bluuebunny/crossref_metadata_2025 huggingface dataset:
What Behaviors Define a Good Physician? Assessing and Communicating About Noncognitive Skills
Authors: Warm Eric J. , Kinnear Benjamin , Lance Samuel , Schauer Daniel P. , Brenner Judith
Published: June 2021

Once medical students attain a certain level of medical knowledge, success in residency often depends on noncognitive attributes, such as conscientiousness, empathy, and grit. These traits are significantly more difficult to assess than cognitive performance, creating a potential gap in measurement. Despite its promise, competency-based medical education (CBME) has yet to bridge this gap, partly due to a lack of well-defined noncognitive observable behaviors that assessors and educators can use in formative and summative assessment. As a result, typical undergraduate to graduate medical education handovers stress standardized test scores, and program directors trust little of the remaining information they receive, sometimes turning to third-party companies to better describe potential residency candidates. The authors have created a list of noncognitive attributes, with associated definitions and noncognitive skills—called observable practice activities (OPAs)—written for learners across the continuum to help educators collect assessment data that can be turned into valuable information. OPAs are discrete work-based assessment elements collected over time and mapped to larger structures, such as milestones, entrustable professional activities, or competencies, to create learning trajectories for formative and summative decisions. Medical schools and graduate medical education programs could adapt these OPAs or determine ways to create new ones specific to their own contexts. Once OPAs are created, programs will have to find effective ways to assess them, interpret the data, determine consequence validity, and communicate information to learners and institutions. The authors discuss the need for culture change surrounding assessment—even for the adoption of behavior-based tools such as OPAs—including grounding the work in a growth mindset and the broad underpinnings of CBME. Ultimately, improving assessment of noncognitive capacity should benefit learners, schools, programs, and most importantly, patients.
The Dissolution of the Step 2 Clinical Skills Examination and the Duty of Medical Educators to Step Up the Effectiveness of Clinical Skills Assessment
Authors: Kogan Jennifer R. , Hauer Karen E. , Holmboe Eric S.
Published: June 2021

In this Invited Commentary, the authors explore the implications of the dissolution of the Step 2 Clinical Skills Examination (Step 2 CS) for medical student clinical skills assessment. The authors describe the need for medical educators (at both the undergraduate and graduate levels) to work collaboratively to improve medical student clinical skills assessment to assure the public that medical school graduates have the requisite skills to begin residency training. The authors outline 6 specific recommendations for how to capitalize on the discontinuation of Step 2 CS to improve clinical skills assessment: (1) defining national, end-of-clerkship, and transition-to-residency standards for required clinical skills and for levels of competence; (2) creating a national resource for standardized patient, augmented reality, and virtual reality assessments; (3) improving workplace-based assessment through local collaborations and national resources; (4) improving learner engagement in and coproduction of assessments; (5) requiring, as a new standard for accreditation, medical schools to establish and maintain competency committees; and (6) establishing a national registry of assessment data for research and evaluation. Together, these actions will help the medical education community earn the public’s trust by enhancing the rigor of assessment to ensure the mastery of skills that are essential to providing safe, high-quality care for patients.
Discontinuation of the USMLE Step 2 Clinical Skills Examination: Studying the Past to Define the Future
Authors: Howley Lisa D. , Engle Deborah L.
Published: June 2021

The United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) was discontinued in January 2021, marking a significant milestone in assessment of clinical skills. In this commentary, the authors trace the history of the Step 2 CS exam—beginning with its early roots in the 1960s up to its discontinuation in 2021. In this new era, the medical education community is replete with opportunities for advancing methodology and content associated with clinical skills assessment. The authors propose 3 main lessons gleaned from this rich history and modern evolution, which are aimed at defining a future that includes creative collaboration toward development of comprehensive, equitable, student-focused, and patient-centered clinical performance assessment.

First, as it has done throughout history, the medical education community should continue to innovate, collaborate, and improve upon methods of clinical skills assessment. Second, medical educators should continue to shift to more complex and student-driven approaches of assessment, that is, assessments that provide an unstructured environment, are realistic with respect to the natural conditions, and do not limit students to lists of options or force them to take a certain path of reasoning. Third, medical educators should continue to rethink the role of assessment and ensure that all assessments, regardless of stakes or type, provide sufficient feedback for the student to identify areas of strength and weakness.
Clinical Characteristics and Histologic Features of Hysterectomy Specimens From Transmasculine Individuals
Authors: Cao Connie D. , Amero Molly A. , Marcinkowski Katrina A. , Rosenblum Norman G. , Chan Joanna S. Y. , Richard Scott D.
Published: June 2021

OBJECTIVE:

To describe the clinical characteristics of transmasculine individuals who underwent hysterectomy and characterize surgical pathology findings.

METHODS:

Under an institutional review board-approved protocol, transmasculine individuals who were undergoing hysterectomy and bilateral salpingectomy or bilateral salpingo-oophorectomy were retrospectively identified from a single institution. Past medical, surgical, obstetric, and gynecologic history were collected, including prior testosterone use, cervical cancer screening status, and preoperative pelvic imaging. Surgical pathologic findings of the endometrium, ovaries, and cervix were collected.

RESULTS:

A total of 72 individuals were included. The median age was 30 years (range 19–51). The majority of patients had private insurance (n=53, 74%) and were on testosterone at time of the preoperative visit (n=63, 88%). Forty-two patients (58%) reported anxiety, depression, or bipolar disorder, and 34 patients (47%) were taking an antidepressant or mood stabilizer. Of the 68 patients eligible for cervical cancer screening, 33 (49%) were up to date before their surgical consultation visits. Pelvic pain was the leading indication for surgery (n=65, 90%), and 29 patients (40%) had multiple listed indications for surgery. Surgical pathology results included cervical intraepithelial neoplasia 2–3 in three patients (4%), endometrial or cervical atrophy in 13 patients (18%), and ovarian or paratubal cysts in 16 patients (22%).

CONCLUSION:

This study describes the distinct clinical characteristics and surgical pathology findings that health care professionals should consider when caring for this unique patient population, including a relatively high rate of mental health conditions, pelvic pain as the leading indication for surgery, and the presence of endometrial or cervical atrophy and ovarian or paratubal cysts on surgical pathology.
Pregnancy Outcomes Associated With a Single Elevated Blood Pressure Before 20 Weeks of Gestation
Authors: Duffy Jennifer Y. , Getahun Darios , Chen Qiaoling , Fong Alex
Published: June 2021

OBJECTIVE:

To evaluate maternal and fetal outcomes among women with a single elevated blood pressure before 20 weeks of gestation.

METHODS:

We conducted a retrospective cohort study of women who delivered at Kaiser Permanente Southern California hospitals between January 1, 2008, and December 31, 2019. Participants were divided into two groups: normotensive (all systolic blood pressures lower than 130 mm Hg and diastolic pressures lower than 80 mm Hg) compared with single elevated blood pressure (single systolic pressure 130 mm Hg or higher, diastolic pressure 80 mm Hg or higher, or both). Women with chronic hypertension were excluded. Maternal comorbidities and maternal and neonatal outcomes were extracted from electronic health records using International Classification of Diseases codes. Adjusted odds ratios (aORs) derived from logistic regression were used to describe the magnitude of association.

RESULTS:

Of 303,689 women who delivered during the study period, 23% had a single elevated blood pressure. Rates of hypertensive disorders of pregnancy differed between the two groups (10.6% for single elevated blood pressure, 4.5% for normotensive group; aOR 2.06, 95% CI 2.00–2.13), as did iatrogenic preterm delivery (3.7% vs 2.7%, respectively; aOR 1.27, 95% CI 1.21–1.33).

DISCUSSION:

Women with a single elevated blood pressure before 20 weeks of gestation are at increased risk for hypertensive disorders of pregnancy and iatrogenic preterm delivery.
Management of Cervical Ectopic Pregnancies
Authors: Fowler Mary Louise , Wang Dongyu , Chia Victoria , Handal-Orefice Roxane , Latortue-Albino Paula , Mulekar Sujata , White Katharine , Perkins Rebecca
Published: June 2021

OBJECTIVE:

To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics.

METHODS:

PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown–rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy.

RESULTS:

A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64–10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06–11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14–23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy.

CONCLUSIONS:

Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.
Effects of a Resident's Reputation on Laparoscopic Skills Assessment
Authors: Tannenbaum Evan , Walker Melissa , Sullivan Heather , Huszti Ella , Farrugia Michele , Sobel Mara
Published: June 2021

OBJECTIVE:

To quantify the effect of a resident's reputation on the assessment of their laparoscopic skills.

METHODS:

Faculty gynecologists were randomized to receive one of three hypothetical resident scenarios: a resident with high, average, or low surgical skills. All participants were then asked to view the same video of a resident performing a laparoscopic salpingo-oophorectomy that differed only by the resident description and provide an assessment using a modified OSATS (Objective Structured Assessment of Technical Skills) and a global assessment scale.

RESULTS:

From September 6, 2020, to October 20, 2020, a total of 43 faculty gynecologic surgeons were recruited to complete the study. Assessment scores on the modified OSATS (out of 20) and global assessment (out of 5) differed significantly according to resident description, where the high-performing resident scored highest (median scores of 15 and 4, respectively), followed by the average-performing resident (13 and 3), and finally, the low-performing resident (11 and 3) (P=.008 and .043, respectively).

CONCLUSION:

Faculty assessment of residents in gynecologic surgery is influenced by the assessor's knowledge of the resident's past performance. This knowledge introduces bias that artificially increases scores given to those residents with favorable reputations and decreases scores given to those with reputed surgical skill deficits. These data quantify the effect of such bias in the assessment of residents in the workplace and serve as an impetus to explore systems-level interventions to mitigate bias.
Adverse Birth Outcomes Associated With Prepregnancy and Prenatal Electronic Cigarette Use
Authors: Regan Annette K. , Bombard Jennifer M. , O’Hegarty Michelle M. , Smith Ruben A. , Tong Van T.
Published: June 2021

OBJECTIVE:

To evaluate the risk of adverse birth outcomes among adults who use electronic cigarettes (e-cigarettes) before and during pregnancy.

METHODS:

Data from the 2016–2018 PRAMS (Pregnancy Risk Assessment Monitoring System) were used to assess the association between e-cigarette use during the 3 months before and last 3 months of pregnancy among 79,176 individuals with a recent live birth and the following birth outcomes: preterm birth, small for gestational age, and low birth weight (LBW). Adjusted prevalence ratios were generated using average marginal predictions from multivariable logistic regression models. Models were stratified by prenatal combustible cigarette smoking and frequency of e-cigarette use (daily or less than daily use).

RESULTS:

In the 3 months before pregnancy, 2.7% (95% CI 2.6–2.9%) of respondents used e-cigarettes; 1.1% (95% CI 1.0–1.2%) used e-cigarettes during the last 3 months of pregnancy. Electronic cigarette use before pregnancy was not associated with adverse birth outcomes. Electronic cigarette use during pregnancy was associated with increased prevalence of LBW compared with nonuse (8.1% vs 6.1%; adjusted prevalence ratio 1.33; 95% CI 1.06–1.66). Among respondents who did not also smoke combustible cigarettes during pregnancy (n=72,256), e-cigarette use was associated with higher prevalence of LBW (10.6%; adjusted prevalence ratio 1.88; 95% CI 1.38–2.57) and preterm birth (12.4%; adjusted prevalence ratio 1.69; 95% CI 1.20–2.39). When further stratified by frequency of e-cigarette use, associations were seen only for daily users.

CONCLUSION:

E-cigarette use during pregnancy, particularly when used daily by individuals who do not also smoke combustible cigarettes, is associated with adverse birth outcomes.
Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception
Authors: BakenRa Abena , Gero Alexandra , Sanders Jessica , Simmons Rebecca , Fay Kathryn , Turok David K.
Published: June 2021

OBJECTIVE:

To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days.

METHODS:

This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before).

RESULTS:

Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0–1.3%) or with any unprotected intercourse episode 6–14 days before IUD placement (0.0%, 97.5% CI 0.0–3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI −0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI −0.2% to 0.5%).

CONCLUSION:

With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days.

Clinical Trial Registration:

ClinicalTrials.gov, NCT02175030.
Prospective Validation of the Preschool Confusion Assessment Method for the ICU to Screen for Delirium in Infants Less Than 6 Months Old
Authors: Canter Marguerite O. , Tanguturi Yasas C. , Ellen Wilson Jo , Williams Stacey R. , Exum Sylvia A. , Umrania Hiren M. , Betters Kristina A. , Raman Rameela , Ely E. Wesley , Pandharipande Pratik P. , Fuchs D. Catherine , Smith Heidi A. B.
Published: June 2021

OBJECTIVES:

ICU delirium is a predictor of greater morbidity and higher mortality in the pediatric population. The diagnostic obstacles and validity of delirium monitoring among neonates and young infants have yet to be fully delineated. We sought to validate the Preschool Confusion Assessment Method for the ICU in neonates and young infants and determine delirium prevalence in this young population.

DESIGN:

Prospective cohort study to validate the Preschool Confusion Assessment Method for the ICU for the assessment of ICU delirium in neonates and young infants compared with the reference standard, Child and Adolescent Psychiatry.

SETTING:

Tertiary medical center PICU, including medical, surgical, and cardiac patients.

PARTICIPANTS:

Infants less than 6 months old admitted to the PICU regardless of admission diagnosis.

MEASUREMENTS AND MAIN RESULTS:

We enrolled 49 patients with a median age of 1.8 months (interquartile range, 0.7–4.1 mo), 82% requiring mechanical ventilation. Enrolled patients were assessed for delirium in blinded-fashion by the research team using the Preschool Confusion Assessment Method for the ICU and independently assessed by the psychiatry reference rater using Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A total of 189 paired assessments were completed, and the Preschool Confusion Assessment Method for the ICU performed with a sensitivity of 95% (95% CI, 89–100%), specificity of 81% (68–90%), “negative and positive predictive values” of 97% (94–100%) and 69% (55–79%), respectively, compared with the reference rater. Delirium prevalence was 47%, with higher rates of 61% observed among neonates (< 1 mo old) and 39% among infants 1–6 months old.

CONCLUSIONS:

The Preschool Confusion Assessment Method for the ICU is a valid screening tool for delirium monitoring in infants less than 6 months old. Delirium screening was feasible in this population despite evolving neurocognition and arousal architecture. ICU delirium was prevalent among infants. The consequence of acute brain dysfunction during crucial neurocognitive development remains unclear. Future studies are necessary to determine the long-term impact of ICU delirium and strategies to reduce associated harm in critically ill infants.
Long-Term Functional Outcome and Quality of Life Following In-Hospital Cardiac Arrest—A Longitudinal Cohort Study
Authors: Pound Gemma M. , Jones Daryl , Eastwood Glenn M. , Paul Eldho , Hodgson Carol L. ,   The Australia and New Zealand Cardiac Arrest Outcome and Determinants of ECMO (ANZ-CODE) Investigators
Published: June 2021

Objectives:

To evaluate the functional outcome and health-related quality of life of in-hospital cardiac arrest survivors at 6 and 12 months.

Design:

A longitudinal cohort study.

Setting:

Seven metropolitan hospitals in Australia.

Patients:

Data were collected for hospitalized adults (≥ 18 yr) who experienced in-hospital cardiac arrest, defined as “a period of unresponsiveness, with no observed respiratory effort and the commencement of external cardiac compressions.”

Interventions:

None.

Measurements and Main Results:

Prior to hospital discharge, patients were approached for consent to participate in 6-month and 12-month telephone interviews. Outcomes included the modified Rankin Scale, Barthel Index, Euro-Quality of Life 5 Dimension 5 Level, return to work and hospital readmissions. Forty-eight patients (80%) consented to follow-up interviews. The mean age of participants was 67.2 (± 15.3) years, and 33 of 48 (68.8%) were male. Good functional outcome (modified Rankin Scale score ≤ 3) was reported by 31 of 37 participants (83.8%) at 6 months and 30 of 33 (90.9%) at 12 months. The median Euro-Quality of Life-5D index value was 0.73 (0.33–0.84) at 6 months and 0.76 (0.47–0.88) at 12 months. The median Euro-Quality of Life-Visual Analogue Scale score at 6 months was 70 (55–80) and 75 (50–87.5) at 12 months. Problems in all Euro-Quality of Life-5D-5 L dimension were reported frequently at both time points. Hospital readmission was reported by 23 of 37 patients (62.2%) at 6 months and 16 of 33 (48.5%) at 12 months. Less than half of previously working participants had returned to work by 12 months.

Conclusions:

The majority of in-hospital cardiac arrest survivors had a good functional outcome and health-related quality of life at 6 months, and this was largely unchanged at 12 months. Despite this, many reported problems with mobility, self-care, usual activities, pain, and anxiety/depression. Return to work rates was low, and hospital readmissions were common.
A Novel 29-Messenger RNA Host-Response Assay From Whole Blood Accurately Identifies Bacterial and Viral Infections in Patients Presenting to the Emergency Department With Suspected Infections: A Prospective Observational Study*
Authors: Bauer Wolfgang , Kappert Kai , Galtung Noa , Lehmann Dana , Wacker James , Cheng Henry K. , Liesenfeld Oliver , Buturovic Ljubomir , Luethy Roland , Sweeney Timothy E. , Tauber Rudolf , Somasundaram Rajan
Published: June 2021

OBJECTIVES:

The rapid diagnosis of acute infections and sepsis remains a serious challenge. As a result of limitations in current diagnostics, guidelines recommend early antimicrobials for suspected sepsis patients to improve outcomes at a cost to antimicrobial stewardship. We aimed to develop and prospectively validate a new, 29-messenger RNA blood-based host-response classifier Inflammatix Bacterial Viral Non-Infected version 2 (IMX-BVN-2) to determine the likelihood of bacterial and viral infections.

DESIGN:

Prospective observational study.

SETTING:

Emergency Department, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Germany.

PATIENTS:

Three hundred twelve adult patients presenting to the emergency department with suspected acute infections or sepsis with at least one vital sign change.

INTERVENTIONS:

None (observational study only).

MEASUREMENTS AND MAIN RESULTS:

Gene expression levels from extracted whole blood RNA was quantified on a NanoString nCounter SPRINT (NanoString Technologies, Seattle, WA). Two predicted probability scores for the presence of bacterial and viral infection were calculated using the IMX-BVN-2 neural network classifier, which was trained on an independent development set. The IMX-BVN-2 bacterial score showed an area under the receiver operating curve for adjudicated bacterial versus ruled out bacterial infection of 0.90 (95% CI, 0.85–0.95) compared with 0.89 (95% CI, 0.84–0.94) for procalcitonin with procalcitonin being used in the adjudication. The IMX-BVN-2 viral score area under the receiver operating curve for adjudicated versus ruled out viral infection was 0.83 (95% CI, 0.77–0.89).

CONCLUSIONS:

IMX-BVN-2 demonstrated accuracy for detecting both viral infections and bacterial infections. This shows the potential of host-response tests as a novel and practical approach for determining the causes of infections, which could improve patient outcomes while upholding antimicrobial stewardship.
Role of IVIG in the Treatment of Autoimmune Conditions With Concurrent Immune Checkpoint Inhibitors for Metastatic Cancer
Authors: Punekar Salman Rafi , Castillo Rochelle , Sandigursky Sabina , Cho Daniel Chang
Published: June 2021

Immune checkpoint inhibitors (ICIs) are a class of medications targeting mostly the PD-1/PD-L1 and CTLA-4 immune pathways in the treatment of many cancers. Despite the encouraging success of ICIs, they are associated with immune-related adverse events as well as exacerbation of underlying autoimmune conditions. The treatment of these conditions often involves discontinuation of ICI in addition to the utilization of immunomodulatory agents. In this report, we discuss a case in which a patient with metastatic renal cell carcinoma experienced exacerbation of underlying paraneoplastic dermatomyositis after treatment with ICI. He was successfully continued on ICI with the use of intravenous immunoglobulin. The patient experienced adequate control of his myositis but also experienced deepening of his antitumor response.
Incidence of the “Adrenaline Rush” and Vasovagal Response with Local Anesthetic Injection
Authors: Greene Bradley H. C. , Lalonde Donald H. , Seal Shane K. F.
Published: June 2021

Background:

Many patients feel an “adrenaline rush” or a vasovagal reaction when injected with lidocaine and epinephrine during wide awake surgery. The incidence of these reactions is not well documented in the literature.

Methods:

In total, 387 patients were prospectively injected with lidocaine and epinephrine for minor procedures without sedation between July 1, 2019 and November 1, 2020. A concentration of epinephrine with 1:100,000 in 2% lidocaine was injected, with most patients getting less than 20 mL of volume.

Results:

Eight (2.2%) of the patients had adrenaline rush symptoms, which included nervousness, anxiety, tremors, shaky feelings, flushing, diaphoresis, light-headedness, tingling, and “heart racing.” Seven patients (1.8%) experienced vasovagal responses, which included nausea, a feeling of being unwell, faint, or lightheaded, or had circumoral pallor.

Conclusions:

Patients run a low risk of feeling an adrenaline rush or vasovagal reaction when injected with lidocaine and epinephrine. Routinely advising patients that the adrenaline rush can happen, and that this is not an allergic reaction can be helpful to allay fear of the unknown and to prevent false allergy beliefs. Injecting patients lying down may decrease the incidence of vasovagal reactions by increasing cerebral blood flow with the advantage of gravity.
Effect of COVID-19 on Geographic Distribution of the Integrated Plastic Surgery Match
Authors: Om Anjali , Losken Albert
Published: June 2021

Background:

COVID-19 had significant impact on the 2021 integrated plastic surgery match, most notably through cancellation of away rotations and virtual interviews. While previous studies have analyzed geographic outcomes of the match in prior years, the effects of COVID-19 have not been determined. This study aims to contribute 2021 match data to determine the effects of COVID-19 on the geographic distribution of the integrated plastic surgery match.

Methods:

Official match results for each program were populated by searching official program institutional websites and social media pages. Trainees’ home medical institutions and current integrated plastic surgery residency programs were noted. Statistical analysis compared geographic distribution in COVID-19 affected (2021) and non-COVID-19 affected (2015-2020) match years.

Results:

Of 85 integrated plastic surgery programs, 80% (n = 68) of programs and 1,015 matched trainees were included in this study. The average percentage of institutional matches in COVID-19-affected match year was 25.12%, compared to 16.67% for non-COVID-19-affected match years (p = 0.0012). The odds ratio of matching at a home institution in 2021 compared to prior years was 1.68 (95% CI 1.11-2.53).

Conclusions:

Our study is consistent with previous studies that demonstrate strong match preferences for affiliated medical students but also adds that this trend may be amplified in the post-COVID-19 era. While multiple factors may be involved in geographic distributions of residency match outcomes, the results of this study suggest that COVID-19 restrictions on travel and exposure to outside programs may have contributed to an even higher percentage of matches within the same institution.
Management of Bacille Calmette-Guérin Lymphadenitis and Abscess in Immunocompetent Children
Authors: Villanueva Paola , Pittet Laure F. , Curtis Nigel
Published: June 2021

Background:

There is no consensus on managing common adverse reactions to Bacille Calmette-Guérin (BCG) vaccination. We systematically reviewed the management of BCG-associated regional lymphadenitis and injection site abscess in immunocompetent individuals.

Methods:

Searches of Medline, Embase and PubMed were done until November 2020. Randomized controlled trials (RCTs) and cohort studies that compared management strategies for complications of intradermal BCG vaccination were included.

Results:

Of 1338 individual articles, 15 met inclusion criteria. Six RCTs, 4 prospective and 4 retrospective cohort studies compared management in 1022 children with BCG-associated lymphadenitis. For nonsuppurative lymphadenitis, no antimicrobial was found to significantly impact on time to resolution or prevention of suppuration. For suppurative lymphadenitis, there was some evidence that needle aspiration shortens time to resolution and prevents sinus tract formation. Surgical excision (mainly offered for persistent suppurative lymphadenitis) generally had favorable outcome. Two cohort studies (including 1 aforementioned) compared management strategies in up to 36 children with BCG injection site abscess; one showed no difference in outcome in children treated with antibiotics and the other reported complete resolution without treatment.

Conclusions:

Evidence does not support a role for antimicrobial therapy in the management of localized reactions to BCG vaccination in immunocompetent children. Needle aspiration may shorten the recovery period for BCG-associated suppurative lymphadenitis. BCG injection site abscess usually heals without treatment. However, studies are limited and cases are not well defined. Growing research into novel BCG applications provides opportunities to investigate optimal management strategies for adverse reactions in a prospective manner using active safety surveillance.
Psychometric Evaluation of the Korean Version of Control Attitudes Scale-Revised
Authors: Lee Kyoung Suk , Park Da-In
Published: June 2021

Background

Heart failure (HF) is a chronic heart condition that requires patients to adapt to the disease and maintain a high degree of self-management. Patients with HF commonly feel loss of control, which has a negative effect on their compliance to self-care, health-related quality of life, and health outcomes. To promote self-care behavior and to develop healthy coping mechanisms, it is important to understand individual HF patients' perceived control, a self-generated belief that one has the ability to bring forth desired outcomes. Currently, there is no valid and reliable Korean instrument available in measuring perceived control among patients with HF.

Objective

The objective of this study was to cross-culturally translate, adapt, and evaluate psychometric properties of the Korean version of Control Attitudes Scale-Revised (KCAS-R) in Korean patients with HF.

Methods

The KCAS-R was developed using a translation/back-translation process and an examination of semantic and conceptual equivalence. Reliability was assessed using Cronbach α to determine internal consistency, and item-total and interitem correlations were assessed to test item homogeneity. The construct validity was examined using exploratory factor analysis, confirmatory factor analysis, and testing hypotheses for known associations with self-efficacy, self-care confidence, and self-care.

Results

A convenience sample of 138 patients with HF were included for the psychometric testing of an 8-item KCAS-R. The Cronbach α for internal consistency was 0.835, and the item-total correlation was acceptable. The construct validity revealed a 2-factor structure accounting for 63.23% of the total variance. The KCAS-R was associated with higher levels of self-efficacy, self-care confidence, and self-care. In addition, patients with higher perceived control had less depression and anxiety compared with those with lower levels of perceived control.

Conclusion

This study provided support for the satisfactory reliability and validity of the 8-item KCAS-R in measuring perceived control in Korean patients with HF.
Quetiapine in the Anxiety Dimension of Mood Disorders
Authors: Crapanzano Calogero , Damiani Stefano , Guiot Cecilia
Published: June 2021

Purpose/Background

Bipolar disorder and major depressive disorder are heterogeneous conditions characterized by marked variations in mood. High levels of anxiety are often present in these conditions and are associated with increased suicidal risk, increased disease duration, and treatment resistance. Mood stabilizers or antipsychotics are recommended for the treatment of bipolar disorder in comorbidity with anxiety disorders. This study examines current knowledge to evaluate the efficacy of quetiapine in the treatment of anxiety in mood disorders.

Methods/Procedures

A systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, selecting randomized control trials that evaluated the efficacy of quetiapine on anxiety symptoms in patients diagnosed with bipolar disorder or major depressive disorder and included anxiety evaluation scales.

Findings/Results

We collected 27 studies (19 with primary data analysis, 8 with secondary data analysis) regarding the use of quetiapine in mood disorders. Quetiapine was more effective than placebo and active comparators in reducing anxiety in unipolar and bipolar patients in 20 of these studies. In 7 studies, quetiapine was not superior to psychoactive comparators or placebo on the anxiety dimension.

Implications/Conclusions

Statistical power might be limited by small sample size in 5 of the studies included in our review. Moreover, data on anxiety were a secondary outcome in most studies. Nevertheless, the reported studies show with good levels of concordance that quetiapine is effective in controlling anxiety symptoms in patients with mood disorders. This evidence supports current guidelines and recommendations concerning the use of quetiapine in clinical practice.
A Review of Nursing Position Statements on Racism Following the Murder of George Floyd and Other Black Americans
Authors: Knopf Amelia , Budhwani Henna , Logie Carmen H. , Oruche Ukamaka , Wyatt Erin , Draucker Claire Burke
Published: June 2021

National outrage over the killings of George Floyd and other Black Americans in the United States prompted public outcry against police brutality and racism in law enforcement and drew national attention to systemic racism as a public health crisis. In response, during the summer of 2020 many health organizations issued position statements in response to the murders. This article examines such statements issued by 3 prominent nursing organizations and 18 schools of nursing. Thematic analysis revealed six themes in the statements of the professional organizations, and a content analysis revealed that the statements of the schools of nursing were generally aligned with these themes. Such position statements can provide a viable approach to the public commitment to anti-racist reforms, but it is unclear if such statements can promote meaningful and measurable change.
Factors Associated with Perceived Insufficient Milk in the First Three Months of Breastfeeding
Authors: Wood Natsuko K. , Odom-Maryon Tamara , Smart Denise A.
Published: June 2021

Purpose:

Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included.

Study Design and Methods:

A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods.

Results:

Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk.

Clinical Implications:

Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk.
Sensitivity of Self-Reported Human Papillomavirus Vaccination History Among 18- to 26-Year-Old Men Who Have Sex With Men: Seattle, WA, 2016 to 2018
Authors: Forward Terra , Meites Elissa , Lin John , Hughes James P. , Unger Elizabeth R. , Markowitz Lauri E. , Golden Matthew , Swanson Fred , Faestel Paul M. , Winer Rachel L.
Published: June 2021

Background

We assessed the sensitivity of self-reported human papillomavirus (HPV) vaccination among young adult men who have sex with men (MSM) with documented HPV vaccination.

Methods

During 2016–2018, MSM and transgender women aged 18 to 26 years were enrolled in Seattle, WA. A history of HPV vaccination was assessed via self-administered survey, clinic electronic medical records, and the Washington State Immunization Information System. We assessed self-report sensitivity among participants with documented prior HPV vaccination (≥1 dose) in either the electronic medical record or the Washington State Immunization Information System, and used logistic regression to compare sensitivity by age, number of doses, and time since first dose.

Results

Of 292 participants with ≥1 documented HPV vaccine dose, 243 self-reported ≥1 dose (sensitivity, 83.2%; 95% confidence interval [CI], 78.4%–87.3%). Compared with participants whose first dose was <1 year ago, the likelihood of self-report was lower among those with ≥3 years since first dose (adjusted odds ratio [aOR], 0.2; 95% CI, 0.1–0.5). Furthermore, compared with participants with only 1 documented HPV vaccine dose, the likelihood of self-reporting ≥1 dose was higher among those with 2 (aOR, 2.4; 95% CI, 1.0–5.5) or ≥3 doses (aOR, 6.2; 95% CI, 2.7–14.4). Among 115 participants with ≥3 documented doses, sensitivity for recalling ≥3 doses was 69.6% (95% CI, 60.3%–77.8%).

Conclusions

Most young adult MSM with a documented history of HPV vaccination self-reported prior HPV vaccination. Although recall was highest in those with ≥3 doses, 30% of this fully vaccinated subgroup did not correctly recall the number of doses received, highlighting limitations of self-reporting. Furthermore, results indicating reduced recall with ≥3 years since first dose suggest that sensitivity of self-report among young adult MSM may decline over time as adolescent vaccination coverage increases.
Improving Sampling Efficiency for Determining Pediatric HIV Prevalence in National Surveys: Evidence From 8 Sub-Saharan African Countries
Authors: Reid Giles , Voetsch Andrew C. , Stupp Paul , McCracken Stephen , Kalton Graham , Dlamini Sindisiwe , McOllogi Juma James , Kalua Thoko , Kirungi Wilford , Koto Masebeo , Mugurungi Owen , Mulenga Lloyd , Mutenda Nicholus , Marum Lawrence , Saito Suzue
Published: June 2021

Background:

Measurement of mother-to-child HIV transmission through population-based surveys requires large sample sizes because of low HIV prevalence among children. We estimate potential improvements in sampling efficiency resulting from a targeted sample design.

Setting:

Eight countries in sub-Saharan Africa with completed Population‐based HIV Impact Assessment (PHIA) surveys as of 2017.

Methods:

The PHIA surveys used a geographically stratified 2-stage sample design with households sampled from randomly selected census enumeration areas. Children (0–14 years of age) were eligible for HIV testing within a random subsample of households (usually 50%). Estimates of child HIV prevalence in each country were calculated using jackknife replicate weights. We compared sample sizes and precision achieved using this design with a 2-phase disproportionate sample design applied to strata defined by maternal HIV status and mortality.

Results:

HIV prevalence among children ranged from 0.4% (95% confidence interval: 0.2 to 0.6) in Tanzania to 2.8% (95% confidence interval: 2.2 to 3.4) in Eswatini with achieved relative standard errors between 11% and 21%. The expected precision improved in the targeted design in all countries included in the analysis, with proportionate reductions in mean squared error ranging from 27% in Eswatini to 61% in Tanzania, assuming an equal sample size.

Conclusions:

Population-based surveys of adult HIV prevalence that also measure child HIV prevalence should consider targeted sampling of children to reduce required sample size, increase precision, and increase the number of positive children tested. The findings from the PHIA surveys can be used as baseline data for informing future sample designs.
Successful Use of Near Point-of-Care Early Infant Diagnosis in NAMPHIA to Improve Turnaround Times in a National Household Survey
Authors: Domaoal Robert A. , Sleeman Katrina , Sawadogo Souleymane , Dzinamarira Tafadzwa , Frans Ndahafa , Shatumbu Saara P. , Kakoma Ligamena N. , Shuumbwa Terthu K. , Cox Mackenzie Hurlston , Stephens Sally , Nisbet Lydia , Metz Melissa , Saito Suzue , Williams Daniel B. , Voetsch Andrew C. , Patel Hetal K. , Parekh Bharat S. , Duong Yen T.
Published: June 2021

Background:

In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants <18 months without a prior diagnosis. For the Namibia population-based HIV impact assessment (NAMPHIA), the GeneXpert platform was assessed for the feasibility of near POC EID testing compared with the standard Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) platform. Quality assurance measures and turnaround time were compared to improve EID results reporting.

Methods:

NAMPHIA participants were screened for HIV exposure using Determine HIV-1/2 rapid test; samples reactive on Determine received EID testing on the GeneXpert instrument and Xpert HIV-1 Qual assay using whole blood. Results were confirmed at the Namibia Institute of Pathology using dried blood spots on the Roche CAP/CTM platform per national guidelines.

Results:

Of the 762 screened infants, 61 (8.0%) were Determine-reactive and considered HIV-exposed. Of the 61 exposed infants, 2 were found to be HIV-infected whereas 59 were negative on both GeneXpert and Roche platforms, achieving 100% concordance. Average turnaround time was 3.4 days for the Xpert HIV-1 Qual assay, and average time from collection to testing was 1.0 days for GeneXpert compared with 10.7 days for Roche. No samples failed using GeneXpert whereas 1 sample failed using Roche and was repeated.

Conclusion:

Quality POC EID testing is feasible in a national survey through extensive training and external quality assurance measures. The use of decentralized POC EID for national testing would provide rapid diagnosis and improve TATs which may prevent loss to follow-up, ensure linkage to care, and improve clinical outcomes for infants.
Unawareness of HIV Infection Among Men Aged 15–59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015–2019
Authors: West Christine A. , Chang Gregory C. , W. Currie Dustin , Bray Rachel , Kinchen Steve , Behel Stephanie , McCullough-Sanden Rachel , Low Andrea , Bissek Anne , Shang Judith D. , Ndongmo Clement B. , Dokubo Emily K. , Balachandra Shirish , Lobognon Legre R. , Dube Lenhle , Nuwagaba-Biribonwoha Harriet , Li Michelle , Pasipamire Munyaradzi , Getaneh Yimam , Lulseged Sileshi , Eshetu Frehywot , Kingwara Leonard , Zielinski-Gutierrez Emily , Tlhomola Mphotleng , Ramphalla Puleng , Kalua Thokozani , F. Auld Andrew , B. Williams Daniel , Remera Eric , Rwibasira Gallican N. , Mugisha Veronicah , Malamba Samuel S. , Mushi Jeremiah , Jalloh Mohamed F. , Mgomella George S. , Kirungi Wilford L. , Biraro Sam , C. Awor Anna , Barradas Danielle T. , Mugurungi Owen , H. Rogers John , Bronson Megan , M. Bodika Stephane , Ajiboye Aderonke , Gaffga Nicholas , Moore Carole , Patel Hetal K. , C. Voetsch Andrew
Published: June 2021

Background:

Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15–59 years who ever tested for HIV in 13 SSA countries.

Methods:

Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV.

Results:

A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%–58.7%, in Rwanda and Cote d’Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity.

Conclusion:

Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services.
P1 gene of Mycoplasma pneumoniae isolated from 2016 to 2019 and relationship between genotyping and macrolide resistance in Hokkaido, Japan
Authors: Ishiguro Nobuhisa , Sato Rikako , Kikuta Hideaki , Nakanishi Masanori , Aoyagi Hayato , Mori Toshihiko , Nagano Naoko , Tabata Yuichi , Hazama Kyosuke , Konno Mutsuko , Yamanaka Tatsuru , Azuma Katsumi , Tanaka Hiroshi , Narita Mitsuo , Morita Keisuke , Odagawa Yasuhisa , Ishizaka Akihito , Tsuchida Akira , Sasaki Satoshi , Horino Atsuko , Kenri Tsuyoshi , Togashi Takehiro , Manabe Atsushi
Published: June 2021

We characterized 515

Mycoplasma pneumoniae

specimens in Hokkaido. In 2013 and 2014, the p1 gene type 1 strain, mostly macrolide-resistant, was dominant and the prevalence of macrolide resistance was over 50 %. After 2017, the p1 gene type 2 lineage, mostly macrolide-sensitive, increased and the prevalence of macrolide resistance became 31.0 % in 2017, 5.3 % in 2018 and 16.3 % in 2019.