bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ocular Surface Impairment After Coronavirus Disease 2019: A Cohort Study
Authors: Gambini Gloria , Savastano Maria Cristina , Savastano Alfonso , De Vico Umberto , Crincoli Emanuele , Cozzupoli Grazia Maria , Culiersi Carola , Rizzo Stanislao 
Published: November 2020

Purpose:
This is a cohort study to evaluate the presence of objective signs and subjective symptoms of dry eye disease in postcoronavirus disease 2019 (COVID-19) patients compared with the control.

Methods:
Prospective, observational, single-ctenter, cohort study. Sixty-four post-COVID-19 patients and 50 control were recruited. All participants underwent a complete ophthalmological examination including Ocular Surface Disease Index Questionnaire (OSDI), best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, Schirmer test type 1, tear break-up time test (tBUT), evaluation of conjunctival hyperemia, corneal staining, and tear film osmolarity test.

Results:
The OSDI score was higher in the post-COVID-19 group in the quantitative and qualitative analysis (P < 0.001 and P =0.012, respectively). The mean tBUT in post-COVID-19 patients was 6.95 ± 4.07 seconds compared with a mean tBUT of 10.12 ± 3.90 seconds in the control group. The post-COVID-19 group showed a higher number of patients with a simultaneous impairment of the OSDI score and tBUT (P = 0.019). The Schirmer test results were strikingly significant both in the quantitative analysis and qualitative analysis (P <0.001 and P = 0.0014, respectively). Both quantitative analysis and qualitative analysis revealed a significant difference in tear osmolarity in the 2 groups.

Conclusions:
Comparing the ocular surface assessment of post-COVID-19 patients with heathy control, a statistically significant increase of dry eye disease has emerged both in subjective and objective evaluations. Our clinical results support the findings that suggested a susceptibility of the ocular surface to the virus, and it underlines the importance of the ocular surface assessment in post-COVID-19 patients for a correct diagnosis and therapy.
Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria M. 
Published: November 2020

Abstract

Background:
Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit.

Methods:
This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge.

Results:
There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001).

Conclusions:
N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.
Experience of a Portuguese radiation therapy department in the treatment of synchronous and metachronous head, neck, and oesophageal cancers
Authors: Garcia Sofia C.M. , Tavares Alda , Pinto Maria G. , Fontes Maria P.P.L. , Águas Lúcia , Vendeira Maria L.A. 
Published: November 2020

Abstract

Background:
Multiple primary cancers in patients with head and neck squamous cell carcinoma (HNSCC) and oesophageal squamous cell carcinoma (ESCC) share common features. Their treatment approach can be a challenge. This retrospective study aims to estimate the cumulative incidence and to describe the outcome of patients with multiple primary cancers, treated in a Tertiary Centre in Portugal.

Methods:
The study includes patients with HNSCC, ESCC, and multiple tumours (synchronous or metachronous), treated with curative intent in a Centre, between 2004 and 2019. The analysis is focused on the clinical baseline characteristics, the treatment approach, and the outcomes. Patients with distant metastasis at tumour diagnosis were excluded.

Results:
Of a total of 820 cases, 31 had multiple tumours. In 15.8 years, the cumulative incidence of multiple tumours was 6.45%. Twenty-seven patients were treated with curative intent (n = 7 synchronous, n = 20 metachronous). The most frequent HNSCC cancers in synchronous tumours were oropharynx and hypopharynx tumours (n = 4); oral cavity was the most frequent HNSCC cancer (n = 12) in metachronous tumours. The primary treatment included surgery, adjuvant or definitive radiation therapy or chemoradiation. With a median follow-up time of 73 months, the median overall survival was 51.8 months for synchronous and 102 months for metachronous tumours.

Conclusions:
Multiple tumours of HNSCC and ESCC are uncommon. In the small group of Portuguese patients analysed, there is a potential pattern of occurrence and treatment outcome. Due to the limited number of patients this study has included, the authors have considered that additional prospective studies with large samples are needed.
Flipped Classrooms in Physician Assistant Education
Authors: Vajravelu Bathri N. , Kelley Alicia , Moktar Afsoon , Orrahood Scott 
Published: November 2020

Purpose
This study assessed the impact of flipped classrooms on physician assistant (PA) students' performance and opinions.

Methods
Students completed quizzes and an opinion survey in Genetics, Human Pathophysiology (HPP), Clinical Medicine (CM) (n = 105) and Physical Exam (PE) (n = 98) courses.

Results
In Genetics and PE, the quiz scores were significantly higher for flipped classrooms (Genetics 95.00 ± 6.56; PE 83.09 ± 11.47) compared to the traditional lectures (Genetics 90.00 ± 10.53; PE 55.43 ± 16.66). In HPP, students performed better with traditional lectures (86.54 ± 8.82) compared to the flipped classrooms (75.12 ± 8.54). In CM, students' gain score was significantly higher for flipped classrooms (37.85 ± 16.73) than for traditional lectures (20.97 ± 15.55). The opinion surveys showed that the students surveyed preferred traditional lectures over flipped classrooms in Genetics (4.58 ± 0.46 vs. 2.29 ± 0.71) and HPP (4.14 ± 0.35 vs. 2.09 ± 0.53).

Conclusion
Flipped classrooms improved the quality of learning in courses that deliver a hands-on skill or use case-based scenarios. They may not be an ideal choice for courses that require explanation of intricate scientific concepts.
Physical Therapy in Addition to Standard of Care Improves Patient Satisfaction and Recovery Post-cesarean Section
Authors: Stone Jennifer , Skibiski Katie , Hwang Sarah , Barnes Courtney 
Published: November 2020

Background:
Cesarean section represents the most commonly performed inpatient surgical procedure in the United States. The few studies currently available regarding the role of physical therapy in postoperative recovery only look at the first few days or weeks postpartum. The goal of this pilot randomized controlled trial was to assess the impact of physical therapy post-cesarean delivery and to serve as a potential basis for future research.

Objective:
To evaluate the short- and long-term impact of an individualized, comprehensive physical therapy program on post-cesarean delivery recovery.

Study Design:
Unblinded randomized controlled trial.

Methods:
The intervention group went through an individualized 6-week physical therapy program, which included in-clinic treatment and home exercises in addition to usual postoperative care. Outcome measures used were a visual pain rating scale, Oswestry Disability Index, patient satisfaction questionnaire, and self-rated exercise confidence scale.

Results:
Seventy-two participants were included in final analysis. Satisfaction was significantly higher at 14 weeks (P = .048) and 6 months (P = .047) in the intervention group. Pain rating was significantly lower at 14 weeks (P = .049) in the intervention group. A significant change was found between baseline and 14-week/6-month follow up for Oswestry (P < .0001), patient satisfaction (P = .024), and self-efficacy with exercise (P = .034) in the intervention group. A significant main effect for self-efficacy with exercise (P = .025) in the intervention group was found at all time points compared with standard of care. Significant differences between variables were found for the Oswestry intervention group [8-14 weeks (P = .003), 8 weeks to 6 months (P = .001), and 8 weeks to 1 year (P = .007)] and the standard of care group [8 weeks to 6 months (P = .001) and 8 weeks to 1 year (P = .006)].

Conclusions:
Participants who received physical therapy had significantly improved outcomes compared with the standard of care group. This suggests that physical therapy may be a helpful adjunct to cesarean delivery recovery, although larger studies should be done for definitive conclusions.
Current Fertility Preservation Options for Female Patients With Hodgkin Lymphoma
Authors: Hutchcraft Megan L. , McCracken Kate , Whiteside Stacy , Lustberg Maryam , Lindheim Steven R. , Nahata Leena , Appiah Leslie C. 
Published: November 2020

ABSTRACT

Importance
Many adolescents and young adults diagnosed with Hodgkin lymphoma (HL) experience disease progression requiring high-dose alkylating salvage therapy, which often results in permanent infertility.

Objective
The aim of this report is to discuss fertility preservation options in female patients with consideration of chemotherapeutic agents in HL.

Evidence Acquisition
An electronic literature review was performed utilizing a combination of the terms “Hodgkin lymphoma,” “fertility preservation,” “ovarian tissue cryopreservation,” “oocyte cryopreservation,” “embryo cryopreservation,” and “gonadotropin-releasing hormone agonist.” References and data from identified sources were searched and compiled to complete this review.

Results
Initial treatment of HL is often nonsterilizing; however, salvage therapy and conditioning for stem cell transplantation confer significant gonadotoxicity. Established fertility preservation options for pubertal females include embryo cryopreservation and oocyte cryopreservation. These options are contraindicated within 6 months of receipt of chemotherapy. Ovarian tissue cryopreservation is an option for patients who require salvage therapy within 6 months of first-line therapy.

Conclusions
Timing and choice of fertility preservation techniques depends on planned first-line chemotherapy and response to treatment. In patients initially treated with low-risk chemotherapy, it is reasonable to defer invasive fertility techniques until treatment failure; however, upfront fertility preservation should be considered in patients planning to undergo primary treatment with high-risk therapy.

Relevance
As advances in cancer therapy are made, the number of survivors of reproductive age increases. The ability to recognize risks for infertility and offer options for fertility preservation is paramount for optimizing quality of life in those with HL.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After completing this activity, the learner should be better able to distinguish cure and progression rates of HL in reproductive-aged women; describe fertility preservation options for front-line and salvage therapy in HL; and explain the importance of longitudinal fertility preservation management for reproductive-aged patients with HL.
Nutrition in Pregnancy: A Comparative Review of Major Guidelines
Authors: Tsakiridis Ioannis , Kasapidou Eirini , Dagklis Themistoklis , Leonida Ioannis , Leonida Christos , Bakaloudi Dimitra Rafailia , Chourdakis Michail 
Published: November 2020

Importance
Nutrition patterns in pregnancy play a decisive role in the well-being of the mother and the fetus.

Objective
The aim of this review was to summarize and compare guidelines and recommendations on nutrition in pregnancy.

Evidence Acquisition
A descriptive review of major guidelines on antenatal nutrition was conducted, including the most recently published guidelines, namely, by the Australian Government Department of Health (2018); the Canadian Nutrition Working Group and Society of Obstetricians and Gynaecologists of Canada (2016); the World Health Organization (2016); the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland (2016); the International Federation of Gynecology and Obstetrics (2015); the Academy of Nutrition and Dietetics (2014); and the National Institute for Health and Care Excellence (2008).

Results
There is almost universal agreement regarding macronutrient requirements during pregnancy. The WHO, FIGO, and the NICE guidelines make no recommendation on fluid intake. Almost all guidelines state that weight gain during pregnancy should be closely monitored. Folic acid supplementation is universally recommended from the preconception period, but there are controversies regarding other vitamins' supplementation. Multiple micronutrient supplementation could be an option in specific settings according only to the FIGO. Probiotics are not routinely recommended in pregnancy.

Conclusions
There is wide agreement among the reviewed guidelines regarding nutrition in pregnancy, but still there are controversies. Evaluation and classification of influential guidelines can be beneficial for establishing a universal consensus on nutrition during pregnancy, in order to achieve more favorable perinatal outcomes.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After participating in this activity, the learner should be better able to identify all aspects of recommended macronutrients intake during pregnancy; assess the need for vitamin supplementation in pregnancy; and describe potential micronutrient supplementation in the antenatal period, in order to achieve a favorable perinatal outcome.
Associations Between Polycystic Ovary Syndrome and Adverse Obstetric and Neonatal Outcomes: A Population Study of 9.1 Million Births
Authors: Mills Ginevra , Badeghiesh Ahmad , Suarthana Eva , Baghlaf Haitham , Dahan Michael H. 
Published: November 2020

(Abstracted from Hum Reprod 2020;35(8):1914–1921)
Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovarian morphology that may be associated with an increased risk of requiring cesarean section (C/S), experiencing preterm delivery (PTD), having small-for-gestational-age (SGA) infants, and undergoing induction of labor. This syndrome is commonly associated with insulin resistance (IR) and is indicated to be independently associated with gestational diabetes mellitus, hypertensive disorders of pregnancy, and preeclampsia.
Influence of Cardiopulmonary Resuscitation Coaching on Interruptions in Chest Compressions During Simulated Pediatric Cardiac Arrest*
Authors: Kessler David O. , Grabinski Zoe , Shepard Lindsay N. , Jones Sara I. , Lin Yiqun , Duff Jonathan , Tofil Nancy M. , Cheng Adam 
Published: November 2020

Objectives:
To determine the impact of a cardiopulmonary resuscitation coach on the frequency and duration of pauses during simulated pediatric cardiac arrest.

Design:
This is a secondary analysis of video data collected from a prospective multicenter trial. Forty simulated pediatric cardiac arrest scenarios (20 noncoach and 20 coach teams), each lasting 18 minutes in duration, were reviewed by three clinical experts to document events surrounding each pause in chest compressions.

Setting:
Four pediatric academic medical centers from Canada and the United States.

Subjects:
Two-hundred healthcare providers in five-member interprofessional resuscitation teams that included either a cardiopulmonary resuscitation coach or a noncoach clinical provider.

Interventions:
Teams were randomized to include either a trained cardiopulmonary resuscitation coach or an additional noncoach clinical provider.

Measurements and Main Results:
The frequency, duration, and associated factors with each interruption in chest compressions were recorded and compared between the groups with and without a cardiopulmonary resuscitation coach, using t tests, Wilcoxon rank-sum tests, or chi-squared tests, depending on the distribution and types of outcome variables. Mixed-effect linear models were used to explore the effect of cardiopulmonary resuscitation coaching on pause durations, accounting for multiple measures of pause duration within teams. A total of 655 pauses were identified (noncoach n = 304 and coach n = 351). Cardiopulmonary resuscitation-coached teams had decreased total mean pause duration (98.6 vs 120.85 s, p = 0.04), decreased intubation pause duration (median 4.0 vs 15.5 s, p = 0.002), and similar mean frequency of pauses (17.6 vs 15.2, p = 0.33) when compared with noncoach teams. Teams with cardiopulmonary resuscitation coaches are more likely to verbalize the need for pause (86.5% vs 73.7%, p < 0.001) and coordinate change of the compressors, rhythm check, and pulse check (31.7% vs 23.2%, p = 0.05). Teams with cardiopulmonary resuscitation coach have a shorter pause duration than non-coach teams, adjusting for number and types of tasks performed during the pause.

Conclusions:
When compared with teams without a cardiopulmonary resuscitation coach, the inclusion of a trained cardiopulmonary resuscitation coach leads to improved verbalization before pauses, decreased pause duration, shorter pauses during intubation, and better coordination of key tasks during chest compression pauses.
The Effect of Alpha Lipoic Acid on the Recovery of Sciatic Nerve Injury in Rats
Authors: Kurt Oktay Kubra Neslihan , Akpinar Pinar , Unlu Ozkan Feyza , Aktas Ilknur , Ersoy Canillioglu Yasemin , Erkanli Senturk Gozde 
Published: November 2020

Objective
The aim of this study was to investigate the regenerative effects of alpha lipoic acid on the recovery of sciatic nerve crush injury (SNCI) in rats.

Design
This was a randomized, experimental, and sham-controlled study. The sciatic nerves of 28 rats in four groups were traumatized for 60 secs: G1, sham operated + saline; G2, SNCI + saline; G3, SNCI + alpha lipoic acid 50 mg/kg/day; and G4, SNCI + alpha lipoic acid 100 mg/kg/day. Sciatic functional index values were measured on day 0, 1, 7, 14, 21, and 28. Sciatic nerve stimulation threshold values were recorded on day 1, 14, and 28. End-point histopathologic evaluation was conducted.

Results
The mean sciatic functional index value of G2 but not G3/G4 on day 7 was significantly lower than on day 0 (P = 0.035, P = 0.447/P = 0.800). The mean sciatic functional index value of G2 but not G3/G4 increased significantly between day 7 and 14 (P = 0.035, P = 0.447/P = 0.438). The day 14 mean sciatic nerve stimulation threshold values of G3/G4 but not G2 were decreased significantly compared with those on day 1 (P = 0.022/P = 0.022, P = 0.933). The mean sciatic nerve stimulation threshold values of G3/G4 on day 14 were similar to those on day 0 (P = 0.106/P = 0.418). Regeneration in muscle and nerve connective tissues and nerve structures was observed in G3/G4. Inflammation in the muscle and nerve tissues of G4 was suppressed down to similar levels of G1. Myelinated nerve fibers were less degenerated in G3/G4.

Conclusion
Alpha lipoic acid has the potential to accelerate the process of nerve healing in the context of SNCI in rats.
Validation of the Trust in the Surgical Decision Scale
Authors: Brodney Suzanne , Sepucha Karen , Fowler Floyd J. , Valentine K. D. , Barry Michael J. 
Published: November 2020

Objective:
To develop and validate a short measure of trust in the surgical decision making process.

Summary of Background Data:
Having a reliable and valid measure of trust is important to assess the quality of the patient-surgeon relationship when decisions about surgical procedures are made.

Methods:
A previously published 10-item trust scale was qualitatively tested with patients, and a revised set of 14 items was tested using a web-based survey of 300 people who had hip, knee or back surgery in the past 2 years. The 14 items were evaluated using patterns of correlations and relevance to medical decision making to create a 5-item version. A 5-item subset was compared to the 14-item version to assess reliability and validity of patient's trust in the surgical decision making process.

Results:
Of the 300 participants, 32% had hip surgery, 33% had knee surgery, and 34% back surgery. Mean age was 53 years, 45% female, 80% White, and 36% had a high school degree or less. The item intercorrelations for the 14 items were 0.43–0.72 and 0.58–0.71 for the 5 items. Correlation between the versions was 0.96 (P < 0.01). The 14- and 5-item versions were positively correlated with participants’ shared decision making process scores (0.42 and 0.41, both P = 0.01), internal consistency reliability scores were 0.95 and 0.89, respectively, and were negatively correlated with their Decision Regret scores (–0.51 and –0.48, both P = 0.01).

Conclusion:
The 5-item Trust in the Surgical Decision Scale has strong evidence of validity and reliability for patients who underwent common orthopedic procedures.