bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total pancreatectomy with islet autotransplantation in diabetic and pre-diabetic patients with intractable chronic pancreatitis
Authors: Bachul Piotr J. , Grybowski Damian J. , Anteby Roi , Basto Lindsay , Perea Laurencia , Golab Karolina , Wang Ling-Jia , Tibudan Martin , Gutierrez Angelica P. , Komorniczak Michal , Nagpal Sajan , Lucander Aaron , Fung John , Matthews Jeffrey B. , Witkowski Piotr 
Published: May 2020

Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is an effective treatment option for non-diabetic patients with intractable chronic pancreatitis. The outcome and potential benefits for pre-diabetic and diabetic patients are less well established. Thirty-four patients underwent TPIAT were retrospectively divided into 3 groups according to pre-operative glycemic control: diabetes mellitus (DM) (n = 5, 15%), pre-DM (n = 11, 32%) and non-DM (n = 18, 54%). Pre-operative fasting c-peptide was detectable and similar in all 3 groups. Islet yield in the DM group was comparable to pre-DM and non-DM groups (median islet equivalents [IEQ] was 191,800, 111,800, and 232,000 IEQ, respectively). Patients received islet mass of over the target level of 2000 IEQ/kg in pre-DM and DM at lower but clinically meaningful rates compared to the non-DM group: 45% (5/11) and 60% (3/5) for a combined 50% (8/16) rate, respectively, compared to 83% (15/18) for the non-DM group. At 1 year, fasting c-peptide and HbA1c did not differ between DM and pre-DM groups but c-peptide was significantly higher in non-DM. Islet transplantation failed (negative c-peptide) only in 1 patient. Pre-operatively, all patients experienced pancreatic pain with daily opioid dependence in 60% to 70%. Pancreatic-type pain gradually subsided completely in all groups with no differences in other painful somatic symptoms. Diabetic patients with measurable pre-operative c-peptide can achieve similar benefit from TPIAT, with comparable outcomes to pre-diabetic and non-diabetic patients including pain relief and the metabolic benefit of transplanted islets. Not surprisingly, endocrine outcomes for diabetic and pre-diabetics patients are substantially worse than in those with normal pre-operative glucose control.
Early drain removal after major pancreatectomy reduces postoperative complications: a single-center, randomized, controlled trial
Authors: Dai Menghua , Liu Qiaofei , Xing Cheng , Kleeff Jorg , Liao Quan , Guo Junchao , Han Xianlin , Xu Qiang , Wang Shunda 
Published: May 2020

Abstract

Objectives:
Timing of drain removal and its effects on complications after major pancreatectomy remain controversial. We designed this study to assess whether early drain removal after major pancreatectomy influences the incidence of complications in the patients with low risk of postoperative pancreatic fistula (POPF).

Methods:
This is a single-center randomized controlled trial (RCT). A total of 144 patients undergoing pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) who met the criteria, including drain amylase on postoperative day (POD) 1 and 3 less than 5000 U/L and drain output within POD 3 less than 300 mL/d, were randomly assigned to early drain removal (POD 3) or standard drain removal (≥POD 5). The primary outcome was major complications (Clavien-Dindo grades 2–4), and the secondary outcome was POPF, reintervention treatment, readmission, and total medical expense within 3 months after surgery.

Results:
A total of 5 patients in early drain removal group had at least 1 major complications (grades 2–4), compared to 15 patients in standard drain removal group (P = .028). The incidence of grade B/C pancreatic fistula was not significantly different (2.8% vs 0%). Multivariate analysis demonstrated that early drain removal was an independent factor associated with a reduced risk of major complications (P = .039, odds ratio = 0.314). Majority of major complications occurred in PD patients, and only very few cases occurred in DP patients. Stratified analysis showed that early drain removal significantly reduced the major complications only in the patients undergoing PD.

Conclusion:
This single-center RCT shows early drain removal on POD 3 is safe for both DP and PD patients, under our criteria. Early drain removal could reduce the incidence of major complications in patients undergoing PD.
Training and learning curves in minimally invasive pancreatic surgery: from simulation to mastery
Authors: Haney Caelán M. , Karadza Emir , Limen Eldridge F. , de Santibanes Martin , Kinny-Köster Benedict , Müller Philip C. , Bintintan Vasile V. , Kulu Yakub , Hackert Thilo , Müller-Stich Beat-Peter , Nickel Felix 
Published: May 2020

Abstract

Background:
Minimally invasive pancreatic surgery (MIPS) has developed over the last 3 decades and is nowadays experiencing an increased interest from the surgical community. With increasing awareness of both the public and the surgical community on patient safety, optimization of training has gained importance. For implementation of MIPS we propose 3 training phases. The first phase focuses on developing basic skills and procedure specific skills with the help of simulation, biotissue drills, video libraries, live case observations, and training courses. The second phase consists of index procedures, fellowships, and proctoring programs to ensure patient safety during the first procedures. During the third phase the surgeons aim is to safely implement the procedure into standard practice while minimizing learning curve related excess morbidity and mortality. Case selection, skills assessment, feedback, and mentoring are important methods to optimize this phase. The residual learning curve can reach up to 100 cases depending on the surgeons’ previous experience, selection of cases, and definition of the parameters used to assess the learning curve. Adequate training and high procedural volume are key to implementing MIPS safely.
Pedagogy for Effective Learning of Clinical Skills: An Integrated Laboratory Model
Authors: Reilly Michelle , Beran-Shepler Kimberly , Paschal Karen A. 
Published: May 2020

Background and Purpose.
The teaching, learning, and assessment of clinical skills is a critical component of entry-level physical therapy education. The intention of this article was to describe a successful model for teaching clinical skills in the context of the patient and client management model across the domains of physical therapist education with emphasis on motor learning principles, experiential learning, and clinical reasoning.

Method/Model Description and Evaluation.
The model describes a cohesive laboratory learning environment that integrates skills from the clinical science courses that coincide each semester. A laboratory director coordinates with faculty teaching clinical sciences in a given semester to ensure the necessary psychomotor content is included, creates experiential learning opportunities that integrate skills across content areas, and promotes clinical reasoning in the context of the patient and client management model. Success of this model was measured through student outcomes on skills competency tests (SCTs), Clinical Competence Performance Examinations (CCPEs), American Physical Therapy Association (APTA) Clinical Performance Instrument (CPI) benchmarks, and the National Physical Therapy Examination (NPTE).

Outcomes.
Each student passed SCTs administered during semesters 1–6 given a maximum of 3 trials. Every student passed the CCPE administered at the end of each semester in one of 3 trials except for one student in semester 6. Each student met expectations for performance as measured on the CPI for 4 clinical education experiences including entry-level performance for the final 2terminal experiences. All students were successful on the NPTE.

Discussion and Conclusion.
Implementation of this model has prepared students for authentic physical therapy practice by promoting integration of curriculum content and has fostered faculty collaboration. While initial student and curricular outcomes have been positive, assessment of the model is ongoing.
Influence of noninvasive central blood pressure devices for afterload monitoring with aortic velocity-pressure Loop in anesthetized patients
Authors: Leve Charlotte , Hong Alex , Millasseau Sandrine , Joachim Jona , Touchard Cyril , Mateo Joaquim , Serrano José , Mebazaa Alexandre , Gayat Etienne , Vallee Fabrice 
Published: May 2020

Background
Global afterload angle (GALA) is a parameter derived from velocity-pressure loop (VP Loop), for continuous assessment of cardiac afterload in the operating room. It has been validated with invasive measure of central pressure. The aim of this study was to evaluate the feasibility of noninvasive VP Loop obtained with central pressure measured with two different noninvasive tonometers.

Methods
A prospective, observational, monocentric study was conducted in 51 patients under general anesthesia. Invasive central pressure (cPINV) was measured with a fulfilled intravascular catheter, and noninvasive central pressure signals were obtained with two applanation tonometry devices: radial artery tonometry (cPSHYG: Sphygmocor tonometer) and carotid tonometry (cPCOMP: Complior tonometer). Three VP Loops were built: VP LoopINV, VP LoopSPHYG and VP LoopCOMP. Patients were separated according to cardiovascular risk factors.

Results
In the 51 patients under general anesthesia, cPSHYG was adequately obtained in 48 patients (89%) but, compared to cPINV, SBP was underestimated (−4 ± 6 mmHg, P < 0.0001), augmentation index (AIXSPHYG) and a GALASPHYG were overestimated (+13 ± 19%, P = 0.0077 and +4 ± 8°, P = 0.0024, respectively) with large limit of agreement (LOA) (−21 to 47% and −13 to 21° for AIXSPHYG and GALASPHYG, respectively). With the Complior, the failure rate of measurement for cPCOMP was 41%. SBP was similar (3 ± 17 mmHg, P = 0.32), AIXCOMP was underestimated (−11 ± 19%, P = 0.0046) and GALACOMP was similar but with large LOA (−50 to 26% and −20 to 18° for AIXCOMP and GALACOMP, respectively).

Conclusion
In anesthetized patient, the reliability of noninvasive central pressure monitoring by tonometry seems too limited to monitor cardiac afterload with VP Loop.
Dynamic Change of β to α Ratio in Islets of Chinese People With Prediabetes and Type 2 Diabetes Mellitus
Authors: Liu Tengli , Liang Rui , Wang Le , Zou Jiaqi , Wang Guanqiao , Liu Na , Sun Peng , Liu Yaojuan , Ding Xuejie , Lu Chenxi , Liang Xue , Wang Shusen , Shen Zhongyang 
Published: May 2020

Objectives
The present study aimed to investigate the dynamic change of α cells and β cells, and their ratios in prediabetes and type 2 diabetes in the Chinese population.

Methods
Pancreata from 27 nondiabetic (ND), 8 prediabetic (PreD), and 19 type 2 diabetic (T2D) organ donors were subjected to immunofluorescence staining with insulin and glucagon.

Results
The β to α ratio in islets (β/α) in PreD was significantly higher than that in ND, resulting from an increase of β cells and a decrease of α cells per islet, but that in T2D was significantly lower than that in ND, resulting from a decrease of β cells and an increase of α cells per islet. The β-cell percentage and β/α ratio positively correlated and α-cell percentage negatively correlated with HbA1c (glycated hemoglobin) in ND and PreD, but these correlations disappeared when T2D subjects were included.

Conclusions
The islet β to α ratio increased in PreD individuals because of a relative α-cell loss and β-cell compensation and decreased after T2D onset because of both β-cell loss and α-cell reexpansion.
Positive and Useful Voices in Patients With Schizophrenia
Authors: Lorente-Rovira Esther , Grasa Eva , Ochoa Susana , Corripio Iluminada , Peláez Trinidad , López-Carrillero Raquel , Morano-Guillén María , Gutiérrez-Gea Ángela , Villagrán José M. , Llácer Blanca , Sanjuán Julio 
Published: May 2020

Abstract
Auditory verbal hallucinations (AVHs) in schizophrenia have been characterized by their negative emotional valence. However, positive hallucinations have also been described. The objective of the current study is to explore the prevalence, course, characteristics, and associations of positive and useful voices. The Positive and Useful Voices Inquiry and some clinical and functioning instruments were administered to a sample of 68 patients with schizophrenia or schizoaffective disorder presenting with AVHs. Both the lifetime and current prevalences of positive and useful voices were high. Although AVHs tended to remain stable, there was a trend to decrease over time. The strongest positive attributions of such voices were that they help patients to feel important, amuse them, and help them to conduct their studies and carry out their profession. They seem to be mainly related to more grandiosity and to worse general functioning. Interference with biological and psychological treatments and the need for personalized formulations in patients with auditory hallucinations are discussed.
Designing for Efficiency
Authors: Fay Lindsey , Santiago Joshua E. , Real Kevin , Isaacs Kathy 
Published: May 2020

OBJECTIVE
This study examined the impact of centralized and decentralized unit designs on an interdisciplinary team's perceptions of efficiency through the use of a preoccupancy and postoccupancy evaluation of a cardiovascular unit.

BACKGROUND
During the premove study, the service line was housed across 4 separate locations, each with a centralized nurses' station. The postmove design was housed on 1 floor with decentralized stations.

METHODS
For this qualitative study, 14 focus groups and 1 interview were conducted. Analysis of the data was guided by a developed framework for efficiency classified into 7 categories.

RESULTS
Outcomes reveal that efficiency was impacted by issues including walking, access to supplies and equipment, proximity to staff, and overall unit configuration and size.

CONCLUSIONS
Although the design of the decentralized unit positions staff members closer to patients, many feel isolated while the centralized units seemed to better promote staff proximity and access to supplies.
Exome Sequencing and Its Emerging Role in Prenatal Genetic Diagnosis
Authors: Hopkins Maeve K. , Dugoff Lorraine , Kuller Jeffrey A. 
Published: May 2020

Importance
Prenatal genetic diagnosis can guide pregnancy management and decision making. Genetic diagnosis has advanced rapidly, and chromosomal microarray has become widely used, in addition to conventional karyotype. Exome sequencing may provide an even higher detection rate of genetic anomalies and may be more commonly applied in the future.

Objective
The objectives of this manuscript are to review current practices in prenatal genetic diagnosis, define exome sequencing, identify scenarios in which exome sequencing may be indicated, identify potential concerns regarding exome sequencing, and review the importance for the general obstetrician-gynecologist to understand exome sequencing technology and its uses.

Evidence Acquisition
A MEDLINE search of “prenatal genetic testing,” “chromosomal microarray,” “conventional karyotype,” or “exome sequencing” in the review was performed.

Results
The evidence cited in this review includes 6 medical society committee opinions and 17 additional peer-reviewed journal articles that were original research or expert opinion summaries.

Conclusions and Relevance
Exome sequencing may be a useful prenatal genetic diagnostic tool in cases with ultrasound anomalies with previously normal chromosomal microarray and/or karyotype. As more data become available, technology improves, and costs fall, exome sequencing may become more widely used in prenatal genetic diagnosis.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to identify indications for prenatal genetic diagnosis; compare available methods of prenatal genetic diagnosis; define exome sequencing; refer patients for whom exome sequencing may be considered; and explain the benefits and limitations of exome sequencing for prenatal genetic diagnosis.
Exposure and Confidence With Critical Nonairway Procedures
Authors: Craig Simon S. , Auerbach Marc , Cheek John A. , Babl Franz E. , Oakley Ed , Nguyen Lucia , Rao Arjun , Dalton Sarah , Lyttle Mark D. , Mintegi Santiago , Nagler Joshua , Mistry Rakesh D. , Dixon Andrew , Rino Pedro , Kohn Loncarica Guillermo , Dalziel Stuart R. ,   for the Pediatric Emergency Research Networks
Published: May 2020

BackgroundChildren rarely experience critical illness, resulting in low exposure of emergency physicians (EPs) to critical procedures. Our primary objective was to describe senior EP confidence, most recent performance, and/or supervision of critical nonairway procedures. Secondary objectives were to compare responses between those who work exclusively in PEM and those who do not and to determine whether confidence changed for selected procedures according to increasing patient age.MethodsSurvey of senior EPs working in 96 emergency departments (EDs) affiliated with the Pediatric Emergency Research Networks. Questions assessed training, performance, supervision, and confidence in 11 nonairway critical procedures, including cardiopulmonary resuscitation (CPR), vascular access, chest decompression, and cardiac procedures.ResultsOf 2446 physicians, 1503 (61%) responded to the survey. Within the previous year, only CPR and insertion of an intraosseous needle had been performed by at least 50% of respondents: over 20% had performed defibrillation/direct current cardioversion. More than 50% of respondents had never performed or supervised ED thoracotomy, pericardiocentesis, venous cutdown, or transcutaneous pacing. Self-reported confidence was high for all patient age groups for CPR, needle thoracocentesis, tube thoracostomy, intraosseous needle insertion, and defibrillation/DC cardioversion. Confidence levels increased with increasing patient age for central venous and arterial line insertion. Respondents working exclusively in PEM were more likely to report being at least somewhat confident in defibrillation/DC cardioversion, intraosseous needle insertion, and central venous line insertion in particular age groups; however, they were less likely to be at least somewhat confident in ED thoracotomy and transcutaneous pacing.ConclusionsCardiopulmonary resuscitation and intraosseous needle insertion were the only critical nonairway procedures performed by at least half of EPs within the previous year. Confidence was higher for these procedures, and needle and tube thoracostomy. These data may inform the development of continuing medical education activities to maintain pediatric procedural skills for emergency physicians.
Point-of-Care Ultrasound Training Programs Across Italian Pediatric Residency Schools: A National Survey
Authors: Buonsenso Danilo , Malamisura Monica , Musolino Anna Maria 
Published: May 2020

Introduction
The role of point-of-care ultrasound (POCUS) in routine clinical practice is rapidly growing, whereas adult specialties have already included training programs regarding this topic; pediatric residency schools are still late on this topic, particularly in Italy.

Methods
We performed an online anonymous survey to Italian residents. The online survey has been submitted to the resident representatives of each pediatric residency school in Italy by the Italian Observatory of Pediatric Residents; each representative in turn distributed it to the pediatric residents of his own school.

Results
Three sixty-one residents responded to the survey. Only 7.8% of residents declared that in their residency school, an official training program on POCUS exists, although more than 95% of respondents declared that such a training would be of primary importance for their future practice. Most residents do not know how to use an ultrasound machine nor the differences between different probes.

Conclusions
Our results demonstrate that POCUS training is still missing in Italy. Given the growing number of evidences of the benefits from including POCUS in clinical practice and patient evaluation, efforts are needed to fill this gap, in Italy and, probably, in most European countries. Such a training will definitely help the new generation of pediatricians improve their curriculum and, therefore, child health.
COVID-19 Prevention and Control Public Health Strategies in Shanghai, China
Authors: Zhang Ni , Shi Tianqin , Zhong Heng , Guo Yijia 
Published: May 2020

Context:
COVID-19 was characterized as a pandemic by the World Health Organization on March 11, 2020. This research aims to analyze the public health strategies to prevent and control COVID-19 in Shanghai, China, and provide recommendations for public health policy and interventions in the United States.

Program:
Based on the Social-Ecological Model, this research collected information for public health strategies from the Shanghai Municipal Health Commission and various Chinese websites.

Evaluation:
The daily confirmed new cases of COVID-19 decreased from 27 to 0 in 53 days since the first case of COVID-19 was confirmed in Shanghai on January 20, 2020.

Discussion:
The pattern of daily confirmed new cases suggests the effectiveness of public health strategies. This research also provides recommendations on the development and improvements of public health strategies in the U.S. by acknowledging the differences in political and social systems between the two countries.
Improving Early Discharges With an Electronic Health Record Discharge Optimization Tool
Authors: Perry Michael F. , Macias Charlie , Chaparro Juan D. , Heacock Allison C. , Jackson Kenneth , Bode Ryan S. 
Published: May 2020

Introduction:
Delays in hospital discharge can negatively impact patient care, bed availability, and patient satisfaction. There are limited studies examining how the electronic health record (EHR) can be used to improve discharge timeliness. This study aimed to implement an EHR discharge optimization tool (DOT) successfully and achieve a discharge before noon (DBN) percentage of 25%.

Methods:
We conducted a single-center quality improvement study of patients discharged from 3 pediatric hospital medicine teaching service teams at a quaternary care academic children’s hospital. The multidisciplinary team created a DOT centrally embedded within the care team standard workflow to communicate anticipated time until discharge. The primary outcome was the monthly percentage of patients discharged before noon. Secondary outcomes included provider utilization of the DOT, tool accuracy, and patient length of stay. Balancing measures were 7- and 30-day readmission rates.

Results:
The DBN percentage increased from 16.4% to an average of 19.3% over the 13-month intervention period (P = 0.0005). DOT utilization was measured at 87.2%, and the overall accuracy of predicting time until discharge was 75.6% (P < 0.0001). Median length of stay declined from 1.75 to 1.68 days (P = 0.0033), and there was no negative impact on 7- or 30-day readmission rates.

Conclusion:
This initiative demonstrated that a highly utilized and accurate discharge tool could be created in the EHR to assist medical care teams with improving DBN percentage on busy, academic teaching services.