bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining and Adopting Clinical Performance Measures in Graduate Medical Education: Where Are We Now and Where Are We Going?
Authors: Smirnova Alina , Sebok-Syer Stefanie S. , Chahine Saad , Kalet Adina L. , Tamblyn Robyn , Lombarts Kiki M.J.M.H. , van der Vleuten Cees P.M. , Schumacher Daniel J.
Published: February 2019

Assessment and evaluation of trainees’ clinical performance measures is needed to ensure safe, high-quality patient care. These measures also aid in the development of reflective, high-performing clinicians and hold graduate medical education (GME) accountable to the public. Although clinical performance measures hold great potential, challenges of defining, extracting, and measuring clinical performance in this way hinder their use for educational and quality improvement purposes. This article provides a way forward by identifying and articulating how clinical performance measures can be used to enhance GME by linking educational objectives with relevant clinical outcomes. The authors explore four key challenges: defining as well as measuring clinical performance measures, using electronic health record and clinical registry data to capture clinical performance, and bridging silos of medical education and health care quality improvement. The authors also propose solutions to showcase the value of clinical performance measures and conclude with a research and implementation agenda. Developing a common taxonomy of uniform specialty-specific clinical performance measures, linking these measures to large-scale GME databases, and applying both quantitative and qualitative methods to create a rich understanding of how GME affects quality of care and patient outcomes is important, the authors argue. The focus of this article is primarily GME, yet similar challenges and solutions will be applicable to other areas of medical and health professions education as well.
Novel Technique for Toe-to-Hand Transplantation: The Fourth-toe as an Alternative Option for Toe-to-Hand Transplantation for Pediatric Patients
Authors: Ozols Dzintars , Zarins Janis , Petersons Aigars
Published: February 2019

The first toe-to-hand transplantation was done in 1898 by Nicoladoni. It was a staged procedure and the toe flap was based on a pedicle. With advancement of optical instruments and microsurgeons’ skills in 1964 the first microvascular toe-to-hand transplantation on a rhesus monkey was done. The technique’s development has not stopped, many authors have modified it to achieve better outcomes for both traumatic and congenital hand defects. The most commonly used toes for transplantation are first, second, and second to third toe block. Well described plantar and dorsal vascular systems for first web space vessels as well as possibility to perform successful perforator anastomosis allows us to improve toe-to-hand transplantation further. There is a paucity of studies on single fourth toe-to-hand transplantation. We performed fourth-toe transplantation for three pediatric patients (mean age, 73 mo) with congenital (n=2) and traumatic (n=1) hand defects. Common plantar digital arteries were used for blood supply to the transplanted toes. No vascular problems occurred, and all transplanted toes survived. Patients and parents are satisfied with functional and esthetic outcomes. Early podometry results show insignificant changes which should not harm the foot in the long-term. We believe the fourth-toe transplantation is a promising method to use to reconstruct congenital or traumatic absence of digits for pediatric population.
Nurses “Seeing Forest for the Trees” in the Age of Machine Learning
Authors: Kwon Jae Yung , Karim Mohammad Ehsanul , Topaz Maxim , Currie Leanne M.
Published: February 2019

Although machine learning is increasingly being applied to support clinical decision making, there is a significant gap in understanding what it is and how nurses should adopt it in practice. The purpose of this case study is to show how one application of machine learning may support nursing work and to discuss how nurses can contribute to improving its relevance and performance. Using data from 130 specialized hospitals with 101 766 patients with diabetes, we applied various advanced statistical methods (known as machine learning algorithms) to predict early readmission. The best-performing machine learning algorithm showed modest predictive ability with opportunities for improvement. Nurses can contribute to machine learning algorithms by (1) filling data gaps with nursing-relevant data that provide personalized context about the patient, (2) improving data preprocessing techniques, and (3) evaluating potential value in practice. These findings suggest that nurses need to further process the information provided by machine learning and apply “Wisdom-in-Action” to make appropriate clinical decisions. Nurses play a pivotal role in ensuring that machine learning algorithms are shaped by their unique knowledge of each patient's personalized context. By combining machine learning with unique nursing knowledge, nurses can provide more visibility to nursing work, advance nursing science, and better individualize patient care. Therefore, to successfully integrate and maximize the benefits of machine learning, nurses must fully participate in its development, implementation, and evaluation.
Nurse Decision Making in Acute Care
Authors: Nibbelink Christine W. , Carrington Jane M.
Published: February 2019

Effective nurse decision making is essential for best patient outcomes in the acute care nurse practice environment. The purpose of this study was to explore acute care RNs' perceptions of clinical decision making for a patient who experienced a clinical event. Clinical events include changes in patient condition and are manifested by fever, pain, bleeding, changes in output, changes in respiratory status, and changes in level of consciousness. Naturalistic decision making framework supported the exploration of important contextual factors associated with decision making, provided new information for nursing science, and served as the conceptual framework for this research. Data collected from interviews of 20 acute care nurses were analyzed using qualitative content analysis. The emergent categories included Awareness of Patient Status, Experience and Decision Making, Following Established Routine, Time Pressure, Teamwork/Support From Staff, Goals, Education, Resources, Patient Education, Consideration of Options to Meet Goals, and Nursing Roles. Acute care nurses incorporated a wide variety of complex factors when decision making. This study sought to improve understanding of the factors nurses found important to their decision making for the potential development of improved decision support in the electronic health record.
Participation in Physical Activity During Center and Home-Based Pulmonary Rehabilitation for People With COPD
Authors: Lahham Aroub , McDonald Christine F. , Mahal Ajay , Lee Annemarie L. , Hill Catherine J. , Burge Angela T. , Cox Narelle S. , Moore Rosemary , Nicolson Caroline , O'Halloran Paul , Gillies Rebecca , Holland Anne E.
Published: February 2019

Purpose:

To compare levels of physical activity during center and home-based pulmonary rehabilitation (PR) in people with chronic obstructive pulmonary disease.

Methods:

Forty-five consecutive participants (23 male, n = 20, in the home-based group) with mean age of 68 ± 8 yr and forced expiratory volume in the first second of expiration (FEV1) 53 ± 18% predicted undertook physical activity monitoring using the SenseWear Armband during the final week of the interventions of center or home-based PR. Differences in time spent in total physical activity (≥1.5 METs), time spent in moderate to vigorous intensity physical activity (≥3 METs), and steps were compared.

Results:

Home participants spent a median and interquartile range of 310 (199-328) min/d engaged in total physical activity (29% moderate to vigorous intensity physical activity) compared with 300 (204-370) min/d for the center group (28% moderate to vigorous intensity physical activity, P = .98). Daily step count did not differ between groups (home-based median 5232 [2067-7718] versus center-based median 4049 [1983-6040], P = .66). Of note, center-based participants took 38% more steps on days of program attendance compared with nonattendance days (mean difference: 761 steps/d; 95% CI, −56 to 1579, P = .06).

Conclusion:

For people with chronic obstructive pulmonary disease undertaking PR, no differences in physical activity levels between center and home-based programs were demonstrated. Understanding the impact of the indirect supervision and motivational interviewing technique utilized during home-based PR on levels of physical activity in people with chronic obstructive pulmonary disease may support clinical implementation of the model as an alternative option to traditional care.
The Relationship Between Critical Thinking Skills and Learning Styles and Academic Achievement of Nursing Students
Authors: Shirazi Fatemeh , Heidari Shiva
Published: February 2019

Background:

Academic achievement is one of the most important indicators in evaluating education. Various factors are known to affect the academic achievement of students.

Purpose:

This study was performed to assess the relationship between critical thinking skills and learning styles and the academic achievement of nursing students.

Methods:

In this cross-sectional study, 139 sophomores to senior-year nursing students were selected using a simple random sampling method. The data were gathered using a three-part questionnaire that included a demographic questionnaire, the Kolb's Learning Style Standard Questionnaire, and the California Critical Thinking Skills Questionnaire. The previous semester's grade point average of the students was considered as a measure of academic achievement. The data were analyzed using descriptive and analytical statistics in SPSS 20.

Results:

The mean score for critical thinking skills was 6.75 ± 2.16, and the highest and lowest scores among the critical thinking subscales related to the evaluation and analysis subscales, respectively. No relationship between critical thinking and academic achievement was identified. “Diverging” was the most common learning style. The highest mean level of academic achievement was earned by those students who adopted the “accommodating” style of learning. A significant relationship was found between learning style and academic achievement (p < .001).

Conclusions:

According to the findings, the critical thinking skills score of students was unacceptably low. Therefore, it is essential to pay more attention to improving critical thinking in academic lesson planning. As a significant relationship was found between learning style and academic achievement, it is suggested that instructors consider the dominant style of each class in lesson planning and use proper teaching methods that take into consideration the dominant style.
Impact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome
Authors: Yoshida Takeshi , Amato Marcelo B.P. , Kavanagh Brian P. , Fujino Yuji
Published: February 2019

Purpose of review

Facilitating spontaneous breathing has been traditionally recommended during mechanical ventilation in acute respiratory distress syndrome (ARDS). However, early, short-term use of neuromuscular blockade appears to improve survival, and spontaneous effort has been shown to potentiate lung injury in animal and clinical studies. The purpose of this review is to describe the beneficial and deleterious effects of spontaneous breathing in ARDS, explain potential mechanisms for harm, and provide contemporary suggestions for clinical management.

Recent findings

Gentle spontaneous effort can improve lung function and prevent diaphragm atrophy. However, accumulating evidence indicates that spontaneous effort may cause or worsen lung and diaphragm injury, especially if the ARDS is severe or spontaneous effort is vigorous. Recently, such effort-dependent lung injury has been termed patient self-inflicted lung injury (P-SILI). Finally, several approaches to minimize P-SILI while maintaining some diaphragm activity (e.g. partial neuromuscular blockade, high PEEP) appear promising.

We update and summarize the role of spontaneous breathing during mechanical ventilation in ARDS, which can be beneficial or deleterious, depending on the strength of spontaneous activity and severity of lung injury. Future studies are needed to determine ventilator strategies that minimize injury but maintaining some diaphragm activity.
Independent and Joint Use of Statins and Metformin by Elderly Patients With Diabetes and Overall Survival Following HCC Diagnosis
Authors: Antwi Samuel O. , Li Zhuo , Mody Kabir , Roberts Lewis R. , Patel Tushar
Published: February 2019

Goal:

To investigate associations of prediagnosis and postdiagnosis use of statins and metformin on overall survival of patients with diabetes who later developed HCC.

Background:

Statins and metformin have received considerable interest as potential chemopreventive agents against hepatocellular carcinoma (HCC) development in individuals with type 2 diabetes mellitus (T2DM); however, their impact on overall survival of patients with T2DM who later develop HCC (diabetic HCC patients) is unclear.

Study:

Data on 2499 elderly diabetic HCC patients obtained from the SEER-Medicare program (2009 to 2013) were analyzed. Patients were categorized based on use of statins only, metformin only, both, or neither (reference for all comparisons). The patients were further categorized based on: (1) metformin dose: ≤1500 or >1500 mg/d; (2) statins functional form: hydrophilic (pravastatin and rosuvastatin) or lipophilic (atorvastatin, fluvastatin, lovastatin, and simvastatin); (3) statins potency: high (atorvastatin, rosuvastatin, and simvastatin) or low (fluvastatin, lovastatin, and pravastatin); and (4) individual statins type. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models.

Results:

Prediagnosis use of metformin dose ≤1500 mg/d was associated with lower risk of death after HCC diagnosis in patients with T2DM (HR, 0.72; 95% CI, 0.58-0.91), adjusting for postdiagnosis metformin dose, diabetes severity, Charlson comorbidity index, tumor characteristics, and other relevant factors. No association was found for prediagnosis metformin dose >1500 mg/d or postdiagnosis metformin use. Further, no association was found for either prediagnosis or postdiagnosis statins use.

Conclusions:

Prediagnosis use of metformin dose ≤1500 mg/d is associated with longer overall survival of elderly diabetic HCC patients.
Effect of Chronic Domperidone Use on QT Interval
Authors: Field Justin , Wasilewski Melissa , Bhuta Rajiv , Malik Zubair , Cooper Joshua , Parkman Henry P. , Schey Ron
Published: February 2019

Goals:

The goal of this study was to determine the effect and safety of domperidone on QTc interval at the commonly prescribed doses of 30 to 80 mg daily.

Background:

Domperidone is a dopamine receptor antagonist used for the treatment of gastroparesis. However, it has been associated with QT prolongation, ventricular arrhythmias, and sudden cardiac death.

Study:

This study analyzed patients prescribed domperidone for treatment of gastroparesis between January 2012 and September 2017 at a single center. This study reviewed EKGs, primarily the QTc interval, taken at baseline, 2 to 6 months after initiation of domperidone, 6 to 12 months after initiation, and ≥12 months after initiation. Concurrent QTc prolonging medications were recorded for each patient. The primary endpoint was QTc prolongation >500 ms. Secondary endpoints were QTc >450 ms for males, a QTc>470 ms for females, QTc prolongation ≥20 ms above baseline, and QTc prolongation >60 ms above baseline.

Results:

In total, 246 patients were included for analysis (age, 46.3±17.4 y; F 209). EKGs were available for all 246 patients before treatment, 170 patients at 2 to 6 months, 135 at 6 to 12 months, and 152 patients at least 1 year after domperidone initiation.

Of 246 subjects, 15 patients (6.1%, 9 female) had clinically important QTc prolongation; 11 had QTc >450 ms for males or >470 ms for females; none had QTc prolongation >500 ms; 5 (2.0%) had >60 ms over baseline and 61 (24.7%) patients had QTc increase of ≥20 ms but <60 ms from baseline.

Conclusions:

Domperidone at the conventionally used doses to treat gastroparesis (30 to 80 mg/d) was associated with QTc prolongation in only 6% of patients with no QT interval reaching the point considered to be clinically significant. These data suggest that domperidone can be safely prescribed at doses of 30 to 80 mg daily for the treatment of gastroparesis.
Chronic Pancreatitis
Authors: Schwarzenberg Sarah J. , Uc Aliye , Zimmerman Bridget , Wilschanski Michael , Wilcox C. Mel , Whitcomb David C. , Werlin Steven L. , Troendle David , Tang Gong , Slivka Adam , Singh Vikesh K. , Sherman Stuart , Shah Uzma , Sandhu Bimaljit S. , Romagnuolo Joseph , Rhee Sue , Pohl John F. , Perito Emily R. , Ooi Chee Y. , Nathan Jaimie D. , Muniraj Thiruvengadam , Morinville Veronique D. , McFerron Brian , Mascarenhas Maria , Maqbool Asim , Liu Quin , Lin Tom K. , Lewis Michele , Husain Sohail Z. , Himes Ryan , Heyman Melvin B. , Guda Nalini , Gonska Tanja , Giefer Matthew J. , Gelrud Andres , Gariepy Cheryl E. , Gardner Timothy B. , Freedman Steven D. , Forsmark Christopher E. , Fishman Douglas S. , Cote Gregory A. , Conwell Darwin , Brand Randall E. , Bellin Melena , Barth Bradley , Banks Peter A. , Anderson Michelle A. , Amann Stephen T. , Alkaade Samer , Abu‐El‐Haija Maisam , Abberbock Judah N. , Lowe Mark E. , Yadav Dhiraj
Published: February 2019

Objectives:

The aim of the present study was to investigate the natural history of chronic pancreatitis (CP); patients in the North American Pancreatitis Study2 (NAPS2, adults) and INternational Study group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE, pediatric) were compared.

Methods:

Demographics, risk factors, disease duration, management and outcomes of 224 children and 1063 adults were compared using appropriate statistical tests for categorical and continuous variables.

Results:

Alcohol was a risk in 53% of adults and 1% of children (P < 0.0001); tobacco in 50% of adults and 7% of children (P < 0.0001). Obstructive factors were more common in children (29% vs 19% in adults, P = 0.001). Genetic risk factors were found more often in children. Exocrine pancreatic insufficiency was similar (children 26% vs adult 33%, P = 0.107). Diabetes was more common in adults than children (36% vs 4% respectively, P < 0.0001). Median emergency room visits, hospitalizations, and missed days of work/school were similar across the cohorts. As a secondary analysis, NAPS2 subjects with childhood onset (NAPS2‐CO) were compared with INSPPIRE subjects. These 2 cohorts were more similar than the total INSPPIRE and NAPS2 cohorts, including for genetic risk factors. The only risk factor significantly more common in the NAPS2‐CO cohort compared with the INSPPIRE cohort was alcohol (9% NAPS2‐CO vs 1% INSPPIRE cohorts, P = 0.011).

Conclusions:

Despite disparity in age of onset, children and adults with CP exhibit similarity in demographics, CP treatment, and pain. Differences between groups in radiographic findings and diabetes prevalence may be related to differences in risk factors associated with disease and length of time of CP.
Similarities and Differences in Allocation Policies for Pediatric Liver Transplantation Across the World
Authors: Fischler Björn , Baumann Ulrich , D'Agostino Daniel , D'Antiga Lorenzo , Dezsofi Antal , Debray Dominique , Durmaz Ozlem , Evans Helen , Frauca Esteban , Hadzic Nedim , Jahnel Jörg , Loveland Jerome , McLin Valérie , Ng Vicky L. , Nobili Valerio , Pawłowska Joanna , Sharif Khalid , Smets Francoise , Verkade Henkjan J. , Hsu Evelyn , Horslen Simon , Bucuvalas John
Published: February 2019

Objectives:

We aimed to investigate national allocation policies for pediatric liver transplantation (LT).

Method:

A survey was prepared by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Hepatology Committee in collaboration with the North American Studies of Pediatric Liver Transplantation consortium. The survey was sent to pediatric hepatologists and transplant surgeons worldwide. National data were obtained from centrally based registries.

Results:

Replies were obtained from 15 countries from 5 of the world continents. Overall donation rate varied between 9 and 35 per million inhabitants. The number of pediatric LTs was 4 to 9 per million inhabitants younger than 18 years for 13 of the 15 respondents. In children younger than 2 years mortality on the waiting list (WL) varied between 0 and 20%. In the same age group, there were large differences in the ratio of living donor LT to deceased donor LT and in the ratio of split liver segments to whole liver. These differences were associated with possible discrepancies in WL mortality.

Conclusions:

Similarities but also differences between countries were detected. The described data may be of importance when trying to reduce WL mortality in the youngest children.
The Impact of Increased Allocation Priority for Children Awaiting Liver Transplant
Authors: Perito Emily R. , Mogul Douglas B. , VanDerwerken Douglas , Mazariegos George , Bucuvalas John , Book Linda , Horslen Simon , Kim Heung B. , Miloh Tamir , Ng Vicky , Reyes Jorge , Rodriguez‐Davalos Manuel I. , Valentino Pamela L. , Gentry Sommer , Hsu Evelyn
Published: February 2019

Objective:

The aim of the study was to investigate the impact of prioritizing infants, children, adolescents, and the sickest adults (Status 1) for deceased donor livers. We compared outcomes under two “SharePeds” allocation schema, which prioritize children and Status 1 adults for national sharing and enhanced access to pediatric donors or all donors younger than 35 years, to outcomes under the allocation plan approved by the Organ Procurement and Transplant Network in December 2017 (Organ Procurement and Transplantation Network [OPTN] 12‐2017).

Methods:

The 2017 Liver Simulated Allocation Model and Scientific Registry of Transplant Recipients data on all US liver transplant candidates and liver offers 7/2013 to 6/2016 were used to predict waitlist deaths, transplants, and post‐transplant deaths under the OPTN 12‐2017 and SharePeds schema.

Results:

Prioritizing national sharing of pediatric donor livers with children (SharePeds 1) would decrease waitlist deaths for infants (<2 years, P = 0.0003) and children (2–11 years, P = 0.001), with no significant change for adults (P = 0.13). Prioritizing national sharing of all younger than 35‐year‐old deceased donor livers with children and Status 1A adults (SharePeds 2) would decrease waitlist deaths for infants, children, and all Status 1A/B patients (P < 0.0001 for each). SharePeds 1 and 2 would increase the number of liver transplants done in infants, children, and adolescents compared to the OPTN‐2017 schema (P < 0.00005 for all age groups). Both SharePeds schema would increase the percentage of pediatric livers transplanted into pediatric recipients.

Conclusions:

Waitlist deaths could be significantly decreased, and liver transplants increased, for children and the sickest adults, by prioritizing children for pediatric livers and with broader national sharing of deceased donor livers.
Disclosure and Quality of Life Among Unemployed Individuals With Mental Health Problems
Authors: Rüsch Nicolas , Malzer Alexandra , Oexle Nathalie , Waldmann Tamara , Staiger Tobias , Bahemann Andreas , Wigand Moritz E. , Becker Thomas , Corrigan Patrick W.
Published: February 2019

Unemployment and mental disorders are associated with impaired quality of life. Because of the stigma associated with mental illness, unemployed individuals with mental health problems face the difficult decision whether to disclose their condition to others. Disclosure has both risks and benefits, and it is unclear how it affects quality of life. We therefore examined disclosure attitudes at baseline as predictors of quality of life after 6 months and also assessed social support, depressive symptoms, self-stigma, and perceived discrimination among 301 unemployed individuals with mental health problems. Better quality of life at follow-up was predicted by better attitudes toward disclosure among family and friends, shorter length of unemployment, less symptoms, and, at a trend level, less self-stigma at baseline. Thus disclosure in one's private environment may improve quality of life among unemployed individuals with mental health problems.
Efficacy and Safety of Single-Dose Oral Delafloxacin Compared With Intramuscular Ceftriaxone for Uncomplicated Gonorrhea Treatment: An Open-Label, Noninferiority, Phase 3, Multicenter, Randomized Study
Authors: Hook Edward W. , Golden Matthew R. , Taylor Stephanie N. , Henry Eugenia , Tseng Carol , Workowski Kimberly A. , Swerdlow Jerri , Nenninger Ashley , Cammarata Sue
Published: February 2019

Background

We evaluated single oral dose of delafloxacin versus single intramuscular ceftriaxone in participants with uncomplicated urogenital gonorrhea (primary objective). Secondary objectives included the efficacy, safety, and tolerability of delafloxacin versus ceftriaxone for uncomplicated urogenital, rectal, and/or pharyngeal gonorrhea.

Methods

In this open-label, multicenter study, 460 participants at 25 study centers were randomized (2:1) to receive a single 900-mg oral dose of delafloxacin or 250-mg intramuscular ceftriaxone. Neisseria gonorrhoeae culture, nucleic acid amplification test, and clinical responses were evaluated. The primary efficacy end point was the urogenital microbiological cure in the urogenital microbiological intention-to-treat population; noninferiority (NI) was assessed using a 10% NI margin.

Results

In the urogenital microbiological intention-to-treat population, urogenital cure rates for delafloxacin were 85.1% (194/228) versus 91.0% (91/100) for ceftriaxone (95% confidence interval, −13.18% to 1.36%). Because the lower bound of the confidence interval exceeded the prespecified −10% NI margin, delafloxacin did not demonstrate NI to ceftriaxone. Treatment failures were more often associated with N. gonorrhoeae with higher delafloxacin minimum inhibitory concentration (MIC) values. In microbiologically evaluable participants, failure occurred in 1 (0.6%) of 177 urogenital infections caused by isolates with delafloxacin MICs <0.008 μg/mL and 31 (64.6%) of 48 infections caused by isolates with delafloxacin MICs ≥0.008 μg/mL. Gastrointestinal adverse events were common with 900-mg of delafloxacin and typically included mild to moderate diarrhea, flatulence, nausea, and vomiting. The most common adverse event was diarrhea in both treatment groups.

Conclusions

A single 900-mg dose of delafloxacin is not a reliable treatment of uncomplicated urogenital gonorrhea. Treatment failures were common in infections caused by N. gonorrhoeae with delafloxacin MICs ≥0.008 μg/mL. Additional testing with alternative dosing regimens could be considered.

ClinicalTrials.gov Identifier: NCT02015637.
Employee Perceptions About Public Health Agencies' Desired Involvement in Impacting Health Equity and Other Social Determinants of Health
Authors: Shah Gulzar H. , Yin Jingjing , Young Jessica L. , Waterfield Kristie
Published: February 2019

Context:

Despite a growing consensus in public health to address health inequities and leverage social determinants of health (SDoH), the level of public health practitioners' readiness to become the agents of change in promoting health equity and shaping SDoH is not well researched.

Objectives:

To examine (1) the level of public health agency employees' perceived desirability for impacting health equity and SDoH, and (2) the impact of employee characteristics such as a (PH WINS) public health degree and awareness of health in all policies on such desirability.

Methods:

Data from the 2017 Public Health Workforce Interests and Needs Survey were used in examining the sense of desirability among agency employees for affecting health equity and SDoH in the agency jurisdictions.

Results:

Fifty-seven percent of health agency employees believed that their agencies should be very involved in affecting health equity in their jurisdictions. Fairly smaller proportions of employees believed in the desirability of affecting SDoH, and the proportions who believed that the agency should bevery involvedin affecting specific SDoH were 17.8% for affecting the quality of transportation, 18.5% for affecting the economy, 22.2% for quality of housing, 22.4% for quality of the built environment, 25.4% for K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (P< .05) of believing that the agency should be very involved in affecting health equity.

Conclusions:

With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in the public health workforce's perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity. Our study findings imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. Fostering cross-sector partnerships with a focus on Health in All Policies (HiAP), SDoH, and health equity must be a high priority for public health agencies, which can be formalized through organizational strategic plans.
The First Nationally Representative Benchmark of the Local Governmental Public Health Workforce: Findings From the 2017 Public Health Workforce Interests and Needs Survey
Authors: Robin Nathalie , Castrucci Brian C. , McGinty Meghan D. , Edmiston Ashley , Bogaert Kyle
Published: February 2019

Context:

A changing public health landscape requires local governmental health departments (LHDs) to have a workforce prepared to meet complex challenges. While previous assessments looked at organizational data on the LHD workforce, the Public Health Workforce Interests and Needs Survey (PH WINS) is the first nationally representative survey to examine individual perceptions of training needs, workplace environment, job satisfaction, and awareness of emerging concepts in public health.

Objectives:

Characterize key interests and needs of the local governmental public health workforce.

Design:

Survey invitations were sent to individual LHD employees on the basis of a stratified sampling approach. The LHDs had to employ a minimum of 25 staff and serve a population of 25 000 or greater to be eligible for inclusion.

Setting:

399 LHDs across the United States.

Participants:

A total of 26 533 LHD employees completed the survey (59% response rate).

Results:

The majority of local public health workers are female (81%, 95% confidence interval [CI]: 78%-84%) and white non-Hispanic (68%, 95% CI: 64%-72%). Of the nearly quarter of workers who declared an intent to leave within the next year excluding retirement (22%, 95% CI: 19%-25%), the most common reasons included pay (46%, 95% CI: 42%-50%), lack of opportunities for advancement (40%, 95% CI: 38%-50%), and workplace environment (30%, 95% CI: 27%-32%). Across jurisdiction size and supervisory level, skills gaps were noted in budget and financial management, systems and strategic thinking, developing a vision for a healthy community, and change management.

Conclusions:

As the first nationally representative sample of the local governmental public health workforce, these data create a national benchmark against which LHDs can measure their workforce. Given the similarities found across LHDs serving different jurisdiction sizes, a unified approach to workforce development should be employed across all LHDs. The LHD leadership should address retention, reward creativity and innovation, improve communication between leadership and employees, and provide opportunities for advancement.
CNS Drug Development, Lessons Learned, Part 4: The Role of Brain Circuitry and Genes—Tasimelteon as an Example
Authors: PRESKORN SHELDON H.
Published: February 2019

This is the fourth in a series of columns discussing the rational and targeted development of drugs to affect specific central nervous system (CNS) circuits in specific ways based on knowledge gained by molecular biology and the human genome project. The first column in this series described 6 CNS drugs with novel mechanisms of action developed over the last 25 years. The second column discussed differences between syndromic diagnoses as exemplified by the third through the fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM III through DSM-5) and the new approach to psychiatric diagnoses championed by the National Institute of Mental Health in their Research Domain Criteria Initiative. The third column reviewed the last 9 years of drug development contrasting the development of drugs in other therapeutic areas (eg, cancer) with psychiatric and related CNS-active drugs. This column extends the discussion of modern drug development for psychiatric and other CNS-related indications, using the development of tasimelteon as an example of how modern drug development focuses rationally on novel targets of interest while simultaneously achieving “specificity.” Tasimelteon, which is indicated for the treatment of non-24-hour sleep-wake disorder, was developed to be a selective agonist at the melatonin MT1 and MT2 receptors, with limited or no effects at other pharmacologically relevant receptors and enzymes to minimize the potential for off-target effects (eg, nuisance side effects), toxicity, drug-drug interactions, and effects on oxidative drug metabolizing enzymes. The next column in this series will continue the discussion of the development of CNS drugs with novel mechanisms of action, using suvorexant, which targets orexin-1 and orexin-2 receptors, to illustrate the preclinical and human studies that were carried out to assess its safety as part of a successful new drug application.
Diagnosis of Primary Clear Cell Carcinoma of the Vagina by 18F-FDG PET/CT
Authors: Fu Zhanli , Chen Xueqi , Yang Xing , Li Qian
Published: February 2019

A 41-year-old woman presented with irregular vaginal bleeding, and a vaginal tumor was found and proved to be a clear cell carcinoma by biopsy. An 18F-FDG PET/CT was performed to exclude its metastatic possibility, which showed the vaginal tumor was the only lesion with 18F-FDG avidity. The vaginectomy and hysterectomy were performed to resect the lesion, and primary clear cell carcinoma of the vagina was finally diagnosed.
Quality and Safety in Health Care, Part LI
Authors: Harolds Jay A.
Published: February 2019

Engagement has 3 different components, the most important of which are felt by some to be vigor and dedication. The third component is absorption. Engagement is considered by some to be the opposite of burnout, although others consider these terms to be not quite opposite, but nearly so. Engaged physicians have greater job satisfaction and less burnout and are less likely to leave their job than physicians who are not engaged. Those physicians who are engaged in their work tend to render patient care that is not only more efficient but also has a higher degree of quality and safety.
68Ga-PSMA-11 PET/MR Can Be False Positive in Normal Prostatic Tissue
Authors: Ferraro Daniela A. , Rupp Niels J. , Donati Olivio F. , Messerli Michael , Eberli Daniel , Burger Irene A.
Published: February 2019

Prostate-specific membrane antigen (PSMA) is a transmembrane glycoprotein expressed in the cytosol of normal prostate tissue and highly overexpressed on the membrane of prostate cancer, therefore increasingly used to image prostate cancer. We report a case of a 65-year-old man with two focal PSMA-positive areas on a 68Ga-PSMA-11 PET/MR, one corresponding to a prostate carcinoma (Gleason score 4 + 3) and another region without any evidence of malignancy, but with corresponding high PSMA-expression on immunohistochemistry.
Superscan 18F-Fluciclovine PET/CT of PSA-Negative Prostate Cancer Bone Metastases
Authors: Chen Bo , Macapinlac Homer A. , Lu Yang
Published: February 2019

A 76-year-old man presented with recently diagnosed prostate adenocarcinoma, Gleason score of 4 + 4, and a Super bone scan with concurrent PSA of 1.7 ng/mL. Approximately 3.5 months later, an 18F-fluciclovine PET/CT was performed despite of a decreased PSA of 0.3 ng/mL. A Superscan fluciclovine PET/CT was identified, and bone metastasis were later confirmed at biopsy.
Noncontrast Chest Computed Tomographic Imaging of Obesity and the Metabolic Syndrome
Authors: Nattenmüller Johanna , Schlett Christopher L. , Tsuchiya Nanae , Reeder Scott B. , Pickhardt Perry J. , Kramer Harald , Kauczor Hans-Ulrich , Wielpütz Mark O. , Seo Joon B. , Hatabu Hiroto , van Beek Edwin J.R. , Schiebler Mark L.
Published: February 2019

The purpose of this review article is to acquaint the reader with the current state of the art for the noncardiovascular imaging biomarkers of metabolic syndrome found on noncontrast computed tomography (NCCT) of the chest and their prognostic significance. Routine chest NCCT includes quantitative information with regard to tissue density and organ volumes in the neck, chest, and upper abdomen. The specific imaging biomarkers that may be seen in association with metabolic syndrome include low thyroid iodine organification, hepatic steatosis, sarcopenia (muscle volume and density), demineralization of the thoracic and upper lumbar vertebral bodies, loss of axial skeletal muscle mass, premature lung inflammation, and an increased deposition of subcutaneous and visceral fat. These easily identified imaging biomarkers can have prognostic implications, which include nonalcoholic steatohepatitis, cirrhosis, hypothyroidism, early lung fibrosis with interstitial abnormalities, sarcopenia, and osteoporotic thoracic and lumbar spine vertebral body compression fractures. NCCT examinations of the chest have the opportunity to become an important imaging tool for outcomes research.
Cervical Thymic Cyst Around Hypoglossal Nerve
Authors: Atalay Fatma , Kars Ayhan , Önder Mehmet Oğuz Kaan , Gözeler Mustafa Sitki , Demirci Elif
Published: February 2019

Cervical thymic cyst is rare lesions leading to cervical mass. As it is a rare entity, it might be confused with other congenital neck masses or neoplastic lesions. Preoperative diagnosis is almost impossible. In the present study, a patient who was operated with prediagnosis of branchial cyst and diagnosed with thymic cyst according to the histopathologic examination was presented. A 16-month-old girl was admitted to our clinic with the complaint of growing right neck mass that was realized about 4 months ago. Magnetic resonance imaging (MRI) of the neck demonstrated a rim-enhanced hypointense cystic lesion in the posterior aspect of the submandibular gland, without tracheal right lateral and mid plane on MRI, curving common carotid artery to the medial. Patients underwent surgery under general anesthesia in company with existing findings. Hypoglossal nerve was surrounded by the mass, and the mass was totally resected. The final pathology result was reported as thymic cyst. Cervical thymic masses might be unnoticed in the differential diagnosis of the cervical mass as they are rarely seen entities. Histopathologic examination of the thymus tissue was performed for diagnosis. Surgical excision is the ideal treatment approach and no postoperative recurrence has been reported.
Surgical Implications of the Anteriorly Displaced Segments of the Anterior Cerebral Artery in the Management of Frontoethmoidal Meningoencephalocele
Authors: Prasad Vani , David David J. , Santoreneos Steve , Moore Mark H.
Published: February 2019

Background:

Preservation of the anterior cerebral arteries (ACAs) is important in the surgical management of frontoethmoidal meningoencephalocele (FEME). This would avoid complications related to the loss of blood supply to the part of the brain supplied by the ACA. Previous reports have identified hydrocephalus, microcephaly, cerebral dysplasias amounting to a 15% to 20% prevalence of brain anomalies in patients with FEME. What has not been previously reported are cerebral vasculature changes in the frontal region in FEME and how these may impact on the surgical correction and clinical outcome.

Methods:

Two patients of FEME that demonstrate cautionary radiologic findings in relation to the ACAs and anterior fossa anatomy are discussed.

Results:

The ACA in a 4-year-old boy with FEME was displaced anteriorly with the long A1 segments that extend into the defect. In the 2nd patient, a 4-year-old girl, we report on the complications related to the injury of ACAs from a previously partially resected FEME.

Conclusion:

The importance of the anterior cerebral vasculature around the FEME during surgery is crucial to prevent complications resulting from damage to a looping A1 segment of the ACA.
Endoscopic Transgastric Versus Surgical Approach for Infected Necrotizing Pancreatitis: A Systematic Review and Meta-Analysis
Authors: Luo De , Liu Xiangdong , Du Juan , Liu Jiang , Chen Xinpei , Zhou Pengcheng , Li Bo , Su Song
Published: February 2019

Surgical approach (SA) is the standard treatment for infected necrotizing pancreatitis (INP) and endoscopic transgastric approach (ETA) is a promising alternative treatment. This systematic review and meta-analysis aimed to compare the effectiveness and safety of ETA versus SA in INP. Several databases were systematically searched for eligible studies that compared ETA with SA for INP. Predefined criteria were used for study selection. Three reviewers independently assessed the risk of bias. Primary outcomes included clinical resolution rate, short-term mortality, major complications, and hospital stay. Study-specific effect sizes and their 95% confidence interval (CI) were combined to calculate the pooled value using fixed-effects or random-effects model. Six studies were included with 295 patients. Major complication rate [odds ratio (OR), 0.13; 95% CI, 0.06-0.29], new-onset organ failure rate (OR, 0.26; 95% CI, 0.12-0.54), postoperative pancreatic fistula rate (OR, 0.09; 95% CI, 0.03-0.28), and incisional hernia rate (OR, 0.10; 95% CI, 0.01-0.85) were lower in the ETA group. There was a shorter hospital stay (mean difference, −17.72; 95% CI, −21.30 to −14.13) in the ETA group. No differences were found in clinical resolution, short-term mortality, postoperative bleeding, perforation of visceral organ, and endocrine or exocrine insufficiency. Compared with SA, ETA showed comparable effectiveness and safety for the treatment of INP based on current evidence.
Caregiving for Persons With Dementia
Authors: Bourgeois Michelle S.
Published: February 2019

Speech–language pathologists (SLPs) have an important role in supporting the caregivers of persons with dementia from diagnosis through the end of life in 4 major areas: education, training to use effective cognitive communication strategies identified for clients with dementia, psychosocial/emotional support, and counseling. Speech–language pathologists may be involved in this process from the initial diagnosis when families need guidance to navigate the vast amounts of information on the Internet and elsewhere, until they need assistance in making end-of-life decisions. Speech–language pathologists must recognize that caregivers have needs, and differing needs, depending on the stage of dementia of the person to whom they are providing care. The research in caregiving interventions for family, professional, and paraprofessional caregivers provides an understanding of effective, evidence-based approaches, resources, and promising caregiver outcomes for the SLP working with individuals with dementia and their caregivers. It is important for SLPs to know that these interventions exist and to seek out appropriate services to which to refer the caregivers of their clients. Other person-centered interventions specifically developed for SLPs to implement with their clients with dementia and their family and professional caregivers are crucial for ensuring a quality life for clients and caregivers and for meeting the demands of a quality dementia care workforce.
Economic aspects of the deployment of fusion energy: the valley of death and the innovation cycle
Authors: Cardozo N. J. Lopes
Published: February 2019

The speed at which fusion energy can be deployed is considered. Several economical factors are identified that impede this speed. Most importantly, the combination of an unprecedentedly high investment level needed for the proof of principle and the relatively long construction time of fusion plants precludes an effective innovation cycle. The valley of death is discussed, i.e. the period when a large investment is needed for the construction of early generations of fusion reactors, when there is no return yet. It is concluded that, within the mainstream scenario—a few DEMO reactors towards 2060 followed by generations of relatively large reactors—there is no realistic path to an appreciable contribution to the energy mix in the twenty-first century if economic constraints are applied. In other words, fusion will not contribute to the energy transition in the time frame of the Paris climate agreement. Within the frame of this analysis, the development of smaller, cheaper and most importantly, fast-to-build fusion plants could possibly represent an option to accelerate the introduction of fusion power. Whether this is possible is a technical question that is outside the scope of this paper, but this question is addressed in other contributions to the Royal Society workshop.

This article is part of a discussion meeting issue ‘Fusion energy using tokamaks: can development be accelerated?’.