bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation
Authors: Oliveira-Ferreira Cláudia , Leuzinger-Dias Mariana , Tavares Ferreira João , Macedo João Paulo , Falcão-Reis Fernando 
Published: February 2020

Purpose:
To determine the incidence of intraoperative complications of phacoemulsification cataract surgery in a teaching hospital and to compare the intraoperative complication rate between resident trainees and staff ophthalmologists, to ascertain the overall rate of intraocular pressure (IOP) elevation on postoperative day 1 (POD1), and, again, to compare this value between resident trainees and staff surgeons.

Setting:
Centro Hospitalar São João, Oporto, Portugal.

Design:
Retrospective study.

Methods:
This study included eyes submitted for phacoemulsification cataract surgery from January 1, 2017, to December 31, 2017. There were no exclusion criteria. Data collected included the type of surgeon, level of resident training, case complexity, and intraoperative complications. From all noncomplicated surgeries, preoperative IOP and IOP-POD1 were collected.

Results:
A total of 2937 surgeries were included; 25.6% were performed by resident trainees. The complication rate was 6.3% with resident trainees and statistically significantly lower (3.3%) in staff surgeons. The complication rate of resident trainees did not differ according to their level of residency. There was a significantly increased incidence of IOP-POD1 elevation in the resident trainee group compared with the staff surgeon group. Surgeries performed by resident trainees, a preexisting history of glaucoma, and pseudoexfoliation were significant risk factors for IOP elevation.

Conclusions:
To our knowledge, this is the first European study comparing the incidence of intraoperative and postoperative complications in cataract surgery performed by resident trainees and staff surgeons. We report a significantly higher rate of intraoperative complications and IOP elevation on POD1 in resident trainees vs staff surgeons.
One-year visual and astigmatic outcomes of keratoconus patients following sequential crosslinking and topography-guided surface ablation: the TOPOLINK study
Authors: Nattis Alanna S. , Rosenberg Eric D. , Donnenfeld Eric D. 
Published: February 2020

Purpose:
To evaluate long-term visual and astigmatic outcomes of sequential corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK).

Setting:
Single-practice outpatient setting.

Design:
Retrospective case review.

Methods:
This is a single-surgeon retrospective case review of eyes with keratoconus undergoing sequential CXL and then topography-guided PRK. Change in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), topographic, refractive, and keratometric astigmatism was analyzed using power vector analyses at baseline, 6 months, and 12 months after topography-guided PRK. Changes in higher-order aberrations (HOAs), posterior astigmatism, spherical equivalent (SE), and central corneal thickness (CCT) were also analyzed. Correlations between age, time between CXL and PRK, sex, manifest SE, CCT, maximum and average keratometric values, and HOAs were evaluated for significance.

Results:
Of the 62 eyes studied, regardless of refractive treatment, topography-guided PRK following CXL in patients with keratoconus improved CDVA (mean 20/30; 2-line improvement) and UDVA (mean 20/50; 4-line improvement). Over 12 months, visual acuity continued to improve across all eyes treated (P < .001). Overall, there were significant improvements in corneal astigmatism, maximum keratometry, mean keratometry, SE, posterior astigmatism, and total HOAs. No significant correlations were found between age, sex, time elapsed between CXL and PRK, and age at the time of either procedure on final visual acuity.

Conclusions:
Results of this study reinforced previous findings that topography-guided PRK in previously cross-linked keratoconus eyes proves to be an efficacious and safe method for improving visual acuity and reducing irregular corneal astigmatism, with continued improvement.
A Biopsychosocial Approach to Analyzing Inpatient Falls
Authors: Noonan Rebecca , Bath Jessica , Fitzsimmons Amber 
Published: February 2020

Purpose:
While research exists identifying factors that contribute to inpatient falls, patients in hospitals continue to fall. We suggest this is influenced by a lack of consistency in the implementation and documentation of evidence-based fall precautions, and that existing fall screens and protocols do not consistently identify potential fallers or prevent falls. This study examines biopsychosocial factors not commonly investigated that may affect falls. We analyzed patient mobility level, polypharmacy, mental status, language spoken, insurance type, and substance use on fall incidence and fall precaution protocol implementation in an urban, academic health care system.

Materials/Methods:
Using the incident reporting system, postfall huddles and electronic medical records, a comprehensive aggregate database was created of 217 inpatient fall incidents and 100 randomized nonincidents. Variables included insurance type, primary spoken language, history of substance use, mental status, polypharmacy, mobility level, and whether the fall precaution protocol was implemented. Chi-square tests, z tests of proportions, and absolute risk reduction (ARR) and increase (ARI) were calculated to assess associated fall potential for each predictor.

Results:
55.2% of patients screened to be at risk for falls did not have a fall precaution protocol in place when they fell. The predictor with the largest effect (ARI 30%) on fall incidence was whether the fall precaution protocol was missing. Patients requiring Supervision through Minimal Assist for mobility were associated with an ARI of 18%; nonintact mental status (ARI 20%) and history of substance use (ARI 10%) were also associated with fall incidences. Having a history of substance use or having Medicaid insurance each reduced fall precaution protocol implementation by 15%.

Conclusions:
Novel results suggest that patients requiring less assistance for mobility experienced higher incidences of falls, and patients with a history of substance use and Medicaid insurance had a higher risk for not having fall precaution protocols implemented. Patients would benefit if physical therapists and nurses shared mobility assessment tools and communication methods, potentially improving mobilization triaging between the professions.
The Symptom Experience of Patients With Atrial Fibrillation Before Their Initial Diagnosis
Authors: Wilson Ryan E. , Rush Kathy L. , Hatt Linda , Reid R. Colin , Laberge Carol G. 
Published: February 2020

Background
Atrial fibrillation (AF), the most common form of dysrhythmia, steadily increases in prevalence with age. If left untreated, AF significantly increases the risk of stroke, heart failure, and death. Despite the increasing prevalence, there are significant research gaps in the prediagnosis symptom experiences of patients with AF.

Objective
The purpose of this qualitative descriptive study was to explore the prediagnosis symptom experience of patients with AF.

Methods
Participants 19 years or older with AF diagnosed in the previous year were recruited (n = 26) from outpatient cardiac rehabilitation and AF clinics. Semistructured interviews, broadly guided by the Symptom Experience Model, explored perceptions, evaluations, and responses to AF symptoms. Thematic analysis used a 2-step approach, deductively coding for participants' symptom perceptions, evaluations, and responses and inductively coding within these broader Symptom Experience Model concepts.

Results
Perception involved awareness of bodily sensations, ranging from imperceptible noticing to commanding attention, heightened by rest and activity. In evaluation, participants used self-derived theories to explain their symptoms, gathered evidence to support/refute their theories, and formulated alternative theories as symptoms changed over time. Responses consisted of nontreatment, self-treatment, and health seeking; most participants needed repeated healthcare visits before diagnosis.

Conclusions
The current study identified challenges participants experienced in developing awareness of their AF symptoms, the complex cognitive processes associated with evaluation, and barriers that made it difficult to respond to AF symptoms in a timely manner. Understanding the prediagnosis symptom experience from the patient's perspective is essential for the enhancement of current AF screening practices.
Physician Assistant Program Goals: A Thematic Analysis
Authors: Snyder Jennifer A. , Quincy Brenda , Barton Marian , Tallman Kelsey 
Published: February 2020

Purpose
The purpose of this study was to provide a descriptive analysis of the goals of the accredited physician assistant (PA) programs across the country in order to obtain a baseline understanding of their themes.

Methods
Initial review of the goals resulted in the identification of recurring themes. The goals were evaluated relative to meeting the requirements specified in Standard A3.14 of the Accreditation Review Commission on Education for the Physician Assistant, including listing the goal with the defined benchmark expected and the program's progress in reaching the goal. Accreditation status was compared.

Results
Of the 238 accredited PA programs at the time of the study, 157 (66%) had Accreditation-Continued status, 56 (24%) were Accreditation-Provisional, and 25 (11%) had Accreditation-Probation status. The median number of 5 goals per program did not vary dependent on accreditation status. Only 43 of 238 PA programs (18%) provided goals with required benchmarks and supporting outcomes on their webpages. Almost all programs included at least one goal (and often more than one) with the theme of student acquisition of knowledge, skills, and attitudes needed to be a PA. Other commonly included themes in programmatic goals included the “capacity” of students to graduate from the PA program and become employed, valuing diversity and cultural differences, a comprehensive and strong curriculum, as well as alumni who are self-directed, lifelong learners.

Conclusion
Program goals should be reviewed to ensure they include benchmarks that define success and report progress or outcomes in achieving those goals. Thematic analysis provides a powerful summary that then can be used to make conclusions across a large set of program data.
Impact of a Longitudinal Medical Spanish Curriculum on Student Communication Skills
Authors: Lie Désirée A. , Nodal Sonia , de la Torre Margarita , Forest Christopher P. , Richter-Lagha Regina , Lohenry Kevin 
Published: February 2020

Purpose
This study describes and examines the short- and longer-term impact of a required longitudinal medical Spanish curriculum on physician assistant student preparedness and ability to communicate with patients in Spanish during clinical rotations.

Methods
Fifty-eight preclinical students participated in an 80-hour curriculum delivered weekly over 3 semesters. Teaching followed a framework of second-language acquisition and included structured grammar and medical vocabulary practice with didactic, interactive, and group assignments. Vocabulary and grammar were assessed with quizzes. Oral proficiency was assessed by faculty with Spanish Objective Structured Clinical Examination (OSCE) stations at midpoint and end using the Interagency Language Roundtable (ILR), a 6-level scale (immediate outcome). Students self-rated proficiency and confidence and evaluated curriculum effectiveness for preparing them to care for Spanish-speaking patients (longer-term outcomes).

Results
All students passed the written and oral quizzes. Faculty-scored ILR verbal proficiency at the OSCEs increased by a mean level of 0.5 over 6 months. Student self-assessed proficiency improved on average by one level from baseline to 24 months later. Students rated highly curriculum effectiveness, preparedness to communicate in Spanish during clinical rotations, ability to judge when an interpreter was needed, and the importance of medical Spanish to future practice.

Conclusions
A required integrated longitudinal medical Spanish curriculum was well received. Physician assistant students demonstrated short-term interval progression in Spanish proficiency, with improvements in both faculty and self-rating scores, and readiness to apply the skill to practice. They valued active learning associated with repeated practice with feedback, role playing, and interval assessments throughout the curriculum.
Treatment targets based on autoregulation parameters in neurocritical care patients
Authors: Czosnyka Marek , Hutchinson Peter , Smielewski Peter 
Published: February 2020

Purpose of review
This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow.

Recent findings
The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice. It is hypothesized that if both pressures are used as individual targets and followed, the incidence and severity of dysautoregulation will diminish sufficiently to improve outcomes across the spectrum of acute neurological illnesses. These parameters have not been tested in randomized trials. However, a Phase II trial for CPPopt in Traumatic Brain Injury (COGITATE) is underway. Clinical series suggest that delirium following cardiac surgery may be reduced if blood pressure is actively regulated above the lower limit of autoregulation. In traumatic brain injury, using CPPopt as a single target allows monitoring of the upper and lower limits of autoregulation that provide a well tolerated ‘corridor’ for treatment. Pilot studies in which ABPopt is monitored in preterm newborns suggest fewer haemorrhagic events if blood pressure is closer to its optimal target. Brain imaging studies suggest worse tissue outcomes when blood pressure is below ABPopt.

Summary
Targeted control of brain and systemic blood pressures to optimize cerebral autoregulation is of substantial interest to the neurocritical care and anaesthesia community, as this strategy may help to avoid secondary brain insults associated with ischemia or hyperaemia. The same strategy can be used outside the ICU (e.g. cardiac surgery, or in stroke patients after mechanical thrombectomy); this requires further research.
Rectal Nonsteroidal Anti-Inflammatory Drugs for Endoscopic Retrograde Cholangiopancreatography Postoperative Pancreatitis Prevention
Authors: Yang Jiahui , Wang Wancong , Liu Chuan , Zhao Yan , Ren Mudan , He Shuixiang 
Published: February 2020

Background:
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication of ERCP procedure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are reported to be one protective pharmacological agent with great efficacy regarding this complication. Recently, more trails have addressed this issue and some inconsistent results appeared. Therefore, this study aims to evaluate the efficacy and safety of different rectal NSAIDs schemes to prevent PEP.

Materials and Methods:
Eligible studies published on PubMed, the Cochrane Library, Embase, Web of Science before November 2018 were reviewed, and those which met the inclusion criteria were included in the analysis. The preventions were divided as placebo/no treatment, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, post-ERCP rectal indomethacin, pre-ERCP rectal indomethacin, indomethacin using during ERCP, and pre-ERCP rectal naproxen. The main outcomes included the incidence of PEP and its severity. Other complications were also analyzed.

Results:
A total of 23 randomized controlled trials were included. The results of network meta-analysis illustrated that compared with the control, post-ERCP rectal diclofenac, pre-ERCP rectal diclofenac, and indomethacin were significantly associated with lower incidences of PEP. Moreover, it is notable that pre-ERCP rectal NSAIDs might reduce the severity of pancreatitis. Also, rectal NSAIDs may lead to less occurrence of asymptomatic hyperamylasemia. On the basis of the clustered ranking, pre-ERCP diclofenac appeared to be the superior intervention for PEP with satisfying efficacy.

Conclusions:
The present study showed that pre-ERCP diclofenac is the optimal prevention method for PEP. However, more high quality head-to-head randomized controlled trials and observational studies are expected in the future.
The fat brain
Authors: Montesinos Jorge , Guardia-Laguarta Cristina , Area-Gomez Estela 
Published: February 2020

Purpose of review
The purpose of this brief review is to gain an understanding on the multiple roles that lipids exert on the brain, and to highlight new ideas in the impact of lipid homeostasis in the regulation of synaptic transmission.

Recent findings
Recent data underline the crucial function of lipid homeostasis in maintaining neuronal function and synaptic plasticity. Moreover, new advances in analytical approaches to study lipid classes and species is opening a new door to understand and monitor how alterations in lipid pathways could shed new light into the pathogenesis of neurodegeneration.

Summary
Lipids are one of the most essential elements of the brain. However, our understanding of the role of lipids within the central nervous system is still largely unknown. Identifying the molecular mechanism (s) by which lipids can regulate neuronal transmission represents the next frontier in neuroscience, and a new challenge in our understanding of the brain and the mechanism(s) behind neurological disorders.
Variant m.1555A>G in MT-RNR1 causes hearing loss and multiorgan mitochondrial disorder
Authors: Finsterer Josef 
Published: February 2020

Abstract

Background:
Mitochondrial disorders (MIDs) are usually multisystem disorders, affecting not only a single organ/tissue but also progressively more than one.

Methods:
Letter to the Editor.

Results:
Though phenotypic manifestations of the m.1555A>G mutation are usually mono-organic, there are indications that short stature, osteoporosis, arterial hypertension, and recurrent headache can be also a manifestation of this variant.
MID patients with apparently single organ involvement need to be prospectively investigated for multisystem disease, as multisystem manifestations can be subtle or even subclinical.
Concerning the phenotypic expression of the m.1555A>G variant it is crucial to know the heteroplasmy rates in various tissues, as they may strongly contribute to the phenotypic expression of the disease. Maternal transmission can be confirmed by running a basic local alignment search tool.

Conclusions:
The m.1555A>G variant is not only associated with hearing loss but with a number of other multiorgan manifestations. Heteroplasmy rate are required for establishing a genotype/phenotype correlation.
The changing modes of human immunodeficiency virus transmission and spatial variations among women in a minority prefecture in southwest China
Authors: Xiao Chenghan , Jike Chunnong , Liu Danping , Jia Peng , Xu Xiaohe , Xiao Lin , Yu Gang , Nan Lei , Sun Xiaxia , Ge Jingjing , Wang Ju , Wang Ke , Liao Qiang , Wang Qixing , Wenwen Zhai , Yang Shujuan 
Published: February 2020

Abstract
Liangshan Yi Autonomous Prefecture in Southwest China has a high human immunodeficiency virus (HIV) prevalence rate. This study examined the changing modes of HIV transmission among women with new HIV infections and explored the spatial heterogeneities in the factors associated with heterosexual transmission in this minority region.
The data consisting of women with new HIV infections from 2011 to 2014 were collected from multiple sources. New infections were identified by BED capture enzyme immunoassay. The Bayesian hierarchical model was used to estimate the proportion of women with new HIV infections via heterosexual transmission across all townships in the Prefecture. A geographically weighted regression (GWR) model was utilized to investigate spatial variations in the sociodemographic characteristics associated with the changing modes of HIV transmission.
An analytical sample of 927 women with new HIV infections was constructed and utilized to investigate the changing mode of HIV transmission. The rate of heterosexual transmission among women with new HIV infections in 2011 was below 20%. However, by 2014 this rate dramatically increased to nearly 80%. Among sociodemographic characteristics, GWR results revealed significant ethnic differences in heterosexual HIV transmission between Yi women and women in other ethnic groups, with Yi women demonstrating a lower risk of infection through heterosexual transmission. However, such ethnic differences were observed only in 30% of the townships in the Prefecture. Moreover, having a primary education decreased the odds of heterosexual transmission, which was observed in about 56% of the townships. Also, being involved in occupations other than agriculture or animal husbandry and being single or married decreased the odds of HIV infection through heterosexual contact among women, which did not significantly vary across the Prefecture.
Heterosexual transmission was the predominant mode of HIV transmission among women in the Prefecture, and this transformation was clearly marked by a fast-growing trend and a spatial diffusion pattern. Spatial variations also existed in sociodemographic factors that were associated with the changing modes of HIV transmission.
Antimicrobial photodynamic chemotherapy mediated by PapaMBlue on chronic periodontal disease
Authors: Anselmo Giuliana Giovinazzo , Tortamano Ana Carolina Alves Camargo , Gonçalves Marcela Letícia Leal , Leal-Rossi Adriana , Godoy-Miranda Bianca Aparecida , Oliveira Márcia Regina Cabral , Oliveira Pedro Henrique Cabral , Alves Carol Brandt , Bussadori Sandra Kalil , Prates Renato Araujo 
Published: February 2020

Abstract

Background:
The elimination of the pathogenic microorganisms of the periodontal pocket is one of the main points for success in periodontal treatment. The objective of this study is to investigate the clinical and antimicrobial effect of papain-mediated photodynamic therapy in the clinical treatment of periodontal disease.

Methods:
Twenty patients with chronic periodontitis will be selected. Patients will be randomly divided into 2 groups (n = 10). Group 1 will receive conventional periodontal treatment and group 2 will receive conventional treatment and antimicrobial photodynamic therapy (PACT). Conventional treatment will consist of oral hygiene guidance, with brushing technique instructions and recommendation of daily flossing. The calculus deposits on the teeth will be removed with ultrasound equipment and curettes for scraping and root planning. The PACT will be performed at the end of each periodontal treatment session, at sites with bags ≥4 mm. PapaMblue photosensitizer will be deposited in the periodontal pockets with a syringe and a pre-irradiation time of 1 minute will be adopted. Then, the laser emitting wavelength of 660 nm, with power of 100 mW, for 2 minutes, radiant exposure of 30 J/cm2 and power density of 250 mW/cm2 will be applied. Patients will undergo clinical evaluations before treatment (day 1) at 30, 60, and 90 days after the end of treatment; and microbiological evaluations before and immediately after treatment. The distribution of the data within each group and the homogeneity of the variances will be verified. With this information, the most appropriate statistical test in each evaluation will be used. The sample calculation is based on the literature and the significance level of 5% will be adopted.

Discussion:
The combination of PACT with methylene blue in a papain gel and the conventional treatment may increase the reduction of bacteria in periodontal pockets.