bluuebunny/crossref_metadata_2025_split huggingface dataset:
Point-of-care ultrasound in pediatric anesthesia: perioperative considerations
Authors: Adler Adam C. , Matisoff Andrew J. , DiNardo James A. , Miller-Hance Wanda C. 
Published: April 2020

Purpose of review
To review the perioperative applications of point-of-care ultrasound (POCUS).

Recent findings
The role of point-of-care ultrasonography for perioperative care is expanding with respect to perioperative application. The imaging approach can complement the physical exam and provide additional information for decision-making in pediatric perioperative medicine. This review will focus on applications in the following organ systems: airway, cardiac, pulmonary and gastric. Specifically, POCUS of the airway has been used to optimize endotracheal tube depth, aid in tube size selection and predict difficulty with laryngoscopy and intubation. Lung POCUS has been used to assess for causes hypoxemia as well as to optimize ventilatory mechanics. Cardiac POCUS has been used for assessment of hemodynamics, valvular and ventricular function. Gastric ultrasound has emerged as an evaluative mechanism of gastric content in the setting of fasting as well as to confirm placement of gastric tubes. The applications of POCUS in the perioperative setting continue to evolve as a reliable diagnostic tool that can assist in timely diagnosis, improve procedural safety and has the potential to improve patient outcomes.

Summary
The utility of perioperative POCUS has been well demonstrated, specifically for examination of the airway, stomach and cardiopulmonary system. It is advisable for the novice sonographer to perform POCUS within the guidelines set by the American Society of Echocardiography regarding basic POCUS. As with all diagnostic modalities, understanding the limitations of ultrasound and POCUS as well as continuous self-assessment is crucial.
Perioperative β-blocker use: what is new in 2020?
Authors: Wang Xiaoxiao , Fernandez Robles Claudia , Kertai Miklos D. 
Published: April 2020

Purpose of review
Although the indications for β-blockers in the management of patients with congestive heart failure and myocardial infarction are well established, the use of β-blockers in the perioperative setting remains controversial.

Recent findings
Since 2008 PeriOperative ISchemic Evaluation Trial, there have been numerous studies suggesting that perioperative β-blockers are associated with adverse events such as hypotension, bradycardia, increased mortality, and stroke.

Summary
In this article, we review the most recent evidence to suggest an approach to perioperative β-blocker use tailored to patient and surgical risk factors. We also review recent studies on off-label uses for perioperative β-blockers.
Industry Payments to Orthopedic Spine Surgeons Reported by the Open Payments Database
Authors: Pathak Neil , Mercier Michael R. , Galivanche Anoop R. , Mets Elbert J. , Bovonratwet Patawut , Bagi Paul S. , Varthi Arya G. , Grauer Jonathan N. 
Published: April 2020

Study Design:
This was a retrospective study of publicly available data.

Objective:
The objective of this study was to characterize and assess trends in Open Payments Database (OPD) industry payments reported to orthopedic spine surgeons from 2014 to 2017.

Summary of Background Data:
There have been a lack of studies characterizing OPD industry payments to orthopedic spine surgeons over the 4 full years of data available.

Materials and Methods:
General industry payments made to orthopedic spine surgeons from 2014 to 2017 were characterized by year with analysis of: number of compensated surgeons, median payment per surgeon, top strata of compensated surgeons, and subtype (ie, food/beverage). Research and Ownership Payments were characterized by median payment per surgeon. Mann-Whitney U tests were used to compare payments.

Results:
For General Payments, the number of compensated orthopedic spine surgeons increased from 1539 in 2014 to 1673 in 2017. Later year median General Payments per surgeon were compared with the 2014 median ($1051): 2015 ($1070: P=0.375), 2016 ($1263: P=0.012), and 2017 ($978: P=0.561). In 2014, the top 10% of compensated orthopedic spine surgeons received 89% of the total General compensation to orthopedic spine surgeons, top 5% received 79%, and the top 1% received 55%. The median General Payment for these 3 top strata remained similar over the 4 years evaluated (P>0.05). For subtype analyses, the median aggregate General Payment for “education” increased (P=0.002) across the years. Finally, it was determined that the median payment per surgeon for Research and Ownership Payment categories remained stable across the time period (P>0.05).

Conclusions:
Many expected industry payments to surgeons to decrease under public scrutiny of the OPD, but the present study showed no net change in median payment (General, Research, and Ownership) over the years studied. In the age of greater transparency, these findings shed insight into the orthopedic spine surgeon-industry relationship.

Level of Evidence:
Level III.
Liposomal Bupivacaine Is Both Safe and Effective in Controlling Postoperative Pain After Spinal Surgery in Children
Authors: Chughtai Morad , Sultan Assem A. , Hudson Brittany , Goodwin Ryan C. , Seif John , Khlopas Anton , Bena James , Jin Yuxuan , Gurd David P. , Kuivila Thomas E. , Ballock Robert Tracy 
Published: April 2020

Study Design:
Retrospective comparative cohort study.

Objective:
To evaluate: (1) pain relief efficacy; (2) opioid consumption; (3) length of stay (LOS); (4) discharge disposition (DD); and (5) safety and adverse effects of liposomal bupivacaine (LB) in pediatric patients who underwent spinal deformity correction.

Summary of Background Data:
LB is a long-acting, locally injectable anesthetic. Previous orthopedic studies investigating its use have been limited to adult patients. The use of LB as part of postoperative pain management in pediatric patients undergoing spine deformity correction surgery is yet to be evaluated.

Materials and Methods:
A total of 195 patients that received LB as part of their postoperative pain management regimen were compared with 128 patients who received standard pain management without LB. Pain intensity, opioid consumption, LOS, and DD were recorded. Potential LB-related complications were reported as frequencies and statistically compared for superiority. Noninferiority tests were performed using the Farrington-Manning score test. Multivariate tests based on generalized estimating equations were performed to determine the common and average treatment effects. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Results:
The LB cohort demonstrated lower pain scores [postoperative day 1 (POD 1)—median=2, interquartile range (IQR)=(0–5) vs. 5 (2.5–7); POD 2—3 (0–5) vs. 4 (3–6); P<0.001], lower overall opioid consumption (78.2 vs. 129 morphine milligram equivalents; P=0.0001) and consistently from POD 0 to 3 (mean differences; 7.47, 9.04, 17.2, and 17.3 morphine milligram equivalents, respectively; P<0.01), shorter LOS (median=3 d, IQR=3–4 vs. 4 d, IQR=4–6; P<0.001), and similar to-home DD (98% vs. 97%). Complications were similar among the cohorts in superiority and 10% noninferiority analyses. Patients in the LB cohort had lower odds for complications (odds ratio=0.77; 95% CI, 0.64–0.93; P=0.009 and 0.67; 95% CI, 0.50–0.90; P=0.008).

Conclusions:
This study demonstrated the safety and efficacy of LB when added to the current multimodal postoperative pain management regimens after pediatric spinal surgery.

Level of Evidence:
Level III.
Demographic and Perioperative Factors Associated With Patient-reported Outcomes Measurement Information System (PROMIS) Survey Completion
Authors: Parrish James M. , Jenkins Nathaniel W. , Patel Dil V. , Karmarkar Sailee S. , Yoo Joon S. , Lamoutte Eric H. , Singh Kern 
Published: April 2020

Study Design:
This was a retrospective study.

Objective:
To evaluate independent demographic and perioperative factors associated with lower Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF) survey completion rates after spine surgery.

Summary of Background Data:
There has not been a study evaluating factors related to PROMIS PF survey completion following spine surgery.

Methods:
Patients undergoing spine procedures were retrospectively reviewed. The number of PROMIS PF surveys that were completed at each time period and the number of surveys that were completed in succession starting with the first survey were tabulated and reported using descriptive statistics. Independent preoperative and perioperative factors associated with full survey completion up to the 12-month period were identified using χ2 analysis and Poisson regression with robust error variance. A final multivariate model was created using a backward, stepwise multivariate regression.

Results:
A total of 713 patients were included. Variables positively associated with PROMIS survey completion were aged above 60 years and Patient Health Questionnaire (PHQ)-9≥10. African Americans and Hispanics were negatively associated with survey completion. Postoperative day 0 narcotic use ≥50 oral morphine equivalents was positively associated with survey completion, while outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion. In the final multivariate model, depression was the only variable that was positively associated, while both outpatient surgical setting and high preoperative radicular arm/leg pain were negatively associated with survey completion.

Conclusion:
This study identified demographic and perioperative variables associated with PROMIS survey completion and response rates. Patients who underwent surgery in the outpatient setting and those with high preoperative radicular limb pain were less likely to complete surveys. Interestingly, patients with clinical signs of depression were more likely to fill out surveys. Understanding variables associated with survey completion may provide the clinician with insight into which demographic groups are the most at-risk for not responding to surveys.
Partnering With Family Members to Detect Delirium in Critically Ill Patients*
Authors: Fiest Kirsten M. , Krewulak Karla D. , Ely E. Wesley , Davidson Judy E. , Ismail Zahinoor , Sept Bonnie G. , Stelfox Henry T. 
Published: April 2020

Objectives:
To evaluate the diagnostic accuracy of family-administered tools to detect delirium in critically ill patients.

Design:
Diagnostic accuracy study.

Setting:
Large, tertiary care academic hospital in a single-payer health system.

Patients:
Consecutive, eligible patients with at least one family member present (dyads) and a Richmond Agitation-Sedation Scale greater than or equal to –3, no primary direct brain injury, the ability to provide informed consent (both patient and family member), the ability to communicate with research staff, and anticipated to remain admitted in the ICU for at least a further 24 hours to complete all assessments at least once.

Interventions:
None.

Measurements and Main Results:
Family-administered delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily. A board-certified neuropsychiatrist and team of ICU research nurses conducted the reference standard assessments of delirium (based on Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, criteria) once daily for a maximum of 5 days. The mean age of the 147 included patients was 56.1 years (sd, 16.2 yr), 61% of whom were male. Family members (n = 147) were most commonly spouses (n = 71, 48.3%) of patients. The area under the receiver operating characteristic curve on the Family Confusion Assessment Method was 65.0% (95% CI, 60.0–70.0%), 71.0% (95% CI, 66.0–76.0%) for possible delirium (cutpoint of 4) on the Sour Seven and 67.0% (95% CI, 62.0–72.0%) for delirium (cutpoint of 9) on the Sour Seven. These area under the receiver operating characteristic curves were lower than the Intensive Care Delirium Screening Checklist (standard of care) and Confusion Assessment Method for ICU. Combining the Family Confusion Assessment Method or Sour Seven with the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU resulted in area under the receiver operating characteristic curves that were not significantly better, or worse for some combinations, than the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU alone. Adding the Family Confusion Assessment Method and Sour Seven to the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU improved sensitivity at the expense of specificity.

Conclusions:
Family-administered delirium detection is feasible and has fair, but lower diagnostic accuracy than clinical assessments using the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU. Family proxy assessments are essential for determining baseline cognitive function. Engaging and empowering families of critically ill patients warrant further study.
Filling the gaps of patient information and comprehension
Authors: Ector Geneviève I.C.G. , Hermens Rosella P.M.G. , Blijlevens Nicole M.A. 
Published: April 2020

Purpose of review
This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps.

Recent findings
Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient–physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial.

Summary
Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.
Enhanced recovery after surgery in minimally invasive gynecologic surgery surgical patients: one size fits all?
Authors: Helou Christine M. , Chaves Katherine F. , Limperg Tobias B. , Anderson Ted L. 
Published: April 2020

Purpose of review
Enhanced recovery after surgery (ERAS) programs aim to expedite functional recovery and improve surgical outcomes without increasing complications or cost. First championed by colorectal surgeons, ERAS protocols are now widely utilized among surgical subspecialties. The present review focuses on use of ERAS pathways in minimally invasive gynecologic surgery (MIGS) and risk factors for suboptimal outcomes in this population.

Recent findings
Studies across multiple fields has shown benefit to adoption of ERAS protocols. However, lack of protocol standardization among institutions, implementation of interventions as a bundle, varied compliance, and lack of study randomization collectively obscure generalizability of findings from such studies. Emerging data in fact suggest benefits may not translate equally across all populations, cautioning against indiscriminate application of protocols to all surgeries or patients. Thus applicability of ERAS protocols to the MIGS population merits close examination.

Summary
ERAS protocols improve postoperative outcomes, satisfaction, and cost of care for most patients undergoing gynecologic surgery. However, modifications to typical ERAS protocols may be beneficial to certain subsets of patients including patients with chronic pelvic pain, opiate dependence, or psychiatric disorders. Identification of risk factors for admission or increased hospital stay may help guide protocol modifications for at-risk groups within the MIGS population.
A Mediterranean Lifestyle Is Associated With Lower Hypertension Prevalence and Better Aerobic Capacity Among New England Firefighter Recruits
Authors: Lan Fan-Yun , Fernandez-Montero Alejandro , Yiannakou Ioanna , Marinos-Iatrides Orestes , Ankeny Jacob T. , Kiser Jeffrey , Christophi Costas A. , Christiani David C. , Sotos-Prieto Mercedes , Kales Stefanos N. 
Published: April 2020

Objective:
Examine the association between healthy Mediterranean lifestyle practices and cardiovascular disease (CVD) risk factors among New England firefighter recruits.

Methods:
A MEDI-Lifestyle score was used to measure adherence to a Mediterranean lifestyle (not smoking, increased physical activity, high adherence to Mediterranean diet, non-obese body mass index, decreased screen time, adequate nightly sleep, and napping) among the recruits. MEDI-Lifestyle scores were cross-sectionally analyzed with blood pressure, aerobic capacity, and other CVD risk factors.

Results:
Among 92 recruits, high adherence to MEDI-Lifestyle was significantly associated with a decreased risk of prevalent hypertension (odds ratio [OR] = 0.14 [0.03–0.71]) and a greater probability of high aerobic capacity (OR = 5.80 [1.05–32.05]) as compared with low adherence in age- and sex-adjusted analyses.

Conclusions:
Increased adherence to MEDI-Lifestyle is associated with a better CVD risk profile in firefighter recruits.
Student Self-Assessments and Peer Assessments of Video Recordings of Physical Examination Practicums in a Physical Diagnosis Course
Authors: Sadowski Catherine K. , Dickerson Lisa , Taylor Leslie F. 
Published: April 2020

Purpose
Self-assessments and peer assessments of video recordings of performance have been used in a variety of educational and professional training programs; however, there is no literature on the application of such performance assessments in physician assistant (PA) education. The purpose of this pilot study was to both explore the feasibility of adding video recordings of existing practicum examinations to a physical diagnosis course and evaluate students' self-assessments and peer assessments of the activity.

Methods
Fifty first-semester students who were enrolled in a 7-semester PA program participated. Three 15-minute practicums were recorded on students' personal smartphones and uploaded to a private YouTube channel. Students completed self- and peer-review questionnaires after each practicum, as well as a separate reflective questionnaire at the end of the course to garner their feedback of the video-recorded practicums on their physical examination (PE) performance.

Results
Students assessed their peers' performances more favorably than their own. Students reported increased awareness of their own verbal and nonverbal communication strengths and weaknesses with the use of video-recorded practicums, as well as increased motivation to practice. The majority of students found these sessions to have improved their performance and decreased their anxiety with performing a complete PE at the end of the course.

Conclusions
The use of periodic video recordings of PE practicums with both self-assessments and peer assessments increased the students' level of practice of these important skills, enhanced students' awareness of nontechnical aspects of patient examination, was well received by the majority of students, and may be implemented with minimal expense.
Assessing Burnout and Interest in Wellness Programs in Physician Assistant Students
Authors: Johnson Aimee K. , Blackstone Sarah R. , Simmons Whitney , Skelly Ashley 
Published: April 2020

PurposeBurnout among health care professionals and preprofessional health care students is of growing concern because of its detrimental effects on performance, mental health, and physical health. Research to date has focused primarily on physicians and medical students. The purpose of this study was to assess burnout and the quality of life among physician assistant (PA) students and gauge their interest in specific wellness interventions that address those issues in their PA program.MethodsAn online survey consisting of validated measures for burnout and quality of life was completed by 320 PA students from all 8 Virginia PA programs (n = 8). Additionally, student interest in various wellness interventions was assessed, including preferences for timing and delivery, to inform development of a tailored well-being component in the PA curriculum to reduce burnout.ResultsWe found burnout to be prevalent among PA students, with 79.69% reporting high levels of emotional exhaustion; 56.56% of students met the criteria for cynicism. Survey participants rated stress reduction (n = 290, 90.63%) and burnout (n = 299, 93.44%) as primary issues that need to be addressed in the PA student population. Furthermore, 77.50% of participants expressed interest in participating in a wellness intervention designed to reduce burnout.ConclusionGiven the high prevalence of burnout in the PA students surveyed, resources and potential interventions that reduce burnout need to be identified. The current study identified PA students' perceived needs and interest in various aspects of potential wellness interventions in the PA program. Students preferred an emphasis on stress reduction and burnout, which can be used to develop a tailored well-being curriculum to promote work-life balance and stress management for PA students.
Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder
Authors: Rizzolo Denise , Smith Noël E. , McCall Timothy C. , Roberts Amy , Porta Kelly 
Published: April 2020

Purpose
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers.

Methods
A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected.

Results
A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD.

Conclusion
The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.