bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fecal impaction in adults
Authors: Louwagie Victoria , Steinman Mark D. , Wang Ming-Hsi 
Published: April 2023

ABSTRACT
Fecal impaction is a common digestive disorder and is considered an acute complication of chronic and untreated constipation. Generally, the factors responsible for fecal impaction are similar to those associated with constipation. Early identification and treatment minimize complications and patient discomfort. Common treatment options to address fecal impaction of the rectum include manual disimpaction or fragmentation, the use of distal and/or proximal softening or washout procedures such as enemas and suppositories, and oral or nasogastric tube placement for the administration of polyethylene glycol solutions containing electrolytes. In severe cases, surgical intervention is necessary. Post-treatment evaluation should include a colonic evaluation by flexible sigmoidoscopy, a colonoscopy, or a barium enema after the fecal impaction resolves. Following treatment, conduct an evaluation of causes and create a preventive therapy plan.
From Battles to Burnout: Investigating the Role of Interphysician Conflict in Physician Burnout
Authors: Amick Ashley E. , Schrepel Caitlin , Bann Maralyssa , Watsjold Bjorn , Jauregui Joshua , Ilgen Jonathan S. , Lu Dave W. , Sebok-Syer Stefanie S. 
Published: April 2023

PurposeDespite the recognized importance of collaborative communication among physicians, conflict at transitions of care remains a pervasive issue. Recent work has underscored how poor communication can undermine patient safety and organizational efficiency, yet little is known about how interphysician conflict (I-PC) impacts the physicians forced to navigate these tensions. The goal of this study was to explore the social processes and interpersonal interactions surrounding I-PC and their impact, using conversations regarding admission between internal medicine (IM) and emergency medicine (EM) as a lens to explore I-PC in clinical practice.MethodThe authors used constructivist grounded theory to explore the interpersonal and social dynamics of I-PC. They used purposive sampling to recruit participants, including EM resident and attending physicians and IM attending physicians. The authors conducted hour-long, semistructured interviews between June and October 2020 using the Zoom video conferencing platform. Interviews were coded in 3 phases: initial line-by-line coding, focused coding, and recording. Constant comparative analysis was used to refine emerging codes, and the interview guide was iteratively updated.ResultsThe authors interviewed 18 residents and attending physicians about how engaging in I-PC led to both personal and professional harm. Specifically, physicians described how I-PC resulted in emotional distress, demoralization, diminished sense of professional attributes, and job dissatisfaction. Participants also described how emotional residue attached to past I-PC events primed the workplace for future conflict.ConclusionsI-PC may represent a serious yet underrecognized source of harm, not only to patient safety but also to physician well-being. Participants described both the personal and professional consequences of I-PC, which align with the core tenets of burnout. Burnout is a well-established threat to the physician workforce, but unlike many other contributors to burnout, I-PC may be modifiable through improved education that equips physicians with the skills to navigate I-PC throughout their careers.
Promoting Sexual and Gender Minority Health Clinical Skills Training for All Medical Students
Authors: Kamal Kanika , Keuroghlian Alex S. , Potter Jennifer 
Published: April 2023

Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities and interweave SGM health education into existing preclerkship courses, opportunities to practice related clinical skills during the clerkship years remain largely elective. Furthermore, national survey data from 2020 indicate that SGM Americans continue to delay or avoid medical care because of physician discrimination. By providing predominantly opt-in opportunities for hands-on SGM health clinical training, educators risk perpetuating existing structural inequities and widening health disparities.
In this article, the authors advocate for required SGM health clinical training for all undergraduate medical students, regardless of intended specialty. They highlight 3 types of elective SGM health clinical training models currently in use at medical schools across the country, including student-run clinics, advanced electives, and longitudinal scholarly concentrations. Using these examples, the authors then outline ways that educators can interweave required SGM health clinical training into undergraduate medical education, including with the recruitment and retention of SGM faculty, staff, and students; required SGM standardized patient experiences; the integration of SGM clinical opportunities throughout the core clerkships; and partnerships with SGM health centers. Using these methods, medical schools can mobilize passionate students, faculty, and leaders to both counter the bigotry and hate faced by SGM populations and develop innovative strategies to improve SGM patient health outcomes and expand opportunities for SGM health scholarship.
Femoral Head Core Decompression and Bone Marrow Concentrate Injection in Pediatric Sickle-cell Related Avascular Necrosis
Authors: Baghdadi Soroush , Chern Irene , Hanstein Regina , Mehraban Alvandi Leila , Fornari Eric 
Published: April 2023

Background:
Femoral head avascular necrosis affects 10% to 40% of patients with sickle cell disease (SCD). The purpose of this study was to evaluate the results of femoral head core decompression and bone marrow aspirate concentrate (CD-BMAC) injection in pediatric patients with SCD.

Methods:
Eligible patients were enrolled in this retrospective study of patients undergoing CD-BMAC. Patients with SCD who were younger than 18 at the time of surgery and had >1 year of follow-up were included in this analysis. Hips were staged based on the Ficat system by 2 raters. The visual analog score for pain, hip outcome score, modified Harris hip score, and the University of California, Los Angeles activity score were used as patient-reported outcome measures preoperatively, at 5 to 9 months postoperatively, and final follow-up. Treatment failure was defined as total hip arthroplasty or visual analog score >3 at the final follow-up.

Results:
Twenty-three hips in 17 patients were included, with a median age at the time of surgery of 15.8 years (interquartile range: 13.1 to 17.8 y). Patients were followed for 4.25 ± 1.7 years. Ten hips showed a 1-stage increase in the Ficat stage at the final follow-up, whereas 11 retained the same stage, and 1 hip had a 1-stage regression. All patient-reported outcome measures showed significant improvement from the preoperative visit to short-term follow-up, but the preoperative to final follow-up improvement was not significant. Six treatment failures were recorded, including 3 total hip arthroplasties and 3 painful hips at the final follow-up. In a multivariate logistic regression model, only skeletal maturity (odds ratio = 16.2, 95% CI: 1.44-183.0, P = 0.024) and femoral head collapse (odds ratio = 12.0, 95% CI: 1.1-130.5, P = 0.041) were significant predictors of treatment failure.

Conclusions:
In the largest study on pediatric SCD patients undergoing CD-BMAC, we found that CD-BMAC injection offers significant improvement in pain and functional outcomes in the short term, with a very low risk for complications. Skeletal maturity and femoral head collapse were significant predictors of treatment failure. Patients with a collapsed femoral head experienced functional deterioration over time after initial improvement, whereas precollapse hips maintained their functional improvement up to the latest follow-up.

Level of Evidence:
Level III, retrospective cohort study.
Adding a nonpainful end to reduce pain recollection of Pap smear screening: a randomized controlled trial
Authors: Yen Hung-Kuan , Cheng Shao-Yi , Chiu Kai-Nan , Huang Chu-Chun , Yu Jung-Yang , Chiang Chien-Hsieh ,   for the NTUH Pap Study Group
Published: April 2023

Abstract
The pain experienced during Pap tests is a crucial gap in reducing cervical cancer burden. This study sought to investigate whether adding a nonpainful step at the end of Pap tests helps women recall less pain. We conducted a randomized controlled trial on women aged 30 to 70 years at a cervical cancer screening center. A nonpainful step was added at the end of Pap test in the modified Pap group. The outcomes included recalled pain after Pap smear screening, real-time pain, and 1-year willingness to receive further Pap tests. Among 266 subjects in the intention-to-treat analysis, the modified Pap group (n = 133) experienced lower 5-minute recalled pain than the traditional Pap group on a 1 to 5 numeric scale (mean [SD], 1.50 [0.77] vs 2.02 [1.12]; P < 0.001) and a 0 to 10 visual analog scale (2.12 [1.79] vs 3.12 [2.23]; P < 0.001). In exploratory subgroup analyses, the association between the modified Pap test and reduced 5-minute recalled pain was not affected by predicted pain, demographic, or socioeconomic characteristics, but it was more apparent in postmenopausal women. Consistently, the modified Pap test attenuated 1-year recalled pain on both pain scales. Furthermore, the modified Pap test increased 1-year willingness grade to receive further Pap tests (adjusted β [SE], 2.11 [0.27]; P < 0.001). In conclusion, adding a nonpainful step at the end of Pap smear screening reduces on-site and long-term recalled pain and strengthens willingness to undergo subsequent Pap tests regularly. The modified Pap test contributes to cervical cancer screening participation.
Current management of avascular necrosis of the metacarpal head: a comprehensive literature review
Authors: Fan Xiao-Lei , Wang Wen-Tao , Wang Jian , Xiao Rui 
Published: April 2023

Background:
Avascular necrosis (AVN) of the metacarpal head is a rare disease that may lead to progressive destruction of the metacarpophalangeal joint and hand function. This study aimed to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head.

Methods:
Articles were searched using the subject words “Dieterich disease”,“Mauclaire’s disease”, and “avascular necrosis of metacarpal head” in the PubMed and Scopus databases. Studies were retained for review after meeting the inclusion criteria. Those outcomes relevant to diagnose and assessing AVN of the metacarpal head and those related to curative management were extracted.

Results:
The literature search revealed 45 studies with 55 patients. Although the aetiology of osteonecrosis has not been clearly delineated, AVN of the metacarpal head most commonly arises from trauma but other risk factors may also be involved. Plain radiographs are often negative and therefore likely to be missed. Early-stage osteonecrosis of the metacarpal head was best assessed using MRI. Given the rarity of this condition, there is no clear consensus on the treatment.

Conclusions:
Avascular necrosis of the metacarpal head should be considered in the differential diagnosis of painful metacarpophalangeal joints. An early understanding of this unusual disease will provide an optimal clinical outcome, restoring joint activity, and resolving pain. Nonoperative treatment cannot cure all patients. Surgical management is based on the patient and lesion characteristics.
Milk and Dairy Consumption and Its Relationship With Abundance of Lactobacillus crispatus in the Vaginal Microbiota: Milk Intake and Vaginal Lactobacillus
Authors: B. Moura Gabriela , G. Silva Márcia , Marconi Camila 
Published: April 2023

Objectives
Diet habits, such as low milk and dairy intake, have been associated with bacterial vaginosis. Thus, we compared vaginal Lactobacillus crispatus abundances in women with different molecularly defined community state types (CSTs) according to the consumption of milk and/or dairy products.

Methods
A total of 516 women from the 5 geographic regions of Brazil were included. Participants were interviewed with a structured questionnaire for assessment of milk and/or dairy intake. Vaginal samples were used for sequencing of V3-V4 regions of the 16S ribosomal RNA gene for further determination of L. crispatus relative abundance (RA) and clustering into 1 of the 5 CSTs (CSTI–CSTV), as firstly described by Ravel et al. (2011). The nonparametric Mann-Whitney test was used to compare L. crispatus RA within the most representative CSTs (L. crispatus-dominant CSTI, Lactobacillus iners-dominant CSTIII, and Lactobacillus-depleted CSTIV) in this population, according to the frequency of milk and/or dairy intake.

Results
The prevalence of CSTI was 33.3% (n = 172), CSTIII was 39% (n = 201), and CSTIV was 27.7% (n = 143). Among the participants with CSTIII, higher L. crispatus RA was observed for those who reported milk/dairy intake (median = 0.02; interquartile range = 0.01–0.09) than those with no consumption (median = 0.01; interquartile range = 0–0.03) (p = .03). Such difference was not observed for participants with CSTI and CSTIV.

Conclusions
Women with vaginal microbiota dominated by L. iners who consume milk and/or dairy present increased abundances of L. crispatus. Therefore, they could benefit from L. crispatus protective properties conferring greater temporal microbiota stability and, consequently, increased protection against infections.
Storytelling
Authors: Karlowicz Karen A. 
Published: April 2023

Background:
An annual patient safety lecture is offered through a partnership with the local children's hospital. Presentations focus on the personal impact of medical errors, as told by families, patients, and care providers. The human stories of involvement with a medical error expose situations and actions that can lead to adverse clinical events.

Problem:
Nursing education strategies heighten students' awareness of patient safety policies and guidelines but may not assist students to understand the human impact of medical errors and their role in preventing them.

Approach:
Storytelling links course content to actual accounts of lived experiences involving medical errors. It promotes reflective learning by prompting students to examine beliefs, challenge assumptions, transform their understanding of concepts, and connect theory to practice.

Outcomes/Conclusion:
The annual culture of safety presentation promotes a deeper understanding of the role and responsibility that nurses have in promoting safe clinical practice.
Atypical Endometriosis: Comprehensive Characterization of Clinicopathologic, Immunohistochemical, and Molecular Features
Authors: Wepy Cindy , Nucci Marisa R. , Parra-Herran Carlos 
Published: April 2023

Atypical endometriosis (A-EMS), defined by cytologic atypia and/or crowded glands resembling endometrial intraepithelial neoplasia, remains poorly understood. We aimed to refine the morphologic, immunohistochemical, and molecular features of A-EMS in an institutional series. Cases were identified through a structured search and reviewed by 2 pathologists. Immunohistochemistry and comprehensive sequencing using a panel 447-gene coverage were performed in suitable cases. A-EMS with synchronous and/or subsequent EMS-related neoplasia were compared with those without. Of 4598 EMS cases over an 11-yr period, 36 A-EMS were identified. The mean age at presentation was 46 (range 26–68) yr. Locations included the ovary (24, 66%), tubo-ovary (6, 17%), fallopian tube (3, 8%), and peritoneum (3, 8%). The mean size was 6.5 (range 0.5–40) mm. Cytologic atypia was mild in 4 (11%), moderate in 21 (58%), and severe in 11 (31%). Most lesions were partially or completely flat (28, 78%); of these, 66% showed hobnail nuclei. Crowded/cribriform and micropapillary/papillary patterns were seen in 11 (31%) and 16 (44%) A-EMS, respectively. Immunohistochemistry, performed in 33 A-EMS, showed wildtype p53 (100%) retained PMS2/MSH6 (100%), and positive estrogen receptor (97%, mean 65% cells), progesterone receptor (76%, mean 30% cells), and Napsin A (39%). Ki67 labelling was <1% to 10% (median 5%). Nine (25%) patients presented with concurrent or subsequent ipsilateral endometrioid, seromucinous, or clear cell neoplasia (4 borderline tumors and 4 carcinomas). The only A-EMS feature statistically more frequent in this subset was crowded/glands (6/9 vs. 2/27 A-EMS without, P=0.001 Fisher exact test). Sequencing showed pathogenic variants in 5 of 6 cases analyzed, involving ATM, BRCA2, KRAS, AKT, CTNNB1, PTEN, and ARID1A among other genes. In 2 cases, synchronous neoplasia showed an accumulation of additional variants. A-EMS is characterized by cytologic atypia and crowded architecture but low proliferation index, positive estrogen receptor, and normal p53 and MMR, which can be helpful in the distinction from malignancy. The prevalence of synchronous/subsequent tubo-ovarian neoplasia in our series was 25%, significantly higher than the reported 1% in conventional EMS. Moreover, A-EMS harbors genomic alterations seen in EMS-related tumors and shares pathogenic variants with synchronous ipsilateral neoplasia. Therefore, it is important to report A-EMS as currently defined and describe its architectural features, especially gland crowding as this appears to increase the risk of EMS-related epithelial neoplasia. Napsin-A is often positive in A-EMS and should be interpreted with caution.
The Revised R Status is an Independent Predictor of Postresection Survival in Pancreatic Cancer After Neoadjuvant Treatment
Authors: Leonhardt Carl-Stephan , Pils Dietmar , Qadan Motaz , Jomrich Gerd , Assawasirisin Charnwit , Klaiber Ulla , Sahora Klaus , Warshaw Andrew L. , Ferrone Cristina R. , Schindl Martin , Lillemoe Keith D. , Strobel Oliver , Fernández-del Castillo Carlos , Hank Thomas 
Published: April 2023

Objective:
To investigate the oncological outcomes of patients with pancreatic ductal adenocarcinoma (PDAC) who had an R0 or R1 resection based on the revised R status (1 mm) after neoadjuvant therapy (NAT).

Background:
The revised R status is an independent prognostic factor in upfront-resected PDAC; however, the significance of 1 mm margin clearance after NAT remains controversial.

Methods:
Patients undergoing pancreatectomy after NAT for PDAC were identified from 2 prospectively maintained databases. Clinicopathological and survival data were analyzed. The primary outcomes were overall survival (OS), recurrence-free survival (RFS), and pattern of recurrence in association with R0 >1 mm and R1 ≤1 mm resections.

Results:
Three hundred fifty-seven patients with PDAC were included after NAT and subsequent pancreatic resection. Two hundred eight patients (58.3%) received FOLFIRINOX, 41 patients (11.5%) received gemcitabine-based regimens, and 299 individuals (83.8%) received additional radiotherapy. R0 resections were achieved in 272 patients (76.2%) and 85 patients (23.8%) had R1 resections. Median OS after R0 was 41.0 months, compared with 20.6 months after R1 resection (P = 0.002), and even longer after additional adjuvant chemotherapy (R0 44.8 vs R1 20.1 months; P = 0.0032). Median RFS in the R0 subgroup was 17.5 months versus 9.4 months in the R1 subgroup (P < 0.0001). R status was confirmed as an independent predictor for OS (R1 hazard ratio: 1.56, 95% CI: 1.07–2.26) and RFS (R1 hazard ratio: 1.52; 95% CI: 1.14–2.0). In addition, R1 resections were significantly associated with local but not distant recurrence (P < 0.0005).

Conclusions:
The revised R status is an independent predictor of postresection survival and local recurrence in PDAC after NAT. Achieving R0 resection with a margin of at least 1 mm should be a primary goal in the surgical treatment of PDAC after NAT.
Proof theory and non-smooth analysis
Authors: Kohlenbach Ulrich , Pischke Nicholas 
Published: April 2023

We develop a general proof-theoretic framework for various classes of set-valued operators, including maximally as well as cyclically monotone and rectangular operators and we discuss a treatment for sums of set-valued operatorsA,Bin that context such that all of the previous fits into logical metatheorems on bound extractions. In particular, we introduce quantitative forms forAbeing (weakly) uniformly rectangular with witnessing moduli. Based on this, we give quantitative forms of the Brezis–Haraux theorem that use such moduli as input. It turns out that a modulus for weak uniform rectangularity, which can be extracted even from non-effective proofs of rectangularity, is sufficient while the bound gets simpler in the case of a modulus forAbeing uniform rectangular which can be extracted from semi-constructive proofs. We use our results to explain recent proof minings in the context of Bauschke’s solution to the zero displacement conjecture and its extensions to other classes of functions than metric projections as instances of logical metatheorems.This article is part of the theme issue ‘Modern perspectives in Proof Theory’.
The uniform Kruskal theorem: between finite combinatorics and strong set existence
Authors: Freund Anton , Uftring Patrick 
Published: April 2023

The uniform Kruskal theorem extends the original result for trees to general recursive data types. As shown by Freund, Rathjen and Weiermann (Freund, Rathjen, Weiermann 2022
Adv. Math.
400
, 108265 (
doi:10.1016/j.aim.2022.108265
)), it is equivalent to

Π
1
1

-comprehension, over

R
C

A
0

with the ascending descending sequence principle (

A
D
S

). This result provides a connection between finite combinatorics and abstract set existence. The present article sheds further light on this connection. Firstly, we show that the original Kruskal theorem is equivalent to the uniform version for data types that are finitely generated. Secondly, we prove a dichotomy result for a natural variant of the uniform Kruskal theorem. On the one hand, this variant still implies

Π
1
1

-comprehension over

R
C

A
0

extended by the chain antichain principle (

C
A
C

). On the other hand, it becomes weak when

C
A
C

is removed from the base theory.

This article is part of the theme issue ‘Modern perspectives in Proof Theory’.
Logics and admissible rules of constructive set theories
Authors: Iemhoff Rosalie , Passmann Robert 
Published: April 2023

We survey the logical structure of constructive set theories and point towards directions for future research. Moreover, we analyse the consequences of being extensible for the logical structure of a given constructive set theory. We finally provide examples of a number of set theories that are extensible.
This article is part of the theme issue ‘Modern perspectives in Proof Theory’.