bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission
Authors: Weddell Joseph , Naismith Sharon L. , Bauman Adrian , Tofler Geoffrey , Zhao Emma , Redfern Julie , Buckley Tom , Gallagher Robyn 
Published: February 2023

Background
Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission.

Objective
In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI.

Methods
Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screened with the Montreal Cognitive Assessment and the Hopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression.

Results
Participants (n = 81) had a mean (SD) age of 63.5 (10.9) years, and 82.7% were male. In total, MCI was identified in 52.5%, 42.5% with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81.5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of an MCI positive screen increased by 11% per year of age (odds ratio, 1.11; 95% confidence interval, 1.04–1.18) and by 3.6 times for those who are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09–11.89).

Conclusion
An estimated half of patients with ACS screen positive for MCI during admission, with single and older patients most at risk. Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management.
Analysis of clinical features of patients with psoriasis and metabolic syndrome in Xinjiang
Authors: Duan Man-Man , Ma Yun-Xia , Zhang Jing-Zhan , Luo Dong , Yu Shi-Rong , Kang Xiao-Jing , Ding Yuan 
Published: February 2023

Objective:
The clinical characteristics of a large sample of patients with psoriasis and metabolic syndrome (MS) in Xinjiang were retrospectively analyzed.

Methods:
The prevalence of MS, age, height, weight, body mass index (BMI), red blood cell count (RBC), white blood cell count (WBC), platelet count, aspartate aminotransferase level, alanine aminotransferase (ALT) level, and other clinical data were analyzed in 2,492 inpatients with psoriasis in our hospital. The patients were divided into two groups based on the presence of MS.

Results:
Among the 2,492 patients, 349 had MS and 1,269 were considered overweight/obese. There were significant differences in sex, age, disease course, age at onset, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) between the two groups (P < 0.05). The RBC, WBC, erythrocyte sedimentation rate, blood urea nitrogen level, creatinine level, triglyceride level, total cholesterol level, and low-density lipoprotein cholesterol level were significantly higher in the MS group than in the psoriasis-only (PO) group (P < 0.05). The high-density lipoprotein cholesterol (HDL-C) level was significantly lower in the MS group than in the PO group (P < 0.05). The ALT and albumin levels were not significantly different between the two groups (P > 0.05). Binary logistic regression analysis showed that sex, age, BMI, SBP, DBP, and fasting plasma glucose (FPG) were independent risk factors for MS in patients with psoriasis, and HDL-C was considered a protective factor for these patients.

Conclusion:
The prevalence of MS in patients with psoriasis is high. Female sex, age, BMI, SBP, DBP, and FPG may be risk factors for psoriasis complicated by MS.
An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery
Authors: Prather Jenifer G. , Stanfill Ansley Grimes 
Published: February 2023

ABSTRACT

BACKGROUND: Stroke survivors (SS) may experience alterations in physical and cognitive processes that increase stress and reduce well-being. Timely and accurate measurement of stress throughout the continuum of recovery is necessary to inform targeted interventions that will improve quality of life for this group. OBJECTIVE: The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. METHODS: A comprehensive literature search was conducted using CINAHL, PsycINFO, PubMed, and Scopus databases. Studies were included if they captured primary data collection using any version of the PSS at any time point in the poststroke recovery period and were published in English between 2011 and 2022. Systematic reviews and meta-analyses were excluded. Evidence was synthesized, and themes were discussed. RESULTS: Among 397 studies, a total of 13 met inclusion criteria. Of these, 8 were cross-sectional studies, 3 were longitudinal studies, 1 was a randomized controlled trial, and the remaining study was a prospective nonrandomized trial. The PSS-10 (n = 7, 54%) was the most used version of the instrument, followed by the PSS-14 (n = 3, 23%) and PSS-4 (n = 2, 15.4%), with the modified PSS-10 being used in only 1 (7.6%) study. The PSS surveys were administered at various time points, ranging from the first day of admission to 3, 6, 9, or 12 months after discharge. Perceived stress may continue to negatively influence SS's psychological and physical well-being throughout the chronic phase of recovery. CONCLUSIONS: Stress is a unique and individualized experience that influences recovery trajectories in SS, an experience often overlooked or marginalized by clinicians and healthcare providers. To help mobilize strategies to achieve long-term health and wellness goals, future studies should explore and tailor interventions to minimize the influence of stress, as identified by the PSS, on well-being and quality of life during poststroke recovery.
Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes
Authors: Ponder Warren N. , Carbajal Jose , Whitworth James , Schuman Donna L. , Galusha Jeanine M. , Yockey R. Andrew 
Published: February 2023

Objective
To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs).

Methods
We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide.

Results
Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs.

Limitations
These data are cross-sectional and should be modeled longitudinally over the course of treatment.

Conclusion
Separate constructs influence suicide for LEOs and FFs/EMTs.
Digital Stress. Effects of Different Intensities of Working From Home on Workers' Health
Authors: Rodríguez-Modroño Paula 
Published: February 2023

Objective
Because hybrid and remote work models have exponentially expanded with digitalization and the COVID-19 pandemic, this study examines how different intensities of WFH impact workers' health.

Methods
Drawing on the job demands–resources model, we applied two-way analysis of variance and regression models to the sixth European Working Conditions Survey to examine how the type and magnitude of WFH effects on health depend on its intensity.

Results
A key aspect in relation to remote work is the frequency with which the worker carries out this type of work, with best results among those WFH only several times a month, for women, and several times a week, for men.

Conclusions
Reasonable intensity of WFH may have beneficial effects on health, but these positive effects are reduced when working fully home-based.
Using Kern’s Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants
Authors: Chalupa Robyn L. , Kocher Benjamin K. , Douglas Matthew S. 
Published: February 2023

Abstract
Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army – Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum. This article describes the use of Kern’s 6-Step Approach for Curriculum Development for Medical Education to redesign a curriculum for an 18-month postgraduate doctoral program for military orthopaedic PAs. The resulting formal curriculum enables 4 geographically separated sites to execute an orthopaedic PA degree program that addresses a critical specialty care access challenge for the military. Kern’s 6-Step approach could be used to design or redesign any PA educational content, from a single course to an entire degree program.
Meeting the Accreditation Standard for Diversity
Authors: Snyder Jennifer , Hills Karen , Alexander Lisa , Statler Michel , Straker Howard , Bowser Jonathan , Alesbury Elizabeth 
Published: February 2023

Abstract
While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.
Quality of Life and Well-being in Patients with Lower-limb Amputation Using a Prosthetic Limb: A Cross-sectional Study in a Major Center in Riyadh, Saudi Arabia
Authors: Alqusaiyer Faisal , Alsergani Abdullah , Aldarsouni Fayez , Aldawood Abdulrahman , Alkhayyal Yazeed , Alzaid Homoud , Al-hazmi Ali 
Published: February 2023

ABSTRACT

Introduction
Quality of life (QoL) has been advocated for as an outcome measure for assessing the effect of treatment and quality of care given to prosthetic users. As such, it is necessary to assess the factors that play a role in influencing QoL to achieve better outcomes. Unfortunately, QoL has not been adequately studied in Saudi Arabia, which warranted further research. The objectives of this study were to estimate the QoL of prosthetic users in Riyadh and determine its association with Ambulation (AM), Social Burden (SB), and Appearance (AP).

Methods
A cross-sectional study design was used to achieve our objectives. Our participants were asked to fill out our self-administered questionnaire, which was composed of the Arabic versions of the Well-being (WB), AP, AM, and SB scales of the Prosthesis Evaluation Questionnaire (PEQ).

Results
A sample of 62 prosthetic users due to unilateral amputations were randomly selected from our sampling frame, 10 of which acted as outliers from the 95% confidence interval of QoL (CI) (56.13–67.94) and were omitted. The WB scale was shown to have a median of 57.5, whereas QoL had a mean of 62.58. In addition, a positive relationship was found between QoL and SB (P < 0.001; R
s = 0.657), AP (P < 0.001; R = 0.547), and AM (P < 0.001; R = 0.634).

Conclusion
Prosthetic users in Riyadh suffer from low QoL and satisfaction. Moreover, QoL was shown to be a multifactorial concept with many different elements and constituents. This suggests that a more comprehensive and inclusive method of prosthetic rehabilitation is required.

Clinical Relevance
There is a scarcity of QoL and well-being studies in Saudi Arabia regarding individuals with amputation and prosthetic users, given the number of prosthetic users, estimated to be around 2092 individuals. By estimating their QoL, we could identify what improvements are to be made to improve their lives.
Provider- and Facility-Level Variation in Pre-Cancerous Cervical Biopsy Diagnoses
Authors: Del Vecchio Natalie J. , Beaber Elisabeth F. , Garcia Michael P. , Wheeler Cosette M. , Kamineni Aruna , Chao Chun , Chubak Jessica , Corley Douglas A. , Owens Christopher L. , Winer Rachel L. , Pruitt Sandi L. , Raine-Bennett Tina , Feldman Sarah , Silverberg Michael 
Published: February 2023

Objectives
Reproducibility of cervical biopsy diagnoses is low and may vary based on where the diagnostic test is performed and by whom. Our objective was to measure multilevel variation in diagnoses across colposcopists, pathologists, and laboratory facilities.

Methods
We cross-sectionally examined variation in cervical biopsy diagnoses within the 5 sites of the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium within levels defined by colposcopists, pathologists, and laboratory facilities. Patients aged 18 to 65 years with a colposcopy with biopsy performed were included, with diagnoses categorized as normal, cervical intraepithelial neoplasia grade 1 (CIN1), grade 2 (CIN2), and grade 3 (CIN3). Using Markov Chain Monte-Carlo methods, we fit mixed-effects logistic regression models for biopsy diagnoses and presented median odds ratios (MORs), which reflect the variability within each level. Median odds ratios can be interpreted as the average increased odds a patient would have for a given outcome (e.g., CIN2 or CIN3 vs normal or CIN1) when switching to a provider with higher odds of diagnosing that outcome. The MOR is always 1 or greater, and a value of 1 indicates no variation in outcome for that level, with higher values indicating greater variation.

Results
A total of 130,110 patients were included who received care across 82 laboratory facilities, 2,620 colposcopists, and 489 pathologists. Substantial variation in biopsy diagnoses was found at each level, with the most occurring between laboratory facilities, followed by pathologists and colposcopists. Substantial variation in biopsy diagnoses of CIN2 or CIN3 (vs normal or CIN1) was present between laboratory facilities (MOR: 1.26; 95% credible interval = 1.19–1.36).

Conclusions
Improving consistency in cervical biopsy diagnoses is needed to reduce underdiagnosis, overdiagnosis, and unnecessary treatment resulting from variation in cervical biopsy diagnoses.
Defecation Symptoms in Relation to Stool Consistency Significantly Reflect the Dyssynergic Pattern in High-resolution Anorectal Manometry in Constipated Patients
Authors: Ingemansson Anna , Walter Susanna A. , Jones Michael P. , Sjödahl Jenny 
Published: February 2023

Goals:
To evaluate the usefulness of a 2-week patient-completed bowel habit and symptom diary as a screening tool for disordered rectoanal coordination (DRC).

Background:
DRC is an important subgroup of chronic constipation that benefits from biofeedback treatment. Diagnosis of DRC requires a dyssynergic pattern (DP) of attempted defecation in high-resolution anorectal manometry (HRAM) and at least 1 other positive standardized examination, such as the balloon expulsion test or defecography. However, HRAM is generally limited to tertiary gastroenterology centres and finding tools for selecting patients for referral for further investigations would be of clinical value.

Study:
Retrospective data from HRAM and a 2-week patient-completed bowel habit and symptom diary from 99 chronically constipated patients were analyzed.

Results:
Fifty-seven percent of the patients had a DP pattern during HRAM. In the DP group, 76% of bowel movements with loose or normal stool resulted in a sense of incomplete evacuation compared with 55% of the non-DP group (P=0.004). Straining and sensation of incomplete evacuation with the loose stool were significantly more common in the DP group (P=0.032). Hard stool was a discriminator for non-DP (P=0.044). Multiple logistic regression including incomplete evacuation and normal stool predicted DP with a sensitivity of 82% and a specificity of 50%.

Conclusions:
The sensation of incomplete evacuation with loose or normal stool could be a potential discriminator in favor of DP in chronically constipated patients. The bowel habit and symptom diary may be a useful tool for stratifying constipated patients for further investigation of suspected DRC.
Reflux Symptoms Increase Following Sleeve Gastrectomy Despite Triage of Symptomatic Patients to Roux-en-Y Gastric Bypass
Authors: Patel Parth , Hobbs Paul , Rogers Benjamin D. , Bennett Michael , Eckhouse Shaina R. , Eagon J. Chris , Gyawali C. Prakash 
Published: February 2023

Background and Aims:
Bariatric surgical options in obese patients include sleeve gastrectomy (SG) and roux-en-Y gastric bypass (RYGB), which may not be equivalent in risk of postoperative reflux symptoms. We evaluated risk and predictive factors for postbariatric surgery reflux symptoms.

Methods:
Patients with obesity evaluated for bariatric surgery over a 15-month period were prospectively followed with validated symptom questionnaires (GERDQ, dominant symptom index: product of symptom frequency and intensity from 5-point Likert scores) administered before and after SG and RYGB. Esophageal testing included high-resolution manometry in all patients, and ambulatory reflux monitoring off therapy in those with abnormal GERDQ or prior reflux history. Univariate comparisons and multivariable analysis were performed to determine if preoperative factors predicted postoperative reflux symptoms.

Results:
Sixty-four patients (median age 49.0 years, 84% female, median BMI 46.5 kg/m2) fulfilled inclusion criteria and underwent follow-up assessment 4.4 years after bariatric surgery. Baseline GERDQ and dominant symptom index for heartburn were significantly higher in RYGB patients (P≤0.04). Despite this, median GERDQ increased by 2 (0.0 to 4.8) following SG and decreased by 0.5 (−1.0 to 5.0) following RYGB (P=0.02). GERDQ became abnormal in 43.8% after SG and 18.8% after RYGB (P=0.058); abnormal GERDQ improved in 12.5% and 37.5%, respectively (P=0.041). In a model that included age, gender, BMI, acid exposure time, and type of surgery, multivariable analysis identified SG as an independent predictor of postoperative heartburn (odds ratio 16.61, P=0.024).

Conclusions:
Despite preferential RYGB when preoperative GERD was identified, SG independently predicted worsening heartburn symptoms after bariatric surgery.
Patients With Autoimmune Hepatitis and Nonalcoholic Fatty Liver Disease
Authors: Strzepka Jessica , Schwartz Benjamin A. , Ritz Ethan M. , Aloman Costica , Reau Nancy 
Published: February 2023

Goal:
The objective of this study was to characterize an autoimmune hepatitis (AIH)/nonalcoholic fatty liver disease (NAFLD) overlap cohort, determine if they received standard of care treatment, and delineate their outcomes in comparison with patients with AIH or NAFLD alone.

Background:
AIH is a relatively rare and heterogeneously presenting liver disease of unknown etiology. NAFLD is a leading cause of liver disease worldwide. AIH treatment includes steroids, which have adverse metabolic effects that can worsen NAFLD. No treatment guidelines are available to mitigate this side on AIH/NAFLD overlap patients. Few studies to date have examined these patients’ characteristics, management practices, and outcomes.

Materials and Methods:
A single-center, retrospective chart review study examining biopsy-proven AIH/NAFLD, AIH, and NAFLD patients. Characteristics, treatment, and 1- and 3-year outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) were evaluated.

Results:
A total of 72 patients (36.1% AIH/NAFLD, 34.7% AIH, and 29.2% NAFLD) were included. AIH/NAFLD patients were found to be more often Hispanic/Latino, female, and with lower liver aminotransaminases, immunoglobulin G, and anti–smooth muscle antibody positivity. AIH/NAFLD patients were less likely to receive standard of care treatment. No significant differences in outcomes were seen between AIH/NAFLD and either AIH or NAFLD.

Conclusions:
Our study demonstrated that AIH/NAFLD patients have unique characteristics and are less likely to receive standard of care treatment compared with patients with AIH alone. Despite this, no difference in outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) was seen. Given NAFLD’s rising prevalence, AIH/NAFLD cases will likely increase, and may benefit from alternative treatment guidelines to prevent worsening of NAFLD.
Trends of Hepatocellular Carcinoma (HCC) Inpatients Mortality and Financial Burden From 2011 to 2017
Authors: Wakil Ali , Wu Yi-Chia , Mazzaferro Natale , Greenberg Patricia , Pyrsopoulos Nikolaos T. 
Published: February 2023

Introduction:
Liver cancer, including Hepatocellular carcinoma (HCC) is the seventh most common tumor worldwide. Previously, the financial burden of HCC in the United States between 2002 and 2011 was noted to be continuously increasing. This study aims to evaluate temporal trends of hospitalizations due to HCC.

Method:
This is a retrospective analysis utilizing the National Inpatient Sample (NIS) database. All subjects admitted between 2011 and 2017 with a diagnosis of HCC were identified. The primary trend characteristics were in-hospital mortality, hospital charges, and length of stay.

Results:
An increase in hospitalization from 67,779 (0.18%) admissions in 2011 to 84,580 (0.23%) admissions in 2017(P<0.05) was noted. Most patients were 45 to 64 years old (median 50%), predominantly men (median 68%) (P<0.05). The primary health care payer was Medicare (Median 49%) and Medicaid (Median 18%) (P<0.05). The most common geographical location was the south (Median 36%) (P<0.05). Most patients were admitted to large hospitals (Median 62%) in urban areas (P<0.05). The median inpatient mortality was estimated to be 9% in 2017 (P<0.05), which has decreased from 10%(P<0.05) in 2011. The total charges per admission have increased steadily from $58,406 in 2011 to $78,791 in 2017 (P<0.05). The median length of stay has increased from 5.79 (SD 6.93) in 2011 to 6.07 (SD 8.3) in 2017(P<0.05). The most common mortality risk factor was sepsis, Acute renal failure, and GI hemorrhage.

Conclusion:
HCC-related admissions continue to be on the rise. HCC mortality has decreased across the years with earlier diagnoses and advances in therapy. However, we observed a significant increase in financial burden on health care with increasing in-hospital costs, a finding that needs to be verified in prospective trials.