bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience
Authors: Bann Maralyssa , Larimore Savannah , Wheeler Jessica , Olsen Lauren D. 
Published: July 2022

PurposeFollowing shifts that broadened the medical profession’s conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.MethodIn-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.ResultsParticipants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.ConclusionsFindings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.
Patient-Reported Outcome Measurement Information System (PROMIS) Scores in Pediatric Idiopathic Toe Walkers
Authors: Lindsay Sarah E. , Bauer Jeremy , Bouton Daniel , Do Patrick , Woodmark Carly , Sienko Susan , Raney Ellen M. 
Published: July 2022

Background:
Idiopathic toe walking (ITW) can result in early contact with the health care system and be distressing for patients and their families. The natural history of ITW is poorly characterized. Deciding how and when to intervene can be difficult.
Patient-reported outcomes are utilized in the clinical setting to assess patient factors and indications that may better inform treatment plans. Patient-Reported Outcomes Measurement Information System (PROMIS) is an instrument designed to collect patient-reported outcomes. Minimum clinically important differences in PROMIS metrics have been established to facilitate clinical relevance and utility of these metrics. The purpose of this study was to characterize the patient perspective of ITW by utilizing the PROMIS scores.

Methods:
Retrospective chart review was performed to identify children aged 5 to 17 with a diagnosis of ITW treated at a single tertiary care center between 2017 and 2020. Inclusion criteria were a diagnosis of ITW and completion of a PROMIS questionnaire. Exclusion criteria were neurologic disease, autism, and previous surgical treatment. Demographic, physical exam, treatment, and available motion analysis data were collected. PROMIS scores for the following domains were available: Mobility, Peer Relationships, and Pain Interference.

Results:
Forty-five children were enrolled. Seventy-three percent of PROMIS scores were patient reported while the remainder were parent reported. PROMIS score means for the cohort by domain were Mobility: 45.2±8.2 (P<0.000); Peer Relationships: 46.4±11.6 (P=0.047); and Pain Interference: 47.4±9.5 (P=0.67). Motion analysis data, available for 11 children, noted age-matched gait velocity negatively correlated (r
s=−0.652, P=0.03) with Peer Relationships. No correlations were found between other aspects of gait, body mass index, or limitations in dorsiflexion and PROMIS domains. Parents reported lower Mobility scores than children did. There were no other significant differences between patient-reported and parent-reported PROMIS scores. PROMIS scores did not differ significantly between those <10 years and those ≥10 years.

Conclusion:
In this cohort of 45 otherwise healthy children without other neurologic diagnoses, there are both clinically and statistically significant differences in PROMIS means between our cohort and the healthy age-matched population. These differences manifested in worse peer relationships and mobility scores.

Level of Evidence:
Level IV.
Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion
Authors: Karamian Brian A. , Mao Jennifer , Toci Gregory R. , Lambrechts Mark J. , Canseco Jose A. , Qureshi Mahir A. , Silveri Olivia , Minetos Paul D. , Jallo Jack I. , Prasad Srinivas , Heller Joshua E. , Sharan Ashwini D. , Harrop James S. , Woods Barrett I. , Kaye Ian David , Hilibrand Alan , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D. 
Published: July 2022

Study Design.
Retrospective case-control study.

Objective.
To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion.

Summary of Background Data.
SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs.

Materials and Methods.
A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05.

Results.
A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P<0.001) and revision surgery (28.6% vs. 12.4%, P=0.048). Both groups improved significantly in Physical Component Score (control: P=0.013, SSI: P=0.039), Oswestry Disability Index (control: P<0.001, SSI: P=0.001), Visual Analog Scale (VAS) Back (both, P<0.001), and VAS Leg (control: P<0.001, SSI: P=0.030). Only the control group improved in Mental Component Score (P<0.001 vs. SSI: P=0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 (P=0.455) on regression analysis. VAS Leg improved significantly less in the infection group (−1.87 vs. −3.59, P=0.039), which was not significant after regression analysis (β=1.75, P=0.050).

Conclusion.
Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.
Discharge readiness after remimazolam versus propofol for colonoscopy
Authors: Yao Yusheng , Guan Jinsheng , Liu Linwei , Fu Bingbing , Chen Lei , Zheng Xiaochun 
Published: July 2022

BACKGROUND
Remimazolam is an ultrashort-acting benzodiazepine that is potentially a practical option for procedural sedation in colonoscopy.

OBJECTIVE
To test the hypothesis that remimazolam could provide a noninferior discharge time to propofol for ambulatory colonoscopy.

DESIGN
A prospective, randomised, double-blind, noninferiority clinical trial.

SETTING
Ambulatory endoscopy centre.

PATIENTS
A total of 132 adult participants undergoing ambulatory colonoscopy were enrolled.

INTERVENTIONS
Participants were randomly assigned in a 1 : 1 ratio to receive propofol or remimazolam for sedation.

MAIN OUTCOME MEASURES
The primary outcome was discharge time after a colonoscopy, assessed using the Modified Postanaesthetic Discharge Scoring System scale. Secondary outcomes included induction time, emergence time, the extent of recovery upon arrival in the postanaethesia care unit, fatigue, endoscopist and patient satisfaction and adverse events.

RESULTS
The median discharge time was 24 min in the remimazolam group versus 21 min in the propofol group, with a difference of 2 min [95% confidence interval (CI), 0 to 4 min], meeting the criteria for noninferiority. Injection pain occurred in 11 of 66 (17%) participants receiving remimazolam versus 32 of 66 (49%) participants receiving propofol (P < 0.001); hypotension occurrence was 20% versus 47%, (P < 0.001), respectively, and bradycardia 6% versus 20%, (P = 0.019), respectively. Compared with propofol, the patient satisfaction score was higher in the remimazolam group (P < 0.001).

CONCLUSION
For sedation in ambulatory colonoscopy, compared with propofol, remimazolam provides a noninferior discharge time. Furthermore, remimazolam is associated with less injection pain, lower risks of hypotension and bradycardia, and improved patient satisfaction.

TRIAL REGISTRATION
Chinese Clinical Trial Registry, identifier: ChiCTR2100048678.
Biochemical Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors by Cardiovascular Risk Profile and Volume Status in a Real-World Diabetic Population
Authors: Gitto Mauro , Kotinas Alexios S. , Terzi Riccardo , Oliva Angelo , Zagoreo Jorgele , Reimers Bernhard , Stefanini Giulio G. , Mirani Marco , Favacchio Giuseppe , Condorelli Gianluigi , Panico Cristina 
Published: July 2022

Abstract:
Despite large-scale randomized clinical trials (RCTs) highlighting a consistent prognostic benefit of sodium–glucose cotransporter 2 inhibitors (SGLT2is) both in diabetic patients at high cardiovascular risk and in those with heart failure, there is relative paucity of data on their biochemical effects in a real-world setting. We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral center and completed at least 1 year of treatment. Changes in glycated hemoglobin, weight, and hematocrit were compared across 2 cardiovascular risk categories, defined through the inclusion criteria of 3 large RCTs. Of the 459 patients screened, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%), and 55 were lost to follow-up (12.0%). The most common cause of drug discontinuation was genital or urinary tract infections (9.4%). At 1 year, reduction in glycated hemoglobin concentration (−0.7 ± 1.5%, P < 0.001) and body weight (2.4 ± 4.6 kg, P < 0.001) was comparable between patients at high versus low cardiovascular risk, while hematocrit increase (2.3 ± 3.3%, P < 0.001) was more marked in patients with high cardiovascular risk and low baseline hematocrit. In a real-world population of diabetic patients, SGLT2is were well-tolerated at 1 year and led to improved glycemic control and weight loss. Hematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating euvolemic restoration as a potential cardioprotective mechanism mediated by these compounds.
Modulation of Mitochondrial Respiration During Early Reperfusion Reduces Cardiac Injury in Donation After Circulatory Death Hearts
Authors: Akande Oluwatoyin , Chen Qun , Cholyway Renee , Toldo Stefano , Lesnefsky Edward J. , Quader Mohammed 
Published: July 2022

Abstract:
Donation after circulatory death (DCD) donors are a potential source for heart transplantation. The DCD process has unavoidable ischemia and reperfusion (I/R) injury, primarily mediated through mitochondria, which limits routine utilization of hearts for transplantation. Amobarbital (AMO), a transient inhibitor of the electron transport chain, is known to decrease cardiac injury following ex vivo I/R. We studied whether AMO treatment during reperfusion can decrease injury in DCD hearts. Sprague Dawley rat hearts subjected to 25 minutes of in vivo ischemia (DCD hearts), or control beating donor hearts, were treated with AMO or vehicle for the first 5 minutes of reperfusion, followed by Krebs–Henseleit buffer reperfusion for 55 minutes (for mitochondrial isolation) or 85 minutes (for infarct size determination). Compared with vehicle, AMO treatment led to decreased infarct size (25.2% ± 1.5% vs. 31.5% ± 1.5%; P ≤ 0.05) and troponin I release (4.5 ± 0.05 ng/mL vs. 9.3 ± 0.24 ng/mL, P ≤ 0.05). AMO treatment decreased H2O2 generation with glutamate as complex I substrate in both subsarcolemmal mitochondria (SSM) (37 ± 3.7 pmol·mg−1·min−1 vs. 56.9 ± 4.1 pmol·mg−1·min−1; P ≤ 0.05), and interfibrillar mitochondria (IFM) (31.8 ± 2.8 pmol·mg−1·min−1 vs. 46 ± 4.8 pmol·mg−1·min−1; P ≤ 0.05) and improved calcium retention capacity in SSM (360 ±17.2 nmol/mg vs. 277 ± 13 nmol/mg; P ≤ 0.05), and IFM (483 ± 20 nmol/mg vs. 377± 19 nmol/mg; P ≤ 0.05) compared with vehicle treatment. SSM and IFM retained more cytochrome c with AMO treatment compared with vehicle. In conclusion, brief inhibition of mitochondrial respiration during reperfusion using amobarbital is a promising approach to decrease injury in DCD hearts.
Association of plant-based diet and early onset of natural menopause
Authors: Grisotto Giorgia , Langton Christine R. , Li Yanping , Bertone-Johnson Elizabeth R. , Baden Megu Y. , Franco Oscar H. , Hu Frank B. , Muka Taulant , Eliassen A. Heather 
Published: July 2022

Abstract

Objective
To evaluate the association of plant-based diet index (PDI) with early onset of natural menopause in the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII).

Methods
We conducted a prospective study with a mean follow-up time of 20 years among premenopausal women living across the US. Participants of the NHS (n = 121,701) and NHSII (n = 116,429) were included from 1984 (age mean [standard deviation]; 44.9 [4.3]) and 1991 (age mean [standard deviation]; 36.4 [4.6]), respectively. Early menopause was self-reported and defined as natural menopause before age 45 years. PDI was derived from semiquantitative food frequency questionnaires administered every 4 years. Cox proportional hazards models were used to assess the association between PDI in quintiles and early menopause in NHS and NHSII separately, and fixed-effect models to pool the results from both cohorts.

Results
During follow-up, 715 and 2,185 women experienced early natural menopause in NHS and NHSII, respectively. After adjustment for potential confounders, no association was observed between PDI and incidence of early natural menopause in either cohort, or when pooling the results from both cohorts, with an exception for unhealthy plant-based diet index which was associated with higher risk of early menopause with increasing levels of consumption (P trend = 0.04).

Conclusion
Adherence to PDI was not associated with timing of menopause while unhealthy plant-based diet might be associated with higher risk of experiencing early menopause.
Risk of high depressive symptoms after the final menstrual period: the Study of Women’s Health Across the Nation (SWAN)
Authors: Kravitz Howard M. , Colvin Alicia B. , Avis Nancy E. , Joffe Hadine , Chen Yuqing , Bromberger Joyce T. 
Published: July 2022

Abstract

Objective
To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms.

Methods
Longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women’s Health Across the Nation for a median follow-up of 19.0 years. Latent class growth analysis identified depression trajectories from baseline to FMP. Multivariable random effects (woman as random effect) linear or logistic regression models were conducted.

Results
Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal. Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores. Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores. Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support.

Conclusions
Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms. Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors.
Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation
Authors: Hughes Joel W. , Kuhn Tyler A. , Ede David , Gathright Emily C. , Josephson Richard A. 
Published: July 2022

Purpose:
Many patients exhibit clinically significant depression upon enrollment in cardiac rehabilitation (CR). Antidepressants are a first-line treatment option for depression, but the effectiveness of antidepressants in patients with heart disease is mixed. The purpose of this meta-analysis was to evaluate the efficacy of antidepressants for depression in patients eligible for CR.

Methods:
A meta-analysis was conducted including randomized controlled trials of antidepressants from January 1990 to September 2021 that compared antidepressants with placebo. Random-effects models were used between group effect sizes (Hedges' g).

Results:
A total of 13 trials with predominately White (68% ± 12; n =7) male (70% ± 11) samples averaging 61 ± 5 yr compared antidepressants (1128 participants) with placebo (1079 participants). Antidepressants reduced depressive symptoms (g = 0.17: 95% CI, 0.08-0.27), but the effect was small. Heterogeneity among study effects was low (I
2 = 6.42) and nonsignificant (Q = 10.75, P = .46), although patients with heart failure (g
HF = 0.05: 95% CI, -0.09 to 0.18) demonstrated smaller effects compared with patients with other cardiovascular disease conditions (gnon-HF = 0.22: 95% CI, 0.11-0.32) (Q
B [1] = 3.97; P < .05). No study reported safety concerns associated with antidepressants.

Summary:
The effect size of antidepressant pharmacotherapy in this population is small. No trials reported on the combined effects of exercise and pharmacotherapy. If the patient is not suicidal, CR staff may consider patient preference and refer patients for additional treatment as necessary.
SCLERAL SUTURE FIXATION FOR DISLOCATED SILICONE PLATE HAPTIC INTRAOCULAR LENS
Authors: Smiddy William E. 
Published: July 2022

Purpose:
To describe results in two cases of a dislocated silicone plate haptic intraocular lens managed with vitrectomy and repositioning with scleral suture fixation.

Methods:
Small case series.

Results:
Two patients presenting with dislocated silicone plate haptic intraocular lens underwent a 23-gauge vitrectomy with a “handshake” maneuver to pass a 9-0 prolene suture through the positioning holes to allow scleral fixation. Best-corrected visual acuity was returned to predislocation Level 2 and 8 months after the vitrectomy.

Conclusion:
Silicone plate haptic intraocular lens can be managed with scleral suture fixation using this adapted technique, avoiding removal and exchange techniques. These are the first reported cases of silicone plate haptic intraocular lens managed with scleral suture repositioning.
Preliminary Evaluation of a Novel Point of Care Diagnostic Device for Sports-Related Concussion
Authors: Wu Yueming , Abner Erin L. , Conley Caitlin , Smoot M. Kyle , Hosey Robert , Kaiser Kim , Lovell Mark A. 
Published: July 2022

Objective:
Visinin-like protein 1 (VILIP-1) is a neuron-specific calcium sensor protein rapidly released into blood after mild traumatic brain injury (mTBI) and may be a suitable biomarker for identification of sports-related concussion (SRC). The objective of the study is to test if quantification of a specific post-translationally modified (ubiquitinated) form of VILIP-1 (ubVILIP-1) from a fingerstick blood sample using a point of care (POC) lateral flow device (LFD) can be used to rapidly identify athletes with SRC.

Design:
Prospective cohort study.

Setting:
Side-line blood collection at football, soccer, and volleyball games/practices.

Participants:
Division I athletes with/without SRC.

Main Outcome Measures:
Blood ubVILIP-1 concentrations.

Results:
Data collected over 2 athletic seasons from non-SRC athletes (controls) show a small but statistically significant elevation of ubVILIP-1 over an individual season for male athletes (P = 0.02) dependent on sport (P = 0.014) and no significant changes in ubVILIP-1 levels between seasons. For SRC athletes, the data show ubVILIP-1 levels substantially increase above baseline as soon as 30 minutes postdiagnosis with peak concentrations and times postinjury that vary based on injury severity.

Conclusion:
Results of the study suggest quantification of blood ubVILIP-1 levels measured using an LFD may provide an objective identification of athletes with SRC, setting the stage for further study with a larger number of SRC patients.
Zoomers: videoconferencing, appearance concerns, and potential effects on adolescents
Authors: Hart Laura M. , Mitchison Deborah , Fardouly Jasmine , Krug Isabel 
Published: July 2022

Purpose of review
The cessation of in-person teaching to reduce the spread of COVID-19 dramatically increased the use of videoconferencing for home learning among adolescents.

Recent findings
A consistent finding across studies assessing the relationship between videoconferencing and appearance concerns was that time spent focused on self-view was related to greater appearance concerns. Videoconferencing was associated with an increase in desire for cosmetic surgery and other nonsurgical treatments. Among those at risk of eating disorders, videoconferencing was associated with more appearance-management behaviours and less engagement in the video call. Research to date has been correlational and predominantly involved White, adult women in the USA and in Australia, leaving important gaps in our knowledge, especially around impacts on adolescents.

Summary
Given their vulnerability to appearance concerns, we encourage practitioners to speak to adolescents about their use of videoconferencing and how they can migitate the potential negative impacts on body image.