bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining Association Between Cognitive Function and Oral Health Status among Rural Community Dwelling Geriatrics
Authors: Balasubramaniam Arthi , Diwakar Madan Kumar Parangimalai , Vaitheswaran Sridhar , Santhosh Kumar M P , Sushanthi S , Pandiyan Indumathy 
Published: August 2023

ABSTRACT

Objective:
Numerous prospective studies worldwide investigated the association between oral health status and dementia or cognitive decline. No clear agreement has emerged on the association. This study aimed to determine the association of cognitive function and oral health status among community dwelling geriatrics in rural South India.

Materials and Methods:
A cross-sectional study was conducted among community dwelling geriatrics in rural South India by recruiting 211 individuals aged above 60 years. Their cognitive function was assessed using pre-validated community screening instrument for dementia (CSI-D) which has informant and cognitive scale. The data on cognitive function was collected by community health workers in electronic version (Web app). Their oral health status was assessed by World Health Organization (WHO) oral health assessment form in electronic version (Web app).

Results:
From the logistic regression analysis, it was observed that cognitive impairment showed an association with 1.6- and 1.9-times risk for root caries and a greater number of missing teeth (P ≤ 0.05). No association of other oral health parameters such as gingivitis, periodontitis, dental erosion, and dental trauma with cognitive impairment exhibited.

Conclusion:
From the results, it can be concluded that cognitive impairment has an association with root caries and number of missing teeth which increases the risk for the same and vice versa.
C-reactive protein and its association with COVID-19
Authors: Devi Yumlembam Bishwabati , Presanambika Hari , Kongbrailatpam Bidyarani , Singh Ksh. Birendra , Chongtham Dhanaraj , Devi Khuraijam Ranjana 
Published: August 2023

Background:
COVID-19 is the third serious Coronavirus outbreak after severe acute respiratory syndrome (2002–2003) and Middle East respiratory syndrome (2012). There is an increasing need for a credible marker to triage patients and for telescoping the prognosis of COVID-19 more so in resource-constrained settings. COVID-19 patients were found to have a significant increase of C-reactive protein (CRP) levels (20–50 mg/L). Severe COVID-19 patients were noted to have up to 86% elevated CRP. 10-fold higher CRP was found in patients who died from COVID-19 than the recovered cases.

Objectives:
To demonstrate the association of CRP levels with COVID-19 infected patients and to assess the findings in accordance with different variables.

Materials and Methods:
Thirty-three nonconsecutive COVID-19 tested positive patients whose blood samples were sent for CRP testing were included for a retrospective study conducted between August 2020 and February 2021.

Results:
This study revealed elevation in CRP levels in patients belonging to severe cases (median = 46.71 mg/L) followed by moderate (median = 21.61 mg/L) and mild cases (median = 8.572 mg/L). Patients with comorbidities were noted to have higher median CRP (37.86 mg/L) compared to those without comorbidities (median = 20.3 mg/L). This study also detected increased CRP levels (median = 43.732 mg/L) in morbid cases compared to recovered cases (median = 20.3 mg/L).

Conclusion:
In a hospital with limited resources, this study successfully demonstrated the significant role of CRP in COVID-19 outcome elucidating the importance of CRP levels when used for triaging patients and monitoring disease progression.
Doctors with skin injuries due to personal protective equipment in a dedicated COVID-19 hospital
Authors: Gupta Vikas , Nayyer Prem Singh , Gupta Vinita , Ranjan Rajesh 
Published: August 2023

Background:
With the emergence of highly infectious epidemics/pandemics, such as Ebola virus diseases, severe acute respiratory syndrome, and coronavirus disease-2019 (COVID-19), doctors are at much greater risk of infection due to the exposure to the highly infectious bodily fluids and droplet nuclei. Hence, treating and caring for patients need the use of personal protective equipment (PPE) to reduce the transmission risk.
Objectives: The present study was conducted to estimate the prevalence of skin injury and its type due to PPE usage, to find the association of related factors with the skin injuries among doctors.

Materials and Methods:
This descriptive cross-sectional study was conducted after obtaining the institutional ethical approval in dedicated COVID-19 hospital for a period of 4 months among 132 doctors wearing grades 2 and 3 PPE kit using a questionnaire collecting the details regarding baseline, duty, skin injury characterization. During analysis of data, an association between variables was significant for P < 0.05.

Results:
It was observed that 17.1% of doctors were wearing the PPE kit for 5 or more hours/and 13.0% of subjects reported absenteeism from duty hours due to PPE-induced skin injuries. 76.4% of subjects have suffered from skin injury after PPE usage. The most common symptoms/signs for the skin injury occurred was indentation and pain on back of ears (61.0%).
Conclusion: The skin injuries of PPE among the doctors may result in reduced morale for overloaded work and made them anxious. Hence, an appropriate monitoring of these adverse effects should be done and effective preventive measures should be adopted.
Maternal deaths
Authors: Singh Khangembam Pradipkumar , Keisham Supriya , Chetri Deepen , Wanio Sungoh James Da O. , Zohlupuii Lynda B. , Meera Th. Devi 
Published: August 2023

Background:
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy. This can be due to direct causes or indirect unrelated causes. It is an important indicator of health-care services. Autopsy, which is an important tool of investigation, provides valuable input regarding the sequence of events leading to maternal death.

Objectives:
The objective of this study is to determine factors causing maternal deaths and to discuss the utility of medicolegal knowledge in ascertaining the causes of maternal deaths.

Materials and Methods:
This was a retrospective study where individual records of all maternal deaths brought for autopsy in the hospital mortuary during the past 10 years from January 2011 to December 2020 were studied. The cause of death and the factors which led to death in each individual case were analyzed.

Results:
A total of 15 maternal deaths were brought during the study period. Most maternal deaths (40%) occurred in the age group of 31-40 years. Maximum of the cases 11 of 15 were able to reach a health-care center before delivery. Direct causes accounted for 86.67% of maternal deaths. Hemorrhage and shock (38.46%) were the major direct cause of maternal deaths. The majority of the deaths occurred during the postnatal period (53.33%). Regarding the pregnancy outcome, 8 (53.33%) mothers were able to deliver live-born babies, of which 5 (62.5%) were delivered by lower segment cesarean sections and 3 (37.5%) by normal vaginal deliveries.

Conclusion:
There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers with round-the-clock functioning blood banks is the need of the hour.
Evaluation of the efficacy of various dry powder inhalation devices in the treatment of bronchial asthma patients
Authors: Kumar Subodh , Pandey Anuj Kumar , Verma Ajay Kumar , Singh R. P. , Chaudhri Sudhir , Kant Surya , Katiyar S. K. 
Published: August 2023

ABSTRACT

Introduction:
In the current study, we aimed to evaluate the efficacy in terms of clinical effectiveness and patients’ acceptability regarding the use of dry powder inhaler devices in asthmatic patients.

Materials and Methods:
Patients with mild-to-moderate asthma were recruited from Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India. A total number of patients were divided into three groups and were given different dry powder inhalation devices, randomly Group one-Rotahaler; Group Two-Diskhaler; and Group Three-Transhaler. Spirometry was performed, and the inhalation technique was checked in each follow-up visit.

Results:
Patients with asthma in all three studied groups improved from the prescribed inhaled steroids, irrespective of the inhalational device. Min Max % as a marker for peak expiratory flow rate variability, improved in all three groups without any significant difference. Predicted forced expiratory volume in the first second percent considered as a marker of asthma severity improved significantly in all patients, but without any significant difference between groups.

Conclusion:
We conclude that these inhalers, particularly in mild-to-moderate asthma, have comparable efficacy; however, we carried out intensive monitoring and teaching of inhalational technique, which could be the reason behind insignificant difference.
The management of fatal hyperhemolysis in a sickle cell anemia patient transfused in a remote Island in North Andaman
Authors: Abdul Shahid .P.P , Shaiji P. S. , Hameed Yameena 
Published: August 2023

ABSTRACT
Hyperhemolysis following red cell transfusion is a potentially fatal complication in sickle cell disease patients. Red cell alloimmunization can lead to a delayed hemolytic reaction further leading to hyperhemolysis resulting in the destruction of patients’ own red blood cells. The chances of alloimmunization increases when there are ethnic differences between the donor and recipients. We report the case of a 25-year-old female with sickle cell anemia, treated with packed red cells in a remote island of North Andaman, India, who suffered from hemolytic transfusion reaction and hyperhemolysis yet could be successfully treated to recovery with the available resources. She had a severe hemolysis, anemia with the hemoglobin levels than pretransfusion hemoglobin, jaundice, acute kidney failure, and deranged liver function tests. Multiple alloantibodies “anti-C and anti-E” were found in her serum which were potentially hemolytic. She was treated with forced diuresis, steroids, and hemodialysis and recovered in a span of 10–14 days.
Dietary practices and physical activity among the school-going adolescents of Bishnupur district, Manipur
Authors: Sanjana Laishram , Konjengbam Shantibala , Christina Soubam 
Published: August 2023

ABSTRACT

Background:
Adolescence is a period during which maximum physical, psychological, and behavioral changes take place. Dietary habits and lifestyle during adolescence are risk factors for several nutrition-related non-communicable diseases in adulthood.

Objective:
The objective is to assess the dietary practices and physical activity among the school-going adolescents of Bishnupur district.

Materials and Methods:
A cross-sectional study was conducted among the school students of standard VIII to X of Bishnupur District. A total of 840 students were selected using a multistage stratified cluster random sampling technique. A self-administered questionnaire was used to collect data. The Chi-square test was used for the comparison of categorical variables. Student’s t-test was used to compare the mean intakes of energy, protein, and fat. A P < 0.05 was taken as statistically significant.

Results:
Overall, the adolescents reported poor dietary intakes; around half (47.7%) of the students reported consumption of fast food on the previous day. Almost half (51.8%) of them had fast foods/junk foods 1–3 times a week. The study also found that 369 (43.9%) participants performed moderate to vigorous physical activity daily.

Conclusion:
The study found that a considerable proportion of adolescents was adopting unhealthy dietary practices and more than half of them were not engaged in physical activity daily. Hence, it is recommended that addressing these risk factors should be given the highest priority and various strategies of primordial, primary, and secondary prevention should be applied.
An investigation into the use of an extended lipid panel in the screening of cardiovascular events
Authors: Jaishankar Thirunavukkarasu , Shivasekar Meera , Vinodhini V. M. 
Published: August 2023

ABSTRACT

Introduction:
Low-density lipoprotein (LDL) is classified into many subclasses based on its atherogenic propensity, with small dense (sd) LDL being a highly important risk biomarker for early coronary heart disease (CHD). Nonhigh-density lipoprotein cholesterol (non-HDLc) is made up of all atherogenic apolipoprotein B-containing lipoproteins, including low-density lipoprotein cholesterol, very-low-density lipoprotein-C, intermediate-density lipoprotein-C, lipoprotein (a), chylomicrons, and chylomicron remnants. Apolipoproteins, which include apolipoprotein B and apolipoprotein A1, are cholesterol transporters that play a key role in lipid metabolism. Furthermore, Apo-B and Apo-A1 indicate total atherogenic and nonatherogenic particles, respectively.

Materials and Methods:
This case–control research was done on participants visiting the cardiology and medicine OP in SRM Medical College Hospital and Research Center. The research included 546 people ranging in age from 30 to 55 years. After an overnight fast, blood samples were obtained for the measurement of apolipoprotein-B and apolipoprotein-A1 using the enzyme-linked immunosorbent assay technique. The calculation was used to determine the sd-LDL, non-HDL, and Apo-B/Apo-A1 ratios.

Results:
When compared to controls, the CHD group had significantly higher levels of sd-LDL, non-HDL, apolipoproteins, and the Apo-B/Apo-A1 ratio. In contrast, the mean level of LDL in CHD was higher and statistically significant (P < 0.001) when compared to normal healthy controls.

Conclusion:
The study shows that there is a high correlation between sd-LDL, nonHDL-C, apolipoproteins, and their Apo-B/Apo-A1 ratio. When compared to standard lipid indicators, the estimate of all of these parameters appears to be a better marker in predicting the early risk of cardiovascular disease in both diabetic and nondiabetic CHD participants and might be utilized successfully in clinical practice.
Using a Consensus-Driven Approach to Incorporate Holistic Review Into an Internal Medicine Residency Program
Authors: Golden Blair P. , Holland Robert , Zakowski Laura , Smith Jeremy 
Published: August 2023

Background Despite growing interest in incorporating holistic review within residency admissions, implementation by residency programs remains challenging.
Objective To incorporate holistic review into the internal medicine residency program at the University of Wisconsin and to report initial feasibility and acceptability data.
Methods During the 2020-2021 application cycle, residency stakeholders performed a consensus-driven process to identify highly valued applicant attributes. We used a holistic review process to identify the presence of these attributes among applicants and updated our rank list algorithm to incorporate these attributes. We modified our interview screening criteria and rank list algorithm to de-emphasize other metrics. We surveyed stakeholders to assess time required for this process and compared our final rank list to what it would have been using our prior system.
Results The final list of 10 prioritized applicant attributes included extraordinary leadership, community service, and grit, among others. Among 25 matched residents, 8 (32%) were recognized to have exceptional achievement within one of these 10 attributes. Four members of the incoming intern class (16%) would have been in a rank position lower than our historical matched resident cutoff had they not received additional points for these attributes. Faculty reported that holistic review of applications took an additional 3.8 minutes on average. It was felt that current application materials limit the ability to implement a fully holistic review.
Conclusions The addition of holistic review to our residency admissions process was achieved using a consensus-driven approach and showed favorable feasibility and acceptability data.
Comparing Machine Learning Models and Human Raters When Ranking Medical Student Performance Evaluations
Authors: Kibble Jonathan , Plochocki Jeffrey 
Published: August 2023

Background The Medical Student Performance Evaluation (MSPE), a narrative summary of each student’s academic and professional performance in US medical school is long, making it challenging for residency programs evaluating large numbers of applicants.
Objective To create a rubric to assess MSPE narratives and to compare the ability of 3 commercially available machine learning models (MLMs) to rank MSPEs in order of positivity.
Methods Thirty out of a possible 120 MSPEs from the University of Central Florida class of 2020 were de-identified and subjected to manual scoring and ranking by a pair of faculty members using a new rubric based on the Accreditation Council for Graduate Medical Education competencies, and to global sentiment analysis by the MLMs. Correlation analysis was used to assess reliability and agreement between student rank orders produced by faculty and MLMs.
Results The intraclass correlation coefficient used to assess faculty interrater reliability was 0.864 (P&lt;.001; 95% CI 0.715-0.935) for total rubric scores and ranged from 0.402 to 0.768 for isolated subscales; faculty rank orders were also highly correlated (rs=0.758; P&lt;.001; 95% CI 0.539-0.881). The authors report good feasibility as the rubric was easy to use and added minimal time to reading MSPEs. The MLMs correctly reported a positive sentiment for all 30 MSPE narratives, but their rank orders produced no significant correlations between different MLMs, or when compared with faculty rankings.
Conclusions The rubric for manual grading provided reliable overall scoring and ranking of MSPEs. The MLMs accurately detected positive sentiment in the MSPEs but were unable to provide reliable rank ordering.
Features of Effective Clinical Competency Committees
Authors: Rowland Kathleen , Edberg Deborah , Anderson Lauren , Wright Katherine 
Published: August 2023

Background The Clinical Competency Committee (CCC) provides accountability to the general public that physicians completing a training program have achieved competence. CCC processes and features that best identify resident outcomes along a developmental spectrum are not well described.
Objective This study sought to describe CCC features associated with effective and efficient CCC performance.
Methods The study was conducted as part of the 2022 Council of Academic Family Medicine Educational Research Alliance survey of family medicine residency program directors. The survey assessed CCC methods, policies, faculty development, structure, and overall CCC time required. The outcomes were identification of residents along a spectrum of development, from failing to exceeding expectations. Ordinal logistic regressions were used to explore the relationship between CCC characteristics and CCC outcomes.
Results The response rate was 43.3% (291 of 672). Eighty-nine percent (258 of 291) of program directors reported their CCC is successful in identifying residents not meeting expectations; 69.3% (201 of 290) agree their CCC identifies residents who are exceeding expectations. Programs with written policies for synthesizing data (OR=2.53; 95% CI 1.22-5.22; P=.012) and written policies for resident feedback (OR=19.91; 95% CI 3.72-106.44; P&lt;.001) were more likely to report successfully identifying residents below expectations. Programs whose members spent fewer than 3 hours per 6-month interval on CCC meetings were less likely to report being able to identify failing residents (OR=0.37; 95% CI 0.19-0.72; P=.004).
Conclusions This survey of family medicine program directors suggests that formal policies, faculty development, and adequate time for CCC faculty are associated with an effective CCC, especially if goals beyond “identifying failure” are desired.
Near-Peer Supervision in Primary Care: Bringing Teaching Teams From the Wards to the Clinic
Authors: Chen Katherine L. , Yuan Stanley E. , Asfaw Elizabeth K. , Sim Myung Shin , Ntim Gifty-Maria J. , Ma Mina W. , Pessegueiro Antonio M. 
Published: August 2023

Background Teaching near-peers yields numerous benefits to residents. Opportunities for near-peer teaching are typically restricted to hospital settings. Little is known about the educational potential of outpatient near-peer teaching.
Objective To describe Primary Care Teaching (PC Teach), a novel outpatient near-peer teaching experience for residents in a large, urban, internal medicine residency program; characterize its feasibility and acceptability; and evaluate changes in residents’ self-reported confidence in outpatient teaching and attitudes toward teaching and primary care/outpatient medicine.
Methods In 2020-2021, following a didactic workshop, 43 postgraduate year 3 (PGY-3) residents at continuity clinics assigned to PC Teach completed a series of half-day sessions acting as preceptor to interns under attending supervision. Worksheets facilitated post-session feedback for residents and interns. Eighteen PGY-3s at nonparticipating clinics, who also completed the workshop, served as controls. We assessed process measures for feasibility and acceptability and analyzed resident attitudes using pre-post surveys.
Results Participating residents completed 2 to 8 sessions each. Post-intervention scores for confidence in outpatient teaching and attitudes toward teaching were greater, relative to pre-intervention group means, for intervention residents (median pre-post changes +0.60 [IQR 0.26, 1.26] and +0.46 [-0.04, 0.46], respectively) vs controls (-0.15 [-0.48, 0.85] and -0.36 [-0.86, 0.39]; between-group differences +0.75 [P=.03] and +0.82 [P=.02]). Changes in attitudes toward primary care/outpatient medicine did not differ significantly between intervention and control groups (+0.43 [-0.07, 0.68] and 0.04 [-0.58, 0.42]; between-group difference +0.39 [P=.12]). In multivariable analyses, odds of gains in confidence in outpatient teaching remained significantly larger for intervention residents vs controls.
Conclusions Implementing PC Teach with existing resources was feasible and acceptable, with program flexibility highlighted as a strength. Resident participation was associated with greater confidence in outpatient teaching.