bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 27 Limitations of Current Human Cell, Tissue, and Cellular-based Product Donor Eligibility Guidance: Analyzing the Impact on a Large Public Cord Blood Bank
Authors: Guggenheim Dana S , Kurtzberg Joanne , Shaz Beth 
Published: September 2022

Abstract

Introduction
Cord blood (CB) is considered a human cell, tissue, and cellular-based product (HCT/P) by the U.S. Food and Drug Administration (FDA) and is licensed through a Biological Licensing Application (BLA). Cord blood units (CBUs) require less precise donor tissue matching than other stem cell sources, which increases their availability for racial/ethnic minorities. However, a small percentage of banked CBUs are used for transplants. Updating FDA donor eligibility guidance may expand licensed CBU supply and cord blood bank (CBB) sustainability.

Objective
The objectives of this study were to analyze the impact of Zika virus (ZIKV) donor screening recommendations on the licensing status of banked CBUs and to propose updated policy recommendations.

Methods
A retrospective analysis of Carolinas Cord Blood Bank (CCBB) data (from January 2016 to May 2022) was performed to describe CBU eligibility and shipment status. Qualitative comparisons of FDA guidance to reduce the risk of relevant communicable diseases were completed for blood versus HCT/P.

Results
CCBB: 8,877 banked CBUs from 2016-2022 (85.3% licensed; 14.7% unlicensed) (Table 1). 4,361 (49.1%) of CBUs were from Caucasian donors and 1,349 (15.2%) were from African American donors. 689 (52.7%) CBUs were unlicensed due to ZIKV risk. The number of CBUs with ZIKV risk banked annually has decreased significantly since 2020, with 174 ZIKV-risk CBUs in 2020 versus 63 in 2021. 26 unlicensed CBUs collected in 2016 or later have been infused versus 210 licensed CBUs. 7 unlicensed, infused CBUs had identified ZIKV risk. No ZIKV transmission was reported from these transplants. FDA Guidance: HCT/P ZIKV recommendations have not been updated since 2018 despite FDA removal of ZIKV from the relevant transfusion-transmitted infections in 2021. Recommendations for minimizing transfusion-transmission risk of human immunodeficiency virus (HIV) and variant Creutzfeldt-Jakob disease (vCJD) were updated in 2020 and 2022, respectively, to increase blood supply. New vCJD guidance eliminated geographic risk-related donor restrictions.

Discussion
Guidance for reducing disease transmission for blood and blood components have recently been updated to increase blood supply. The FDA must consider new data to revise the HCT/P donor screening recommendations. Adopting these changes will increase the number of HCT/P donors, the quantity of licensed CBUs, and potentially improve access to cellular therapies for a more diverse patient population.
Abstract 33 A Diverse and Sustainable State-Run Public Cord Blood Program
Authors: Wilt Kristen , Ober Charis , Garcia John , Botsford Jennifer 
Published: September 2022

Abstract

Introduction
The Arizona Public Cord Blood Program was created in 2011 by the Arizona Biomedical Research Centre, a subsection of the Arizona Department of Health Services, to advance the collection and increase the number of racially and ethnically diverse cord blood units available for transplantation, as well as to promote awareness of the benefits of cord blood stem cells through our educational partner, Save the Cord Foundation (STCF).

Objective
The main objective of this study was to create a sustainable program for women of all racial and ethnic backgrounds to have the opportunity to donate cord blood, with the primary goal of transplantation and the secondary goal of providing non-transplantable cord blood units for research. A second objective was to educate the residents of the state of Arizona about cord blood stem cells and the need for their preservation.

Methods
A portion of state lottery funds support the program monetarily. Those funds are provided to four partner collection hospitals employing "cord blood consenters," whose responsibility it is to consent patients, assist delivery providers with collections, and package and ship cord blood units to our partner cord blood bank at MD Anderson Cancer Center. There are also two clinical coordinators who educate and train hospital staff on quality collection practices, with special emphasis on the importance of high-volume, sterile collections. STCF provides education across the state to expectant parents, health care providers, schools, and the public about the need for cord blood stem cell donation for transplant and research.

Results
Since 2011, the Arizona Public Cord Blood Program has banked several hundreds of racially and ethnically diverse cord blood units with the National Marrow Donor Program (Figure 1) and has had 80 life-saving cord blood units matched with patients in need around the globe. This innovative program has expanded cord blood awareness and promoted the preservation of cord blood, and it also has resulted in the creation of an economic engine for the state of Arizona that is an attractant for STEM-based businesses and careers.

Discussion
A decade later, the Arizona Public Cord Blood Program has proven to be a sustainable model for collecting and providing suitable cord blood units for transplant to diverse patient populations.
Racial disparities in menopausal hormone therapy acceptance: a pilot study
Authors: Pershad Anita , Morris Joshua M. , Pace Diane , Khanna Pallavi 
Published: September 2022

Abstract

Objective
Previous studies provide little data on the role of race in acceptance and utilization of hormone therapy. Our primary objective was to examine differences in hormone therapy acceptance between self-reported racial groups, whereas our secondary objective was to assess patient comorbidities and reported symptom frequency at presentation in these cohorts in a menopause-focused care clinic.

Methods
We conducted a retrospective medical record review of patients presenting to a menopause clinic at an urban university-affiliated academic medical center in the Midsouth between July 2018 and July 2021. Statistical analysis was performed with Student t tests and odds ratios and P values ≤ 0.05 were considered statistically significant. During the 3-year study period, 113 patients presented with menopausal symptoms and were included in the study.

Results
The cohort's self-reported racial composition was 51% Black (58 patients), and 42% White (47), and 7% unknown/declined to answer (8). Of the 42 patients who presented to the clinic with a primary complaint of vasomotor symptoms, 55% (23 patients) accepted lifestyle modification therapy, and 45% (19 patients) accepted hormone therapy. Of 34 patients who presented with a primary complaint of vaginal dryness, 85% (29 patients) accepted the recommendation of moisturizers or lubricants, whereas only 15% (5) accepted vaginal hormone therapy. Of patients with vasomotor symptoms, 10 (25%) were excluded from eligibility for systemic hormone therapy due to medical comorbidities. Thirty-seven individuals were eligible for systemic hormone therapy; 18 (49%) White patients accepted hormone therapy; however, only 9 (24%) Black patients accepted with similar clinical criteria (P = 0.01). Black patients were 24% less likely to accept hormones for menopausal symptom management. The odds ratio was 0.24 (95% confidence interval, 0.09-0.64).

Conclusions
Our pilot study suggests a racial disparity in acceptance of both systemic and local hormonal therapy among perimenopausal and postmenopausal patients. The presence of racial disparity in acceptance of these treatment modalities can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.
Effect of Laughter Therapy on Mood Disturbances, Pain, and Burnout in Terminally Ill Cancer Patients and Family Caregivers
Authors: Moon Hee , Journ Songjah , Lee Seonah 
Published: September 2022

Background
Humor has been commonly used in palliative care and identified as a coping strategy of palliative care patients and family caregivers. However, the use of humor or laughter in palliative care settings is still limited.

Objective
The aim of this study was to examine the effect of laughter therapy involving spontaneous laughter on mood disturbances and pain in terminally ill patients with cancer and mood disturbances and the levels of burnout in family caregivers.

Methods
This quasi-experimental study used a nonequivalent control group pretest-posttest design. The laughter therapy developed was provided for 20 to 30 minutes a day for 5 consecutive days. Twenty-six pairs of terminally ill cancer patients and family caregivers in the intervention group and 23 pairs in the comparison group from the hospice ward of a tertiary teaching hospital participated in this study. The data were collected using structured questionnaires and analyzed using descriptive statistics and 2-way repeated-measures analysis of variance.

Results
There were significant decreases in mood disturbances in the patients (P < .001) and family caregivers (P < .001), pain in the patients (P < .001), and levels of burnout in the caregivers (P < .001) in the intervention group.

Conclusion
Laughter therapy can be an alternative intervention to support both terminally ill patients with cancer and their family caregivers experiencing multidimensional distress in palliative care settings.

Implications for Practice
The appropriate use of laughter or humor therapy needs to be encouraged as a support tool in palliative care. Palliative care teams must be properly trained to provide spontaneous laughter therapy or planned humor therapy.
Prognostic and Goals-of-Care Communication in the PICU: A Systematic Review
Authors: McSherry Megan L. , Rissman Lauren , Mitchell Riley , Ali-Thompson Sherlissa , Madrigal Vanessa N. , Lobner Katie , Kudchadkar Sapna R. 
Published: September 2022

OBJECTIVE:
Admission to the PICU may result in substantial short- and long-term morbidity for survivors and their families. Engaging caregivers in discussion of prognosis is challenging for PICU clinicians. We sought to summarize the literature on prognostic, goals-of-care conversations (PGOCCs) in the PICU in order to establish current evidence-based practice, highlight knowledge gaps, and identify future directions.

DATA SOURCES:
PubMed (MEDLINE and PubMed Central), EMBASE, CINAHL, PsycINFO, and Scopus.

STUDY SELECTION:
We reviewed published articles (2001–2022) that examined six themes within PGOCC contextualized to the PICU: 1) caregiver perspectives, 2) clinician perspectives, 3) documentation patterns, 4) communication skills training for clinicians, 5) family conferences, and 6) prospective interventions to improve caregiver-clinician communication.

DATA EXTRACTION:
Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology.

DATA SYNTHESIS:
Of 1,420 publications screened, 65 met criteria for inclusion with several key themes identified. Parent and clinician perspectives highlighted the need for clear, timely, and empathetic prognostic communication. Communication skills training programs are evaluated by a participant’s self-perceived improvement. Caregiver and clinician views on quality of family meetings may be discordant. Documentation of PGOCCs is inconsistent and most likely to occur shortly before death. Only two prospective interventions to improve caregiver-clinician communication in the PICU have been reported. The currently available studies reflect an overrepresentation of bereaved White, English-speaking caregivers of children with known chronic conditions.

CONCLUSIONS:
Future research should identify evidence-based communication practices that enhance caregiver-clinician PGOCC in the PICU and address: 1) caregiver and clinician perspectives of underserved and limited English proficiency populations, 2) inclusion of caregivers who are not physically present at the bedside, 3) standardized communication training programs with broader multidisciplinary staff inclusion, 4) improved design of patient and caregiver educational materials, 5) the development of pediatric decision aids, and 6) inclusion of long-term post-PICU outcomes as a measure for PGOCC interventions.
Effect of Prearrival Orders on Time to Antibiotics for Immunocompromised Oncology Patients Presenting to the Emergency Department With Fever
Authors: Carolan Patrick L. , Lammers Shea M. , Anderson Cynthia M. , Messinger Yoav H. 
Published: September 2022

Objective
Pediatric cancer patients with fever are at risk for invasive bacterial infection. The administration of antibiotics to these patients within the first hour of evaluation is viewed as a quality of care metric with potential to improve outcome. We sought to evaluate the impact of prearrival patient orders on the timeliness of antibiotic administration for this patient population presenting to the emergency department (ED) because of fever.

Methods
A single-site pediatric ED intervention study was performed. Four hundred thirty-nine consecutively referred febrile immunocompromised pediatric oncology patients were included in the study. The intervention used structured monthly messages sent to oncology and emergency medicine providers highlighting specific roles in prehospital communication and in ED-based care emphasizing the use of standardized, prearrival order (PAO) sets. Primary outcome measures were time to antibiotic administration (TTA) and the proportions of patients receiving PAO placement and antibiotics within 60 minutes of ED arrival. Results were analyzed for the preintervention (September 2016–July 2017), intervention (August 2017–February 2018), and postintervention (March–December 2018) periods.

Results
Improvements occurred across the study periods in the proportion of patients with PAO placement (preintervention, 68%; intervention, 82%; postintervention, 87%; P = 0.001) as well as in the percentages of patients receiving antibiotics in less than 60 minutes (preintervention, 73%; intervention, 84%; postintervention, 85%; P = 0.02). Median TTA decreased from 48 to 40 minutes (P = 0.018). Linear regression with TTA as a dependent variable revealed that PAO placement predicted a shorter TTA, decreasing by more than 15 minutes (B = −15.90; [95% confidence interval, −20.03–−11.78]; P < 0.001).

Conclusions
Standardizing elements of prehospital communication and ED-based care using PAO sets resulted in significant improvements in time to antibiotics and in the proportion of febrile immunocompromised oncology patients receiving antibiotics within 60 minutes of ED arrival.
Physiological Response to the 6-Minute Frame Running Test in Children and Adults With Cerebral Palsy
Authors: Edelman Bos Arnoud M. M. , Hjalmarsson Emma , Dallmeijer Annet J. , Fernandez-Gonzalo Rodrigo , Buizer Annemieke I. , Pingel Jessica , Pontén Eva , von Walden Ferdinand , van Schie Petra E. M. 
Published: September 2022

Purpose:
To determine the physiological response and association to peak oxygen uptake of the 6-minute Frame Running test (6-MFRT) in persons with cerebral palsy (CP).

Methods:
Twenty-four participants with CP, Gross Motor Function Classification System II/III/IV, performed the 6-MFRT. Distance, peak heart rate (HRpeak), peak respiratory exchange ratio (RERpeak), and peak oxygen uptake (

O2peak) were measured.

Results:
HRpeak ranged from 146 to 201 beats per minute, RERpeak from 0.94 to 1.49, 6-MFRT distance from 179 to 1220 m and

O2peak from 0.62 to 2.18 L/min. HRpeak was achieved in 63%, RERpeak in 71%. A strong correlation was observed between 6-MFRT and

O2peak.

Conclusions:
The 6-MFRT represented a (near) maximum effort for 75% of the participants and the 6-MFRT can be used to estimate oxygen consumption on an individual basis.
Evolution in Parental Leave Policies: Plastic Surgery and Obstetrics & Gynecology Lead the Way
Authors: Kasemodel Kaitlyn , Hemal Kshipra , Chen Wendy , Wallace Chelsea , Bourne Debra A 
Published: September 2022

Background:
Forty percent of physicians anticipate becoming parents during residency. This often occurs in the absence of clear parental leave and breastfeeding policies, which may adversely impact parental and child health or jeopardize residents’ board eligibility, fellowship, and job prospects. This study reports on the current status of parental leave and breastfeeding policies across all specialties.

Methods:
Twenty-six specialties recognized by the Accreditation Council on Graduate Medical Education (ACGME) were included. The maximum leave allowed in 2020 and breastfeeding accommodations during board examinations were collected for each specialty. Change in leave since 2006, 2018, and breastfeeding accommodations were analyzed by specialty.

Results:
In 2020, the median time allowed for parental leave without the extension of training was five weeks and there was no significant difference between 2006, 2018, and 2020 (p=0.58). In 2020, Plastic Surgery and Obstetrics/Gynecology provided the longest parental leave at 12 weeks. Surgical specialties provided one additional week of leave as compared to medical specialties after adjusting for year (p=0.02). Twenty-one (81%) specialties allowed additional time for lactation during board examinations, however only seven (27%) guaranteed a private location to pump.

Conclusion:
There has been little improvement in parental leave allowances since 2006 and the current median, five weeks, falls short of guidelines recommending 6-12 weeks following the birth of a child. Starting in July 2021, the ACGME will require medical boards to provide a minimum of six weeks of leave. Ongoing improvement in culture and policy are needed to support residents and their families.
“Videofluorographic analysis of swallowing function after total glossolaryngectomy.”
Authors: Kadota Hideki , Shimamoto Ryo , Fukushima Seita , Ikemura Ko , Kamizono Kenichi , Hanada Masuo , Yoshida Sei , Fukushima Junichi , Yasumatsu Ryuji , Nakagawa Takashi 
Published: September 2022

SUMMARY:
Previously, surgeons believed that after total glossolaryngectomy (TGL), swallowing is mainly dependent on gravity. However, swallowing function after TGL varies widely between patients, and a thorough analysis is lacking. We aimed to clarify the post-TGL swallowing function and determine whether it is primarily dependent on gravity. We retrospectively analyzed videofluorographic examinations (VFs) of patients who underwent TGL and free or pedicle flap reconstruction. We enrolled 20 patients (male, n=12; mean age, 61 years; age range, 43 to 89 years). All patients demonstrated constriction of the reconstructed pharynx to some degree, and no patient’s ability to swallow was dependent on gravity alone. VF showed excellent barium clearance in eight patients and poor clearance in 12. All patients with excellent clearance showed strong constriction of the posterior pharyngeal wall, whereas only 8.3% of the patients with poor clearance showed adequate constriction, which was significantly different (p=0.0007). Velopharyngeal closure and lip closure also contributed significantly to excellent clearance (p=0.041). The shape of the reconstructed pharynx (depressed, flat, protuberant) showed no statistically significant association with excellent clearance. Contrary to our previous understanding, the constriction of the remnant posterior pharyngeal wall played an important role in post-TGL swallowing, and gravity played a secondary role. Dynamic posterior pharyngeal wall movement might result from the increased power of the pharyngeal constrictor muscle and compensate for the immobility of the transferred flap. A well-functioning pharyngeal constrictor muscle and complete velopharyngeal and lip closures can contribute to excellent barium clearance in patients after TGL.
Risk Factors for Partial Flap Loss in a Free Flap: A 12-Year Retrospective Study of Anterolateral Thigh Free Flap in 303 Lower Extremity Cases
Authors: Min Kyunghyun , Hong Joon Pio , Suh Hyunsuk Peter 
Published: September 2022

Background:
Despite remarkable improvements in free flap procedures, partial flap losses in perforator flap still occur. This study aimed to analyze partial necrosis cases which underwent reconstruction of the lower extremities using anterolateral thigh (ALT) free flaps and identifies risk factors causing the occurrence of partial necrosis.

Methods:
From January 2005 to February 2017, 303 ALT free flaps were retrospectively analyzed. After collecting patient’s data, receiver operating characteristic (ROC) curve was conducted to find the critical distance between the perforator and the flap margin which distinguishes incidence of partial necrosis. Also, the rate of partial losses was calculated for each section after dividing the distance from the perforator to the flap margin into 1cm sections. Lastly, logistic regression analyses were performed to identify the risk factors.

Results:
43 cases had partial flap losses (14.19%). Flaps with supra-deep fat layer elevation showed the highest rate of partial necrosis (25.53 %) with statistical significance (p = 0.0001). In ROC curve, the cut-off distance was 10.25 cm. In addition, flap tissues 8 cm away from the perforator have a 10.3 % chance of necrosis, whereas those 12 cm away from the perforator have a 22.9 % chance. Lastly, supra-deep fat layer elevation (OR: 3.952) and large flap dimension (OR: 1.041) were risk factors of partial flap necrosis on multivariate analysis.

Conclusions:
The distance from perforator to flap margin, flap elevation layer, and flap dimension affected the occurrence of partial necrosis. Taking these into consideration, ALT free flap of appropriate size and thickness should be harvested.
Comparative analysis between Side-to-end and End-to-end LVA for secondary lower limb lymphedema
Authors: Kwon Jin Geun , Jeong Seongsu , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio 
Published: September 2022

Introduction
The purpose of this retrospective study is to describe, evaluate and compare the outcome between end-to-end (ETE) and side-to-end (STE) LVA for all stages of lymphedema.

Material and Method:
Total of 123 patients were divided into ETE (n=63) or STE (n=60) group. The demographics, intraoperative and postoperative findings were evaluated. In addition, subcategory evaluation was performed for early and advance phase lymphedema.

Result:
The demographic findings were insignificant. The intraoperative findings showed significantly higher number of LVAs performed for the ETE group (4.1±1.7) over the STE group (3.2±1.2) (p<0.001) while the number of different lymphatic vessels used per patients was not significant (3.4±1.4 vs 3.2±1.2, p=0.386). The diameter of the lymphatic vessels were not significant (0.43±0.06 vs 0.45±0.09mm, p=0.136). While both groups showed significant postoperative volume reduction, STE group had a significantly better reduction in all time intervals (p<0.03) and for longitudinal outcome (p=0.004). However, the subcategory evaluation for early phase patients showed no difference between the two groups while significantly better volume reduction ratio noted for the STE group at all time intervals (p<0.025) and overall longitudinal outcome (p=0.004) in advanced lymphedema patients.

Conclusion:
This is the first study to report the efficacy of ETE versus STE LVA in difference phases of lymphedema. Although both ETE and STE LVAs are significantly effective in volume reduction, there was a significantly better reduction for the STE group in advanced phase lymphedema patients with stage II late and III while no difference was noted for early phase lymphedema patients.