bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Evaluation of Virtual Reality Role-Play Experiences for Helping-Profession Courses
Authors: Rogers Shane L. , Hollett Ross , Li Yanqi R. , Speelman Craig P. 
Published: December 2020

Background: Providing students with virtual role-play experiences has the potential to bring counseling role-plays into large undergraduate courses. Objective: The purpose of this study was to trial a virtual reality role-play experience where students played the role of a student counsellor. Method: Seventy-three undergraduate psychology students played the role of a student counsellor interacting with a virtual client in two role-plays, one via desktop and one via head mounted display (HMD). Students provided feedback on their experience. Results: 70% of the students found the experiences very interesting, engaging and immersive, with 82% preferring the HMD mode of presentation. The virtual characters were believable as distressed clients with 96% of students perceiving greater negative than positive emotion expressed by the characters. Most of the students (64%) mood improved from the beginning of the experience to the end, however 14% experienced a decline in mood. The students agreed (95%) that the experiences would be a valuable experience to a psychology course. Conclusion: Our results provide evidence that the virtual role-play experiences are well-liked by students. Teaching Implications: The approach presented in this paper represents a practical method to provide virtual role-play experiences to both on-campus and online undergraduate students.
Status of cardiovascular surgery in Japan: A report based on the Japan Cardiovascular Surgery Database 2017–2018. 1. Congenital heart surgery
Authors: Hirata Yasutaka , Hirahara Norimichi , Murakami Arata , Motomura Noboru , Miyata Hiroaki , Takamoto Shinichi 
Published: December 2020

Objectives We aimed to analyze the mortality and morbidity associated with congenital heart surgery in Japan. Methods Data on congenital heart surgeries performed between January 2017 and December 2018 were obtained from Japan Cardiovascular Surgery Database. The 20 most frequent procedures were selected, and mortalities and major morbidities associated with the procedures were analyzed. All procedures were classified into Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality categories, and mortalities in each category were also analyzed. Results The mortality rates in atrial septal defect repair and ventricular septal repair were 0% and 0.2%, respectively. The mortality rates in more complex cases (tetralogy of Fallot repair, complete atrioventricular repair, bidirectional Glenn, and total cavopulmonary connection) were 2%–3%. The mortality rates in systemic-to-pulmonary shunt, total anomalous pulmonary venous connection repair, and the Norwood procedure were 4.9%, 11.1%, and 15.7%, respectively, which were not different from those reported in 2015–2016. The mortalities according to the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery categories 1–5 were 0.3%, 2.7%, 2.9%, 5.9%, and 15.5%, respectively, and comparable to those of the Society of Thoracic Surgeons database (2013–2016). Conclusion The mortality rates and frequency of complications in major surgical procedures for congenital heart disease in Japan in 2017–2018 will play an important role as a basis for trends in Japan and for comparison with results from other countries.
Long-term Effect of a Single Subcritical Knee Injury: Increasing the Risk of Anterior Cruciate Ligament Rupture and Osteoarthritis
Authors: Blaker Carina L. , Zaki Sanaa , Little Christopher B. , Clarke Elizabeth C. 
Published: December 2020

Background: Rupture of the anterior cruciate ligament (ACL) is a well-known risk factor for the development of posttraumatic osteoarthritis (PTOA), but patients with the “same injury” can have vastly different trajectories for the onset and progression of disease. Minor subcritical injuries preceding the critical injury event may drive this disparity through preexisting tissue pathologies and sensory changes. Purpose: To investigate the role of subcritical injury on ACL rupture risk and PTOA through the evaluation of pain behaviors, joint mechanics, and tissue structural change in a mouse model of knee injury. Study Design: Controlled laboratory study. Methods: Ten-week-old male C57BL/6J mice were allocated to naïve control and subcritical knee injury groups. Injury was induced by a single mechanical compression to the right hindlimb, and mice were evaluated using joint histopathology, anteroposterior joint biomechanics, pain behaviors (mechanical allodynia and hindlimb weightbearing), and isolated ACL tensile testing to failure at 1, 2, 4, or 8 weeks after injury. Results: Subcritical knee injury produced focal osteochondral lesions in the patellofemoral and lateral tibiofemoral compartments with no resolution for the duration of the study (8 weeks). These lesions were characterized by focal loss of proteoglycan staining, cartilage structural change, chondrocyte pathology, microcracks, and osteocyte cell loss. Injury also resulted in the rapid onset of allodynia (at 1 week), which persisted over time and reduced ACL failure load ( P = .006; mean ± SD, 7.91 ± 2.01 N vs 9.37 ± 1.01 N in naïve controls at 8 weeks after injury), accompanied by evidence of ACL remodeling at the femoral enthesis. Conclusion: The present study in mice establishes a direct effect of a single subcritical knee injury on the development of specific joint tissue pathologies (osteochondral lesions and progressive weakening of the ACL) and allodynic sensitization. These findings demonstrate a predisposition for secondary critical injuries (eg, ACL rupture) and an increased risk of PTOA onset and progression (structurally and symptomatically). Clinical Relevance: Subcritical knee injuries are a common occurrence and, based on this study, can cause persistent sensory and structural change. These findings have important implications for the understanding of risk factors of ACL injury and subsequent PTOA, particularly with regard to prevention and management strategies following an often underreported event.
Endotracheal Tube Obstruction Among Patients Mechanically Ventilated for ARDS Due to COVID-19: A Case Series
Authors: Wiles Samuel , Mireles-Cabodevila Eduardo , Neuhofs Scott , Mukhopadhyay Sanjay , Reynolds Jordan P. , Hatipoğlu Umur 
Published: December 2020

Background: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing endotracheal tube (ETT) obstruction that has not been previously described in patients with ARDS due to other causes. The purpose of this report is to describe a case series of patients with COVID-19 and ARDS in which ETT occlusion resulted in significant clinical consequences and to define the pathology of the obstructing material. Methods: Incidents of ETT occlusion during mechanical ventilation of COVID-19 patients were reported by clinicians and retrospective chart review was conducted. Statistical analysis was performed comparing event rates between COVID-19 and non-COVID 19 patients on mechanical ventilation over the predefined period. Specimens were collected and submitted for pathological examination. Findings: Eleven COVID-19 patients experienced endotracheal tube occlusion over a period of 2 months. Average age was 69 (14.3, range 33-85) years. Mean APACHE III score was 73.6 (17.3). All patients had AKI and cytokine storm. Nine exhibited biomarkers for hypercoagulability. Average days on mechanical ventilation before intervention for ETT occlusion was 14 (5.18) days (range of 9 to 23 days). Five patients were discharged from the ICU, and 4 expired. Average documented airway resistance on admission was 14.2 (3.0) cm H2O/L/sec. Airway resistance before tube exchange was 28.1 (8.0) cm H2O /L/sec. No similar events of endotracheal tube occlusion were identified in non-COVID patients on mechanical ventilation during the same time period. Microscopically, the material consisted of mucin admixed with necrotic cell debris, variable numbers of degenerated inflammatory cells, oral contaminants and red blood cells. Interpretation: Patients with COVID-19 and ARDS on prolonged mechanical ventilation are at risk for developing ETT obstruction due to deposition of a thick, tenacious material within the tube that consists primarily of mucin and cellular debris. Clinicians should be aware of this dangerous but treatable complication.
Chaplain-Physician Interactions From the Chaplain’s Perspective: A Mixed Method Analysis
Authors: Gomez Sofia , Nuñez, BA Christine , White Betty , Browning James , DeLisser Horace M. 
Published: December 2020

Background: The value of healthcare chaplains to patient care is increasingly recognized. However, physicians’ understandings of the role of pastoral care have been reported to be poor, which have raised concerns about the quality of chaplain-physician interactions and their impact on patient care. These interactions, particularly from the perspective of the chaplain, have not been extensively investigated. Methods: An anonymous survey about the interactions of chaplains with physicians was sent to chaplains at a single institution, with subsequent focus group discussions of responding chaplains to obtain additional qualitative data. Results: Quantitative and qualitative data were collected from over 20 chaplains. While chaplains indicated satisfaction regarding their access to physicians, they noted a disconnect between chaplains and physicians, physicians’ unfamiliarity with the chaplain role, a sense that physicians do not always appreciate the chaplain role as significant or helpful, and structural barriers to the integration of chaplains into medical care teams. Conclusions: This study provides contemporary data on the nature of chaplain-physician interactions as reported from the perspective of chaplains. Further, these findings highlight opportunities for interventions to enhance the chaplain-physician relationship.
Skin Deep: Perception of Scars After Cranial Vault Reconstruction
Authors: Roy Tulsi , Chavez Julia , R. Reid Russell 
Published: December 2020

Purpose: Children with craniosynostosis are vulnerable to stigmatization and social withdrawal. Cranial vault reconstruction (CVR) results in large bicoronal scars, which may trigger further insult to self-esteem and social outcasting. This study aimed to delineate determinants of patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child’s overall medical/surgical care. Methods: A 14-item questionnaire was distributed to parents of 95 patients who underwent open CVR at our institution. Age at first surgery, race, hair type, typical style, number of surgeries, complications, and use of distractors were surveyed. Patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child’s overall medical/surgical care were also queried. T tests and linear regressions were performed for binary and continuous variables, respectively. Results: Of 45 respondents, significant associations were found between: (1) complications and decreased parent scar satisfaction; (2) complications and decreased overall satisfaction with medical/surgical care, and (3) older age at time of initial surgery and decreased overall medical/surgical satisfaction. A significant association was found between parental scar satisfaction and overall medical/surgical satisfaction (β = 0.65, P = .002). There was no significant association between parent scar satisfaction and parental-reported patient self-consciousness, or parental-reported patient self-consciousness and overall medical/surgical satisfaction. Conclusions: Our results underscore the value of scar aesthetics in reconstructive goals. Advanced age and complications are important determinants of satisfaction. However, the lack of association between parent-reported patient self-consciousness and parental scar satisfaction suggests differences in aesthetic priorities between parents and children. Further studies may elucidate additional aesthetic considerations of CVR in ethnic/racial minorities.
Hypersensitivity pneumonitis related to imatinib mesylate therapy in a patient with chronic myeloid leukemia
Authors: Kallel Faten , Kassar Olfa , Maaloul Imen , Charfi Maha , Ksouda Kamilia , Elloumi Moez 
Published: December 2020

Introduction Pulmonary toxicity causally related to Imatinib (IM) therapy is uncommon in patients with chronic myeloid leukemia. Case report A 61-year-old patient with chronic myeloid leukemia was treated with IM at 400 mg daily dose. One month within IM, he developed skin lesions and then acute dyspnea and non-productive cough. Chest radiograph and high-resolution lung computed tomography (CT) revealed bilateral reticulonodular infiltration in both lungs. According to Naranjo's algorithm, the causality relationship with the drug is probable with a score of 7. The pharmacovigilance investigation was carried out and implicated IM Management & outcome: IM was discontinued and started steroid therapy (Prednisolone®) at 1 mg/kg daily. Two weeks after, the dyspnea, and abnormal X-ray and CT findings are improved. Discussion The early diagnosis of pulmonary toxicity related to IM therapy is needed to avoid further determinal effects of the drug.
‘The face of the programme’: How local clinicians shape decisions about eligibility for a national caregiver support programme in the USA
Authors: Sperber Nina R , Bruening Rebecca , Dadolf Joshua , Miller Katherine , Henius Jennifer , Kabat Margaret , Perez Jennifer , Houtven Courtney H Van 
Published: December 2020

Objective To examine the causes of variation for determining clinical eligibility for a national caregiver programme in the US Veterans Health Administration (VHA) and so help inform standardization of clinical eligibility assessment for support and establish conditions for more consistent caregiver experiences across the USA. Methods We used mixed methods, including a national survey of caregiver support coordinators (CSCs) across VHA medical centres, semi-structured interviews with a purposive sample of 53 CSCs and interdisciplinary team members, and observations of four VHA medical centre sites. Results A majority (70%) of CSCs across VHA medical centres reported that they used interdisciplinary teams to conduct assessments. Interdisciplinary teams were seen to help mitigate potential harm to therapeutic relationships from eligibility decisions. Survey respondents reported using a range of assessment tools provided by the national VHA Caregiver Support Program office, but participants expressed concerns that the tools did not necessarily effectively assess clinical need. Some local sites had developed innovative person-centered approaches, in which the assessment process provided an opportunity to assess veterans’ holistic clinical needs, in contrast to a programme-centered approach, which focused on assessing whether veterans/their caregivers meet eligibility criteria. Conclusion Discretion by those involved in making decisions on programme eligiblity is important for implementing a national social services programme based on clinical need. Interdisciplinary teams can help mitigate potential harm to therapeutic relationships. Discretion allows for innovation. This work has implications for setting policy in other programme contexts in which applying eligibility criteria requires clinical judgement.
Current Management of Trigger Digit in Rheumatoid Arthritis Patients: A Survey of ASSH Members
Authors: Bickham Rebecca , Carr Logan , Butterfield James , Behar Brittany , Dyer Ann-Marie , Payatakes Alexander 
Published: December 2020

Background Traditional dogma regarding management of rheumatoid arthritis (RA) patients with trigger digit symptoms holds that A1 pulley release should be avoided. Surgical release was thought to further destabilize the metacarpophalangeal joint. Biologic disease modifying anti-rheumatic drugs (DMARDs) have limited the development of hand deformities. Despite advances in RA treatment, many textbooks continue to discourage release of the A1 pulley in RA patients. The aim of this study was to determine if this belief is consistent with current trends in surgical management of trigger digits in patients with RA. Methods Active Members of the American Society for Surgery of the Hand (ASSH) were surveyed on their training and current practices as related to RA patients with trigger digits. Results Five hundred three surveys were completed (16% response rate). During training, 55% of ASSH Members were taught to avoid releasing the A1 pulley in RA patients. Seventy-one percent of respondents currently release the A1 pulley in RA patients with no preexisting deformities, no tenosynovial thickening, or if tenosynovectomy and flexor digitorum superficialis slip excision fail to relieve triggering. Forty percent reported that their practice has evolved toward more frequent release of the A1 pulley in RA patients. Conclusion The majority of ASSH Active Members were taught during training to avoid surgical release of the A1 pulley in RA patients to prevent acceleration of finger deformities. Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs.
Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair
Authors: Fazzini Stefano , Torsello Giovanni , Austermann Martin , Beropoulis Efthymios , Munaò Roberta , Torsello Giovanni F 
Published: December 2020

Objectives The results of branched endovascular repair of thoracoabdominal aneurysms are mainly dependent on durability of the graft used. The purpose of this study was to evaluate postoperative aortic main body and bridging stent-graft remodeling, and their impact on bridging stent-graft instability at one year. Methods Computed tomoangiographies of 43 patients (43 aortic main body mated with 171 bridging stent-grafts) were analyzed before and after branched endovascular repair as well as after a follow-up of 12 months. Primary endpoint was aortic main body remodeling (migration >5 mm, shortening >5 mm, scoliosis >5° or lordosis >5°). Shortening was defined as a reduced length in the long axis, scoliosis as left-right curvature, and lordosis as antero-posterior curvature. Aortic main body remodeling, aneurysm sac changes, and bridging stent-graft tortuosity were evaluated to study their correlations and the impact on the bridging stent-graft instability. Results At 12 months, aortic main body remodeling was observed in 72% of the cases, migration in 39.5% (mean 5.21 mm), shortening in 41.9% (mean 5.79 mm), scoliosis in 58.1%, (mean 10.10°), lordosis in 44.2% (mean 5.78°). Migration, shortening, and scoliosis were more frequent in patients with larger aneurysms ( p = .005), while scoliosis was significantly more frequent in type II thoracoabdominal aneurysm ( p = .019). Aortic main body remodeling was significantly associated to bridging stent-graft remodeling (r: 0.3–0.48). The bridging stent-graft instability rate was 9.3%. Despite a trend toward significance ( p = .07), none of the evaluated aortic main body and bridging stent-graft changes were associated with bridging stent-graft instability at 12 months. Conclusions Aortic main body remodeling is frequent especially in large and extended thoracoabdominal aneurysm aneurysms. Aortic main body and bridging stent-graft remodeling was significantly correlated. While these geometric changes had no significant impact on bridging stent-graft instability at one year, a close long-term follow-up after branched endovascular repair could predict bridging stent-graft failures.
Illness perceptions, coping, and health-related quality of life among individuals experiencing chronic Lyme disease
Authors: Hill Erin M , Frost Andriana 
Published: December 2020

Objective The aim of the present study was to examine illness perceptions and coping in relation to the health-related quality of life (HRQOL) among individuals experiencing chronic Lyme disease (CLD). Methods Participants were 82 individuals who had a confirmed diagnosis of Lyme disease and had been experiencing symptoms for 6 months or more. They were recruited through various online mechanisms (e.g., social media, online support groups), and they completed the consent form and questionnaires via Qualtrics. Participants completed questions about their demographics and health status as well as the Illness Perception Questionnaire-Revised (Moss-Morris et al., 2002), the Brief COPE (Carver, 1997), and the 36-item Short Form Health Survey (SF-36; Ware & Sherbourne, 1992). Results Illness perceptions and coping explained a significant amount of variance in HRQOL. Among the illness perceptions, the consequences and identity dimensions were most strongly associated with HRQOL. Behavioral disengagement and substance use were the coping strategies most strongly associated with the emotional health outcomes. Discussion Illness perceptions and coping are related to HRQOL among individuals with CLD. Given the increase in Lyme disease incidence and the chronicity of symptoms in some cases, it is critical to continue to examine the psychosocial factors associated with HRQOL in this population.
Impact of modified CDC/NHSN surveillance definition on the incidence of CAUTI: a study from an Indian tertiary care hospital
Authors: Behera Bijayini , Jena Jayanti , Mahapatra Ashoka , Biswala Jyoti 
Published: December 2020

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common infections encountered in healthcare settings. Candida spp. were excluded as the causative agents of CAUTIs as per Centres for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions in 2015. Aim: To determine the impact of the 2015 definition change on the CAUTI rate of patients admitted to medical and surgical intensive care units (ICUs) of a tertiary care and teaching hospital in India. Method: CAUTI rates were compared in both the ICUs over a period of two years with inclusion and exclusion of Candida spp. Results: Out of the total 116 CAUTI episodes during the study period, a mean of 9.08 CAUTIs per 1000 catheter days were observed in both the ICUs when Candida spp. were included, but the mean CAUTI rate was reduced to 4.78/1000 catheter days when Candida spp. were excluded. Discussion/Conclusion: The mean CAUTI rate decreased by 46.03% solely by excluding Candida spp. This significant reduction in CAUTI rates may be applicable to institutions having high rates of candiduria in catheterised patients, but may not be applicable in centres where the incidence of candiduria is already low. Disregarding Candida as a causative agent of CAUTI did not impact rates of central line-associated bloodstream infections during the study period.