bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Multidisciplinary Preoperative Protocol for Geriatric Hip Fractures Improves Time to Surgery at a Level III Trauma Center
Authors: Meyer Jacob R. , Earnest Ryan E. , Johnson Brian M. , Steffensmeier Andrew M. , Vyas Dheer A. , Laughlin Richard T. 
Published: June 2023

Introduction Hip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center. Materials and Methods In this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student’s t-test and Chi-square testing. Results There was a significant decrease in TTS in Cohort #2 compared to Cohort #1 ( P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 ( P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS ( P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 ( P = .001). Discussion In general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2. Conclusion A multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.
The Significance of Odontoid Incidence in Patients With Cervical Spondylotic Myelopathy
Authors: Qin Hongyu , Chen Weiyou , Huang Longao , Xiao Xin , Yang Qinghua , Jiang Hua 
Published: June 2023

Study Design Observational study. Objective To analyze the cervical sagittal parameters for standing Digital radiography (DR) and supine Magnetic resonance imaging (MRI), and to further clarify the relationship between odontoid incidence (OI) and cervical spondylotic myelopathy (CSM). Methods 52 CSM patients aged 54.46 ± 2.89 years underwent both standing DR and supine MRI scans of cervical spine between November 2021 and November 2022. OI, odontoid tilt (OT), C2 slope (C2S), T1 slope (T1S), C0-2 angle, C2-7 angle (cervical lordosis [CL]), and T1S-CL were measured in both DR and MRI images using Surgimap ( Version 2.3.2.1). Pearson correlation and linear regression were used to compare these parameters between the two modalities. Results Cervical sagittal parameters, including OI, OT, C2S, C0-2 angle, T1S, C2-7 angle (CL) and T1S-CL, showed no significant differences in the measurements between the two modalities. Based on the DR images, OI was related to OT (r = .386, P < .01), C2S (r = .505, P < .01), CL (r = -.412, P < .01), and T1S-CL (r = .320, P < .05), and OI was matched with CL (r2 = .170) and T1S-CL (r2 = .102). Based on MRI images, OI was related to OT (r = .433, P < .01), C2S (r = .516, P < .01), CL (r = -.355, P < .01), and T1S-CL (r = .271, P < .05), and OI matched with C2-7 (r2 = .126) and T1S-CL (r2 = .073). Conclusion OI is an independent parameter related to cervical anatomy and its measurement is unaffected by external factors. In patients with CSM, odontoid parameters may effectively describe the sagittal alignment of the cervical spine on DR and MRI images.
Outcomes of Revision Arthroscopic Posterior Labral Repair and Capsulorrhaphy: A Systematic Review
Authors: Jewett Callie A. , Reardon Patrick , Cox Charles , Bowman Eric , Wright Rick W. , Dickens Jonathan , LeClere Lance 
Published: June 2023

Background: Failure rates up to 14% have been reported after arthroscopic posterior capsulolabral repair. It is unknown if revision arthroscopic posterior capsulolabral stabilization has inferior restoration of stability and return to sport when compared with primary repair. Optimal management of failed posterior capsulolabral stabilization is unknown. Purpose: To report outcomes of revision posterior capsulolabral repair and factors that contribute to failure and to determine optimal management of failed posterior stabilization procedures. Study Design: Systematic review; Level of evidence, 4. Methods: A computerized search of the PubMed, EMBASE, and Web of Science databases and manual screening of selected article reference lists were performed in January 2022. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision arthroscopic posterior capsulolabral repair were eligible. Patient characteristics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Owing to heterogeneity of reported outcomes, data were summarized and presented without pooled statistics. Results: Only 3 of the 990 identified studies met inclusion criteria. The included studies encompassed 26 revision arthroscopic posterior capsulolabral repairs, with follow-up ranging from 2.3 to 5.3 years. The failed index procedure was arthroscopic capsulolabral repair with suture anchors (n = 22) or posterior thermal capsulorrhaphy (n = 4). The primary indications for revision were recurrent instability and pain. Six patients experienced recurrent instability after revision. Patient satisfaction ranged from 15% to 25%. Conclusion: This systematic review of 3 studies demonstrated that the incidence of persistent pain and recurrent instability after revision arthroscopic posterior shoulder stabilization is common, and despite slight improvement in patient-reported outcomes, many patients are dissatisfied with their clinical outcomes. Revision arthroscopic posterior shoulder stabilization appears to have a significant failure rate, and there is need for additional prospective studies to help determine the best intervention for these patients.
Fluorbritholite-(Nd), Ca2Nd3(SiO4)3F, a new and key mineral for neodymium sequestration in REE skarns
Authors: Holtstam Dan , Casey Patrick , Bindi Luca , Förster Hans-Jürgen , Karlsson Andreas , Appelt Oona 
Published: June 2023

AbstractFluorbritholite-(Nd), ideally Ca2Nd3(SiO4)3F, has been approved by the International Mineralogical Association (IMA2023–001) and constitutes a new member of the britholite group of the apatite supergroup. It occurs in skarn from the Malmkärra iron mine, Norberg, Västmanland (one of the Bastnäs-type deposits in Sweden), associated with calcite, dolomite, magnetite, lizardite, talc, fluorite, baryte, scheelite, gadolinite-(Nd) and other REE minerals. Fluorbritholite-(Nd) forms anhedral and small grains, rarely up to 250 μm across. They are brownish pink and transparent with a vitreous to greasy lustre. The mineral is brittle, with an uneven or subconchoidal fracture and lacks a cleavage. In thin section, the mineral is nonpleochroic, uniaxial (–). Dcalc = 4.92(1) g⋅cm−3 and ncalc = 1.795. The empirical chemical formula from electron microprobe (WDS) point analyses is (Ca1.62Nd0.97Ce0.83Y0.52Sm0.30Gd0.23Pr0.17La0.16Dy0.11Er0.03Tb0.03Ho0.01Yb0.01)Σ4.99(Si2.92P0.08As0.01)Σ3.01O12.00[O0.48F0.26(OH)0.14Cl0.10Br0.02]Σ1.00. The crystal structure of fluorbritholite-(Nd) was refined from single-crystal X-ray diffraction data to R1= 0.043 for 704 unique reflections. It belongs to the hexagonal system, space group P63/m, with unit cell parameters a = 9.5994(3), c = 6.9892(4) Å and V = 557.76(5) Å3 for Z = 2. Fluorbritholite-(Nd) and other britholite-group minerals are a major sink for neodymium in REE-bearing skarns of Bastnäs type.
A survival case of visceral disseminated varicella zoster virus infection in a patient with systemic lupus erythematosus
Authors: Ishino Yuri , Fukasawa Hirotaka , Kitamoto Shuhei , Nakagami Daisuke , Kaneko Mai , Yasuda Hideo , Furuya Ryuichi 
Published: June 2023

Abstract
Background
Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE).

Case presentation
A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged.

Conclusions
Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.
An Indian perspective for umbilical cord blood haematological parameters reference interval
Authors: Sabnis Keyur , Ghanghurde Swati , Shukla Akash , Sukheja Dhriti , Rojekar Mohit V. 
Published: June 2023

Abstract
Background
The Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a major role in laboratory data interpretation and determine the necessary clinical treatment. Currently, India has no well–established RI for cord blood haematological parameters of newborns. This study aims to establish these intervals from Mumbai, India.

Method
A cross sectional study was conducted in a tertiary care hospital of India from October 2022 to December 2022 on healthy and term neonates having normal birth weight and born to healthy pregnant mothers. About 2 – 3 mL of cord blood was collected from the clamped cord into EDTA tubes from 127 term neonates. The samples were analysed in the haematology laboratory of the institute and the data was analysed. The upper and lower limits were determined using non-parametric method. The Mann–Whitney U test was used to compare the distribution of the parameters between sex of infant, modes of deliveries, maternal age and obstetric history. P value less than 0.05 was considered to declare statistical significance.

Result
The median values and 95% RI for umbilical cord blood haematological parameters of newborns were as follows: WBC = 12.35 [2.56–21.19] × 109/L, RBC = 4.34 [2.45–6.27] × 1012/L, HGB = 14.7 [8.08–21.44] g/dL, HCT = 48 [29–67]%, MCV = 109.6 [59.04–159.1] fL, MCH = 34.5 [30.54–37.79] pg, MCHC = 31.3 [29.87–32.75] %, PLT = 249 [16.97–479.46] × 109/L,LYM = 38 [17–62] %, NEU = 50 [26–74] %, EOS = 2.3 [0.1–4.8] %, MON = 7.3 [3.1–11.4], BAS = 0 [0–1]. This study found no statistically significant difference between sex of infants, except MCHC, and obstetric history. A significant difference was observed in WBC, EOS% and absolute NEU, LYM, MON and BAS by delivery type. A higher platelet count and absolute LYM was observed in the cord blood compared to venous blood.

Conclusions
For the first time, haematological reference intervals in cord blood were established for newborns in Mumbai, India. The values are applicable for newborns from this area. Larger study throughout the country is required.
The lived experience of clozapine discontinuation in patients and carers following suspected clozapine-induced neutropenia
Authors: Oloyede Ebenezer , Dunnett Danielle , Taylor David , Clark Ivana , MacCabe James H , Whiskey Eromona , Onwumere Juliana 
Published: June 2023

Abstract
Background
Clozapine is the treatment of choice in refractory psychosis. In most countries, clozapine must be stopped indefinitely if white blood cells fall below a defined threshold during routine monitoring. Despite evidence of severe adverse consequences of clozapine discontinuation, published accounts on the lived experiences and perspectives of patients and carers are scarce.

Method
We completed semi-structured interviews with patients (n = 4) and family carers (n = 4) on experiences of clozapine cessation following suspected drug-induced neutropenia. Interviews were audio-recorded, transcribed and analysed thematically.

Results
The two overarching themes comprised:(i) stress of clozapine below threshold neutrophil results and (ii) patient and carer priorities.

Conclusions
There is a suggested need for evidence-based pharmacological and psychological approaches to support patients and carers after clozapine cessation. Such approaches will minimise the potentially negative physical and emotional sequela in the aftermath of a below threshold neutrophil result and reduce the likelihood of experiencing additional health and social inequalities after clozapine discontinuation.
Linking the demographic, socio-economic and oral health status to oral health-related quality of life of the sudanese older adults: a cross sectional study
Authors: Salih Mayson Ahmed , Ali Raouf Wahab , Nasir Elwalid Fadul 
Published: June 2023

Abstract
Background
Oral Health-Related Quality of Life (OHRQoL) is an important measure of patients’ needs and progress. Identifying the links between clinical and non-clinical factors with OHRQoL in a specific population will facilitate the development of effective preventive strategies. The aim of the study was to assess the OHRQoL of Sudanese older adults, and to identify the possible relations between clinical and non-clinical predictors with OHRQoL using Wilson and Cleary model.

Methods
This cross-sectional study was conducted among older adults attending the out-patient clinics in Khartoum State’s Health Care Centers, Sudan. OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Two modifications of Wilson and Cleary’s conceptual model were tested using structural equations modeling including: oral health status, symptom status, perceived difficulty of chewing, oral health perceptions, and OHRQoL.

Results
249 older adults participated in the study. Their mean age was 68.24 (± 6.7) years. The mean GOHAI score was 53.96 (± 6.31) and trouble biting/chewing was the most commonly reported negative impact. Wilson and Cleary models showed that pain, Perceived Difficulty Chewing (PDC), and Perceived Oral Health had a direct effect on OHRQoL. In model 1, age and gender had direct effects on oral health status, while education had direct effects on OHRQoL. In model 2, poor oral health status is associated indirectly with poor OHRQoL.

Conclusions
The OHRQoL of the studied Sudanese older adults was relatively good. The study partially confirmed Wilson and Cleary model as Oral Health Status was related directly to PDC and indirectly to OHRQoL through functional status.
Identifying at risk populations amongst breast cancer survivors and their common symptoms and concerns
Authors: Roy Pooja , Kovalenko Iuliia , Gomez Janet Chan , Lu Kit , Rudge Beth , Wert Yijin , Torp Lisa 
Published: June 2023

Abstract
Purpose
The survival rate amongst breast cancer survivors (BCS) have been increasing, with a 5-year survival rate of almost 90%. These women face many quality of life (QOL) issues either due to either cancer itself or the complex treatment regimen. Our retrospective analysis aims to identify at risk populations among the BCS and their most common concerns.

Methods
This is a single-institution, retrospective, descriptive analysis of patients who were seen at our Breast Cancer Survivorship Program from October 2016 to May 2021. Patients completed a comprehensive survey which assessed self-reported symptoms, their concerns and degree of worry and recovery to baseline. The descriptive analysis on the patient characteristics included age, cancer stage and treatment type. The bivariate analysis included the relationship between the patient characteristics and their outcomes. Analysis of group differences was completed with Chi-square test. When the expected frequencies were five or less, Fisher exact test was used. Logistic regression models were developed to identify significant predictors for outcomes.

Results
902 patients (age 26–94; median 64) were evaluated. Majority of women had stage 1 breast cancer. The most common self-reported concerns affecting the patients were fatigue (34%), insomnia (33%), hot flashes (26%), night sweats (23%), pain (22%), trouble concentrating (19%), and neuropathy (21%). Though 13% of BCS felt isolated at least 50% of their time, the majority of patients (91%) reported having a positive outlook and felt that they have a sense of purpose (89%). Younger patients were more likely to worry about their cancer more than 50% of the time (p < 0.0001). Patients that were less likely to return back to at least 50% of their pre-treatment baseline were younger (age ≤ 45) (p = 0.0280), had higher stage breast cancer (Stage 2–4) (p = 0.0061), and had chemotherapy either alone or as part of their multi-modality treatment (p < 0.0001).

Conclusion
According to our study, younger patients, those with higher stage breast cancer and survivors who had chemotherapy may experience significant QOL issues. Fortunately, majority of BCS report a positive and optimistic outlook post treatment. Identifying common concerns after treatments and vulnerable populations are especially important to deliver quality care and to optimize interventions.

Implications for Cancer Survivors
Our study identified the most common self-reported concerns affecting BCS. In addition, our results suggest that younger patients, patients with higher stage breast cancer and survivors who had chemotherapy were more likely to have QOL issues. Despite this, our study showed, the majority of BCS reported positive outlooks and emotions.
Construction of a virtual simulation laboratory for gene detection
Authors: Yu Lin , Wang Wenjun , Liu Zhongmin , Liu Ze , Xu Yunjian , Lin Yongping 
Published: June 2023

Abstract
Objective
The current paper aims to discuss the development of a virtual simulation experiment teaching system and review its effectiveness in improving the teaching of clinical skills to college medical students.

Methods
Collaborators used 3D Studio Max, Unity 3D and Visual Studio to develop four modules: laboratory thinking training, biosafety training, gene testing and experimental assessment. Teaching was conducted and a virtual software program was used for evaluation of the students.

Results
The laboratory safety training system, virtual gene experiment system and experimental assessment system were developed. The results of the questionnaire survey show that the software provides good interactivity and guidance. The interest of medical students in study is improved and they received training in clinical experimental thinking. Student evaluation assists their scientific research practice, and can improve the awareness of biosafety.

Conclusion
The virtual simulation experiment teaching system, when applied in the teaching of undergraduate and postgraduate experiment courses, can bring about rapid improvements in the following areas: biosafety awareness, interest in learning about experiments and experimental skills, clinical experimental thinking, and comprehensive experimental ability.
Educators’ perspectives of adopting virtual patient online learning tools to teach clinical reasoning in medical schools: a qualitative study
Authors: Kassianos A.P , Plackett R , Kambouri M.A , Sheringham J 
Published: June 2023

Abstract
Background
Learning tools using virtual patients can be used to teach clinical reasoning (CR) skills and overcome limitations of using face-to-face methods. However, the adoption of new tools is often challenging. The aim of this study was to explore UK medical educators’ perspectives of what influences the adoption of virtual patient learning tools to teach CR.

Methods
A qualitative research study using semi-structured telephone interviews with medical educators in the UK with control over teaching materials of CR was conducted. The Consolidated Framework for Implementation Research (CFIR), commonly used in healthcare services implementation research was adapted to inform the analysis. Thematic analysis was used to analyse the data.

Results
Thirteen medical educators participated in the study. Three themes were identified from the data that influenced adoption: the wider context (outer setting); perceptions about the innovation; and the medical school (inner context). Participants’ recognition of situations as opportunities or barriers related to their prior experiences of implementing online learning tools. For example, participants with experience of teaching using online tools viewed limited face-to-face placements as opportunities to introduce innovations using virtual patients. Beliefs that virtual patients may not mirror real-life consultations and perceptions of a lack of evidence for them could be barriers to adoption. Adoption was also influenced by the implementation climate of the setting, including positioning of CR in curricula; relationships between faculty, particularly where faculty were dispersed.

Conclusions
By adapting an implementation framework for health services, we were able to identify features of educators, teaching processes and medical schools that may determine the adoption of teaching innovations using virtual patients. These include access to face-to-face teaching opportunities, positioning of clinical reasoning in the curriculum, relationship between educators and institutions and decision-making processes. Framing virtual patient learning tools as additional rather than as a replacement for face-to-face teaching could reduce resistance. Our adapted framework from healthcare implementation science may be useful in future studies of implementation in medical education.