bluuebunny/crossref_metadata_2025_split huggingface dataset:
Underneath the White Coat
Authors: Maffoni Marina , Argentero Piergiorgio , Giorgi Ines , Giardini Anna 
Published: January 2020

Palliative care practice is associated with risk factors linked to end-of-life, chronicity, personal, interpersonal, and work characteristics, as well as with protective factors, but how these are perceived by the health care providers themselves is not clear. This article aims to elaborate a theoretical framework explaining the risk and protective factors for palliative care providers in their daily practice. Nineteen providers (16 nurses, 3 physicians) working in a palliative care unit of a clinical-research institute in Northern Italy were interviewed. A Grounded Theory qualitative approach guided the data collection and analysis. From the interviews, 28 codes, subsequently organized into 11 interconnected categories, emerged. They described both stressors (emotion management regarding death/dying, conflicts, communication and relationship with patients/caregivers, discrepancies between patients' and caregivers' needs, communication of poor diagnosis/prognosis, decision making about treatment, and real-life and work interference) and protective factors (social support, positive approach and value of past experience, recognized value of/passion toward professional work, work-family balance). Experiencing these elements as positive or negative depends on the professionals' point of view, as well as their past and present experience.
Understanding what dealing with life-limiting illnesses means may suggest tailored interventions to improve professionals' well-being by fostering the protective elements and combatting the risk factors.
Cognitive and Emotional Empathy in Anorexia Nervosa
Authors: Doba Karyn , Nandrino Jean-Louis 
Published: January 2020

Abstract
The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.
Evaluating Changes in Caring Behaviors of Caritas Coaches Pre and Post the Caritas Coach Education Program
Authors: Brewer Barbara B. , Anderson Jan , Watson Jean 
Published: January 2020

OBJECTIVE
The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP).

BACKGROUND
The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory.

METHODS
A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP.

RESULTS
The mean scores of all measures improved significantly.

CONCLUSIONS
After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.
Transition From Acute to Chronic Pain in Lower Extremity Fracture Patients
Authors: Griffioen Mari A. , Glutting Joseph , O’Toole Robert V. , Starkweather Angela R. , Lyon Debra , Dorsey Susan G. , Renn Cynthia L. 
Published: January 2020

Background
Traumatic injury is a major source of chronic pain, particularly for individuals with traumatic fracture of the fibula and/or tibia (lower extremity fracture [LEFx]). Although several factors (e.g., older age, being female, high pain intensity at time of initial injury) have been identified as risk factors for chronic pain associated with LEFx. Comprehensive biopsychosical models to predict the odds of transitioning from acute to chronic pain after LEFx are needed to better understand the underlying processes, predict risk for chronic pain, and develop personalized therapies for individuals at higher risk for developing chronic pain.

Objective
The aim of the study was to outline the study design that will be used to examine the physiological, psychological, and genetic/genomic variables—models that predict the transition from acute to chronic pain after LEFx.

Method
This prospective descriptive cohort study will enroll 240 participants with a fibula and/or tibia fracture and 40 controls with no LEFx. Data will be collected during an in-hospital baseline visit, five in-person clinic visits (6 weeks, 12 weeks, 24 weeks, 52 weeks, and 24 months), and seven online between-visit surveys (2 weeks, 4 weeks, 8 weeks, 10 weeks, 16 weeks, 20 weeks, and 18 months) from participants with LEFx and at concordant intervals from controls. Measures will consist of 19 questionnaires characterizing pain and psychological status, neurophysiological testing for peripheral sensory nerve function, and peripheral blood samples collections for RNA sequencing. Illumina standard protocols will be used to sequence RNA, and read counts will be used to measure gene expression.

Analysis
Direct-entry, multiple logistic regression will be used to produce odds ratios expressing the relative risk on each explanatory variable when controlling for other predictors/covariates in the model.

Conclusion
This study is one of the first to longitudinally characterize the biopsychosocial variables associated with a clinically relevant problem of the transition from acute to chronic posttraumatic fracture pain in individuals with LEFx. Results from this study will be used to construct predictive risk models of physiological, psychological, and genetic/genomic variables associated with increased risk for transitioning from acute to chronic pain status after LEFx. This work will lead to a better understanding of the trajectory of pain and relevant variables over time; initiate a better understanding of variables associated with risk for transitioning from acute to chronic pain; and, in the future, could provide a foundation for the identification of novel therapeutic targets to improve the outcomes of individuals with LEFx.
Management Considerations for Recalcitrant Hyperemesis
Authors: Spinosa Daniel , Post Annalisa , Kuller Jeffrey A. , Dotters-Katz Sarah 
Published: January 2020

Importance
Hyperemesis gravidarum (HEG) affects 0.3% to 3% of pregnancies and requires additional therapies beyond those commonly used for less severe instances of nausea and vomiting of pregnancy (NVP). Differentiating between NVP and HEG is a vital yet challenging function for any obstetrician. The literature for management of HEG is lacking compared with that of NVP.

Objective
Review etiology of NVP/HEG highlights key considerations in the workup of HEG as they compare to NVP and explore management options for recalcitrant HEG focusing principally on how they affect maternal and fetal outcomes and secondarily on where data are nonprescriptive.

Evidence Acquisition
This was a literature review primarily using PubMed and Google Scholar.

Results
Short-course corticosteroids and treatment for Helicobacter pylori have the most favorable risk-reward profiles of the 4 pharmacologic therapies evaluated. Mirtazapine and diazepam may have a place in highly selected patients. If nutritional supplementation is required, enteral nutrition is strictly preferred to parenteral nutrition. Postpyloric feeding approaches are less likely to induce vomiting. Surgically placed feeding tubes are less likely to be dislodged and may be worth the invasive insertion procedure if nasogastric or nasojejunal tubes are not tolerated.

Conclusions and Relevance
Hyperemesis gravidarum is a diagnosis reserved for refractory cases of NVP and therefore by definition poses treatment challenges. Any clinical presentation that lent itself to prescriptive, algorithmic management would likely fall short of the diagnostic criteria for HEG. However, data can inform management on a patient-by-patient basis or at least help patient and provider understand risks and benefits of therapies reserved for refractory cases.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to evaluate the epidemiology and pathophysiology of HEG, especially as compared with NVP; assess second-line pharmacologic therapies for HEG, with particular focus on the data available for those interventions; and compare different options for nutritional support.
Rapid Testing Algorithm Performance in a Low-Prevalence Environment
Authors: Martin Eugene G. , Cornett Julia , Mohammed Debbie Y. , Salaru Gratian 
Published: January 2020

Background
The performance of a statewide HIV rapid test algorithm (RTA) in a low-prevalence setting (0.71%) was examined for 3 years.

Methods
An initial rapid screening by HIV-1/2 Ag/Ab Combo test (RT#1) with Ab verification using a second, different rapid test (RT#2) was conducted. Clinic referral was immediate for antigen-only–positive screens. Antibody-positive screens were confirmed by RT#2. Specimens were collected following discordant RTA results (initially Ab-POS by RT#1, but negative on RT#2) and tested in accordance with the current Centers for Disease Control and Prevention/Association of Public Health Laboratories–based HIV diagnostic algorithm supplemented by a quantitative viral load whenever possible.

Results
Of 310,785 tests performed, 2400 preliminary positive screens were identified; 2191 (91.8%) confirmed by RT#2. Of 13 Determine Combo AG-POS results identified, only 1 confirmed positive. Of the remaining 196 discordant results, 182 (92.9%) were uninfected, including 13 with AG-POS/AB-POS results. Of 14 true positives (7.1%) identified after discordant RTA results, the average quantitative HIV-1 viral load was 277,385 copies/mL, but 5 (35.7%) of 14 had viral loads <1000 copies/mL. Among the 2191 “presumptive positive” by RTA, 3 false-positive (FP) RTAs were reported (both rapid tests having positive results, while the HIV-1/2 Ag/Ab assay and quantitative HIV-1 viral load showed negative results).

Conclusions
The RTA was effective in predicting true-positive HIV test results and facilitating linkage to care. Discordant results were infrequent. Fingerstick DC Ag detection identified a single early infection. Many discordant cases that were subsequently positive were associated with viral loads <1000 copies/mL.
Death Certification in Northern Alberta
Authors: Wood Kimberly A. , Weinberg Seth H. , Weinberg Mitchell L. 
Published: January 2020

Abstract
Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.
Parents' Perspectives on Communication and Shared Decision Making for Febrile Infants ≤60 Days Old
Authors: Aronson Paul L. , Schaeffer Paula , Niccolai Linda M. , Shapiro Eugene D. , Fraenkel Liana 
Published: January 2020

Objectives
Decisions about the management of febrile infants ≤60 days old may be well suited for shared decision making (SDM). Our objectives were to learn about parents' experiences with receiving and understanding information in the emergency department (ED) and their perspectives on SDM, including for decisions about lumbar puncture (LP).

Methods
We conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Interviews assessed parents' experiences in the ED and their perspectives on communication and SDM. Two investigators coded the interview transcripts, refined codes, and identified themes using the constant comparative method.

Results
Parents' unmet need for information negatively impacted parents' understanding, stress, and trust in the physician. Themes for parents' perspectives on SDM included the following: (1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, (2) parents' preferences for participation in decision making vary considerably, and (3) different perceptions about risks influence parents' preferences about having their infant undergo an LP. Although some parents would defer decision making to the physician, they still wanted to be able to express their opinions. Other parents wanted to have the final say in decision making. Parents valued risks and benefits of having their child undergo an LP differently, which influenced their preferences.

Conclusions
Physicians need to adequately inform parents to facilitate parents' understanding of information and gain their trust. Shared decision making may be warranted for decisions about whether to perform an LP, although parents' preferences for participating in decision making vary.
Pediatric Emergency Department Interventions of Pharmacy Residents
Authors: Anderson Gabrielle L. , Olson Ole J. , Mannenbach Mark S. , Rudis Maria I. 
Published: January 2020

Objective
We sought to assess the frequency and types of interventions performed by pharmacy residents in a pediatric emergency department (ED).

Methods
The study was conducted in an academic ED with 77,000 annual visits, of which 17% are pediatric. Six pharmacy residents completed a total of 9 two-week rotations in the pediatric ED as part of their pharmacy residency programs from February 2016 to December 2018. Pharmacy residents recorded pharmacy intervention data in real time. We quantified the number and type of interventions and time spent making the interventions.

Results
Of 1608 pediatric patients present during the ED shifts when pharmacy residents were on service, pharmacy residents intervened on 294 patients (18.3%). A total of 400 activities and interventions were recorded. The majority (72%) of patients required 1 intervention, whereas the remaining 28% had 2 or more interventions documented. The median time spent per patient was 15 minutes (interquartile range, 10–20 minutes). Pharmacy residents were most commonly involved with medication selection and dosing.

Conclusions
The presence of a dedicated pharmacy team member in the pediatric area of the ED allows for a high level of involvement and interaction with other members of the health care team primarily through providing recommendations regarding medication selection, dosing, optimization, and answering drug information and medication administration questions.
2017 AAAEM Benchmarking Survey
Authors: Rathlev Niels K. , Holt Nate M. , Harbertson Cathi A. , Hettler Joeli , Reznek Martin A. , Tsai Shiu-Lin , Lopiano Kenny K. , Bohrmann Tommy , Scheulen James J. 
Published: January 2020

Objectives
The Academy of Administrators in Academic Emergency Medicine Benchmark Survey of academic emergency departments (EDs) was conducted in 2017. We compared operational measures between pediatric and adult (defined as fewer than 5% pediatric visits) EDs based on survey data. Emergency departments in dedicated pediatric hospitals were not represented.

Methods
Measures included: (1) patient volumes, length of stay, and acuity; and 2) faculty staffing, productivity, and percent effort in academics. t Tests were used to compare continuous measures and inferences for categorical variables were made using Pearson χ2 test.

Results
The analysis included 17 pediatric and 52 adult EDs. We found a difference in the number of annual visits between adult (median, 66,275; interquartile range [IQR], 56,184–77,702) and pediatric EDs (median, 25,416; IQR, 19,840–29,349) (P < 0.0001). Mean “arrivals per faculty clinical hour” and “total arrivals per treatment space” showed no differences. The proportion of visits (1) arriving by emergency medical services and (2) for behavioral health were significantly higher in adult EDs (both P < 0.0001). The mean length of stay in hours for “all” patients was significantly longer in adult (5.4; IQR, 5.0–6.6) than in pediatric EDs (3.5; IQR, 2.9–4.3; P = 0.017). A similar difference was found for “discharged” patients (P = 0.004). Emergency severity indices, professional evaluation and management codes, and hospitalization rates all suggest higher acuity in adult EDs (all P < 0.0001). There were no differences in mean work relative value units per patient or in the distribution of full time equivalent effort dedicated to academics.

Conclusions
In this cohort, significant differences in operational measures exist between academic adult and pediatric EDs. No differences were found when considering per unit measures, such as arrivals per faculty clinical hour or per treatment space.
Does the Role of A Rapid Triage Provider Improve Pain Control in an Academic Pediatric Emergency Department?
Authors: Savage Jillian G. , DePiero Andrew D. , Attia Magdy W. 
Published: January 2020

Abstract
Pediatric pain control in the emergency department (ED) remains problematic. This quantifiable metric may be positively affected by the utilization of a rapid triage provider (RTP). This is a retrospective case control study of pediatric patients requiring either ketorelac intravenous (IV) or morphine IV for painful conditions. Patients in the control group were managed according to standard nursing-driven triage process. Patients in the RTP group were seen by the standard triage team as well as by the RTP.We identified 114 patients who required IV pain medications. The mean time from arrival to pain medication administration for the RTP group as compared with the control group was 47 and 64 minutes (P = 0.02). Similarly, the mean time from arrival to IV pain medication order placement was 15 and 43 minutes (P < 0.01). An RTP improves pain control in the pediatric ED via more efficient order placement and IV pain medication administration.
Increased Muscle Strength Limits Postural Sway During Daily Living Activities in Total Hip Arthroplasty Patients
Authors: Winther Siri B. , Foss Olav A. , Klaksvik Jomar , Husby Vigdis S. 
Published: January 2020

Objective
The aim of the study was to investigate the effect of maximal strength training on postural sway after total hip arthroplasty, performed before and after a battery of physical performance tests that resemble daily living activities.

Design
This study is an exploratory study based on data from a 3-mo randomized controlled trial involving 54 total hip arthroplasty patients performing maximal strength training or conventional rehabilitation. At 3, 6, and 12 mos postoperatively, postural sway was evaluated in two gait tests; ie, one test before and one test after conducting a battery of physical performance tests.

Results
At 3 mos postoperatively, postural sway in the test after was significantly higher for the conventional rehabilitation group than the maximal strength training group (P = 0.045); however, there was no between-group difference at the test before (P = 0.670). Postural sway was also significantly higher in the test after compared with the test before in the conventional rehabilitation group (P < 0.001). No difference was found between the test before and test after in the maximal strength training group (P = 0.713). At 6 and 12 mos postoperatively, there were no statistically significant within- or between-group differences in postural sway.

Conclusions
Increased muscular strength limits postural sway 3 mos postoperatively in total hip arthroplasty patients after a demanding battery of physical performance tests simulating daily living activities.
Genomic Strategies to Personalize Use of Androgen Deprivation Therapy With Radiotherapy
Authors: Glicksman Rachel M. , Berlin Alejandro 
Published: January 2020

AbstractThe use of combination RT and androgen deprivation therapy in many prostate cancer curative-intent treatment scenarios is supported by level 1 evidence. However, in our current clinical paradigm, we have no ability to determine a priori which patients truly benefit from combination therapy and therefore apply the combination RT and androgen deprivation therapy intensification strategy to all patients, which results in overtreatment or undertreatment of the majority of our patients. Genomics has the ability to more deeply and objectively characterize the disease, in turn refining our prognostication capabilities and enabling the individualization of treatments. We review the commercially available prostate cancer genomic tests, focusing on those able to predict patient outcomes following radiotherapy or guide radiotherapy treatment decisions.
Next Generation of Androgen Deprivation Therapy Combined With Radiotherapy for N0 M0 Prostate Cancer
Authors: Barata Pedro , Layton Jodi , Lewis Brian , Sartor Oliver 
Published: January 2020

Abstract
Androgen deprivation therapy in combination with definitive radiation therapy is a standard of care for both intermediate-/high-risk localized prostate, locally advanced prostate cancer. Newer hormonal therapies have shown promising results in patients with castration-resistant disease and are now being investigated in early stages, in combination with radiation therapy. In this section, we review the body of evidence elucidating the mechanism of synergy and immune modulation effect of androgen deprivation therapy and radiation therapy, summarize the pivotal studies supporting its use in the nonmetastatic setting, and present the ongoing studies who will likely shape the management of locally advanced disease, in the upcoming years.