bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronic Health Record Use During the Obstetrics and Gynecology Clerkship by Medical Student Graduates Between 2012 and 2016
Authors: Hammoud Maya , Foster Lauren , Cuddy Monica , Swanson David , Wallach Paul
Published: October 2019

PURPOSE:

To examine medical student accounts of their EHR use during their obstetrics/gynecology (OBGYN) clerkship.

BACKGROUND:

The ability to interface with and enter into an electronic health record (EHR) is viewed as a core competency for medicine and an important skill for entry into residency for graduates of medical school.

METHODS:

An online survey about EHR use was administered to medical students after they completed USMLE Step 2 CK. For inpatient and outpatient rotations, students were asked if they used a record and if they entered notes or orders into it. Descriptive statistics for a sample of 16,366 medical students who graduated from 2012 and 2016 summarized student EHR interactions by rotation type, graduation year, and gender. ANOVA techniques were used to examine mean differences in use and entry.

RESULTS:

In 2016, the majority of students (94%) used EHRs during their OBGYN clerkship, but 26% reported “read-only” access. On the inpatient service, fewer than 10% of students reported any order entry, 58% reported entering progress notes, and 47% reported entering an admitting history and physical. Men entered into EHRs more often than women (70% vs. 67%, p<0.05). Patterns were similar within each graduation year.

DISCUSSION:

Medical school graduates entering OBGYN residencies are expected to be competent in documenting clinical encounters and entering orders, including those notes unique to OBGYN. This study shows that students may receive inadequate experience with entering information into EHRs which could translate into a lack of GME preparedness and entry-level competency.
Ethical Issues Identified by Third Year OB-GYN Medical Students Vary According to Rotational Site
Authors: Petrie Kelsey , Adams Allyson , Glover Jacqueline , Guiahi Maryam
Published: October 2019

PURPOSE:

To categorize ethical concerns identified by OB-GYN medical students and compare across rotational sites.

BACKGROUND:

APGO recognizes that students should understand the basis of ethical issues in OB-GYN in order to promote quality patient care and patient safety. Little, however, is known about how OB-GYN medical students experience ethical issues and if rotational site plays a role. At the University of Colorado School of Medicine, third year OB-GYN students complete an ethics assignment based on their experience rotating at either a university hospital (UH), a safety-net hospital (SH), or a Catholic hospital (CH).

METHODS:

All ethics assignments completed during the 2016-2018 academic years were deidentified of student names and rotational sites. Two investigators independently performed thematic analysis using a previously published OB-GYN ethics framework to categorize assignments and reached consensus. We performed descriptive frequencies and compared ethical categorizations across sites using Pearson’s chi-square.

RESULTS:

252 assignments were analyzed (46.0% UH, 29.8% SH, 24.2% CH). The most common ethical category identified was treatment decisions (80.2%). UH students were more likely to encounter code status (p=0.03), surrogate decision-maker (p=0.03), and fetal viability (p=0.03) issues. SH students were more likely to encounter disagreement in treatment plans between patients and providers (p=0.03) and consent issues (p=0.02). CH students were more likely to encounter issues of institutional policy restricting care (p<0.001) and competing responsibilities of mother versus fetus (p=0.02).

DISCUSSION:

OB-GYN medical students encounter ethical concerns that vary by rotation site. Our findings can inform site-specific educational interventions to address ethical concerns encountered during OB-GYN rotations.
Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy
Authors: Wegleitner Elizabeth , Chirino Octavio
Published: October 2019

PURPOSE:

To evaluate the impact on resident comprehension of biostatistics and research methodology after restructuring a residency journal club based on the CREOG journal club curriculum.

BACKGROUND:

Studies reveal dismal resident performance on statistical literacy evaluations. However, little is known regarding OBGYN residents’ ability to interpret research methodology and results and how these abilities are impacted by the integration of evidence-based medicine principles into journal club curricula.

METHODS:

A pre-/post-intervention study of 22 OBGYN residents at a single institution was conducted to evaluate the impact of integrating the new curriculum (intervention). Participants were administered a survey comprised of 3 sections: a questionnaire in which residents ranked their perceived ability to analyze research literature, a previously validated fifteen question epidemiological/biostatistical knowledge tool, and five questions assessing the curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank sum test, and paired t-test.

RESULTS:

The overall mean percentage correct on statistical knowledge and interpretation of results pre-intervention was 36.6% versus 67.3% (p<0.0001) post-intervention. Higher pre-intervention scores were associated with prior biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention, scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred the restructured journal club, and 19/22 (86.3%) residents report their desire to continue participating in this journal club format post-training.

DISCUSSION:

Significant improvement in residents’ biostatistics knowledge, with resultant increased confidence in their ability to interpret clinical research results, was a demonstrated outcome of the implementation of the CREOG journal club format. Residency programs can provide more effective biostatistics training by incorporating this curriculum.
Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment
Authors: Mahany Erica , Dow Margaret , Winkel Abigail , Palmer James , Morgan Helen , Woodland Mark
Published: October 2019

PURPOSE:

To evaluate OBGYN residents’ perceptions of personal wellness in relation to their clinical learning environment

BACKGROUND:

Resident wellbeing is a significant issue affecting our future physicians’ abilities to fulfill their training potential.

METHODS:

The Council on Resident Education in Obstetrics and Gynecology (CREOG) administered a voluntary, anonymous, six-item wellness survey. One question asked about personal experience with mental health problems (burnout, depression, binge drinking, eating disorders or suicide attempt) and then provided a free text response for “other” issues. The free text responses were reviewed and analyzed. The ACOG IRB determined this survey exempt from review.

RESULTS:

Of 5,061 residents, 4,099 completed the question on personal issues experienced in residency (81% RR), and 200 free text responses were submitted. 1593 residents (32%) endorsed clinical depression. 34 (0.8%) wrote in anxiety, although this was not a formal category. The free text responses clustered into three categories: physical health (n=56), social concerns (n=34), and mood symptoms (n=115). Symptoms of clinical depression comprised 5,992 responses, combining structured questions and free text responses. 18 (0.4%) had attempted suicide, and 18 additional residents wrote in suicide ideation or attempt, translating into almost 1% of our residents having contemplated or tried self-harm, likely related to work stress.

DISCUSSION:

Significant mood disorders and self-harm are under-recognized among OBGYN residents, even as they acknowledge these symptoms. Programs must consider formal evaluations for depression, anxiety, and suicide risk, conduct thorough culture evaluations to ensure these symptoms are not being normalized, and tailor their interventions to provide accessible, confidential support services within the clinical learning environment.
Use of POEs (Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA (Entrustable Professional Activity) Monitoring
Authors: Anbazhagan Aruna , Bynum Blythe , Santen Sally , Browning Joel , Dubinsky Brieanne , Rigby Fidelma
Published: October 2019

PURPOSE:

To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

BACKGROUND:

Our institution is part of the EPA pilot study sponsored by the AAMC to explore the feasibility of teaching and assessing the core EPAs. This year direct observation and assessment of the EPAs was implemented across clerkships. Each clerkship was allowed to determine which EPAs were applicable to their field.

METHODS:

The OBGYN department determined and assessed that EPA1 (History and Physical), EPA2 (Differential Dx), EPA3 (Dx and Screening Tests) and EPA6 (Oral Presentation) were core skills to the clerkship with the following scale (1=student observed, 2=assessor had to talk the student through it, 3=assessor had direct them from time to time, and 4=assessor needed to be available just in case.).

RESULTS:

EPA 1 was 3.0 for OB vs 3.5 for other clerkships (p<.0001). For EPA 2 OB was 3.0 vs 3.4 for other clerkships (p<0.05). For EPA 3 OB was at 3.0 vs 3.4 for other clerkships (n.s). For EPA 6 OB was at 3.1 vs 3.4 for other clerkships (p<.005). For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6. (P<.0001, P<.05 and P<.005) possibly indicating more stringent grading by faculty or lower performance of medical students.

For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6. (P<.0001, P<.05 and P<.005) possibly indicating more stringent grading by faculty or lower performance of medical students.

DISCUSSION:

In comparison to all other clerkships combines, student on OBGYN received lower scores in all four EPAs possibly indicating more stringent grading by faculty or lower performance of medical students. Lower EPA scores may indicate more stringent grading by faculty or lower performance of medical students. This could also be related to lower numbers of overall EPAs required by the OB/GYN clerkship. Further research is needed to determine the significance of these findings.
Surgeon and Contextual Factors Influencing OB-GYN Resident Autonomy in the Operating Room
Authors: McKeon Bri Anne , Fryer Kimberly , Holmstrom Shelly , Ricciotti Hope , Kenton Kimberly
Published: October 2019

OBJECTIVE:

Investigate surgeon and contextual factors affecting the Obstetric and Gynecology (OB-GYN) attending surgeon’s ability to promote resident autonomy in the operating room.

METHODS:

We recruited attending OB-GYN surgeons across subspecialties at one tertiary care academic center to participate in a focus group or individual interview. All focus group discussions and interviews were facilitated by a single investigator using a standardized interview guide. The focus groups and interviews included open-ended questions to probe for participants’ motivations and barriers to granting trainee autonomy. Focus group discussions and interviews were recorded, transcribed and then coded by two investigators using a data driven approach with a priori and emergent codes.

RESULTS:

Fourteen OB-GYN surgeons participated across 4 subspecialties, including 9 Generalists, 3 Gynecologic Oncologists, 1 Family Planning specialist and 1 Reproductive Endocrinology and Infertility specialist. Four thematic code groups included: surgeon, resident, procedural and contextual factors. Surgeon experience and confidence were most commonly identified contributing surgeon factors, with a high level of co-occurrence. Surgeon concerns for patient safety and case difficulty were the most commonly considered procedural factors. The resident’s technical performance and confidence in the operating room allowed for increased resident autonomy, while time constraints limited autonomy. The resident’s technical performance and surgeon concerns for patient safety had a high level of co-occurrence.

CONCLUSION:

Efforts to increase surgeon confidence and experience, while ultimately promoting a culture of patient safety, may provide a framework for optimizing faculty development efforts to support surgical education aimed at preparing residents for independent practice upon graduation.
Design of a Laparoscopic Curriculum for Obstetrics and Gynecology Residents
Authors: Rivard Colleen , Fischer John
Published: October 2019

PROBLEM:

The American Board of Obstetrics and Gynecology (ABOG) announced in January, 2018 it is requiring completion of the Fundamentals of Laparoscopic Surgery (FLS) program as prerequisite for board certification for residents graduating after May, 2020. Currently, our residency program has no formalized laparoscopic curriculum and has never required residents to participate in the FLS program.

INTERVENTION:

Needs assessment was performed to survey faculty in the residency program regarding residents’ current skill levels and faculty perspectives of level-appropriate laparoscopic skills by training year. A comprehensive laparoscopic curriculum was designed to support resident progression through different competency milestones required to ultimately be able to perform laparoscopic hysterectomies as the surgeon. The laparoscopic curriculum addresses a parallel group of requirements designed to assist residents in successful completion of the FLS curriculum.

CONTEXT:

The laparoscopic curriculum was designed in the context of an academically-based obstetrics and gynecology residency program. The residency program has 9 residents a year who rotate at 5 different clinical sites and work with over 50 faculty who perform laparoscopic procedures.

OUTCOMES/LESSONS LEARNED:

The curriculum will be implemented in July 2019 with the new academic year. The curriculum will be assessed in several ways: formal testing of residents with FLS skills by the program administration, time takes resident to progress through the competency milestones for laparoscopy, the FLS pass rate, and scores of our residents. Main lesson learned through the design process was how to manage the varying resident and faculty expectations for surgical skills training.
PAG as a Mandatory ObGyn Training Experience in Canada: A Needs Assessment Study
Authors: Dumont Tania
Published: October 2019

OBJECTIVE:

The primary objective was to perform a needs assessment to determine if mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is feasible.

METHODS:

This is a comparative descriptive design where the 16 ObGyn Residency Program Directors (PD) in Canada will undergo 20-minute phone interviews. The interviews will be recorded and will explore how PAG and Reproductive Endocrinology (RE) objectives are met in each program, PD’s awareness of PAG opportunities in North America and feasibility of a mandatory training experience. This project is REB approved.

RESULTS:

Thirteen program directors agreed to participate, and ten interviews have been completed thus far. There appears to be at least 1-2 PAG-trained ObGyn per institution with some form of mandatory training experience for residents in senior years. PD feel PAG training is important and should be mandatory; however, they report a lack resources to implement. PDs lack of knowledge of available PAG electives and fellowships offered in North America as well as numerous educational tools available to teach PAG.

CONCLUSION:

PAG training experiences should be mandatory in all programs to achieve the RCPSC PAG objectives. PAG providers are available in all Canadian training centers and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents to ensure competency in the care of young women and children. PD need to be educated on available PAG educational resources, resident electives and fellowship opportunities.
Parotid Masses: What Radiologists Need to Know
Authors: Sitta Juliana , Villarinho Luciano de Lima , Santos Cristiane Tuma , Rizvi Tanvir
Published: October 2019

Salivary gland neoplasms comprise a variety of pathologic entities that are not seen in any other organ.1 Salivary gland tumors are relatively rare and comprise less than 3% of all tumors.2 The parotid gland is by far the most frequent salivary gland involved by tumors. Only about 20% of parotid gland tumors in adults are malignant, whereas 35% of all salivary gland tumors in children are malignant. Among risk factors associated with parotid tumors are radiation exposure, tobacco use, sun exposure, and some viruses.3 This article reviews the most common malignant and benign parotid masses, with their clinical and imaging features.
Spotlight on ostomy care
Authors: Doty Sherry Keck
Published: October 2019

It isn't uncommon for nurses to feel ill-prepared to care for patients with ostomies. We give you the information you need.
Measles
Authors: Stinchfield Patricia Ann
Published: October 2019

Measles has reemerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission.
Parkinson disease
Authors: Vacca Vincent M.
Published: October 2019

Parkinson disease (PD) is a progressive, incurable disease caused by dopamine deficiency. This article provides an overview of this neurodegenerative disorder and offers information for optimal outcomes.
The hazards and benefits of social media use in adolescents
Authors: Rajamohan Santhiny , Bennett Erin , Tedone Deborah
Published: October 2019

Studies have found that social media can act as a catalyst to negative attitudes and behaviors in adolescents. This article reviews the current evidence and explores if there is a connection between social media and mental health issues.
Perceptions of Alcohol Risk Among HIV/Hepatitis C Coinfected Patients
Authors: Kim Hyang Nina , Howell Abigail , Blevins Claire E. , Pinkston Megan M. , Herman Debra S. , Stein Michael D.
Published: October 2019

Objectives:

We examined how patient perceptions of alcohol risk, provider discussions about alcohol, and treatment of hepatitis C virus (HCV) differed among HIV–HCV coinfected patients in primary care.

Methods:

Between April, 2016 and April, 2017, we conducted a screening survey with patients in an HIV primary care clinic in Seattle, Washington, who had chronic HCV coinfection or a history of chronic HCV infection who had successfully cleared their infection with treatment.

Results:

Of 225 participants, 84 (37%) were active drinkers (drank ≥2–4 times/mo in past 3 months). Of those with little to no use for ≥3 months, 65 (29%) were former drinkers with a history of alcohol use and 76 were abstainers with no such history. Former drinkers and abstainers were more likely than active drinkers to perceive that any drinking was unsafe (69% vs 58% vs 31%; P < 0.001). Former drinkers were more likely to report a physician's recommendation to stop drinking than active drinkers (63% vs 47%; P = 0.05). The great majority (87%) of former drinkers decided to stop or reduce drinking on their own (most often in response to a nonhealth life event) and only 13% acknowledged doing so on their doctor's prompting. HCV treatment was not associated with former or active drinking status.

Conclusions:

Our findings underscore the importance of educating not only HIV–HCV patients about the effects of alcohol use but also HIV clinicians about delivering consistent counseling about alcohol avoidance. Understanding the reasons that HIV–HCV coinfected persons make changes in their alcohol use could drive novel interventions that reduce the negative consequences of drinking.
Biologic treatment options for the hip: A narrative review
Authors: Temple H. Thomas
Published: October 2019

The goal of surgery around the hip is to preserve both acetabular and femoral bone stock and to optimize function, specifically abductor function. Biologic options include allografts, allograft metal composites, and structural grafts that over time incorporate, are durable, and provide bone stock for future reconstruction(s). Reconstructive principles are guided by the defect(s) after tumor surgery, patient factors (age, chemotherapy, comorbid conditions), and graft availability. The challenges of reconstruction around the hip are stability of the joint and optimizing abductor function. For routine reconstructions around the hip for osteoarthritis and low-energy trauma, metal implants, either arthroplasty or internal fixation, are employed with high rates of success. Biologic implants are generally reserved for revision and oncologic surgery when large structural bone and soft-tissue defects are present. Structural allografts are used for both acetabular and femoral defects to replace bone and or conserve bone stock in anticipation of future reconstructions. Maintaining soft-tissue attachments and optimizing tension in the hip abductors also is an important consideration in optimizing function, especially in younger patients. Biologic options are also important in patients with prior arthroplasty who sustain periprosthetic fractures or develop tumors above or below existing constructs that require excision and reconstruction. Complications are common both early and late postoperatively. For this reason, patients must be apprised of the risks, and surgeons should be poised to take appropriate steps to mitigate and/or treat potential complications and to anticipate future reconstructions to preserve and enhance function.
Therapeutic Implications of Nitrite in Hypertension
Authors: Ling Wei Chih , Mustafa Mohd Rais , Murugan Dharmani Devi
Published: October 2019

Nitrite, an anion produced from the oxidative breakdown of nitric oxide (NO), has traditionally been viewed as an inert molecule. However, this dogma has been challenged with the findings that nitrite can be readily reduced to NO under pathological conditions, hence representing a physiologically relevant storage reservoir of NO either in the blood or tissues. Nitrite administration has been demonstrated to improve myocardial function in subjects with heart failure and to lower the blood pressure in hypertensive subjects. Thus, extensive amount of work has since been carried out to investigate the therapeutic potential of nitrite in treating cardiovascular diseases, especially hypertension. Studies done on several animal models of hypertension have demonstrated the efficacy of nitrite in preventing and ameliorating the pathological changes associated with the disease. This brief review of the current findings aims to re-evaluate the use of nitrite for the treatment of hypertension and in particular to highlight its role in improving endothelial function.
A Network Approach to Neonatal Palliative Care Education
Authors: Knighting Katherine , Kirton Jennifer , Silverio Sergio A. , Shaw Ben N. J.
Published: October 2019

More than 80 000 babies are admitted to specialist neonatal units in the United Kingdom every year, with approximately 2109 neonatal deaths a year; 98% in hospital. A common element in guidance and pathways to facilitate the provision of palliative care to infants and their families is the importance of good education and training to develop high-quality staff and services. This article presents a mixed-methods, sequential, explanatory design evaluation of 1 day palliative care education workshops delivered using a network-wide approach to multidisciplinary professionals. Workshops were delivered by healthcare professionals and bereaved parents and evaluated using questionnaires, adapted for neonatal staff from standardized measures, and follow-up interviews. The workshop content and shared learning approach resulted in significant improvements in participant's knowledge, attitude, self-beliefs and confidence in neonatal palliative care, enhanced awareness of services, and improved links between professionals. Participants cascaded their learning to their teams and provided examples of changes in their clinical practice following the workshop. Parent stories were identified as a very powerful component of the training, with lasting impact on participants. Formal, integrated palliative care education programs for perinatal and neonatal staff and longitudinal research into the impact on practice and the experience received by families are needed.
Natural History of Facial Weakness Following Surgery of the Cerebellopontine Angle: A Tertiary Care Cohort
Authors: Luryi Alexander L. , Babu Seilesh , Michaelides Elias M. , Bojrab Dennis I. , Kveton John F. , Hong Robert S. , Jacob Jeffrey T. , Schutt Christopher A.
Published: October 2019

Objective:

Facial function is a key outcome in surgery of the cerebellopontine angle (CPA). This study describes the natural history of facial weakness after CPA surgery.

Study design and setting:

Retrospective study of two tertiary centers.

Patients and intervention:

Patients undergoing surgery for CPA tumors from 2003 to 2017 with preoperatively normal facial function and without subsequent surgical or adjuvant therapy.

Main outcome measure:

Serial facial nerve examinations using the House–Brackmann (HB) scale.

Results:

Of 301 patients examined, 149 (49.5%) had facial weakness postoperatively and 74.5% of these occurred within 24 hours. Of patients with HB-1 function within 24 hours after surgery, 95.3% had HB-1 function and 100% had HB-3 or better function at last follow-up. Of patients with HB-4 or worse function within 24 hours after surgery, 22.6% ultimately achieved HB-1 function and 83.9% ultimately achieved HB-3 or better function. By 180 days postoperatively, 83.7% of patients’ facial function had stabilized. At last follow-up, 3.0% of patients had facial function poorer than HB-3, which was associated with subtotal resections (12.9% vs. 4.4% for near total and 0.6% for gross total resections, p = 0.002), aspirin use (10.6% vs. 1.6%, p = 0.001), larger tumors (p < 0.0005), longer surgery (p < 0.002), and immediate versus delayed postoperative facial weakness (p = 0.002).

Conclusions:

Facial function over time after CPA surgery is presented. While facial function immediately after surgery correlates with future function, delayed weakness or improvement is common. These data inform patient counseling both preceding and following surgery.
Thrombin generation test with the calibrated automated thrombogram and anticoagulant activity of Mentha crispa
Authors: Leite Paula M. , Miranda Ana P.N. , Amorim Juliana M. , Duarte Rita C.F. , Faraco André A.G. , Carvalho Maria d.G. , Castilho Rachel O.
Published: October 2019

Evaluate the in-vitro effect of Mentha crispa extract on blood coagulation, compare the conventional coagulometric tests with thrombin generation test (TGT), and study the qualitative micromolecular composition of M. crispa. Extract of M. crispa was incubated with plasma and used in the coagulometric tests: prothrombin and activated partial thromboplastin times, fibrinogen, and TGT. A phytochemical prospection was performed to evaluate the chemical composition of this extract. The extract was efficient in prolonging prothrombin time and activated partial thromboplastin time, and reducing fibrinogen levels and TGT parameters, indicating that the extract of M. crispa inhibited the intrinsic and extrinsic pathways of blood coagulation. The results obtained in TGT are in agreement with the results of conventional coagulometric tests and the in-vitro anticoagulant activity of M. crispa suggests that its use by patients using oral anticoagulants deserves caution.
Albumin-bilirubin and platelet-albumin-bilirubin grades for hepatitis B-associated hepatocellular carcinoma in Child–Pugh A patients treated with radical surgery
Authors: Wu Binquan , Hu Xiaosi , Jin Hao , Zhou Lei , Zhang Dengyong , Man Zhongran , Wang Yong , Yang Song , Pang Qing , Liu Huichun , Cui Peiyuan
Published: October 2019

Child–Pugh (CP) grade A patients with early stage hepatocellular carcinoma (HCC) are candidates for curative surgery, while some patients still have a poor outcome. The aim of this study was to investigate the prognostic values of 2 new evaluation models for liver function, named albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades, in CP grade A patients with HCC.

In this retrospective cohort study, we reviewed 134 cases of CP grade A patients with hepatitis B-associated HCC who underwent radical surgery. ALBI and PALBI grades were calculated based on preoperative serologic examinations. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan–Meier curve and Cox regression. The prognostic performances of the models were estimated by using the concordance index (C-index).

During a median follow-up time of 27 months, 27.6% (37/134) of patients died and 26.1% (35/134) experienced recurrence. Kaplan–Meier analyses showed that ALBI and PALBI grades were significantly associated with OS and RFS. Multivariate analyses further revealed that both ALBI and PALBI grades were independent predictors for survival. Furthermore, the prognostic values of the combination of tumor size with ALBI (C-index = 0.754, 95% confidence interval [CI]: 0.675–0.849) or with PALBI (C-index = 0.762, 95% CI: 0.664–0.844) may be comparable with both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program staging systems.

The ALBI and PALBI grades, in particular the combination with tumor size, are effective models for discriminating survival in CP grade A patients with HCC.
Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures
Authors: Zhao Weiguang , Zhang Yingze
Published: October 2019

This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.

The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.

No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.

Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.
A cross-sectional study on serum measles antibody levels of a healthy population in southwest China
Authors: Chen Lihua , Xiao Yuanyuan , Yang Yahong , Xu Chuanzhi , Li Shunxiang , Zhang Tai
Published: October 2019

This study aimed to investigate measles antibody level and its associated factors in a healthy Chinese population, so as to provide evidence to measles prevention and control measures in the future.

We conducted a cross-sectional survey by using probability proportionate to size sampling (PPS) among a healthy population aged 8 months to 45 years. Information on measles vaccination status was obtained from the vaccination certificates. Serum measles IgG antibody was detected by enzyme-linked immunosorbent assay. Multivariate logistic and linear regression models were used to analysis the associated factors of measles antibody.

Of the 663 study subjects, the positive rate, protective rate, and geometric mean concentration (GMC) of measles antibodies were 92.76%, 77.53%, 1612.55 mIU/ml, respectively. The antibody concentration was higher in Han ethnical majority than in Hui minority. The positive rate, protective rate and concentration of antibodies in different age groups and regions were clearly disparate. Age, area, and measles-containing vaccine (MCV) immunization history were the prominent influencing factors of antibody positive rate and protective rate. Ethnicity, age, area, and MVC immunization history were the influencing factors of antibody concentration.

Our major findings suggest that, children in rural China, especially in impoverished mountainous regions, were more likely to suffer from delays in measles vaccination. Various measures in optimizing vaccination practices should be implemented in order to prevent possible measles epidemic, even outbreak in these regions.
Challenges in management of male breast adenomioepithelioma with malignant behavior
Authors: Gafton Bogdan , Scripcariu Viorel , Prutianu Iulian , Alexa-Stratulat Teodora , Terinte Cristina , Nicolau Andrei , Moisiuc Diana , Radu Iulian
Published: October 2019

Rationale:

Male adenomyoepithelioma of the breast with malignant features is a rare tumor with only one previous case reported in the literature over 25 years ago.

Patient concerns:

We report the case of a 63-year-old man admitted to our Oncology Institute with a painless tumor mass of 6 cm in the left breast with no additional regional lymph nodes. Ultrasound revealed a complex cystic tumor mass of 60 mm in the left breast, with both anechoic (cystic) and echogenic (solid) components, with ill-defined margin.

Diagnoses:

Extemporaneous assessment showed a solid (invasive) papillary intracystic carcinoma. Definitive pathology examination revealed the presence of a breast malignant adenomyoepithelioma.

Interventions:

Based on the extemporaneous assessment, wide tumor excision was performed. The tumor board decided to continue treatment with adjuvant anthracycline-based chemotherapy.

Outcomes:

After 6 years of follow-up, the patient is cancer-free. No chronic side effects were noted.

Lessons:

Because this pathology is extremely rare, no guidelines are available for its therapeutic approach. All decisions regarding patient management should be made by a multi-disciplinary team and can only be based on clinical experience and the few cases reported in female patients.
Efficacy of sifalimumab for treatment of skin injury caused by systemic lupus erythematosus
Authors: Huo Ai-xin , Chen Wen-hui , Liu Yu-hong , Gao Peng , Li Jing
Published: October 2019

Background:

This study aims to provide the best possible evidence-based information on the efficacy and safety of sifalimumab for treatment of skin injury (SI) caused by systemic lupus erythematosus (SLE).

Methods:

In this study, electronic databases of MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, Global Health, WHO Global Index Medicus, Virtual Health Library, Social Care Online, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be searched comprehensively from inceptions to June 30, 2019 without language restrictions. We will include randomized controlled trials (RCTs) on evaluating the efficacy and safety of sifalimumab for SI caused by SLE. Two investigators will conduct study selection, data extraction, and risk of bias assessment independently. We will use RevMan 5.3 Software to perform statistical analysis.

Results:

This study will lie in the exhaustive and systematic nature of the literature search and its methods for evaluating quality and analyzing RCTs data. Considering the controversial efficacy of the treatment for sifalimumab, this study is responsible for improving the existing evidence on the efficacy and safety of sifalimumab for SI caused by SLE.

Conclusion:

The results of this study will provide latest evidence for judging whether sifalimumab is an effective intervention for patients with SI caused by SLE or not.

Study registration:

CRD42019148225.
Long-term effects of radiation prior to surgery and chemotherapy on survival of esophageal cancer undergoing surgery
Authors: Zhang Nan , Zhang Shao-wei
Published: October 2019

Esophageal cancer (EC) is one of the most common cancers in the world, with continuously growing diagnoses and morbidity. Because it is still unclear how to choose the best treatment for EC patients, a multimodal treatment is necessary to improve the prospect of the malignancy, including a sequence of surgery, chemotherapy, and radiotherapy, whether alone or combination. Therefore, this paper aims to analyze the effect of the sequence of chemotherapy, radiotherapy, and surgery on the prognosis and survival rate of patients with EC.

The Surveillance, Epidemiology, and End Results (SEER) database was used to extract a dataset of patients who were diagnosed with EC from 1973 to 2015, with follow-up data for 6 years after diagnosis. The data were analyzed using correlation analysis, logistic regression Cox regression, and Kaplan–Meier analysis.

EC patients who had radiation prior to surgery and chemotherapy had a better prognosis than the cases without chemotherapy. Based on univariate logistic regression, the odds radios of vital status recoded for “radiation prior to surgery combined with chemotherapy” is the lowest one among the 8 groups classified by radiation sequence with surgery and chemotherapy (P < .001). Further, radiation prior to surgery and chemotherapy is an independent prognostic factor for better survival among EC patients.

In conclusion, in the treatment of EC, administering radiation prior to surgery and chemotherapy is better than no radiotherapy, perioperative radiotherapy, postoperative radiotherapy, and other combinations without chemotherapy.
Experience of operating an anesthesia preoperative evaluation clinic in South Korea
Authors: Park Ju Yeon , Park Soon Ji , Ri Hyun-Su , Choi Eun-Ji , Choi Yun Mi , Yoon Ji-Uk
Published: October 2019

The benefits of an anesthesia pre-operative evaluation clinic (APEC) based on outpatients are well described in previous literatures. In the majority of hospitals in South Korea, preoperative anesthetic evaluation for surgical patients is limited to hospitalized patients on the day before surgery. Thus, we would like to share our institutional experience of implementing an APEC based on outpatients and report on the attitudes and satisfaction of the medical staff (surgeons).

A 2-page survey was distributed to all specialists and resident physicians involved in surgery at a single university hospital during a 3-month period. A 5-point Likert scale of agreement and an open-ended question examined perceptions of APEC. A total of 123 questionnaires were distributed and 67 surveys were collected over a 3-month period with a 54.5% collection rate. The surgeons’ perceptions of APEC are summarized in Figure 1. It is difficult to state the tendency of surgeons’ perception of the clinic, including workload, patient satisfaction, patient safety, necessity, cost-effectiveness, and efficiency through this survey. However, many surgeons chose to comment on suggestions to improve the quality of the APEC through the open-ended question.

The surgeons’ attitude and satisfaction to anesthetic services including APEC are an important component of achieving quality improvement. Although it is difficult to state the tendency of surgeons’ perception of the clinic, including workload, patient satisfaction, patient safety, necessity, cost-effectiveness, and efficiency through this survey, continuous assessment and feedback may improve efficiency of the APEC and affect patient perception as well.
A case report on crossed aphasia in dextrals
Authors: Torrisi Michele , Pollicino Patrizia , Corallo Francesco , Vermiglio Giuliana , Logiudice Anna Lisa , Mantarro Carmela , Calabrò Cinzia , Bramanti Placido , Calabrò Rocco Salvatore , Morabito Rosa , Marino Silvia
Published: October 2019

Rationale:

The term crossed aphasia in dextrals (CAD) describes aphasia following a right hemisphere lesion in right-handed subjects. The diagnostic criteria for CAD, defined on the basis of clinical cases observed over the years, are aphasia; lesion in right hemisphere; strong preference for right hand use without familial history of left handedness; structural integrity of left hemisphere; and absence of brain damage in childhood. The studies of CAD have mainly been focused on the neurobiological mechanisms underlying the functional neurocognitive lateralization and organization of the brain, such as a dissociation between language and handedness, language and praxis, or other cognitive functions.

Patient concerns: We described a case of a patient affected by an aphasic syndrome following cerebral hemorrhage located in right hemisphere.

Diagnosis: Considering the correlation between clinical data and instrumental investigations such as magnetic resonance imaging, we diagnose the patient with non-fluent aphasia. Specifically, the patient came to our attention showing a trans-cortical mixed aphasia that, later, developed in a trans-cortical motor aphasia. Contrary to most cases of CAD, our patient does not show apraxia and visuo-spatial neglect. Interventions language and visual attention when latter functions are related to right hemisphere.

Interventions:

The rehabilitation program consisted in exercises stimulating verbal fluency, comprehension, reading, and writing.

Outcomes:

After 5 months of rehabilitation patient showed significant improvement in comprehension and absence of echolalia.

Lessons:

At present there is no agreement about pathogenesis of CAD and neural mechanism is still unclear. Considering the clinical symptomatology, we can argue that we observed a non-fluent aphasia. However, a more large sample should be studied to asses the role of brain circuits.
How to continue lipid-lowering therapy in patients with coronary heart disease and severe liver dysfunction?
Authors: Yan Dong , Xu Xiang-Ru , Yue Bo-Wen , Zhao Li-Li , Yan Shi-Hai , Qian Yu-Liang
Published: October 2019

Rationale:

Atherosclerotic cardiovascular disease (ASCVD), including coronary heart disease (CHD), atherosclerotic stroke and peripheral vascular disease, has become the most deadly chronic noncommunicable disease throughout the world in recent decades, while plaque regression could reduce the occurrence of ASCVD. Traditional Chinese Medicine (TCM) has been widely used for prevention and treatment of these diseases. In the perspective of TCM, phlegm and blood stasis are considered to be leading pathogenesis for CHD. Hence, activating blood circulation and dissipating phlegm, which is of great benefit to regress plaque, have been regarded as general principles in treatment.

Patient Concerns:

A 36-year-old man presented with a 3-month history of intermittent exertional chest pain. Coronary angiography revealed 60% stenosis of the proximal left anterior descending coronary artery. Liver function showed: alanine transaminase (ALT):627U/L, aspartate transaminase (AST):243U/L.

Diagnoses:

CHD and hepatitis B with severe liver dysfunction.

Interventions:

The patient should have been treated with high-intensity statin therapy. Actually, due to severe liver dysfunction, Huazhirougan granule instead of statins was administered. In addition, he was treated with TCM according to syndrome differentiation for two and a half years.

Outcomes:

The chest pain disappeared and other symptoms alleviated as well after treatment. Coronary computed tomographic angiography revealed no stenosis in the proximal left anterior descending coronary artery. ALT and AST level returned to normal (ALT:45U/L,AST:24U/L).

Lessons:

For patients with CHD and severe hepatic dysfunction, antilipidemic drugs such as statins are not recommended. This case suggested that TCM might fill a gap in lipid-lowering therapy. Thus, we could see that statins were not the only drug for plaque regression and the effect of TCM in treating coronary artery disease cannot be ignored.
Relationship between anemia, serum bilirubin concentrations, and diabetic retinopathy in individuals with type 2 diabetes
Authors: Chung Jin Ook , Park Seon-Young , Chung Dong Jin , Chung Min Young
Published: October 2019

This study sought to assess the hypothesis that anemia is associated with diabetic retinopathy in type 2 diabetes mellitus (DM) and investigate the factors mediating the relationship between anemia and diabetic retinopathy.

In total, 1637 individuals with type 2 DM were examined in a cross-sectional study. Anemia was defined as hemoglobin level <120 g/L in women and <130 g/L in men. A logistic regression model was used to determine the association between anemia and diabetic retinopathy.

Anemia was more prevalent in individuals with diabetic retinopathy. Logistic regression analysis found a statistically significant association between anemia and diabetic retinopathy after adjustment for traditional risk factors (odds ratio, 1.44; 95% confidence interval, 1.10–1.89, P = .009). Further adjustment for serum bilirubin levels removed the statistically significant association.

In individuals with type 2 DM, anemia is related to diabetic retinopathy, and its association may be mediated by a correlated change in serum bilirubin levels.
Prolonged fever is not a reason to change antibiotics among patients with uncomplicated community-acquired acute pyelonephritis
Authors: Jang Young-Rock , Eom Joong Sik , Chung Wookyung , Cho Yong Kyun
Published: October 2019

The study aimed to determine the pattern of fever resolution among febrile patients undergoing treatment for acute pyelonephritis (APN) and prove that switching therapy based solely on persistent fever beyond 72 hours of antibiotics treatment may be unwarranted.

For the purpose of this study, non-responders were defined as those patients who had a persistent fever over 72 hours after the initiation of antibiotic therapy. Responders were defined as those patients who became afebrile in less than 72 hours after the initiation of antibiotic therapy. Clinical cure was defined as the complete resolution of all symptoms during antibiotic therapy without recurrence during the follow-up period.

A total of 843 female patients with uncomplicated community-acquired APN met all inclusion criteria. The non-responder group comprised of 248 patients (29%), and the remaining patients constituted the responder group. The median initial C-reactive protein level was higher (15.6 mg/dl vs 12.6 md/dl, P < .001) and bacteremia was more frequent (31% vs 40%, P = .001) in the non-responder group. Escherichia coli (E. coli) was the most common pathogen in both groups; there was no significant difference between the groups in the etiology of APN. Antimicrobial resistance and extended spectrum β-lactamase producing strains had an increasing trend in the non-responder group but there was no significant difference between the groups.

This study shows that it is difficult to identify patients at risk of uncomplicated community-acquired APN by antibiotic-resistant pathogens based exclusively on persistent fever. Patients with a prolonged fever for more than 72 hours show similar antibiotic susceptibility patterns and are not associated with adverse treatment outcomes. Therefore, switching of current antibiotics to broad-spectrum antibiotics should be reserved in this patient population until antibiotic susceptibility test results are available.