bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elimination of 24-Hour Call Shifts in an Obstetrics and Gynecology Residency Training Program [ID: 1375098]
Authors: Sinow Carolyn , Bowen Andrea , Nguyen Anh , Zaid Eisha 
Published: May 2023

INTRODUCTION:
Resident duty hour restrictions have resulted in improved resident safety with mixed results on patient safety. There are limited data about 24-hour shifts in obstetrics and gynecology. This project studies resident wellness and performance after eliminating 24-hour call shifts.

METHODS:
This is a preliminary analysis of a quality improvement project. Physicians were surveyed before and after implementation of a call schedule that reduced 24-hour shifts to 14-hour shifts. Resident performance was assessed by self-reported and attending-reported ability to perform tasks.

RESULTS:
At preintervention survey, 13 out of 16 residents and 8 out of 17 attendings favored eliminating 24-hour call shifts. Attendings had more confidence in residents' performance on 24-hour shifts than residents did (P<.02) when stratified by task and residency year. At 3-month follow-up, all residents (19/19) preferred 14-hour shifts. Residents reported improvements in wellness (13/13), sleep (13/13), and burnout (10/13). Residents felt more confident in their ability to perform a vaginal delivery (11/13), cesarean birth (12/13), or communicate effectively (11/13) with 14-hour compared to 24-hour shifts. Thematic analysis showed that residents felt happier and better able to care for patients. Two residents cited improved ability to learn, while only one resident cited lost learning opportunities.

CONCLUSION:
Data suggest that obstetrics and gynecology residency programs should eliminate 24-hour shifts to improve resident wellness and performance, while decreasing burnout. Final follow-up data (to be collected March 2023) will assess whether attendings see a change in resident performance.
Efficacy of Hematoma Block After Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial
Authors: Yue Ruixian Alexander , Shah Nihar S. , Matar Robert N. , Sagi H Claude 
Published: May 2023

Objectives:
To evaluate the efficacy of an intraoperative, postfixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures.

Design:
Prospective, double-blinded, randomized controlled trial.

Setting:
Academic Level I Trauma Center.

Patients/Participants:
Eighty-two consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation.

Intervention:
Patients were randomized to receive an intraoperative, postfixation fracture hematoma injection containing 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids.

Main Outcome Measurements:
Visual analog scale (VAS) pain scores and opioid consumption.

Results:
The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs. 6.7, P = 0.004), 0–8 hours (5.4 vs. 7.0, P = 0.013), 8–16 hours (4.9 vs. 6.6, P = 0.018), and 16–24 hours (4.7 vs. 6.6, P = 0.010), postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared with the control group over the first 24-hour postoperative period (43.6 vs. 65.9, P = 0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration.

Conclusions:
Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Passfall Lara , Moattari Kevin , Krol Oscar , Kummer Nicholas A. , Tretiakov Peter , Williamson Tyler , Joujon-Roche Rachel , Imbo Bailey , Burhan Janjua Muhammad , Jankowski Pawel , Paulino Carl , Schwab Frank J. , Owusu-Sarpong Stephane , Singh Vivek , Ahmad Salman , Onafowokan Tobi , Lebovic Jordan , Tariq Muhammad , Saleh Hesham , Vira Shaleen , Smith Justin S. , Diebo Bassel , Schoenfeld Andrew J. 
Published: May 2023

Study Design.
This was a retrospective review.

Objective.
To assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery.

Summary of Background.
Factors contributing to the long-term sustainability of ASD correction are currently undefined.

Materials and Methods.
Operative ASD patients with preoperatively (baseline) and 3-year postoperatively radiographic/health-related quality of life data were included. At 1 and 3 years postoperatively, a favorable outcome was defined as meeting at least three of four criteria: (1) no proximal junctional failure or mechanical failure with reoperation, (2) best clinical outcome (BCO) for Scoliosis Research Society (SRS) (≥4.5) or Oswestry Disability Index (ODI) (<15), (3) improving in at least one SRS-Schwab modifier, and (4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1 and 3 years. Predictors of robust outcomes were identified using multivariable regression analysis with conditional inference tree for continuous variables.

Results.
We included 157 ASD patients in this analysis. At 1 year postoperatively, 62 patients (39.5%) met the BCO definition for ODI and 33 (21.0%) met the BCO for SRS. At 3 years, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. Ninety-five patients (60.5%) were identified as having a favorable outcome at 1 year postoperatively. At 3 years, 85 patients (54.1%) had a favorable outcome. Seventy-eight patients (49.7%) met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6-week pelvic incidence and lumbar lordosis difference >13.9°, and having a proportional Global Alignment and Proportion score at 6 weeks.

Conclusions.
Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.
Risk Factors for Postoperative Unfavorable Ambulatory Status After Spinal Surgery for Metastatic Spinal Tumor
Authors: Yamada Kentaro , Yoshii Toshitaka , Toba Mikayo , Kudo Atsushi , Egawa Satoru , Matsukura Yu , Hirai Takashi , Inose Hiroyuki , Fushimi Kiyohide , Okawa Atsushi 
Published: May 2023

Study Design.
A retrospective comparative study.

Objective.
This study aimed to investigate factors associated with postoperative unfavorable ambulatory status following surgery for metastatic spinal tumors using a nationwide in-hospital database.

Summary of Background Data.
Surgical treatment for metastatic spinal tumors can improve the ambulatory status and quality of life. However, some patients fail to regain the ability to walk, thereby resulting in poor quality of life. No large-scale study has previously evaluated factors associated with postoperative poor ambulatory status in this clinical context.

Materials and Methods.
The Diagnosis Procedure Combination database from 2018 to 2019 was used to extract data from patients who underwent surgical procedures for spinal metastasis. Postoperative unfavorable ambulatory status was defined as (1) nonambulatory at discharge or (2) a decreased mobility score of the Barthel Index between admission and discharge. Multivariable logistic regression was used to evaluate factors associated with postoperative unfavorable ambulatory status while adjusting for confounders.

Results.
This study analyzed 1786 eligible patients. Of whom, 1061 (59%) patients were ambulatory on admission and 1249 (70%) on discharge. Postoperative unfavorable ambulatory status was observed in 597 (33%) patients, with a significantly lower rate of discharge to home (41%/81%, P<0.001) and a longer postoperative hospital stay (46.2 days/31.4 days, P<0.001). Multivariable regression analysis revealed male sex [odds ratio (OR): 1.43, P=0.002], laminectomy without fusion (OR: 1.55, P=0.034), Charlson Comorbidity Index of ≥7 (OR: 1.37, P=0.014), and preoperative nonambulatory status (OR: 6.61, P<0.001) as factors associated with postoperative unfavorable ambulatory status.

Conclusions.
Our large-scale database analysis revealed that 33% of patients experienced unfavorable ambulatory status following spinal metastasis surgery. Laminectomy without fusion and preoperative nonambulatory status were among several factors influencing the prospect of unfavorable ambulatory status following surgery.
Impact of Frailty on the Development of Proximal Junctional Failure
Authors: Krol Oscar , McFarland Kimberly , Owusu-Sarpong Stephane , Sagoo Navraj , Williamson Tyler , Joujon-Roche Rachel , Tretiakov Peter , Imbo Bailey , Dave Pooja , Mir Jamshaid , Lebovic Jordan , Onafowokan Oluwatobi O. , Schoenfeld Andrew J. , De la Garza Ramos Rafael , Janjua Muhammad Burhan , Sciubba Daniel M. , Diebo Bassel G. , Vira Shaleen , Smith Justin S. , Lafage Virginie , Lafage Renaud , Passias Peter G. 
Published: May 2023

Background.
Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined.

Purpose.
To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty.

Study Design.
Retrospective cohort

Methods.
Operative ASD patients (scoliosis >20°, SVA>5 cm, PT>25°, or TK>60°) fused to pelvis or below with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. The Miller Frailty Index (FI) was used to stratify patients into 2 categories: Not Frail (FI <3) and Frail (>3). Proximal Junctional Failure (PJF) was defined using the Lafage criteria. “Matched” and “unmatched” refers to ideal age-adjusted alignment post-operatively. Multivariable regression determined impact of frailty on development of PJF.

Results.
284 ASD patients met inclusion criteria (62.2yrs±9.9, 81%F, BMI: 27.5 kg/m2±5.3, ASD-FI: 3.4±1.5, CCI: 1.7±1.6). 43% of patients were characterized as Not Frail (NF) and 57% were characterized as Frail (F). PJF development was lower in the NF group compared to the F group, (7% vs. 18%; P=0.002). F patients had 3.2X higher risk of PJF development compared to NF patients (OR: 3.2, 95% CI: 1.3-7.3, P=0.009). Controlling for baseline factors, F unmatched patients had a higher degree of PJF (OR: 1.4, 95% CI:1.02-1.8, P=0.03), however, with prophylaxis there was no increased risk. Adjusted analysis shows F patients when matched post-operatively in PI-LL had no significantly higher risk of PJF.

Conclusions.
An increasingly frail state is significantly associated with the development of PJF after corrective surgery for ASD. Optimal realignment may mitigate the impact of frailty on eventual PJF. Prophylaxis should be considered in frail patients who do not reach ideal alignment goals.
Perceived Advantages and Disadvantages of Online Continuing Professional Development (CPD) During COVID-19: CPD Providers' Perspectives
Authors: MacNeill Heather , Paton Morag , Schneeweiss Suzan , Wiljer David 
Published: May 2023

Abstract:
COVID-19 precipitated many CPD providers to develop new technology competencies to create effective online CPD. This study aims to improve our understanding of CPD providers' comfort level, supports, perceived advantages/disadvantages, and issues in technology-enhanced CPD delivery during COVID-19. A survey was distributed to CPD providers at the University of Toronto and members of the Society for Academic Continuing Medical Education and analyzed using descriptive statistics. Of the 111 respondents, 81% felt very to somewhat confident to provide online CPD, but less than half reported IT, financial, or faculty development supports. The top reported advantage to online CPD delivery was reaching a new demographic; top disadvantages included videoconferencing fatigue, social isolation, and competing priorities. There was interest in using less frequently used educational technology such as online collaboration tools, virtual patients, and augmented/virtual reality. COVID-19 precipitated an increased comfort level in using synchronous technologies to provide CPD, giving the CPD community an increased cultural acceptance and skill level to build on. As we move beyond the pandemic, it will be important to consider ongoing faculty development, particularly toward asynchronous and HyFlex delivery methods to continue expand CPD reach and negate negative online experiences such as videoconferencing fatigue, social isolation, and online distractions.
Variable Delta-9-Tetrahydrocannabinol Pharmacokinetics and Pharmacodynamics After Cannabis Smoking in Regular Users
Authors: Liyanage Marlon , Nikanjam Mina , Capparelli Edmund V. , Suhandynata Raymond T. , Fitzgerald Robert L. , Marcotte Thomas D. , Grant Igor , Momper Jeremiah D. 
Published: May 2023

Background:
Despite its federally restricted status, cannabis is widely used medicinally and recreationally. The pharmacokinetics (PK) and central nervous system (CNS) effects of tetrahydrocannabinol (THC), the major psychoactive cannabinoid, are not well understood. The objective of this study was to develop a population PK model of inhaled THC, including sources of variability, and to conduct an exploratory analysis of potential exposure–response relationships.

Methods:
Regular adult cannabis users smoked a single cannabis cigarette containing 5.9% THC (Chemovar A) or 13.4% THC (Chemovar B) ad libitum. THC concentrations in whole blood were measured and used to develop a population PK model to identify potential factors contributing to interindividual variability in THC PK and to describe THC disposition. Relationships between model-predicted exposure and heart rate, change in composite driving score on a driving simulator, and perceived highness were evaluated.

Results:
From the 102 participants, a total of 770 blood THC concentrations were obtained. A two-compartment structural model adequately fit the data. Chemovar and baseline THC (THCBL) were found to be significant covariates for bioavailability, with Chemovar A having better THC absorption. The model predicted that heavy users—those with the highest THCBL—would have significantly higher absorption than those with lighter previous use. There was a statistically significant relationship between exposure and heart rate, and exposure and perceived highness.

Conclusions:
THC PK is highly variable and related to baseline THC concentrations and different chemovars. The developed population PK model showed that heavier users had higher THC bioavailability. To better understand the factors affecting THC PK and dose–response relationships, future studies should incorporate a wide range of doses, multiple routes of administration, and different formulations relevant to typical community use.
Improvement in cerebral oxygen saturation with sinus conversion during off pump coronary artery bypass graft: A case report
Authors: Hwang He Won , Kim Jin Ho , Ahn So Woon 
Published: May 2023

Rationale:
Near-infrared spectroscopy (NIRS) is a noninvasive bedside tool for monitoring regional cerebral oxygen saturation (rSO2). The sinus conversion of atrial fibrillation (AF) was shown to be responsible for increasing rSO2. However, the reason for this improvement has not yet been clearly explained.

Patient concerns:
We report the case of a 73-year-old woman who underwent cardioversion during an off-pump coronary artery bypass under NIRS and live hemodynamic monitoring.

Interventions:
Unlike previous studies that failed to control and compare all conditions during procedures, this case showed real-time fluctuating hemodynamic and hematological values, such as hemoglobin (Hgb), central venous pressure (CVP), mean arterial pressure (MAP), cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), and SVO2.

Outcomes:
The rSO2 increased immediately after cardioversion and decreased during the obtuse marginal (OM) graft and after AF was obtained. However, no other hemodynamic data showed the same or opposite directional changes in the rSO2.

Lessons:
Significant instantaneous changes were observed in rSO2 using NIRS after sinus conversion, without obvious hemodynamic alterations in the systemic circulation or other monitoring values.
Hypertrophic cardiomyopathy caused by a heterozygous variant in TTR gene: A case report
Authors: Yuan Huayuan , Lin Ya , Wang Jiao , Li Jialian , Chen Xuefeng , Guo Yulong , Tang Jiong 
Published: May 2023

Rationale:
We report a rare case of hypertrophic cardiomyopathy (HCM) caused by a heterozygous variant in TTR gene.

Patient concerns:
The proband had been vomiting without obvious inducement since the age of 27, accompanied by the expulsion of stomach contents. At the age of 28, she began to suddenly syncope.

Diagnosis:
Cardiac magnetic resonance showed thickening of the right ventricular lateral wall and ventricular septum. The left ventricular diastolic function was limited. Targeted Sanger sequencing validates the presence of mutation p.Leu75Pro in TTR gene.

Interventions and outcomes:
After admission to hospital for syncope, she was given metoprolol tablets 25 mg bid, spironolactone tablets 20 mg qd, and trimetazidine 20 mg tid. Her symptoms improved after taking the medicine.

Lessons:
The results of this case show that HCM caused by TTR mutation is not easy to be identified and treatment is easy to be delayed. Therefore, high-risk patients with amyloidosis should be evaluated as soon as possible. Timely diagnosis of HCM caused by TTR mutation before irreversible organ damage is essential for proper treatment and better outcomes.
Ulcerative colitis and thrombocytosis: Case report and literature review
Authors: Zhou Yaqi , Zhu Fengqin , Jing Dehuai , Wang Quanyi , Zhou Guangxi 
Published: May 2023

Rationale:
Ulcerative colitis (UC) is an autoimmune disease of unknown etiology, sometimes associated with anemia and thrombocytosis. Platelets (PLTs) play a role in amplifying inflammatory and immune responses in chronic inflammation. This study discusses the diagnosis and treatment of a case of UC combined with secondary thrombocytosis and reviews the relevant literature. We report an interaction between thrombocytosis and UC to raise clinicians’ awareness of this condition.

Patient concerns:
In the current report, we discuss the case of a 30-year-old female patient who presented with frequent diarrhea and thrombocytosis.

Diagnosis:
Severe UC combined with intestinal infection was diagnosed based on colonoscopy and intestinal biopsy. The patient had a PLT count >450 × 109/L and was diagnosed with reactive thrombocytosis.

Interventions and outcomes:
The patient was discharged from the hospital in remission after receiving vedolizumab and anticoagulant treatment.

Lessons:
In patients with severe UC with thrombocytosis, clinicians should pay attention to PLTs promoting inflammatory progression, as well as screening for venous thromboembolism risk and prophylactic anti-venous thromboembolism therapy at the time of dosing to avoid adverse effects.
Network analysis to explore the pharmacological mechanism of Shenmai injection in treating granulocytopenia and evidence-based medicine approach validation
Authors: Hou Xianbing , Chen Dandan , Wang Yao , Cui Bixian , Xu Hui , Wang Yuanyuan , Chen Hongzhou , Wang Dan , Chen Ying , Cheng Tongfei , Dai Xiaojun 
Published: May 2023

Background:
Shenmai injection is frequently utilized in China to clinically treat granulocytopenia in oncology patients following chemotherapy. Despite this, the drug’s therapeutic benefits remain a topic of contention, and its active components and potential treatment targets have yet to be established. The present study utilizes a network pharmacology approach to investigate the drug’s active ingredients and possible therapeutic targets, and to evaluate the effectiveness of Shenmai injection in treating granulocytopenia through meta-analysis.

Methods:
In our subject paper, we utilized the TCMID database to investigate the active ingredients present in red ginseng and ophiopogon japonicus. To further identify molecular targets, we employed SuperPred, as well as OMIM, Genecards, and DisGeNET databases. Our focus was on targets associated with granulocytopenia. The DAVID 6.8 database was utilized to perform gene ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis. Additionally, a protein-protein interaction network was established. The resulting “drug-key component-potential target-core pathway” network was used to predict the mechanism of action of Shenmai injection in the treatment of granulocytopenia. In order to evaluate the quality of the studies included in our analysis, we utilized the Cochrane Reviewers’ Handbook. We then conducted a meta-analysis of the clinical curative effect of Shenmai injection for granulocytopenia, utilizing the Cochrane Collaboration’s RevMan 5.3 software.

Results:
After conducting a thorough screening, the study identified 5 primary ingredients of Shenmai injection – ophiopogonoside a, β-patchoulene, ginsenoside rf, ginsenoside re, and ginsenoside rg1–that can potentially target 5 essential proteins: STAT3, TLR4, PIK3CA, PIK3R1, and GRB2. Additionally, Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that Shenmai injection can be beneficial in treating granulocytopenia by interacting with pathways such as HIF-1 signaling, T-cell receptor signaling, PI3K-Akt signaling, chemokine signaling, and FoxO signaling. The results of meta-analysis indicate that the treatment group exhibited superior performance in terms of both efficiency and post-treatment leukocyte count when compared to the control group.

Conclusion:
In summary, studies in network pharmacology demonstrate that Shenmai injection exerts an impact on granulocytopenia via various components, targets, and mechanisms. Additionally, evidence-based studies provide strong support for the effectiveness of Shenmai injection in preventing and treating granulocytopenia.