrence increases for women with a history of VTE. Despite this, evidence-based research on thromboprophylaxis strategies is lacking and the optimal dose of low–molecular-weight heparin (LMWH) thromboprophylaxis during the peripartum and postpartum periods is uncertain. This study aimed to assess the safety and efficacy of low-dose compared to intermediate-dose LMWH for pregnant women with past occurrences of VTE.
Labor Risk Factors for Fetal Heart Rate Abnormality After Combined Spinal-epidural Analgesia
Authors: Yamamoto Y. , Umehara N. , Yamashita Y. , Sato M. , Takehara K. , Sago H. 
Published: September 2023

(Int J Gynaecol Obstet. 2023;160:892–899)
Labor analgesia use is increasing in Japan, and combined spinal-epidural analgesia (CSE) is a favored method due to its rapid pain relief. While fetal heart rate (FHR) monitoring is widely assessed during labor and delivery and well-studied, some aspects of FHR following CSE have not been thoroughly investigated. This study aimed to identify the association between obstetric outcomes and FHR abnormalities following CSE.
A Ketamine Package for Use in Emergency Cesarean Delivery When No Anesthetist is Available: An Analysis of 401 Consecutive OperationsAnesthesia and AnalgesiaAnesthesia and Analgesia
Authors: Burke T.F. , Mantena S. , Opondo K. , Orero S. , Rogo K. 
Published: September 2023

(Int J Gynecol Obstet. 2022;158:377–384)
Average maternal mortality in low-income countries has been reported as 40 times higher than that of high-income countries. One contributing factor to this discrepancy is the shortage of surgical care either due to inaccessible resources or inaccessible clinicians such as anesthesiologists. There is a particularly noticeable gap in anesthesiology care, as most low-income countries do not have anesthesiology training programs, or the programs do not produce enough clinicians to fully staff what is needed. This study aimed to understand the implications of using ketamine as an anesthetic to support emergency surgical delivery if no anesthetist is available. Effectiveness and safety was evaluated through maternal and newborn outcomes. The primary outcome was maternal and infant survival, and the ability of ketamine to safely support cesarean deliveries (CD).
Associations Between Postpartum Pain Type, Pain Intensity and Opioid Use in Patients With and Without Opioid Use Disorder: A Cross-sectional Study
Authors: Lim G. , LaSorda K.R. , Krans E. , Rosario B.L. , Wong C.A. , Caritis S. 
Published: September 2023

(British Journal of Anaesthesia. 2023;130:94e102)
Pain is a sensory, cognitive, and emotional experience and is affected by a number of biological, psychological, and social factors. Postpartum pain assessment and management remain limited to a one-size-fits-all approach, despite the wide range of pain experiences and types. Patients with opioid use disorder (OUD) may have more complex pain experiences and are at increased risk of severe post-traumatic pain, postoperative complications, readmission, and overdose than those without OUD. The over-prescribing of opioids for postpartum pain management is mitigated by recent efforts to promote shared-decision making. However, overly conservative prescribing practices or poorly managed pain can lead to negative outcomes. This study aimed to investigate the associations between pain type, pain intensity and opioid use during hospital stay, and examine the way pain type influences pain intensity and opioid use among people with and without OUD.
Virtual Nursing Education with Ignatian Pedagogy and Jesuit Charisms During a Pandemic
Authors: Wodwaski Nadine , Courtney Renee , Ruel Jennifer 
Published: September 2023

ABSTRACT:
Amid the COVID-19 pandemic, higher education faculty at a Jesuit university were compelled to adapt pedagogies that were immersive and learner-centered within a virtual learning environment. The Ignatian pedagogical paradigm presented in this article is based on a practical teaching context that values Ignatian principles and world views while promoting Jesuit education. This educational interventional study measured the transformation of nursing student online learners into active, caring, and compassionate participants as they developed their nursing knowledge in a maternal–child health course. With an Ignatian pedagogy as a structure for the online courses, students were challenged to embrace diverse ways of thinking, knowing, and learning.
Foot Plantar Pressure Profile Alteration after Microsurgical Great Toe-to-thumb Transfer
Authors: Tang Simon Fuk Tan , Tang Alice Chu Wen , Chen Chih Kuang , Wu Ho Mu , Wei Fu-Chan 
Published: September 2023

Background:
Microsurgical great toe-to-thumb transfer (mGTT) is a widely used procedure when immediate replantation of thumb is not feasible. The aim of this study was to investigate the alteration of plantar pressure profile of the donor foot after mGTT.

Methods:
Twenty patients receiving microsurgical great toe-to-hand transfer between 1985 to 2014, and 16 healthy subjects were recruited. Group 1 consisted of 20 feet receiving mGTT, whereas group 2 consisted of 32 normal feet as control. The flap design in this study was to preserve 1 cm of the proximal phalanx to maintain the attachment of the plantar aponeurosis and intrinsic muscles. The Taiwan Chinese version of the Foot Function Index was used for patient-reported outcome measurement. A novel Emed-X system was used for dynamic plantar pressure measurement. A total of four parameters were collected, including peak pressure, contact area, contact time, and pressure–time integral.

Results:
In group 1, the peak pressure redistributed under the first metatarsal bone and was significantly higher than group 2 (P < 0.05). There was no significant change of the contact area between the midfoot region of group 1 and group 2 (P > 0.05). Furthermore, similar foot clearance efficiency was demonstrated in group 1 and group 2 (P > 0.05).

Conclusions:
The windlass effect of the foot will not be affected when performing mGTT with preservation of 1 cm of the proximal phalanx. Therefore, this surgical procedure is highly recommended for clinical application.
Use of Tranexamic Acid in Aesthetic Surgery: A Retrospective Comparative Study of Outcomes and Complications
Authors: Neel Omar Fouda , AlKhashan Raghad , AlFadhel Emad Abdulrahman , Al-Terkawi Reem Abdulmonem , Mortada Hatan 
Published: September 2023

Background:
Bleeding is a potential complication of aesthetic surgery. Surgeons have adhered to the principle of minimizing blood loss. Tranexamic acid (TXA) is an antifibrinolytic medication capable of reducing bleeding. This study aimed to investigate TXA and its effect on complications and overall outcomes in aesthetic surgery patients.

Methods:
This retrospective chart review of patients undergoing various aesthetic procedures between 2019 and 2022 was conducted in Riyadh, Saudi Arabia. Preoperative and postoperative hemoglobin levels, blood transfusions, and complications were the primary outcomes. Furthermore, the predictors of giving TXA were studied.

Results:
In total, 435 patients were included in the study. TXA was administered to 181 patients (41.6%). Significantly higher proportions of patients who received TXA underwent trunk aesthetic surgery (P < 0.001), and those who received TXA underwent combined procedures more frequently than non-users (P < 0.001). The mean operative time and length of hospital stay were significantly longer among patients who did not receive TXA (P < 0.001, and P < 0.001, respectively). Most predictors for using TXA were significantly associated with performing liposuction (OR = 5.5), trunk aesthetic surgery (OR = 4.9), and undergoing combined procedures (OR = 2.7). No significant difference was noted in the rate of complications between the two cohorts.

Conclusions:
Although our data show improvement in patient outcomes in multiple aspects, the heterogeneity of our cohort makes us unable to draw definite conclusions to recommend the use of TXA in aesthetic surgery. Thus, a randomized controlled trial is necessary to support the findings of this study.
A model for individualized prediction of liver-related death in outpatients with alcohol-associated cirrhosis
Authors: Marot Astrid , Henrion Jean , Knebel Jean-François , Trépo Eric , Moreno Christophe , Deltenre Pierre 
Published: September 2023

Introduction:
In alcohol-associated cirrhosis, an accurate estimate of the risk of death is essential for patient care. We developed individualized prediction charts for 5-year liver-related mortality among outpatients with alcohol-associated cirrhosis that take into account the impact of abstinence.

Methods:
We collected data on outpatients with alcohol-associated cirrhosis in a prospective registry. The model was derived, internally and externally validated, and compared with the Child-Pugh and the Model For End-Stage Liver Disease (MELD) scores.

Results:
A total of 527 and 127 patients were included in the derivation and validation data sets, respectively. A model was developed based on the 3 variables independently associated with liver-related mortality in multivariate analyses (age, Child-Pugh score, and abstinence). In the derivation data set, the model combining age, Child-Pugh score, and abstinence outperformed the Child-Pugh and the MELD scores. In the validation data set, the Brier score was lower for the model (0.166) compared with the Child-Pugh score (0.196, p = 0.008) and numerically lower compared with the MELD score (0.190) (p = 0.06). The model had the greatest AUC (0.77; 95% CI 0.68–0.85) compared with the Child-Pugh score (AUC = 0.66; 95% CI 0.56–0.76, p = 0.01) and was numerically higher than that of the MELD score (AUC = 0.66; 95% CI 0.56–0.78, p = 0.06). Also, the Akaike and Bayesian information criterion scores were lower for the model (2163; 2172) compared with the Child-Pugh (2213; 2216) or the MELD score (2205; 2208).

Conclusion:
A model combining age, Child-Pugh score, and abstinence accurately predicts liver-related death at 5 years among outpatients with alcohol-associated cirrhosis. In this study, the model outperformed the Child-Pugh and the MELD scores, although the AUC and the Brier score of the model were not statically different from the MELD score in the validation data set.
Suboptimal diagnostic accuracy of ultrasound and CT for compensated cirrhosis: Evidence from prospective cohort studies
Authors: Hetland Liv E. , Kronborg Thit M. , Thing Mira , Werge Mikkel P. , Junker Anders E. , Rashu Elias B. , O’Connell Malene B. , Olsen Beth H. , Jensen Anne-Sofie H. , Wewer Albrechtsen Nicolai J. , Møller Søren , Hobolth Lise , Mortensen Christian , Kimer Nina , Gluud Lise Lotte 
Published: September 2023

Introduction:
Abdominal ultrasound (US) and CT are important tools for the initial evaluation of patients with liver disease. Our study aimed to determine the accuracy of these methods for diagnosing cirrhosis.

Methods:
In all, 377 participants from 4 prospective cohort studies evaluating patients with various liver diseases were included. All patients were included between 2017 and 2022 and had undergone a liver biopsy as well as US and/or CT. Using the histological assessment as the gold standard, we calculated diagnostic accuracy for US and CT. Liver biopsies were evaluated by expert histopathologists and diagnostic scans by experienced radiologists.

Results:
The mean age was 54 ± 14 years and 47% were female. Most patients had NAFLD (58.3%) or alcohol-associated liver disease (25.5%). The liver biopsy showed cirrhosis in 147 patients (39.0%). Eighty-three patients with cirrhosis had Child-Pugh A (56.4% of patients with cirrhosis) and 64 had Child-Pugh B/C (43.6%). Overall, the sensitivity for diagnosing cirrhosis by US was 0.71 (95% CI 0.62–0.79) and for CT 0.74 (95% CI 0.64–0.83). The specificity was high for US (0.94, 95% CI 0.90–0.97) and for CT (0.93, 95% CI 0.83–0.98). When evaluating patients with Child-Pugh A cirrhosis, sensitivity was only 0.62 (95% CI 0.49–0.74) for US and 0.60 (95% CI 0.43–0.75) for CT. For patients with Child-Pugh B/C, sensitivity was 0.83 (95% CI 0.70–0.92) for US and 0.87 (95% CI 0.74–0.95) for CT. When limiting our analysis to NAFLD (20% with cirrhosis), the sensitivity for US was 0.45 (95% CI 0.28–0.64) and specificity was 0.97 (95% CI 0.93–0.99).

Conclusion:
US and CT show moderate sensitivity and may potentially overlook compensated cirrhosis underlining the need for additional diagnostic testing.
Prerequisite Delivery Method and Academic Outcomes in a Physician Assistant Education Program
Authors: Chalupa Robyn L. , Nevels Torrance L. , Kucia Margaret M. , Jones James J. 
Published: September 2023

Purpose
The Interservice Physician Assistant Program (IPAP) educates up to 169 matriculants per year. Each service branch sets the admission criteria, including all prerequisites, for their applicants. We hypothesized that prerequisites obtained online/virtual are less rigorous than coursework completed in-person. The purpose of this investigation was to evaluate whether online/virtual prerequisite courses were associated with academic deceleration or attrition at any point.

Methods
Student self-reported data were retrospectively analyzed to evaluate program scores of students who took prerequisites online/virtual or in-person.

Results
There were no statistically significant differences in foundational course performance between online/virtual and in-person coursework. In addition, students who took anatomy online performed better than students who completed the coursework in-person (140.6 ± 15.6 vs. 145.6 ± 14.7, P = .05).

Conclusions
This analysis indicates that using the prerequisite source to predict academic difficulty may not be possible in IPAP students. Faculty will need to continue to search for other predictors of academic difficulty.
Preceptor Tools for Success: Student Review on Creating an Effective Clinical Rotation
Authors: Bogenschutz Kevin 
Published: September 2023

Purpose
The purpose of this article was to explore student perspectives regarding effective preceptors with the intention to improve development of supervised clinical practice experiences.

Methods
In total, 136 clinical year physician assistant (PA) students, representing 9 accredited PA programs, participated in a mixed-methods survey, including a 5-point Likert scale to identify characteristics of an effective preceptor. The survey achieved a 36.2% response rate. Quantitative data were analyzed based on mean and standard deviation (SD) with the analysis of variance to promote generalizability. Thematic analysis was performed on qualitative responses.

Results
Students reported the highest level of agreement that an effective preceptor welcomes questions from the student (mean 4.88, SD 0.54), are enthusiastic about having a student (4.84, 0.52), and provide a welcoming support staff who encourages student education (4.71, 0.66). Students also highlighted the positive effect of preceptor engagement during clinical rotations.

Conclusion
A preceptor who actively engages their student has the greatest positive impact on clinical education. Preceptors can implement clinical teaching strategies from this article to improve student-perceived effectiveness of their rotation.
Effect of ciprofol on swallowing function in patients undergoing painless gastrointestinal endoscopy
Authors: Liao Jinsong , Lv Shun , Wang Xiong , Ye Yu , Zhang Qiuyu , Zeng Lin , Dong Shuhua 
Published: September 2023

Background:
Gastroscopy is one of the most commonly used diagnostic modalities for upper gastrointestinal disorders. This study compared the effect of ciprofol and propofol on swallowing function during painless gastroenteroscopy.

Methods:
This was a single-center, placebo-controlled randomized trial. Three hundred sixty-eight patients undergoing painless gastroscopy were included in this study and randomly divided into 2 groups: the propofol group (PRO group, n = 183) and the ciprofol group (CIP group, n = 185). Sufentanil, ciprofol, and propofol are used to anesthetize the patients, and the effects of different solutions on these patients are compared and analyzed. The patient’s general condition, vocal cord adduction reflex, dysphagia severity score, penetration and aspiration scale score, vital signs at different times, complications, recovery time (minutes), residence time in the resuscitation room (minutes), and adverse reactions were recorded.

Results:
During the examination, the incidence of severe swallowing dysfunction in CIP group was lower than that in PRO group (P < .05). The BP in CIP group was higher than that in PRO Group (P < .05). The HR of CIP group was lower than that of PRO Group (P < .05). SpO2 in CIP group was higher than that in PRO Group (P < .05). The recovery time of CIP group was longer than that of PRO Group, and the postanesthesia care unit stay time of PRO group was longer than that of CIP group(P < .05). The incidence of respiratory depression, hypotension and cough in CIP group was lower than that in PRO Group (P < .05). The incidence of injection pain in CIP group was lower than that in PRO Group (P < .05).

Conclusion:
Compared with propofol, ciprofol has less inhibition on swallowing function, less impact on hemodynamics, less respiratory depression, and less injection pain, which is more suitable for painless gastroscopy.