bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of a goal-directed movement intervention (GOAL) using a movement sensor for hospitalized patients: An intervention mapping approach
Authors: van Grootel JWM , Bor P , Veenhof C , Valkenet K 
Published: August 2023

Objective To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design Implementation Research. Setting Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients’ perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s) This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended.
Non-contrast computed tomography findings for identification of chronically occluded coronary artery bypass grafts
Authors: Chamberlin Jordan H , Smith Carter D , Van Swol Elizabeth , Maisuria Dhruw , Baruah Dhiraj , Schoepf Uwe Joseph , Burt Jeremy R , Kabakus Ismail M 
Published: August 2023

Background Detecting occlusions of coronary artery bypass grafts using non-contrast computed tomography (CT) series is understudied and underestimated. Purpose To evaluate morphological findings for the diagnosis of chronic coronary artery bypass graft occlusion on non-contrast CT and investigate performance statistics for potential use cases. Material and Methods Seventy-three patients with coronary artery bypass grafts who had CT angiography of the chest (non-contrast and arterial phases) were retrospectively included. Two readers applied pre-set morphologic findings to assess the patency of a bypass graft on non-contrast series. These findings included vessel shape (linear-band like), collapsed lumen and surgical graft marker without a visible vessel. Performance was tested using the simultaneously acquired arterial phase series as the ground truth. Results The per-patient diagnostic accuracy for occlusion was 0.890 (95% confidence interval = 0.795–0.951). Venous grafts overall had an 88% accuracy. None of the left internal mammary artery to left anterior descending artery arterial graft occlusions were detected. The negative likelihood ratio for an occluded graft that is truly patent was 0.121, demonstrating a true post-test probability of 97% for identifying a patent graft as truly patent given a prevalence of 20% occlusion at a median 8.4 years post-surgery. Neither years post-surgery, nor number of vessels was associated with a significant decrease in reader accuracy. Conclusion Evaluation of coronary bypass grafts for chronic occlusion on non-contrast CT based off vessel morphology is feasible and accurate for venous grafts. Potential use cases include low-intermediate risk patients with chest pain or shortness of breath for whom non-contrast CT was ordered, or administration of iodine-based contrast is contraindicated.
Agreement between distal and forearm radial arterial pressures in patients undergoing prone spinal surgery: a prospective, self-controlled, observational study
Authors: Xiong Jingwei , Xu Miaomiao , Hui Kangli , Zhou Jiejie , Zhang Jie , Duan Manlin , Zhang Lidong 
Published: August 2023

Objective To test agreement and interchangeability between distal (dRA) and forearm radial arterial (RA) pressures (AP) during general anesthesia (GA) for prone spinal surgery. Methods This prospective observational study involved 40 patients scheduled for GA spinal surgery. The right dRA and left forearm RA were cannulated in all patients to continuously measure invasive blood pressures (IBP). We compared the agreement and trending ability of systolic AP (SAP), diastolic AP (DAP), and mean AP (MAP) at each site 15 minutes after tracheal intubation, start of surgery, 30 and 60 minutes after the start of surgery, and after skin suturing. Results Paired BP values (n = 184) (37 cases) were analyzed. The bias (standard deviation), limits of agreement, and percentage error were: SAP: 0.19 (3.03), −5.75 to 6.12, and 5.04%; DAP: −0.06 (1.75), −3.50 to 3.38, and 5.10%; and MAP: 0.08 (1.52), −2.90 to 3.05, and 3.54%, respectively. The linear regression coefficients of determination were 0.981, 0.982, and 0.988 for SAPs, DAPs, and MAPs, respectively; four-quadrant plot concordance rates were 95.11%, 92.03%, and 92.66%, respectively. Conclusion All arterial BPs showed good agreement and trending capabilities for both the dRA and RA. The dRA may be substituted for the RA in IBP monitoring.
Identifying the optimal cutoff point of Ki-67 in breast cancer: a single-center experience
Authors: Li Wang , Lu Ning , Chen Caiping , Lu Xiang 
Published: August 2023

Objective Ki-67 is associated with breast cancer subtypes, but the optimal cutoff point of Ki-67 has not been established in our center. We evaluated the cutoff point of Ki-67 in breast cancer and analyzed the associations among Ki-67, clinicopathological features, and prognosis. Methods The clinicopathological data and prognostic information of patients with breast cancer treated in our center were retrospectively collected, and the optimal cutoff point of Ki-67 was determined by univariate and multivariate survival risk analyses. The cutoff point was used to group the patients, and the differences in the clinicopathological features and prognosis were analyzed between the two groups. Results In total, 609 patients with estrogen receptor-positive and human epidermal growth factor receptor 2-negative primary breast cancer were enrolled. The mean Ki-67 value was 22.3% ± 15.4%, the median was 20%, and a cutoff point of 30% was an independent factor influencing recurrence-free survival. When 30% was used as the cutoff point, patients with a Ki-67 value of ≤30% had a better prognosis and lower tumor malignancy. Conclusion The optimal cutoff point of Ki-67 in breast cancer in our center is 30%.
Post-operative chyle leak following nephrectomy: Inference from tertiary care center and review of literature
Authors: Sarangi Shakti Swarup , Bhirud Deepak Prakash , Sandhu Arjun Singh , Aggarwal Amit , Singh Mahendra , Navriya Shiv Charan , Choudhary Gautam Ram 
Published: August 2023

Objectives: Lymphatic channels (LC) are not as prominent as blood vessels, so they tend to get damaged during surgical procedures. It can present with chyle leak in the postoperative period. We aimed to study the occurrence of chyle leak in patients undergoing nephrectomy and its management. Methods: During the period of January 2021 and January 2023, 158 adult patients underwent nephrectomy for various reasons like non-functioning kidney, donor nephrectomy, and malignancy. We retrospectively analyzed data of patients who had chyle leak after nephrectomies. Results: Eight patients out of the 158 patients (5.06%) undergoing nephrectomy developed chyle leak. One out of these eight patients underwent nephrectomy by open approach while seven underwent laparoscopic approach. All eight patients who had chyle leak undergone left sided nephrectomy. Six patients of chyle leak could be managed with dietary modification while two patients needed octreotide therapy for treatment. Higher Body Mass Index (BMI; p-value = 0.012), left sides nephrectomy ( p-value = 0.013), h/o pyelonephritis ( p-value = 0.005) were associated with higher incidence of chyle leak on univariate analysis. While on multivariate analysis no factor was found to be independently associated with chyle leak. Hospital stay was significantly prolonged in patients with chyle leak ( p-value = 0.007). Conclusion: Chyle leak is not a very rare complication after nephrectomy. Patients with higher BMI, who undergo left sided nephrectomies and patients who had history of pyelonephritis or infectious complications had higher incidence of chyle leak. Most cases can be managed with conservative management (CM). Chyle leak is associated with a prolonged hospital stay.
Constructing integrated thermal conductive and flame-retardant filler network in ceramifiable epoxy composites
Authors: Kong Lingcheng , Zhao Dong , Jiang Guodong , Jiang Genjie , Shen Yucai , Wang Tingwei 
Published: August 2023

Simultaneously improving the thermal conductivity and flame resistance of epoxy composite is still a challenge. Herein, a novel epoxy composite with high thermal conductivity and greatly enhanced flame retardancy was developed through constructing integrated three-dimensional (3D) network based on boron nitride (BN), talc, ammonium polyphosphate (APP). The thermal conductivity of the composite with filler network reached 3.04 Wm−1K−1, which was 15.2 and 3.1 times of those of pure epoxy and sample with random filler distribution. The LOI value of the composite with filler network reached 37.8%, which was 1.9 and 1.4 times of those of pure epoxy and sample with random filler distribution, respectively. In addition, the effects of various combinations of filler on the flame resistance of the epoxy composite were also evaluated. The prepared composite with filler network exhibited excellent shape stability and mechanical strength even after ablation at 1000°C. The network structure constructed by BN had a positive effect on heat transfer, while APP led to the formation of phosphoric acid at high temperature, adhering to talc and other residues together. A ceramic-like residue was formed on the firing surface, which enhanced the barrier effect of char layer and flame resistance of the composite.
Impact of online health information-seeking behavior on shared decision-making in patients with systemic lupus erythematosus: The TRUMP2-SLE project
Authors: Ichikawa Takanori , Kishida Dai , Shimojima Yasuhiro , Yajima Nobuyuki , Oguro Nao , Yoshimi Ryusuke , Sakurai Natsuki , Hidekawa Chiharu , Sada Ken-ei , Miyawaki Yoshia , Hayashi Keigo , Shidahara Kenta , Ishikawa Yuichi , Sekijima Yoshiki , Kurita Noriaki 
Published: August 2023

Objective Providing appropriate health information to patients with systemic lupus erythematosus (SLE) is advantageous in the treatment decision-making process. We aimed to investigate how online health information-seeking behaviors affect shared decision-making (SDM) in patients with SLE. Methods This cross-sectional study included 464 patients with SLE from five institutions. The main exposure was time spent on the internet per day, divided into four categories (none, <1 h, 1– < 2 h, ≥2 h). Participants categorized their preferred first source of health information as physicians, the internet, or other media. The outcome was the degree of SDM measured via the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). A general linear model was applied. Results Compared to no internet use, longer internet use was associated with a higher SDM-Q-9 score: <1 h, 6.9 points (95% confidence interval [CI] 0.32 to 13.6) and ≥2 h, 8.75 points, (95% CI 0.61 to 16.9). The SDM-Q-9 did not differ between the individuals who chose physicians and those who chose the Internet as their preferred first source of health information (–2.1 points, 95% CI –6.7 to 2.6). Individuals who chose other media had significantly lower SDM-Q-9 scores than those who chose physicians (–7.6 points, 95% CI –13.2 to –1.9). Conclusions The present study suggests that SDM between physicians and patients is positively associated with online information-seeking behavior, with no negative influence associated with accessing the Internet before clinical consultations. Rheumatologists may need to introduce their patients to websites offering high-quality health information to establish a good physician–patient relationship for SDM.
A patient with congenitally restrictive strabismus and contralateral secondary muscle enlargement
Authors: Zimmermann-Paiz Martin A. 
Published: August 2023

Aim To report the case of a congenital restrictive strabismus with a contralateral enlargement of extraocular muscles. Case The clinical presentation, findings, and postoperative outcomes of a 4 years old boy referred to evaluation for presenting a left eye deviation since birth are detailed. Conclusion A unilateral congenital restrictive strabismus (congenital hypotropia and esotropia) can be the cause of contralateral secondary enlarged extraocular muscle and It must be included in the differential diagnosis.
Substance Use and Mental Health Screening Within an Emergency Department-Based HIV Screening Program: Outcomes From 1 Year of Implementation
Authors: Brown Jennifer L. , Gause Nicole K. , Braun Robert , Punches Brittany , Spatholt David , Twitty T. Dylanne , Sprunger Joel G. , Lyons Michael S. 
Published: August 2023

Introduction The emergency department (ED) may be an optimal setting to screen for substance use disorders (SUDs) and co-occurring psychiatric disorders (CODs). We report on the frequency of problematic substance use and comorbid elevated mental health symptoms detected during a 1-year implementation period of an ED-based SUD/COD screening approach within an established ED HIV screening program. Methods Patients (N = 1,924) were approached by dedicated HIV screening staff in an urban, Midwestern ED. Patients first completed measures assessing problematic alcohol (Alcohol Use Disorder Identification Test-Concise [AUDIT-C]) and substance use across 10 categories of substances (National Institute on Drug Abuse–Modified Alcohol, Smoking, and Substance Involvement Screening Test [NIDA-Modified ASSIST]). Patients with positive alcohol and/or substance use screens completed measures assessing symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and post-traumatic stress disorder (PTSD) (PTSD Checklist-Civilian [PCL-C]). Results Patients were predominantly male (60.3%) with a mean age of 38.1 years (SD = 13.0); most identified as White (50.8%) or Black (44.8%). A majority (58.5%) had a positive screen for problematic alcohol and/or other substance use. Of those with a positive substance use screen (n = 1,126), 47.0% had a positive screen on one or more of the mental health measures with 32.1% endorsing elevated depressive symptoms, 29.6% endorsing elevated PTSD-related symptoms, and 28.5% endorsing elevated anxiety symptoms. Conclusions Among those receiving ED HIV screening, a majority endorsed problematic alcohol and/or other substance use and co-occurring elevated mental health symptoms. Substance use and mental health screening programs that can be integrated within other ED preventive services may enhance the identification of individuals in need of further assessment, referral, or linkage to substance use treatment services.
Qualitative Assessment of Key Implementation Factors in a Faith-Based Response to Intimate Partner Violence
Authors: Debinski Beata , Bittle Mark , Kennedy Caitlin E. , Jones Vanya , Gielen Andrea Carlson 
Published: August 2023

Background Faith-based organizations (FBOs) have a scant history in the literature of implementing intimate partner violence (IPV) initiatives, though many members of faith communities consider it an important issue. Furthermore, the limited studies on this topic have not explored organizational factors that are important in the implementation of such efforts. Purpose To investigate factors that influence the implementation of IPV prevention and response by one Catholic organization at both diocesan and parish levels. Methods We conducted sixteen semi-structured interviews with members of Archdiocese of Chicago Domestic Violence Outreach (ACDVO) leadership. Using deductive content analysis, we drew on all 14 constructs and sub-constructs from the inner setting domain of the Consolidated Framework for Implementation Research (CFIR) for coding transcripts and characterizing factors influencing implementation success. Results Seven CFIR constructs were useful in identifying factors that influenced implementation success of ACDVO. At the diocesan level, the organization’s leadership structure, their driven culture, and in-kind available resources propelled their work. At the level of parish ministries, successful implementation was facilitated by networking and communication among parishes. At the diocesan-level, access to knowledge and information through ACDVO’s Parish Support Committee, compatibility with parish values, leadership engagement, and available resources from parishes supported implementation. Conclusions We identified modifiable and reproducible inner setting factors that influence implementation of a Catholic IPV initiative at the diocesan-level and support parish ministries in their local activities. Future work should validate these findings in other dioceses and examine non-Catholic FBO settings.
Safety and Efficacy of Inner Branched Stent-Graft in the Treatment of Aortic Arch Disease: A Systematic Review
Authors: Kwan Kristine J. S. , Li Hai-Lei , Chan Yiu Che , Cheng Stephen W. K. 
Published: August 2023

Objective: To provide a descriptive overview on the contemporary outcomes of thoracic endovascular arch repair with inner branched endoprosthesis (bTEVAR) for the treatment of aortic arch pathologies. Methods: A comprehensive literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Pre-defined search terms were used to interrogate PubMed and OVID Medline databases from January 1999 to July 2022. Patient characteristics, indication for treatment, procedural data, mortality rates, postoperative complications, and reintervention rate during follow-up were evaluated. Results: Nineteen articles were included, encompassing a total of 618 patients who received bTEVAR, most of which were double-branched (63.9%, n=395). The main indication for treatment was aneurysm secondary to chronic aortic dissection (38.8%, n=240/618) with a mean maximum diameter of 58.3±11.4 mm. Pooled mean technical success rate was 97.4±4.4% (95% confidence interval [CI]=95.1%–99.5%); 2 and 3 patients required conversion to chimney technique and open repair, respectively. Among the pooled rates of early complications, postoperative stroke was the highest (10.5%; 95% CI=6.8%–14.3%). Thirty-day and in-hospital mortality rate was 5.5% (95% CI=2.6%–9.7%). Forty patients (6.5%; 95% CI=2.5%–9.5%) required early reintervention. During a mean follow-up of 20.7±13.5 months, the mortality rate was 18.2% (n=108/593; 95% CI=8.6%–20.6%) where 12 (11.1%) were aortic-related. Pooled late reintervention rate was 9.6% (95% CI=4.8%–14.3%). Comparison of demographics and outcomes found no significant difference between single and double bTEVAR. Conclusion: Branched thoracic endovascular aortic repair is a promising approach for aortic arch pathologies with a high technical success rate despite a steep learning curve. However, contemporary outcomes reflect that postoperative stroke remains the predominant concern. Further experience and long-term follow-up are required to sufficiently elucidate the safety and durability of bTEVAR in the management of aortic pathologies for high-risk patients. Clinical Impact This systematic review summarized the contemporary outcomes of thoracic endovascular aortic repair with different inner branched stent-grafts for the management of aortic arch pathologies. Pooled results from nineteen studies with 618 patients demonstrated a high technical success rate and an acceptable mortality rate. However, postoperative stroke remains the major concern. Long-term follow-up is needed to evaluate its durability.
Comparative evaluation of isoflurane and desflurane for postoperative cognitive decline in elderly patients: A prospective observational pilot study
Authors: Haritha Damarla , Sarkar Soumya , Maitra Souvik , Kashyap Seema , Verma Rohit , Satapathy Sujata , Kashyap Lokesh , Singh Akhil Kant , Singh Lata , Ray Bikash Ranjan , Anand Rahul Kumar , Kumar Shailendra , Khanna Puneet 
Published: August 2023

Background: Approximately 16%–62% of patients undergoing non cardiac surgeries develop postoperative cognitive dysfunction. We compared the incidence of postoperative cognitive dysfunction in older adults aged 60–80 years who underwent open abdominal surgeries under general anaesthesia using isoflurane or desflurane and correlated it with the serum concentration of interleukin 1, interleukin 6, tumour necrosis factor alpha, amyloid β and S100 on postoperative day 3. Method: Forty American Association of Anesthesiologists Physical Classification I or II patients were included after acquiring institutional ethics committee approval, registering in the Clinical Trials Registry – India, and informed written consent. They underwent open abdominal surgery under general anaesthesia and epidurals between 2017 and 2019. Patients with substance abuse or any disorder affecting cognition were excluded. Postoperative cognitive dysfunction was assessed by Stroop test, Wisconsin Card Sorting Test, Trail making test – B, Porteus Maze test, PGI memory scale, mini-mental state examination, and Bender Gestalt test the day before surgery and on the third postoperative day along with blood samples. Results: Thirty-seven percent of the patients developed postoperative cognitive dysfunction. The risk was similar to isoflurane in comparison with desflurane (risk ratio: 0.65, 95% confidence interval: 0.30, 1.40). A significant percentage increase in reaction time for Porteus Maze test and Trail making test – B was noted with isoflurane (6.69 (4.20–8.94) and 8.01 (2.08–12.5), respectively) in comparison with desflurane group (13.01 (9.09–17.33), p = 0.003 and 11.62 (7.5–17.5), p = 0.017, respectively). Conclusion: Isoflurane and desflurane had a similar impact on the elderly for developing postoperative cognitive dysfunction and no correlation with any of the biomarkers used in the study on postoperative day 3.