bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability and Validity of the Respect Factor in Student Evaluations of Clinical Educators
Authors: Wilson Anita M. , Douglas Aaron , Spandorfer John M. 
Published: February 2025

Abstract

Purpose
Medical student mistreatment has profound negative effects on student education. When medical students feel mistreated, they may also feel that they have been treated disrespectfully. This study examines the validity and reliability of a tool to measure students’ perception of educators’ level of respect.

Method
Data from 516 student raters of 2,534 clinical educators (i.e., faculty and residents across 8 clinical departments) were used to investigate validity evidence based on Kane’s validity framework for an instrument that includes 2 items for measuring educator respect and 7 items for measuring teaching effectiveness. Exploratory and confirmatory factor analyses were conducted to investigate construct validity. Generalizability theory analysis was conducted to project estimates of the level of reliability of departmental-level respect scores for different data collection scenarios. The raters were third- and fourth-year students attending clinical rotations at Sidney Kimmel Medical College, Thomas Jefferson University, during the 2022 to 2023 academic year.

Results
Exploratory factor analysis revealed 2 correlated latent factors that represent respect and teaching effectiveness. The estimated confirmatory factor analysis model, with 2 first-order latent factors (i.e., respect and teaching effectiveness) and 1 second-order latent factor (i.e., teaching quality), resulted in a root mean square error of approximation index of 0.10 (indicating mediocre fit), a nonnormed fit index of 0.95 (indicating good fit), and a standardized root mean square residual of 0.03 (indicating good fit). Generalizability theory decision studies revealed plausible scenarios that would lead to reliability estimates between 0.71 and 0.81.

Conclusions
This study suggests that the respect rating scale yields sufficiently valid measures of students’ experiences and reliable department-level respect scores for plausible scenarios when ratings are obtained from 10 students nested in each of 35 educators per department. The results also suggest that the scale allows for valid decision-making about feedback to clinical educators and their departments.
Privacy, Care-seeking, and Stigma: A Qualitative Investigation of Patient Perspectives on Sharing Substance Use Disorder Treatment Records
Authors: Aluri James , Gurule Evelyn , Siddiqi Tulha Dobler , Upson Camryn R. , D’Sa Adam , Strain Eric C. , Antoine Denis G. 
Published: February 2025

Objectives:
To examine, among persons with substance use disorders (SUDs), how their decision-making to seek care is influenced by concerns about the privacy of their treatment records, how they weigh the risks and benefits of record sharing, and their awareness of how records are shared and regulated.

Methods:
This qualitative study followed the Standards for Reporting Qualitative Research and analyzed semi-structured interviews of 13 men and 14 women recruited from inpatient and residential SUD treatment programs. Due to the onset of the COVID-19 pandemic, recruitment took place over an extended period (between May 2020 and July 2023). Interview transcripts were analyzed using qualitative thematic analysis. Saturation was checked using established quantitative methods.

Results:
Most participants reported that privacy concerns about their records were not a significant factor in the decision to seek treatment. Participants identified many benefits to record sharing, and stigma was viewed as a primary risk. Several women reported that health care professionals, particularly in emergency or perinatal care contexts, treated them differently or negatively after learning about their substance use history. Most participants were unaware of how their substance use treatment records were protected or who had access to their records.

Conclusions:
Sharing of SUD treatment records with health care professionals was generally viewed positively and privacy concerns did not appear to deter participants from seeking care. Stigma was a concern among participants, especially women. The unawareness of how records are shared highlights the need to better engage persons with SUDs in clinical conversations about their records.
Rotational Alignment in tibia diaphyseal fractures with the Suprapatellar Semi-extended Versus Standard Upper Entry Tibial Intramedullary Nailing: A Randomized Controlled Trial (RASPUTIN)
Authors: Varghese Viju Daniel , Jamshed Jubin , John Chandy Viruthipadavil , Kandagaddala Madhavi , Livingston Abel , Bliss Jeremy , Yadav Bijesh 
Published: February 2025

OBJECTIVES:
To determine whether suprapatellar or infrapatellar approach makes a difference in the rate of rotational malalignment in tibial diaphyseal fractures treated with intramedullary nailing.

METHODS:

Design: Non inferiority, randomized controlled trial, with 2 arms (Suprapatellar and Infrapatellar approach)

Setting:
Single centre trial at a Level I trauma centre in South India.

Patient Selection Criteria:
Adults presenting with tibial diaphyseal fractures (OTA/AO 42A, B and C, 43A) planned for intramedullary nailing between September 2021 to July 2022.

Outcome Measures and Comparisons:
The primary outcome compared was the degree of rotational malignment in patients undergoing tibia nailing with Suprapatellar and Infrapatellar approaches. This was done using CT scan in the immediate post-operative period. Secondary outcomes included across the 2 groups were post-operative entry site pain, anterior knee pain (Kujala score), functional scores and union rates.

RESULTS:
50 patients, 25 in each arm were included and followed up to a period of 1 year. The mean age was 34 (16-67) years (68% male) in the suprapatellar group and 45 (16-72) years (72% male) in the infrapatellar group. The rate of rotational malalignment was 34% with 8 (32%) in the suprapatellar group and 9 (36%) in the infrapatellar group and was independent of approach (P=0.76). The rotational malalignment had no association with knee functional scores (P=0.24). Factors such as location of fracture (P=0.81), mechanism of injury (P=0.76), type of injury (P=0.24) and surgeon seniority (P=0.2) had no association with malrotation. Suprapatellar and infrapatellar groups were similar in terms of knee function (P=0.52), knee (P=0.31) and ankle P=0.23) range of movement and union rates (P=0.84). Entry site pain was found to be significantly less (P=0.021) in the suprapatellar group (6/25) as compared to the infrapatellar group (14/25).This difference persisted at 1 year.

CONCLUSIONS:
Rotational malalignment in tibial diaphyseal fractures treated by intramedullary nailing was independent of the approach used. Entry site pain was less common with suprapatellar approach.

LEVEL OF EVIDENCE:
Level I
Impact of Cervical Micro-Endoscopic Laminotomy on Postoperative Neck Pain and Range of Motion
Authors: Kobayashi Hiroshi , Nikaido Takuya , Watanabe Kazuyuki , Kato Kinshi , Kobayashi Yoshihiro , Nakamura Masataka , Sekiguchi Miho , Hakozaki Michiyuki , Kameda Takuya , Kaneuchi Yoichi , Otani Koji , Yabuki Shoji , Konno Shin-ichi , Matsumoto Yoshihiro 
Published: February 2025

Study Design.
Retrospective case-control study.

Objective.
To evaluate clinical outcomes of cervical microendoscopic laminotomy (CMEL) and segmental partial laminectomy (SPL) in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.
CSM often requires posterior decompression surgery. Conventional techniques such as laminoplasty and SPL are associated with significant challenges, including axial neck pain and reduced cervical range of motion (ROM). In contrast, CMEL, a minimally invasive approach, may offer superior outcomes. However, direct comparisons with SPL remain limited.

Methods.
We retrospectively analyzed 105 patients (58 with CMEL and 47 with SPL) who underwent posterior decompression surgery for CSM between 2003 and 2020. The evaluated outcomes included intraoperative parameters, postoperative clinical measures (e.g., Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, including recovery rate and treatment satisfaction), radiographic assessments, and complication rates.

Results.
Compared to SPL, CMEL resulted in reduced blood loss, shorter hospital stay, less postoperative neck pain, ROM preservation, and fewer complications at 1 year postoperatively.

Conclusions.
CMEL is a minimally invasive alternative to SPL, providing reduced morbidity and improved outcomes. This is particularly true for aging populations that require functional preservation and quality of life improvement. By avoiding instruments such as interlaminar spacers and implants, CMEL can potentially reduce healthcare costs.
Medicare work-related injuries: Underutilization of workers' compensation leads to higher out-of-pocket costs for older adults
Authors: McFalls Matthew , Virnig Beth A. , Andrew Ryan M.S , Erickson Darin J. , Kim Hyun , Jarosek Stephanie , Alexander Bruce H. , Ramirez Marizen R. 
Published: February 2025

ABSTRACT

Objective: Older adults may pay healthcare-related costs for work injuries if Medicare covers claims over workers' compensation (WC). We assessed Medicare enrollee costs after a work-related injury by WC status.

Methods: We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for age 65+ Medicare enrollees with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models.

Results: WC covered at least one Medicare claim for 16% of the 13,039 enrollees with work-related injuries. Over 90 days, mean Medicare out-of-pocket costs were lower with WC ($447) than without ($778). With WC, enrollees owed $1,432 at the 90th percentile compared to $2,465 without, an adjusted difference of $600 (95% CL -767, -432).

Conclusions: While WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses.
Magnetic Resonance Imaging of Inner Ear and Internal Auditory Canal Structures in the Presence of a Cochlear Implant
Authors: Dewey Rebecca Susan , Dineen Robert A. , Clemence Matthew , Menon Nitin , Bowtell Richard , Boyle Patrick , Hartley Douglas E. H. 
Published: February 2025

Objective
To determine whether the internal auditory canal (IAC) can be visualized using magnetic resonance imaging (MRI) in users of a cochlear implant (CI) model that can safely undergo MRI at 3 T.

Patients
Four normally hearing controls and three individuals unilaterally implanted with a HiRes Ultra 3D (Advanced Bionics LLC, California, USA).

Interventions
Participants underwent 3 T MRI using sequences appropriate for the postoperative surveillance of the IAC. Images in normally hearing individuals were acquired after placing a fully functional, unpowered, CI underneath a swimming cap at each of eight candidate scalp positions, four on each side of the head. Images were compared to a control condition without a CI present. and CI users were imaged with similar sequences.

Main Outcome Measures
In normally hearing controls, the likely impact of the artifact on detection of pathology for multiple neuroradiological locations as rated by two independent radiologists. In CI users, a qualitative assessment of the diagnostic usability of images.

Results
Visibility of the ipsilateral IAC and cochlea varied among the three CI users, with images from one participant deemed largely usable, while those from the other two participants exhibited less diagnostic certainty, likely due to differences in implant locations and cranial/neuroanatomical variations. Ratings of images in normally hearing participants showed that more middle-to-anterior CI locations were associated with reduced likelihood of overlooking gross abnormalities.

Conclusion
Through meticulous surgical placement, bilateral IAC visualization may be achievable for monitoring chronic health conditions such as tumor surveillance in high-risk patients, and as a safety monitoring outcome measure in clinical trials.
Impact of cytochrome P-450 3A4 enzyme/P-glycoprotein inducing antiseizure medications on direct oral anticoagulant therapy
Authors: McNary Sean M. , Kuhlenberg Madalyn , Basilio Lucia F. , Clark Nathan P. , Hui Rita L. , Niu Fang , Delate Thomas 
Published: February 2025

Objectives
Concomitant use of cytochrome P-450 and P-glycoprotein (CYP 3A4/P-gp) inducing antiseizure medications and direct oral anticoagulants (DOAC) may result in reduced DOAC effectiveness, but study results are inconsistent and of variable quality. The purpose of this study was to assess the safety of concomitant CYP 3A4/P-gp inducing antiseizure medications and DOAC use.

Methods
This was a retrospective cohort study of adult patients who were newly, concomitantly receiving a DOAC (apixaban, dabigatran, or rivaroxaban) and either a CYP 3A4/P-gp inducer (carbamazepine, phenytoin, phenobarbital, or primidone) or noninducer (gabapentin). The primary outcome was the occurrence of a thromboembolic complication, defined as the composite of ischemic stroke and systemic embolism (S/SE) and venous thromboembolism (VTE). Secondary outcomes included the components of the primary composite as well as all-cause mortality and clinically relevant bleeding. Adjusted multivariate proportional hazards modeling was used to compare outcomes for each DOAC individually in the inducer and noninducer groups.

Results
There were 1843 and 14 647 patients who received a DOAC plus a CYP3A4/P-gp inducer and noninducer, respectively. Overall, patients were primarily older, white, had atrial fibrillation, and were dispensed dabigatran. After adjustment, there were no statistically significant differences in the primary outcome between the groups (P > 0.05); however, concomitant inducer and DOAC use was associated with an increased risk of all-cause mortality (P < 0.05).

Conclusions
No excess risk of thrombosis during concomitant use of DOACs with CYP3A4/P-gp inducing antiseizure medications compared to use with gabapentin was identified. Further research is needed to confirm an association with excess all-cause mortality.
Clinical outcomes of rotational atherectomy followed by cutting balloon for calcified coronary lesions
Authors: Zhou Tingquan , Jin Xian , Ma Shixin , Han Jiming , Shen Chengxing 
Published: February 2025

Objective
Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions.

Methods
This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People’s Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model.

Results
The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan–Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23–0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17–0.76; P < 0.01) for the PSM-adjusted model.

Conclusion
Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.
Electrical impedance tomography to set positive end-expiratory pressure
Authors: Francovich Juliette E. , Katira Bhushan H. , Jonkman Annemijn H. 
Published: February 2025

Purpose of review
To summarize the rationale and concepts for positive end-expiratory pressure (PEEP) setting with electrical impedance tomography (EIT) and the effects of EIT-based PEEP setting on cardiopulmonary function.

Recent findings
EIT allows patient-specific and regional assessment of PEEP effects on recruitability and overdistension, including its impact on ventilation-perfusion (V̇/Q) mismatch. The overdistension and collapse (OD-CL) method is the most used EIT-based approach for PEEP setting. In the RECRUIT study of 108 COVID-19 ARDS patients, the PEEP level corresponding to the OD-CL crossing point showed low overdistension and collapse (below 10% and 5%, respectively) regardless of recruitability. In a porcine model of acute respiratory distress syndrome (ARDS), it was shown that at this crossing point, respiratory mechanics (compliance, ΔP) were consistent, with adequate preload, lower right ventricular afterload, normal cardiac output, and sufficient gas exchange. A recent meta-analysis found that EIT based PEEP setting improved lung mechanics and potentially outcomes in ARDS patients. EIT thus provides critical insights beyond respiratory mechanics and oxygenation for individualized PEEP optimization. EIT-based methods for PEEP setting during assisted ventilation have also been proposed.

Summary
EIT is a valuable technique to guide individualized PEEP setting utilizing cardiopulmonary information that is not captured by respiratory mechanics and oxygenation response alone.
Prediction of risk of blood transfusion in patients with cirrhosis
Authors: Li Ying , Zhu Wenwen , Song Zhiqun , Liang Wenbiao , Zhou Xiaoyu 
Published: February 2025

Background
Blood transfusion is usually required for cirrhotic patients with bleeding which is related to high risk of mortality. Identifying cirrhotic patients at high risk of bleeding and needing blood transfusions would benefit these patients, yet this remains an unmet need.

Objectives
This study aims to enhance blood transfusion management for patients with cirrhosis by developing a predictive model to assess the risk of transfusion.

Methods
We enrolled a cohort of 711 patients diagnosed with cirrhosis at The First Affiliated Hospital of Nanjing Medical University and divided into training set (n = 537) and validation set (n = 174). Each participant underwent a comprehensive clinical assessment. Data on prothrombin time (PT), platelet counts, and inflammatory markers were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The nomogram was constructed. Model performance was evaluated through receiver operating characteristic curve analysis.

Results
The study successfully identified PT, platelet counts, and the mentioned inflammatory markers as significant predictors of the need for transfusion. The resulting nomogram demonstrated high predictive accuracy, with area under the curve values of 0.85 in the training set and 0.83 in the validation set.

Conclusion
The developed nomogram for predicting the need for blood transfusion in patients with cirrhosis shows promising effectiveness for clinical application. This tool can significantly contribute to optimizing transfusion practices, potentially improving patient care and outcomes through more personalized and efficient transfusion strategies.
Metabolic dysfunction-associated steatotic liver disease correlates with higher lower graft survival in liver transplant recipients with hepatocellular carcinoma
Authors: Alsaqa Marwan , Sierra Leandro , Marenco-Flores Ana , Parraga Ximena , Barba Romelia , Goyes Daniela , Ozturk N. Begum , Curry Michael P. , Bonder Alan , Saberi Behnam 
Published: February 2025

Background
Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment. The changing landscape of hepatocellular carcinoma (HCC) in liver transplant (LT) recipients lacks a thorough description of the outcomes of HCC based on etiology.

Objective
To assess the waitlist (WL) dropout and graft survival in HCC LT candidates based on the etiology of HCC in the post-DAA era.

Methods
This retrospective cohort study analyzed United Network Organ Sharing/Organ Procurement Transplant Network data from 2015 to 2022. Graft survival was analyzed using Kaplan–Meier curves, and predictors of WL dropout and graft failure were assessed using multivariate analysis.

Results
Among LT recipients, etiologies were HCV (53.6%), alcohol-associated liver disease (ALD) (12.0%), metabolic dysfunction-associated steatotic liver disease (MASLD) (16.6%), hepatitis B virus (HBV) (5.6%), and other (12.1%). MASLD and ALD had the highest dropout rates (1-year: 20.4%, 21.7%; 3-year: 58.2%, 51.1%; P < 0.001). Dropout was linked to diabetes, low albumin, high Model of End-Stage Liver Disease, high alpha-fetoprotein, tumor number, and size. MASLD had the worst 1-, 3-, and 5-year graft survival (89.8%, 81.8%, and 74.1%) and higher failure risk than HCV (hazard ratio: 1.143, 95% CI: 1.021–1.281). Diabetes negated MASLD’s impact on graft failure but worsened survival for MASLD-HCC compared with HBV and ALD, matching HCV.

Conclusion
MASLD has the highest WL dropout and post-LT graft failure among HCC LT candidates, surpassing HCV in the post-DAA era. The worst graft survival in MASLD-HCC is associated with pre-LT diabetes.
Comparison of acute pancreatitis and acute on chronic pancreatitis: a retrospective cohort study
Authors: Bouça-Machado Tiago , Araújo Teixeira João Paulo , Rebelo Paula , Barbosa Elisabete , Pedersen Jan Bech , Drewes Asbjørn Mohr , Olesen Søren Schou 
Published: February 2025

Background
Acute on chronic pancreatitis (ACP) shares a similar clinical presentation with acute pancreatitis (AP) and is often diagnosed and treated in the same way. However, these two conditions may have distinct clinical risk profiles and prognoses. There is currently limited evidence available regarding the specific characteristics of ACP.

Methods
This retrospective cohort study included all adult patients admitted with a diagnosis of AP or ACP between 2017 and 2019 at two tertiary referral centers. The primary outcome was disease severity as defined by the Atlanta classification. Secondary outcomes included the presence of local and systemic complications, organ failure, ICU admission, and mortality. Differences in outcomes between ACP and AP were compared using multivariate logistic regression models, with results presented as odds ratios (ORs).

Results
We included 1163 patients, 90% of whom had AP and 10% had ACP. ACP patients were predominantly male (81 vs. 46%; P < 0.001), whereas AP patients were older (mean age 62.6 vs. 56.5 years, P < 0.001). ACP patients had lower amylase and lipase levels (P < 0.001). Multivariate analysis showed no difference in the risk of moderate or severe pancreatitis (OR, 1.15; 95% CI, 0.66–1.98; P = 0.615). ACP patients had a higher risk of local complications (predominantly pseudocysts) (OR, 1.71; 95% CI, 1.00–2.92; P = 0.049) and a lower risk of organ failure (P = 0.019) and ICU admission (P = 0.005).

Conclusion
Our study confirms previous observations that ACP has a more favorable in-hospital prognosis than AP and extends these findings to a modern European setting.