bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG-TERM ADHERENCE TO POSITIVE AIRWAY PRESSURE THERAPY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND CARDIOVASCULAR DISEASES
Authors: Khachatryan Narine , Elfimova Evgenia , Mikhalova Oksana , Litvin Alexander , Chazova Irina 
Published: June 2022

Objective:
to study long-term (more than 12 months) adherence to positive airway pressure (PAP) therapy and its effectiveness in OSA patients with arterial hypertension (AH) and to determine possible factors influencing adherence to PAP therapy

Design and method:
The study involved 194 patients with OSA and AH (156 men and 38 women), median age 64 [55; 69] years, who were on PAP therapy for more than 12 months. Patients had severe OSA (apnea-hypopnea index (AHI) - 49 [35,6; 63,2] events/h. The duration of the PAP-therapy usage - 2,0 years [1,0; 5,0]. Data from PAP therapy for the last year was downloaded from the device’s internal memory card, including effectiveness and adherence. The adherence criteria was the usage of PAP therapy for more than 4 hours per night for more than 70% of nights, effectiveness - residual AHI less than 5 events per hour. The main parameters of the disease and PAP-therapy were analyzed depending on the adherence to therapy.

Results:
All patients used PAP-therapy in auto regime with constant use of a humidifier. Average time of long-term PAP-therapy usage was 6,2 hours [4,8; 7,3] and 84,6% [61,2; 97,0] of nights. The criteria for adherence to PAP - therapy was met in 64,9% of patients. The residual AHI was 3,0 events/h [1,3; 6,0]. When comparing the clinical parameters of PAP-therapy, it was found that in the group of adherent patients, residual AHI was statistically significantly lower: 2,4 events/h [1,2; 5,0] versus 4,0 events/h [2,0; 6,4], p < 0,05. Usage of PAP therapy less than 70% of nights and less than 4 hours per night statistically significantly more often complained of daytime sleepiness (44%) and nocturia (19%) versus 24% and 8% respectively in the compared group. Adherent patients were statistically significantly more likely to use nasal masks in 81,7% of cases, compared with 64,7% of patients in the low-adherence group, p < 0,05.

Conclusions:
In patients with OSA and AH, 64,9% of patients meet the criteria for adherence to long-term PAP therapy. Residual daytime sleepiness and nocturia during prolonged PAP therapy are associated with low adherence.
INTENSIVE SYSTOLIC BLOOD PRESSURE TARGET IN OLDER HYPERTENSIVE PATIENTS - IS IT BENEFICIAL?
Authors: Leite Vanessa , Abecasis Francisca , Beirão Pedro , Cunha Vitória 
Published: June 2022

Objective:
The prevalence of hypertension increases with age, and the treatment in older patients is more challenging due to their comorbidities and frailty. The ideal target for systolic blood pressure (SBP) remains unclear. This study analysed how intensive blood-pressure control in older patients reflects cardiovascular events and hypertensive-mediated organ damage (HMOD) reversion.

Design and method:
We present a descriptive and retrospective study, including patients over 60 years, followed in a central hospital hypertension clinic over two years. One group had an SBP target < 130mmHg (intensive treatment), while the other had a more lenient target. Stroke, acute coronary syndromes, acute decompensated heart failure or death from cardiovascular causes were the evaluated cardiovascular events. The analysed HMOD included microalbuminuria, echocardiographic left ventricular hypertrophy (LVH) and chronic kidney disease (CKD).

Results:
150 of 296 patients were selected. 30% were over 80 years old. Cardiovascular events occurred in 9% of patients with SBP < 130mmHg and in 7% of patients with > 130mmHg. More than half of patients (64%) had HMOD. LVH was the most frequent HMOD (78%), followed by microalbuminuria (44,8%) and CKD (37,5%). 61% of patients in intensive treatment had HMOD versus 66% with SBP target > 130mmHg. Reversion of HMOD occurred in 83% of patients with standard treatment compared with 17,6% in the intensive treatment group. Regarding previous cardiovascular events in the studied population, stroke was the most prevalent (56%), followed by acute coronary syndrome (41%). The majority (59%) of these very high cardiovascular risk patients presented an SBP target < 130mmHg.

Conclusions:
In this study, intensive treatment in older patients did not appear to benefit cardiovascular events prevention and HMOD reversion. However, the HMOD reversion might have been underestimated due to patient discharge prior to further evaluation. In patients with previous cardiovascular events, a tendency to select an intensive treatment seems evident.
Beyond plaque psoriasis – pathogenesis and treatment of other psoriasis phenotypes
Authors: Iznardo Helena , Puig Lluís 
Published: June 2022

Purpose of review
Psoriasis vulgaris is the commonest presentation of psoriatic disease, but morphologic variants such as pustular psoriasis (PP) and a closely related disease, pityriasis rubra pilaris (PRP), have been known for a long time, have been associated with rheumatologic manifestations indistinguishable from psoriatic arthritis (PsA) that may go unrecognized, and often represent a therapeutic conundrum. There is recent evidence that underlying genetic and pathogenetic differences may provide the basis for newer therapeutic approaches.

Recent findings
This narrative review highlights the clinical, genetic and pathogenetic characteristics of PP and PRP, their association with PsA and recent developments in their treatment, especially with biologic agents targeting IL-36 and other cytokines of pathogenic relevance.

Summary
The clinical manifestations of PP and PRP are less well known to rheumatologists than those of psoriasis, and recent advances in our insight on their pathogenesis may eventually overcome the therapeutic difficulties faced by dermatologists and rheumatologists in the management of these diseases and their rheumatologic manifestations.
Defining and managing flares in axial spondyloarthritis
Authors: Aouad Krystel , Gossec Laure 
Published: June 2022

Purpose of review
Flares correspond to fluctuations in disease activity or symptoms. They should be avoided in chronic inflammatory diseases. In axial spondyloarthritis (axSpA), work is ongoing to better conceptualise and treat flares. This review highlights recent data on the definition and management of flares in axSpA.

Recent findings
Many definitions of flares have been used in clinical trials, limiting the interpretation and comparison of studies. The expert group Assessment of SpondyloArthritis International Society (ASAS) developed a data-driven definition of flares/disease worsening: an increase in Ankylosing Spondylitis Disease Activity Score (ASDAS)-C-reactive protein of at least 0.9 points, for use in axSpA clinical trials. Flares are more challenging to define in clinical practice because of their multifaceted nature. Qualitative studies have shown that flares from the patient's perspective are related not only to disease activity, but also to fatigue, mood, sleep and general well-being. The management of axSpA relies on a treat-to-target (T2T) strategy and aims at reaching clinical remission while monitoring closely disease activity to prevent and shorten flares.

Summary
The concept of flares has been clarified, and definitions have been developed for use in trials. The T2T approach aims at minimising flares in axSpA. The early recognition of flares and their severity may lead to better management.
Pro and contra: is synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) a spondyloarthritis variant?
Authors: Furer Victoria , Kishimoto Mitsumasa , Tomita Tetsuya , Elkayam Ori , Helliwell Philip S. 
Published: June 2022

Purpose of review
The purpose of this review is to present the up-to-date evidence on the epidemiology, pathogenesis, musculoskeletal manifestations, and imaging of the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and to discuss its relationship with spondyloarthritis (SpA).

Recent findings
SAPHO is a rare inflammatory disorder of bone, joints, and skin, with a worldwide distribution that predominantly affects the middle-age adults. The hallmark of the syndrome is a constellation of sterile inflammatory osteitis, hyperostosis, and synovitis involving the anterior chest wall, associated with acneiform and neutrophilic dermatoses, such as palmoplantar pustulosis and severe acne. The axial skeleton, sacroiliac, and peripheral joints can be involved in a similar fashion to SpA. The pathogenesis of the syndrome is multifactorial. The diagnosis is mainly based on the clinical and typical radiological features. The treatment approach is based on the off-label use of antibiotics, bisphosphonates, disease-modifying antirheumatic drugs, and anticytokine biologics.

Summary
The SAPHO syndrome shares common features with SpA-related diseases, yet also shows some unique pathogenetic and clinical features. The nosology of SAPHO remains a subject of controversy, awaiting further research into the pathogenetic and clinical aspects of this syndrome. A better understanding of these aspects will improve the diagnostics and clinical care of patients with SAPHO.
Surgical Realignment After Anterior Multilevel Decompression Using Cages and Plate for 3-level to 5-level Degenerative Fusions
Authors: Koller Heiko , Hostettler Isabel C. , Stengel Felix C. , Koller Juliane , Ferraris Luis , Hitzl Wolfgang , Hempfing Axel 
Published: June 2022

Study Design:
Retrospective, single-center case study.

Objective:
Postoperative cervical imbalance with cervical sagittal vertical axis (cSVA) >4 cm can be predicted in 3-level to 5-level anterior-only cervical multilevel fusion surgery (ACMS).

Summary of Background Data:
Previous studies established correlations between cervical kyphosis (CK) correction and postoperative balance (cSVA ≤4 cm) with improved clinical outcomes. Understanding of what influences restoration of cervical lordosis (CL) in patients with degenerative disease with mild to moderate CK subjected to ACMS is important. To achieve a better understanding of geometric changes after ACMS, this study examines factors predicting perioperative alignment changes and regional interdependencies.

Materials and Methods:
Analysis of patients with ACMS. Analysis included patient baseline characteristics, demographics and complications, and focused on radiographic measures including CL C2-7, fusion angle (FA), C7-Slope (C7S), T1-slope (T1S), T1-CL mismatch, and cSVA (cSVA ≤4 cm/>4 cm). We aimed to predict postoperative imbalance (cSVA >4 cm) and conducted a multivariable logistic regression analysis.

Results:
Inclusion of 126 patients with 3-level to 5-level ACMS, mean age was 56 years and 4 fusion levels on average. Preoperative CK was present in 9%, mean FA-correction was 8 degrees, maximum 46 degrees. Postoperatively, 14 patients had cSVA >4 cm. A neural network model for prediction of cSVA >4 cm was established including preoperative cSVA, preoperative CL and correction of FA. The model achieved high performance (positive predictive value=100%, negative predictive value=94%, specificity=100%, sensitivity=20%). Also, variables such as nonunion, chronic lumbar pain or thoracolumbar multilevel fusion influenced the postoperative cSVA >4 cm rate. Alignment analysis highlighted strong correlations between C7S/T1S and cSVA/C2-tilt (r=0.06/r=0.7, P<0.0001). A formula was established to transfer cSVA data into C2-tilt data.

Conclusion:
This study identified independent variables predicting postoperative cSVA >4 cm including FA, which can be influenced by the surgeon. Our model supports the decision-making process targeting a postoperative cSVA ≤4 cm.
Does Age Younger Than 65 Affect Clinical Outcomes in Medicare Patients Undergoing Lumbar Fusion?
Authors: Karamian Brian A. , Toci Gregory R. , Lambrechts Mark J. , Canseco Jose A. , Basques Bryce , Tran Khoa , Alfonsi Samuel , Rihn Jeffery , Kurd Mark F. , Woods Barrett I. , Hilibrand Alan S. , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. , Kaye Ian David 
Published: June 2022

Study Design:
This was a retrospective cohort study.

Objective:
To determine if age (younger than 65) and Medicare status affect patient outcomes following lumbar fusion.

Summary of Background Data:
Medicare is a common spine surgery insurance provider, but most qualifying patients are older than age 65. There is a paucity of literature investigating clinical outcomes for Medicare patients under the age of 65.

Materials and Methods:
Patients 40 years and older who underwent lumbar fusion surgery between 2014 and 2019 were queried from electronic medical records. Patients with >2 levels fused, >3 levels decompressed, incomplete patient-reported outcome measures (PROMs), revision procedures, and tumor/infection diagnosis were excluded. Patients were placed into 4 groups based on Medicare status and age: no Medicare under 65 years (NM<65), no Medicare 65 years or older (NM≥65), yes Medicare under 65 (YM<65), and yes Medicare 65 years or older (YM≥65). T tests and χ2 tests analyzed univariate comparisons depending on continuous or categorical type. Multivariate regression for ∆PROMs controlled for confounders. Alpha was set at 0.05.

Results:
Of the 1097 patients, 567 were NM<65 (51.7%), 133 were NM≥65 (12.1%), 42 were YM<65 (3.8%), and 355 were YM≥65 (32.4%). The YM<65 group had significantly worse preoperative Visual Analog Scale back (P=0.01) and preoperative and postoperative Oswestry Disability Index (ODI), Short-Form 12 Mental Component Score (MCS-12), and Physical Component Score (PCS-12). However, on regression analysis, there were no significant differences in ∆PROMs for YM <65 compared with YM≥65, and NM<65. NM<65 (compared with YM<65) was an independent predictor of decreased improvement in ∆ODI following surgery (β=12.61, P=0.007); however, overall the ODI was still lower in the NM<65 compared with the YM<65.

Conclusion:
Medicare patients younger than 65 years undergoing lumbar fusion had significantly worse preoperative and postoperative PROMs. The perioperative improvement in outcomes was similar between groups with the exception of ∆ODI, which demonstrated greater improvement in Medicare patients younger than 65 compared with non-Medicare patients younger than 65.

Level of evidence:
Level III (treatment).
The Importance of Sociocultural Factors in Moderating the Applicability of Test-Enhanced Learning to Continuing Professional Development
Authors: McConnell Meghan M. 
Published: June 2022

Abstract:
Many studies have shown that repeated testing promotes learning, an effect known as test-enhanced learning. Although test-enhanced learning has been well-established within health care trainees, there are mixed findings of whether testing facilitates learning within continuing professional development (CPD) contexts. This piece argues that for testing to support learning in CPD, there is need to understand the various social, cultural, and structural factors that influence clinicians' willingness to participate in regular testing activities. The solution to this problem is conceptual in nature, whereby CPD programs must consider how learning cultures shape practicing clinicians' perspectives toward testing.
Determining the Attitudes of Medicine Faculty Instructors Toward LGBT Individuals
Authors: Arslantas Inan , Gokdemir Ozden , Dagbagli Gamze , Mustan Kemal , Guldal Dilek 
Published: June 2022

Introduction:
It has been shown that lesbian, gay, bisexual, transgender (LGBT) patients are not able to receive the health care they need due to in part homophobia among health care providers. The aim of this study is to determine the attitudes toward LGBT people by medical school faculty members, the educators of the health care providers.

Methods:
The study was designed as cross-sectional, using the Hudson-Ricketts homophobia scale and a questionnaire prepared by the researchers and conducted in two different medical schools.

Results:
A medium level of homophobia was found among the faculty of medical schools. A greater tendency to homophobia was found in men, assistant professors, those working at the university smaller in size, and those think who believe that there is no discrimination against LGBT students.

Discussion:
Recognizing homophobic attitudes of medical faculty and lack of LGBT health issues in the medical curriculum are problems needing resolution.
Seeing Yourself Through the Learner's Eyes: Incorporating Smart Glasses Into Objective Structured Teaching Exercises for Faculty Development
Authors: Reed Trent , Wagner Sarah , Ozark Gregory , Chaidez Cynthia , Boyle Mary , Gruener Gregory 
Published: June 2022

Introduction:
Although physicians gain clinical knowledge in their specialty, it does not mean they receive adequate instruction to teach and provide feedback. Using smart glasses (SG) to provide educators with a first-person learner perspective has not been explored in faculty development such as Objective Structured Teaching Exercises (OSTEs).

Methods:
Integrated within a 6-session continuing medical education–bearing certificate course, this descriptive study involved one session where participants provided feedback to a standardized student in an OSTE. Participants were recorded by mounted wall cameras (MWCs) and SG. They received verbal feedback on their performance based on a self-designed assessment tool. Participants reviewed the recorded content and identified areas for improvement, completed a survey about their experience with SG, and wrote a narrative reflection.

Results:
Seventeen physicians at the assistant professor level participated in the session; data were analyzed on the 14 who had both MWC and SG recordings and who also completed the survey and reflection. All were comfortable with the standardized student wearing SG and indicated it did not affect communication. Eighty-five percent of the participants felt the SG provided additional feedback not available with the MWC, with majority noting additional feedback was related to eye contact, body language, voice inflection, and tone. Eighty-six percent see value in using SG for faculty development, and 79% felt that periodically using SG in their teaching would improve quality.

Conclusion:
Use of SG during an OSTE on giving feedback was a nondistracting and positive experience. SG provided affective feedback otherwise not perceived from a standard MWC.
A Patient Safety Champion Program for Interprofessional Health Care Educators: Implementation and Outcomes
Authors: Nowicki Mariko , Berg Benjamin W. , Okada Yuito , Yagi Machiko Saeki , Tomisawa Toshiko , Kawahara Chikako , Ouchi Gen , Moritoki Yuki , Otori Toru 
Published: June 2022

Introduction:
Health care educators are challenged with helping clinicians develop competencies beyond their foundational training. In health care systems where continuing professional development is not integral to practice, clinicians may have few opportunities. We describe the design, implementation, and evaluation of a professional development program in patient safety for Japanese clinical educators to acquire simulation instructional skills and become Patient Safety Champions at their organizations.

Methods:
Mixed methods were used in a longitudinal pre/post study design. The Kirkpatrick evaluation model was used to evaluate outcomes of a workshop, overall program, on-site training experiences, and impact as Patient Safety Champions. Self-assessment data on skills and knowledge of patient safety, simulation instructional methods, interprofessional collaboration, and leadership were collected and analyzed.

Results:
Eighty-nine percent of participants facilitated on-site patient safety training within 6 months of workshop completion. Skills and knowledge improvement were observed immediately postworkshop in four categories: patient safety, simulation instructional methods, interprofessional collaboration and communication, and leadership as a patient safety champion. Skills and knowledge increased at 6 months after facilitation of on-site safety training. Program mean satisfaction scores ranged from 84% to 92%. Mean Patient Safety Champion in-facility evaluations were 4.2 to 4.7 on a 5-point scale.

Discussion:
High levels of knowledge, skill retention, and behavior change are attributed to goal setting, outcome-oriented pedagogy, and reflective sessions. The Patient Safety Champion model and experiential learning approach gave Japanese clinical educators in medicine, nursing, and pharmacy an opportunity to learn from each other in simulations reflecting the practice environment.
Development and Validation of a Simple Method for Simultaneously Measuring the Concentrations of BCR-ABL and Bruton Tyrosine Kinase Inhibitors in Dried Blood Spot (DBS): A Pilot Study to Obtain Candidate Conversion Equations for Predicting Plasma Concentration Based on DBS Concentration
Authors: Mukai Yuji , Yoshida Tatsunari , Kondo Takeshi , Miura Jun , Inotsume Nobuo , Toda Takaki 
Published: June 2022

Background:
Dried blood spots (DBSs) are promising candidates for therapeutic drug monitoring. In this study, a simple method for the simultaneous measurement of tyrosine kinase inhibitors (TKIs), including bosutinib, dasatinib, ibrutinib, imatinib, nilotinib, and ponatinib, using DBS was developed and validated. The prediction of the plasma concentration of TKIs based on the TKI concentrations in the DBS was assessed using the developed measurement method.

Methods:
DBS was prepared using venous blood on Whatman 903 cards. One whole DBS sample containing the equivalent of 40 μL of blood was used for the analysis. The analytical method was validated according to the relevant guidelines. For clinical validation, 96 clinical samples were analyzed. The regression equation was derived from a weighted Deming regression analysis, and correction factors for calculating the estimated plasma concentrations (EPCs) of the analytes from their concentrations in the DBS and the predictive performance of EPC were evaluated using 2 conversion equations.

Results:
This method was successfully validated. Hematocrit had no significant effect on the method's accuracy or precision. Ibrutinib was stable in the DBS for up to 8 weeks at room temperature, whereas all BCR-ABL TKIs were stable for 12 weeks. All BCR-ABL TKIs exhibited similar predictive performance for EPCs using both calculation methods. Good agreement between EPCs and the measured plasma concentrations of bosutinib, imatinib, and ponatinib was observed with both conversion equations. However, Bland–Altman analysis showed that blood sampling time affected the EPC accuracy for dasatinib and nilotinib.

Conclusions:
A simple method for the simultaneous determination of BCR-ABL and Bruton TKI concentrations in DBS was developed and validated. Owing to the small clinical sample size, further clinical validation is needed to determine the predictive performance of EPCs for the 6 TKIs.