bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recent advances in cell-based regenerative therapies for corneal disease
Authors: Kaufman Ron , Jun Albert S. 
Published: May 2023

Purpose of review
With limited access of more than half the world's population to corneal transplantation, regenerative medicine may represent a promising alternative. This review explores the main advancements achieved in cell-based therapies for corneal epithelium, stroma, and endothelium during 2021–2022.

Recent findings
Multiple surgical techniques have been developed for epithelial limbal stem cell replacement. Recent studies aimed to gain greater understanding and characterization of these techniques. Though no clear superiority could be demonstrated, simple limbal epithelial transplantation seems to have the most clinical and cost effectiveness. For stromal disease, autologous adipose-derived stem cells have shown favorable results. For endothelial dysfunction, the validity of intracameral cultivated allogeneic endothelial cell injection and Descemetorrhexis without endothelial keratoplasty, as well as the benefits of adjunctive rho-associated kinase inhibitors, were emphasized.

Summary
A plethora of innovative cell-based regenerative therapies for corneal diseases have been developed in past years. While recent literature solidifies our knowledge, most studies are still in preliminary or preclinical stages. Though showing great promise, these approaches will require larger studies with better-defined endpoints to establish their benefits over currently available treatments.
Opportunities to improve high-risk behavior screenings during well-child examinations
Authors: Ederle Hannah M. , Finley Kallie M. , Reisinger Michele E. , Hartman Amanda L. 
Published: May 2023

ABSTRACT

Background:
Nurse practitioners serve an essential role in the completion of age-appropriate adolescent high-risk behavior screenings including tobacco/nicotine, alcohol, illicit drug use, and sexual activity during well-child examinations (WCEs).

Local problem:
Midwestern adolescents demonstrate a suboptimal rate of engaging in annual preventative medical visits in comparison to national data.

Methods:
This mixed-methods quality improvement pilot sought to evaluate health care providers' beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11–17 years in two midwestern primary care clinics. Quantitative data were obtained through queried reports and manual electronic health record chart audits. Qualitative data were obtained through focus group interviews.

Interventions:
Interventional strategies included providing education to key stakeholders regarding data analysis findings indicating process deficiencies regarding adolescent WCEs. Project members championed integration of advanced practice nurses as leaders of change within urban, multisite tertiary health care systems.

Results:
Results demonstrate that the lack of standardized assessment during an adolescent WCE can lead to fragmentation of high-risk behavior screenings.

Conclusions:
This quality improvement pilot demonstrates the need for nurse practitioners to be at the forefront of interprofessional committees advancing the implementation of evidence-based guidelines and practice improvement initiatives. Standardization of high-risk behavior screening as part of the WCE in adolescence provides the foundation for health promotion and chronic disease prevention spanning into adulthood.
Nurse practitioner educational preparation and confidence related to managing antipsychotic medications and associated drug-induced movement disorders
Authors: Gallagher Shawn , Bouchard Lindsay 
Published: May 2023

ABSTRACT

Background:
Antipsychotic medications (APMs) have been used to treat multiple psychiatric disorders for decades. The conditions to use these medications have expanded from primarily psychotic disorders to Food and Drug Administration–approved uses as first-line mood stabilizers in bipolar disorder and adjunctive pharmacotherapy in unipolar depression. Antipsychotic medications can have serious side effects, including drug-induced movement disorders (DIMDs). Nurse practitioners (NPs) in non–psychiatric-mental health specialties are increasingly managing psychotropic medication regimes. There is a void in peer-reviewed literature capturing the scope of NPs managing APMs, such as whether they received training to prescribe and manage risks of APM, and if so, what type (e.g., continuing education, attending conferences, consulting), and their confidence assessing and managing DIMDs.

Purpose:
To describe the scope of NP management, knowledge, and confidence related to APMs and associated risks of DIMDs.

Methodology:
Nonexperimental, descriptive, cross-sectional survey. Participants (n = 400) recruited through a professional association membership portal.

Results:
Nearly two-thirds of participants reported managing APMs (64%) and receiving training to prescribe and manage risks of APMs (63%). More than half (54%) reported they received training to do so in their NP education program. Thirty-five percent of participants indicated they were either completely (6%) or fairly (29%) confident, whereas most (65%) endorsed being somewhat (26%), slightly (20%), or not (19%) confident in assessing and managing DIMDs.

Conclusions/Implications:
Opportunities exist to broaden NP education in managing APMs and associated risks of DIMDs.
Betahistine Prescribing Practices in England: An Analysis of Prescribing and National Spending Pre- and Post-BEMED Trial
Authors: Sutton Liam , Ghedia Reshma , Harcourt Jonny 
Published: May 2023

Objective
Betahistine has not been proven to be superior to placebo in the BEMED study, a multicenter, double-blind, randomized, placebo controlled trial. Our study aimed to establish the prescribing practices of clinicians in England in relation to betahistine and to assess if there has been any change in prescribing practices since the publication of the BEMED trial.

Study Design
Retrospective study and clinician survey.

Patients
All patients who were prescribed betahistine from primary care.

Main Outcome Measure
Total quantity of betahistine prescribed and total actual cost.

Results
The average total monthly quantity prescribed was 11,143,253 tablets (range, 10,056,516–12,276,423). Prescribing did not decrease from the period before (January 2014–February 2016) to after (February 2016–February 2021) the publication of the BEMED trial, with the average monthly prescribing before publication being 11,294,848 tablets (range, 10,280,942– 12,276,423) and the average monthly prescribing after publication being 11,081,123 tablets (range, 10,056,516–11,915,707). The average actual monthly cost increased from the period before publication to after publication from a sum of £279,264.82 to a sum of £428,846.22. Most (90.5%) of the survey respondents prescribed betahistine for Menière’s disease. Less than half (38.09%) prescribed betahistine for indications other than Menière’s disease. Only 45.24% of the clinicians were aware of the results of the BEMED trial.

Conclusions
Knowledge of the BEMED trial among otology and neurotology subspecialists is lacking. The results of the BEMED have made no difference to prescribing practice, and in fact, the cost of the medication to the health bill has increased.
Cochlear Implant Revisions Over Three Decades of Experience
Authors: Andresen Nicholas S. , Shneyderman Matthew , Bowditch Stephen P. , Wang Nae-Yuh , Della Santina Charles C. , Sun Daniel Q. , Creighton Francis X. 
Published: May 2023

Abstract

Importance
The indications, technology, and surgical technique for cochlear implantation have evolved over the last three decades. Understanding the risk of cochlear implant revision (CIR) is important for patient counseling.

Objective
The objective of this study was to analyze the rates, indications, and audiologic outcomes for CIR over three decades of experience at a single academic medical center.

Design
A retrospective chart review was performed at a single academic medical center for individuals who underwent cochlear implantation between 1985 and 2022.

Setting
Single academic medical center.

Participants
Three thousand twenty-five individuals who underwent 3,934 cochlear implant operations from 1985 to 2022.

Exposure
Cochlear implantation.

Main Outcomes and Measures
Rates, indications, risk factors, and audiologic outcomes for CIR.

Results
There were 276 cases of CIR after primary implantation and an overall revision rate of 7.6% (95% confidence interval, 6.8–8.5%) over 37 years of follow-up with many cases of CIR secondary to Advanced Bionics vendor B and field action failure groups. CIR rates increased sharply through the early and mid-2000s and have since remained stable. Hard or soft device failure was the most common indication for CIR, accounting for 73% of cases. Pediatric patient status and previous CIR were associated with an increased risk of CIR. Audiologic outcomes after CIR were similar to those before device failure.

Conclusions and Relevance
CIR remains a common procedure most often performed for device failure. Pediatric patients and those who have undergone previous CIR are at the highest risk for future CIR. Audiologic outcomes remain stable after CIR, and these data will help providers counsel patients at the risk of future CIR and understand the risk factors associated with CIR.
Obesity and physical exercise in hemophilia
Authors: Nieva Natalia Rodríguez 
Published: May 2023

The new coagulation factors have made possible to increase the life expectancy of patients with hemophilia to around 70 years of age.
However, there are some comorbidities to take into account such as obesity, hypertension, cardiovascular or metabolic diseases.
Improving dietary habits and promoting physical exercise are the two ways of preventing this. But, less than 50% of people with haemophilia actually do something in this sense, even though to practice physical activity or sport is save if you under treatment.
Follow-up of Military Blood Donors Who Test Positive for Syphilis
Authors: Hojnoski Cara E. , Kieffer John W. , Casey Theresa M. , Osuna Angela B. , Casleton Brian G. , Okulicz Jason F. , Marcus Joseph E. 
Published: May 2023

Abstract

Background
Several large studies have demonstrated that syphilis, carries a risk of future sexually transmitted infections (STI), such as human immunodeficiency virus. There is limited data on outcomes of syphilis infections that occur in populations that undergo universal syphilis screening, such as blood donors. Military trainees who donate blood can be followed through their military career to determine future risk of STIs.

Methods
Blood donor data was gathered from the Armed Services Blood Bank Center-San Antonio for those with positive Treponema pallidum antibodies between 2014-2021. The medical chart of each case was compared to 6 sex- and military accession date-matched controls with negative T. pallidum antibodies to determine risk of STI in the three years following donation.

Results
63,375 individuals donated blood during the study period. A total of 23 military trainees (0.36 per 1,000 donors) had positive T. pallidum antibodies. A minority (n = 7, 30%) of cases were treated for early syphilis. Only 6 (26%) cases received a follow-up nontreponemal test within one year. Donors who tested positive had a significantly higher risk of developing an STI within three years after blood donation compared to blood donors who tested negative (RR 3.8, 95% CI 1.3-10.5; p = 0.01) including gonorrhea (9% vs. 0%, p = 0.02) and syphilis (9% vs. 0%, p = 0.02).

Conclusion
This study shows the presence of T. pallidum antibodies in blood donors was associated with increased risk of future STIs. These cases support the need for close follow-up and broad STI testing in blood donors with positive T. pallidum antibodies.
Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*
Authors: Emeriaud Guillaume , Pons-Òdena Marti , Bhalla Anoopindar K. , Shein Steven L. , Killien Elizabeth Y. , Modesto i Alapont Vicent , Rowan Courtney , Baudin Florent , Lin John C. , Grégoire Gabrielle , Napolitano Natalie , Mayordomo-Colunga Juan , Diaz Franco , Cruces Pablo , Medina Alberto , Smith Lincoln , Khemani Robinder G. ,   Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: May 2023

OBJECTIVES:The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.DESIGN:Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.SETTING:One hundred five international PICUs.PATIENTS:Patients with newly diagnosed PARDS admitted during 10 study weeks.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pao2/Fio2was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pao2/Fio2less than 100, and immunosuppression all present. Among patients with Pao2/Fio2greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61–1.80]) or mortality in a propensity score matched analysis (p= 0.369).CONCLUSIONS:Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.
Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity
Authors: Vernick Robert C , Beckwitt Colin H , Fowler John R 
Published: May 2023

Background:
It remains unclear if physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index (BMI) on CTS severity is not well characterized.

Methods:
Unilateral and bilateral CTS patients were seen from October 2014-February 2021. Obese and non-obese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6 measures were obtained. NCS recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used the Wilcoxon signed-rank testing for paired continuous variables, Mann-Whitney U testing for non-paired continuous variables, and chi-squared for continuous variables with a significance level of p < 0.05.

Results:
109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score (p < 0.0001), CTS-6 score (p < 0.0001), DML (p < 0.0001), and DSL (p < 0.01). Bilateral patients also had higher symptom severity scale (p < 0.01) and DSL (p < 0.001) outcomes compared to unilateral. Obese patients had higher median nerve CSA (p < 0.01), prolonged DML, and DSL (p < 0.0001) values despite similar CTS severity (BCTSQ, CTS-6).

Conclusions:
Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS, BCTSQ). Obesity increases median nerve CSA and prolongs NCS without influencing CTS severity. This information can be utilized when considering which diagnostic testing to order for CTS.

Level of Evidence:
Level 3 Diagnostic
A Logistic Regression Analysis of Factors Associated with Guarded Outcome After Carpal Tunnel Release in Symptomatic Carpal Tunnel Syndrome
Authors: Chow Ian , Kaufmann Robert A. , Goitz Robert J. , Fowler John R. 
Published: May 2023

Background:
The Boston Carpal Tunnel Questionnaire (BCTQ) is a validated measurement tool for the severity of carpal tunnel syndrome (CTS) and improvements in the BCTQ following carpal tunnel release (CTR) have been demonstrated to influence patient satisfaction. We hypothesized that patient-related factors influence response in BCTQ subscales including the symptom severity scale (SSS) and the functional status scale (FSS) following CTR.

Methods:
Patients who underwent surgery with follow-up BCTQ were identified from a prospectively maintained database. Paired t-tests were used to compare BCTQ sub-scales at each follow-up time point. Minimal clinically important differences (MCID) were set. Patients below these thresholds were deemed as failures to improve following CTR. Univariate analysis was used to identify risk factors for failure to improve following CTR. Multi-variate logistic regression was used to identify independent predictors for failure to improve following CTR.

Results:
106 patients met inclusion criteria. Patients demonstrated significant improvements at all follow-up time points. The factor most associated with improvement beyond the MCID was a more severe score in the respective domain assessed. Other independent factors that influenced outcome following CTR included ethnicity, concomitant cubital tunnel release, gender, and age.

Conclusions:
CTR results in significant improvements in BCTQ and its subscales with improvements stabilizing after six weeks. A select cohort of patients fails to improve following CTR with factors independently associated with a lower degree of improvement. Identification of patients with these risk factors will provide a basis for counseling and increased monitoring of patients at risk for a guarded prognosis.
Localization of Brown Tumors With 18F-Fluorocholine PET/CT Imaging in Severe Primary Hyperparathyroidism
Authors: Werner Jonas , Grünig Hannes , Loher Hannah , Fischli Stefan , Strobel Klaus , Wicke Corinna 
Published: May 2023

Abstract
We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. 18F-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. 18F-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.
Reconstruction of Hemifacial Congenital Giant Nevus with Pre-expanded Scalp Flaps and Deltopectoral Skin Flaps
Authors: Ding Jianke , Chu Feifei , Dong Liwei , Zhang Yu , Liu Wei , Yu Zhou , Tang Yinke , Ma Xianjie 
Published: May 2023

Background:
The hemifacial congenital giant nevus impacts both physical and mental health of the patients. Excision is typically the most suitable option in these situations, but reconstructing the subsequent surgical defects is always a serious challenge.

Methods:
Between February 2012 and January 2021, a retrospective review of 4 patients who suffered from hemifacial congenital giant nevus was conducted, and they were treated by pre-expanded scalp flap and deltopectoral flap simultaneously. All patients receive tissue expansion, nevus resection, expanded skin flap transfer, and pedicle division.

Results:
Four patients with hemifacial congenital giant nevi were successfully treated with no major complications. One patient with a transferred deltopectoral flap experienced distal necrosis of the flap, and healed after dressing changes. No recurrence of the nevus was found during the follow-up period, and the transferred skin flaps match well with facial skin in contour and color.

Conclusion:
This modified pre-expanded scalp flap combined with a deltopectoral flap provides an easy and reliable way for hemifacial reconstruction in patients with a congenital giant nevus.
Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students
Authors: Paris Donna Marie , Slaymaker Rachel Renee , Guest Heather Ann , Kalb Amy Christine 
Published: May 2023

Background
The concept of collaborative practice within health professions is viewed as “best practice.” Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities.

Objectives
This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve.

Methods
Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results.

Results
Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students.

Conclusions
This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.