bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of a Flipped Classroom Obstetrics Didactics Module in the OBGYN Clerkship
Authors: Tran Susan 
Published: October 2019

OBJECTIVE:
To contemporize the OBGYN medical student learning experience, flipped classroom/team-based learning models were implemented starting with select obstetrics topics.

METHODS:
Preeclampsia and preterm premature rupture of membranes were taught using a flipped classroom/team-based learning model. Remainder of clerkship curriculum was taught using traditional didactics. Pre-work included corresponding APGO Educational videos and individual completion of corresponding APGO Teaching Case questions. In class, students worked through Teaching Case questions. Test of change was evaluated over 4 clerkship rotations (between 8/20/18–12/14/18). Using two-tailed t-tests, mean clerkship didactics satisfaction scores (scored 1–5) and final exam scores (percent correct) were evaluated from these 4 study groups, and compared to the 4 rotations from the same time of year (between 8/21/17–12/15/17) prior to implementation of the flipped classroom, to control for differences in student satisfaction and exam performance that may be affected by the time of year in which student completes OBGYN clerkship.

RESULTS:
There were 54 students in test of change study group compared to 44 in control group. The mean final exam scores were 70.0% (study group) and 74.9% (control group) (p<.05). The mean student satisfaction scores were 4.92 in the study group and 4.57 in the control group (p=0.07).

CONCLUSION:
Implementation of a flipped classroom was associated with lower mean final exam score compared to utilization of traditional didactics model. Student satisfaction scores were higher in the flipped classroom group, but did not reach statistical significance.
CAST (Cultural Awareness Through Student Theater): A Workshop to Improve Resident Communication Skills With Patients from Diverse Backgrounds
Authors: Valthaty Rebekah , Kuo Yen Hong , Schwartzberg Paul 
Published: October 2019

PROBLEM:
ACGME requires cultural competency training. Yet, trainees often do not receive formal training in the setting of cultural competency. We propose to apply the use of medical students as simulated patients to teach these skills.

INTERVENTION:
At orientation our interns participated in a workshop involving case-based scenarios created to include culturally sensitive topics simulated by medical students.

CONTEXT:
Small group sessions included 5-6 interns, a faculty member, student actor and expert. Immediate feedback was given. Each intern completed a brief pre-and post- survey and a reflection essay. A checklist created using the ETHNIC model was used. Medical students and faculty attended a didactic training session, and faculty received the cases and learning objectives prior to the workshop.

OUTCOME/LESSONS LEARNED:
Statistically significant improvements were noted in familiarity with cultural competency (P = 0.0001), comfort with medical needs of patients from different cultural backgrounds (p = 0.0016), understanding individual’s cultural background can be a health determinant (p = 0.0001), understanding how differences between cultures and personal healthcare practices can affect the perception of care (p=0.001), importance of negotiating a mutually acceptable treatment plan that may differ based on the patient’s cultural background (p = 0.0001), and understanding that it is the physician’s job to create a culturally sensitive environment (p = 0.0001). No statistically significant differences were noted in understanding how a patient explains/perceives illness or importance of collaboration with patient's other health providers. These outcomes will be used to improve the case-based scenarios.
Implementation of a Smartphone App to Measure and Manage Anxiety in Undergraduate Clinical Nursing Students
Authors: Peters Anya Bostian , Kellogg Marni , Zhang Yuan 
Published: October 2019

Abstract
Various causes exist for nursing student anxiety in the clinical setting. There is a need for further intervention research that may be effective to reduce student anxiety related to clinical. The purpose of this pilot research study was to measure and manage anxiety for nursing students in the clinical area with the assistance of a smartphone app. The usefulness of the app was evaluated by means of a focus group.
Does Repeated Painful Stimuli Change Cerebral Near-Infrared Spectroscopy Response in Healthy, Term, Large for Gestational Age Newborns?
Authors: Ozdemir Hulya , Bilgen Hulya , Gokulu Gamze , Memisoglu Asli , Ozek Eren 
Published: October 2019

Objective:
The objective of this study was to evaluate the effect of repeated painful stimuli on short-term pain response in healthy, term, large for gestational age newborns by measuring the regional cerebral oxygen saturation (rScO2), and behavioral and physiological responses.

Methods:
We compared term large for gestational age infants who received repeated painful stimuli (study group) with term, appropriate for gestational age infants (control group). A pulse oximeter and a near-infrared spectroscopy probe were connected to babies during the study period, and the responses of the babies were recorded by video, from which the crying time and the Neonatal Infant Pain Scale were obtained. The heart rate, peripheral oxygen saturation (SpO2), and rScO2 data were sampled every 1 second and exported to a personal computer via digital output during the study period. The maximum heart rate, the minimum SpO2, and peak, baseline, and mean rScO2 measurements following skin puncture were recorded. Data were compared within 1 group and between the 2 groups.

Results:
After the heel prick, crying time (P<0.001) and Neonatal Infant Pain Scale scores (P=0.024) increased, and SpO2 levels decreased significantly (P=0.012) in the study group versus the control group. Although mean rScO2 increased significantly within 1 group (P<0.001), it was not significant between the 2 groups. The percent change in rScO2 was greater in the study group (5.2 [2.5 to 9.3]) compared with the control group (2.8 [1.1 to 8.2], P=0.037).

Conclusion:
We showed that rScO2 values changed significantly within the first few days of life in babies who received more painful stimuli compared with the control group, similar to behavioral and physiological responses.
Use of Asynchronous Video Interviews for Selecting Obstetrics and Gynecology Residents
Authors: Breitkopf Daniel M. , Green Isabel C. , Hopkins Matthew R. , Torbenson Vanessa E. , Camp Christopher L. , Turner Norman S. 
Published: October 2019

OBJECTIVE:
To assess the effect of using of asynchronous video interviewing as a screening tool for obstetrics and gynecology residency selection.

METHODS:
This project was part of a quality-improvement effort to enhance the resident application process. Applications to a single obstetrics and gynecology residency program were scored using standardized criteria. In the 2018 Match, top-scored applicants were invited to in-person interviews, and second-tier applicants were asked to complete a three-question asynchronous video interview. Video interviews were scored and used to invite the remaining applicants for in-person interviews. In the 2019 Match, video interviewing was expanded to all applicants with top application scores, and the video score was used to determine in-person interview invitations. Applicants for 2019 were surveyed on their views regarding video interviewing.

RESULTS:
Half of the candidates interviewed in person in the 2018 season were screened by the video interview process compared with 82% in the 2019 season. The mean in-person interview score increased from 59.0 in 2017, before screening with asynchronous video interviews, to 62.2 in 2018 (effect size 0.50; 95% CI 0.09–0.90) In 2018, a nonsignificant correlation was seen between the video interview score and rank list percentile (r=0.22, P=.15, n=27) and in-person interview score (r=0.18, P=.12, n=46). United States Medical Licensing Examination step 1 and 2 scores were not correlated with video interview scores in either season. Most (58%) candidates indicated that the asynchronous video interview was an effective way to tell their story; however, only 42% were comfortable with the interview process.

CONCLUSION:
Video interviewing may have promise as a tool for program directors to use to select candidates from a competitive applicant pool by measuring important noncognitive skills. Acceptance by obstetrics and gynecology applicants was mixed.
Chemoprophylaxis for the Hip Fracture Patient: A Comparison of Warfarin and Low-Molecular-Weight Heparin
Authors: Trivedi Nikunj N. , Sivasundaram Lakshmanan , Wang Christopher , Kim Chang Y. , Buser Zorica , Wang Jeffrey C. , Ochenjele George 
Published: October 2019

Objective:
To compare the rates of deep venous thrombosis (DVT), rates of pulmonary embolus (PE), and complication profiles of warfarin and low-molecular-weight heparin (LMWH) in patients undergoing operative fixation of hip fractures.

Design:
Retrospective cohort study.

Setting:
Insurance-based database of more than 22 million patient records.

Patients:
Adult hip fracture patients who were treated operatively and received chemoprophylaxis from 2007 to 2016. A total of 7594 patients met inclusion criteria and were available for final analysis.

Intervention:
Pharmacological anticoagulation with warfarin or LMWH to prevent postoperative venous thromboembolism after hip fracture surgery.

Main Outcome Measures:
Development of DVT or PE within 30 and 90 days of surgery.

Results:
Patients prescribed warfarin had higher rates of DVT and PE compared with those prescribed LMWH. Patients on warfarin were more likely to develop a postoperative hematoma and to be readmitted within 30 and 90 days compared with those on LMWH. Patients in both groups had similar rates of total complications.

Conclusions:
Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Adrenal tumours: open surgery versus minimally invasive surgery
Authors: Fiori Cristian , Checcucci Enrico , Amparore Daniele , Cattaneo Giovanni , Manfredi Matteo , Porpiglia Francesco 
Published: October 2019

Purpose of review
The aim of this article is to focus on state-of-the-art minimally invasive adrenalectomy (MIA) and the most recent role of open adrenalectomy for adrenal tumours, respect to MIA and open adrenalectomy for adrenocortical cancer (ACC).

Recent findings
The laparoscopic (both transperitoneal and retroperitoneal) approach is the first-choice treatment in cases of small-to-medium benign adrenal tumours. This approach is feasible and well tolerated even for larger lesions without radiological signs of malignancy. Robotic adrenalectomy has recently increased in popularity, although the results appear to be fully comparable with those of laparoscopy. Open approach is the keystone of ACC surgery, especially when neighbour tissues, organs, or vessels are involved. Recent evidence suggests caution in treating localized ACC with laparoscopy, because of the higher rate of local or peritoneal recurrence, and shorter recurrence-free survival rates with respect to open adrenalectomy.

Summary
MIA has progressively replaced the traditional open approach and plays a complementary role in the treatment of adrenal tumour. It is the first option for benign lesions, whereas open adrenalectomy is a cornerstone treatment for ACC. The overlap of indications for laparoscopic adrenalectomy and open adrenalectomy is today confined to the treatment of organ-confined adrenal cancer, in which the role of laparoscopic surgery is far from being clearly defined.
Does preventive oophorectomy increase the risk of depression in BRCA mutation carriers?
Authors: Kotsopoulos Joanne , Gronwald Jacek , Lubinski Jan , McCuaig Jeanna , Lynch Henry T. , Neuhausen Susan L. , Foulkes William D. , Weitzel Jeffrey N. , Senter Leigha , Tung Nadine , Eng Charis , Karlan Beth , Sun Ping , Narod Steven A. 
Published: October 2019

Abstract

Objective:

BRCA mutation carriers are advised to undergo bilateral salpingo-oophorectomy to prevent ovarian cancer. The abrupt hormonal withdrawal associated with early surgical menopause has been shown to increase the risk of depression and anxiety among women in the general population. The impact in women with a BRCA1 or BRCA2 mutation is not known.

Methods:
We undertook a matched prospective study of BRCA mutation carriers to evaluate the impact of oophorectomy on self-reported initiation of antidepressant use. We identified women with no personal history of cancer or depression and prospectively evaluated the frequency of self-reported medication use after surgery. Each exposed participant (oophorectomy) was randomly matched to a control participant (no oophorectomy) according to year of birth (within 3 years), BRCA mutation type (BRCA1 or BRCA2), and country of residence (Canada, United States, Poland). A total of 506 matched sets were included. We estimated the odds ratio (OR) and 95% confidence intervals (CIs) of antidepressant use (ever/never) following preventive oophorectomy in the entire study population and stratified by age at oophorectomy and by use of hormone therapy.

Results:
Oophorectomy was not associated with more frequent antidepressant use among BRCA mutation carriers (OR = 0.46; 95% CI 0.22-0.96). We observed reductions in the odds of antidepressant medication use among women who underwent oophorectomy before the age of 50 years (OR = 0.33; 95% CI 0.14-0.78) and among those who initiated hormone therapy use after oophorectomy (OR = 0.35; 95% CI 0.14-0.90). Findings were similar when the analysis was based on self-reported depression (rather than antidepressant use).

Conclusions:
Although based on a small number of women, these findings suggest that oophorectomy does not increase psychological distress among women at an elevated risk of ovarian cancer.
β-3 adrenergic receptor gene polymorphisms are associated with gestational diabetes mellitus in a Chinese population
Authors: Jia He , Pan Yuan , Wang Yun , Yin Feng-Ling , Xu Na 
Published: October 2019

Abstract
Increasing studies demonstrated that genetic susceptibility attributes to the development of gestational diabetes mellitus (GDM). The polymorphisms of the β-3 adrenergic receptor(β-3AR) gene have been found to be of great importance in bodyweight elevation and dyslipidaemias. We aimed to determine the influence of β-3AR polymorphisms on the GDM risk. Thus, we performed a case-control study including 136 GDM cases and 138 controls to evaluate the relation between the rs201607471 and susceptibility to GDM. Likelihood ratios X

2
analysis showed the distribution of the genotype frequency (rs201607471 in β-3AR gene) was accorded with the Hardy-Weinberg genetic equilibrium. Although no significant association between rs201607471 alleles and GDM susceptibility (Chi-square test, P > .05), we observed that β-3AR gene rs201607471 CT genotype was significantly prevalent in GDM (Chi-square test, P < .05). Moreover, we observed that β-3AR gene rs201607471 C > T was significantly associated with an increased risk of GDM using the recessive model (CC vs CT/TT: P = .026) and the additive model (CC vs CT vs TT: P = .038). These data indicate that β-3AR rs201607471 may be a helpful susceptibility marker for GDM in Chinese pregnant women.
Increased Elabela levels in the acute ST segment elevation myocardial infarction patients
Authors: Dönmez Yurdaer , Acele Armağan 
Published: October 2019

Abstract
Elabela is a bioactive peptide and a part of Apelinergic system. Elabela has an important role in the early embryonic stages. Elabela's beneficial effects in cardiovascular system were shown in some animal models or in vitro studies. Lately, some investigational studies in humans are started to be seen in literature. Our aims were to investigate serum Elabela levels in the first day of ST segment elevation myocardial infarction (STEMI), to compare with healthy controls, and to see if there is a correlation between other cardiac biomarkers in humans.
The study was planned as cross-sectional. The patients group had 124 STEMI subjects. They were grouped as inferior (n = 59) and anterior myocardial infarction (n = 65) groups, and compared with the healthy control population (n = 77). Routine blood tests and serum Elabela levels were measured. Transthoracic echocardiography performed to all subjects.
Frequency of diabetes mellitus, hypertension, smoking, and hyperlipidemia in both STEMI groups were significantly higher than control subjects. Glucose, high density lipoprotein (HDL) cholesterol, triglyceride, high sensitive C reactive protein (Hs-CRP), troponin I, N-terminal brain natriuretic peptide (NT-ProBNP), and Elabela levels were significantly higher in both STEMI groups. Other laboratory parameters were similar. Group 2 and 3 had significantly lower left ventricular ejection fraction (LVEF) than group 1. Group 3 had also significantly lower LVEF than group 2. There was a positive but moderate correlation between Elabela, troponin I, and NT-ProBNP. Elabela was negatively correlated with LVEF. This correlation was also moderate.
We showed increased Elabela levels in STEMI patients in this study. Also, we observed a moderate positive correlation between troponin I, NT-ProBNP, and Elabela.
Traumatic posterior atlantooccipital dislocation combined with type II dens fracture and C1 anterior arch fracture
Authors: Chang Dong-Gune , Park Jong-Beom , Cho Yoon Joo , Kim Gang-Un 
Published: October 2019

Abstract

Rationale:
Traumatic AOD is rare but highly associated with upper cervical spine injuries. We found no references in the literature of traumatic posterior atlantooccipital dislocation (AOD) combined with type II dens fracture (Anderson-D’Alonzo classification) and C1 anterior arch fracture.

Patient concerns:
The first case was a 93-year-old male patient who was admitted to the Emergency Department complaining of incomplete quadriplegia after a fall from a height. The second was a 53-year-old male patient who visited the emergency department complaining of posterior neck pain following a high-speed motor vehicle collision.

Diagnosis:
Reconstructed computed tomography (CT) scans clearly demonstrated posterior AOD combined with type II dens fracture and C1 anterior arch fracture. In addition, magnetic resonance imaging (MRI) also revealed type II transverse atlantal ligament injury (Dickman's classification) in the first patient.

Interventions:
The patients chose not to undergo surgery; instead, they were immobilized with a rigid cervical brace.

Outcomes:
The patients were lost to follow-up.

Lessons:
A thorough clinical evaluation and radiologic investigation (CT and MRI) on concomitant upper cervical injuries should be evaluated in traumatic AOD patients.
The ongoing D-lemma of vitamin D supplementation for nonskeletal health and bone health
Authors: Charoenngam Nipith , Shirvani Arash , Holick Michael F. 
Published: October 2019

Purpose of review
The goal of this review is to give some perspective on the results and conclusions of three recent randomized controlled vitamin D intervention studies that have challenged the health benefit of vitamin D supplementation for reducing risk for cardiovascular disease, cancer, all-cause mortality and type 2 diabetes and improving bone health.

Recent findings
Vitamin D supplementation to adults who were vitamin D sufficient or insufficient did not reduce risk for developing cardiovascular disease, cancer, type 2 diabetes nor increases bone mineral density (BMD). Patients who were vitamin D deficient with cancer and received vitamin D reduced risk for mortality by 25% and prediabetic adults who were vitamin D deficient and received vitamin D reduced their risk of developing type 2 diabetes by 62%. Older adults receiving 4000 and 10 000 IUs of vitamin D3 daily for 3 years had reduced radial BMD but had no change in either total hip areal bone density or bone strength in the radius and tibia.

Summary
Caution is needed when evaluating results and conclusions from randomized controlled trials that investigate health benefits of vitamin D; most studies suggest health benefits when vitamin D supplementation is provided to vitamin D deficient populations and little benefit when given to populations that are vitamin D sufficient/insufficient.
Travel Nurse Onboarding
Authors: Bethel Claire , Olson Susan , Bay Curt , Uyeda Tami , Johnson Karen 
Published: October 2019

OBJECTIVE
The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs.

BACKGROUND
Onboarding must be streamlined and organized for TRNs to provide safe patient care.

METHODS
Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page.

RESULTS
The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work.

CONCLUSION
Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.
Timing of and factors associated with HIV disclosure among perinatally infected children in rural Zambia
Authors: Sutcliffe Catherine G. , Drogt Carolyn S. , van Dijk Janneke H. , Hamangaba Francis , Muleka Mathias , Munsanje Bornface , Munsanje Jeridy , Thuma Philip E. , Moss William J. 
Published: October 2019

Objective:
This study was conducted to understand the process of disclosure among HIV-infected children receiving care in rural Zambia.

Design:
Cross-sectional and longitudinal analyses were conducted within an ongoing clinical cohort study of HIV-infected children receiving care in Macha, Zambia from 2007 to 2016.

Methods:
Children receiving HIV care were enrolled into the cohort study and assessed every 3 months. At each study visit, disclosure status was ascertained through questionnaire. Disclosure was categorized as none (child did not know they were chronically ill), partial (child knew they were chronically ill but not of their HIV infection status), or full (child knew they had HIV infection). Barriers to disclosure, and the timing of and factors associated with disclosure, were evaluated among children 5–15 years of age.

Results:
At study entry, the prevalence of full disclosure increased with age, from 2.1 to 76.2% among children 5–6 and 13–15 years of age, respectively. Reasons provided by caregivers for not disclosing the child's status included they felt the child was too young, they were afraid to, or they did not know how to tell the child. During follow-up, the median age at full disclosure was 9.0 years. Among children with full disclosure, 89.5% first had partial disclosure at a median age of 7.4 years. Factors associated with disclosure included being female, sharing responsibility for taking their own medication, and low weight-for-age z-score.

Conclusion:
Given the complexity of the disclosure process and potential for health benefits, interventions and protocols are needed to support caregivers through the disclosure process.