bluuebunny/crossref_metadata_2025_split huggingface dataset:
Initial Implementation of Resident-Sensitive Quality Measures in the Pediatric Emergency Department: A Wide Range of Performance
Authors: Schumacher Daniel J. , Martini Abigail , Holmboe Eric , Carraccio Carol , van der Vleuten Cees , Sobolewski Brad , Busari Jamiu , Byczkowski Terri L. 
Published: January 2020

Purpose
A lack of quality measures aligned with residents’ work led to the development of resident-sensitive quality measures (RSQMs). This study sought to describe how often residents complete RSQMs, both individually and collectively, when they are implemented in the clinical environment.

Method
During academic year 2017–2018, categorical pediatric residents in the Cincinnati Children’s Hospital Medical Center pediatric emergency department were assessed using RSQMs for acute asthma exacerbation (21 RSQMs), bronchiolitis (23 RSQMs), and closed head injury (19 RSQMs). Following eligible patient encounters, all individual RSQMs for the illnesses of interest were extracted from the health record. Frequencies of 3 performance classifications (opportunity and met, opportunity and not met, or no opportunity) were detailed for each RSQM. A composite score for each encounter was calculated by determining the proportion of individual RSQMs performed out of the total possible RSQMs that could have been performed.

Results
Eighty-three residents cared for 110 patients with asthma, 112 with bronchiolitis, and 77 with closed head injury during the study period. Residents had the opportunity to meet the RSQMs in most encounters, but exceptions existed. There was a wide range in the frequency of residents meeting RSQMs in encounters in which the opportunity existed. One closed head injury measure was met in all encounters in which the opportunity existed. Across illnesses, some RSQMs were met in almost all encounters, while others were met in far fewer encounters. RSQM composite scores demonstrated significant range and variation as well—asthma: mean = 0.81 (standard deviation [SD] = 0.11) and range = 0.47–1.00, bronchiolitis: mean = 0.62 (SD = 0.12) and range = 0.35–0.91, and closed head injury: mean = 0.63 (SD = 0.10) and range = 0.44–0.89.

Conclusions
Individually and collectively, RSQMs can distinguish variations in the tasks residents perform across patient encounters.
pathCast: An Interactive Medical Education Curriculum That Leverages Livestreaming on Facebook and YouTube
Authors: Madrigal Emilio , Mannan Rifat 
Published: January 2020

Problem
Global connectivity and awareness have significantly increased over the past 3 decades, yet medical education remains mostly unchanged in its delivery—local didactic teaching, supplemented with hands-on clinical experiences.

Approach
Beginning in 2016, the authors leveraged the livestreaming capabilities of Facebook and YouTube to create a platform called pathCast to broadcast pathology lectures to an international community of medical professionals. An interactive pathology curriculum was designed to address challenging topics across various subspecialties. Expert pathologists were invited to deliver 60-minute lectures using digital or glass slides or traditional slide decks. Remote (online) attendees interacted with lecturers in real time using the broadcasts’ chat interface. Facebook’s and YouTube’s analytics were evaluated to assess the performance of all lectures.

Outcomes
From June 2016 to December 4, 2019, 53 speakers delivered 87 lectures representing 18 pathology subspecialties in 9 different languages (with 78 [89.7%] in English only) and from various geographic regions. The lectures hosted on the Facebook channel have garnered 8,333 followers and 52,171 views for a total of 386,200 minutes of watch time, and the lectures hosted on the YouTube channel have accumulated 5,891 subscribers and 292,735 views for a total of 50,674 hours of watch time. The lectures have been viewed by users from 1,093 unique cities across 124 countries.

Next Steps
The authors will continue to develop the curriculum to further disseminate pathology education on a global scale.
Morphological characteristics of Malaysian Malay shoulders for the Latarjet procedure: A cross-sectional CT scan based study
Authors: Lakha Singh Sarbhjit Singh , Tengku Md. Shihabudin Tengku Muzaffar , Pall Singh Taran Singh , Bin Musa Ahmad Tarmizi , Mohd Daud Norfataha binti 
Published: January 2020

Background:
The Latarjet procedure requires a 2.5-cm to 3-cm coracoid graft. The coracoid dimensions as they relate to coracoid transfer procedures have been studied in Caucasian, Chinese, and Mongolian populations. Data on coracoid dimensions as they relate to coracoid transfer procedures among other Asian populations are lacking. The objective of this study was to define the morphological characteristics of Malaysian Malay shoulders for the Laterjet procedure.

Methods:
CT with three-dimensional reconstruction of shoulders in 40 Malaysian Malay patients who had undergone CT to the thorax and neck were analyzed. The orientation of the images with regards to the axial, sagittal, and coronal planes was kept constant using tilt and spin function. Intraclass correlations were calculated to assess the agreement between measurements collected by the researcher and an independent radiologist.

Results:
The mean maximum length of the coracoid available for transfer was 19.6 mm. The mean coracoid midpoint height and width were 12.4 mm and 13.5 mm, respectively. The mean radii of curvature of the coracoid undersurface and the anterior lower half of the glenoid was 28.4 degrees and 68.8 degrees, respectively. Intraclass correlation agreement ranged from 0.85 to 0.96, which translated to good and excellent interrater agreement.

Conclusions:
The maximum length of the coracoid available for transfer in Malasian Malay patients was less than what has been recommended in the literature for the Latarjet procedure. The surface area that would be increased after a coracoid graft is placed on the glenoid would be 12.4±1.8 mm. Knowledge obtained from this study may help us further optimize osseous considerations for the Latarjet procedure in the Malaysian Malay population.

Level of Evidence:
Level III.
Postoperative Outcomes Based on American Society of Anesthesiologists Score After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Yoo Joon S. , Parrish James M. , Jenkins Nathaniel W. , Khechen Benjamin , Haws Brittany E. , Narain Ankur S. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern 
Published: January 2020

Study Design:
A retrospective cohort study.

Objective:
To examine the association between the American Society of Anesthesiologists (ASA) score and patient-reported outcomes (PROs) after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:
Few studies have investigated the correlation between ASA score and PROs after MIS TLIF.

Methods:
Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed and placed into 3 cohorts: ASA score ≤2 and outpatient status, ASA score ≤2 and inpatient status, and ASA score >2. Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, and Short Form-12 Physical Component Score (SF-12 PCS) were administered preoperatively and at 6-week, 12-week, and 6-month time points. ASA scores were tested for association with improvements in PROs using linear regression.

Results:
A total of 187 patients had an ASA score ≤2 and 41 patients had an ASA score >2. Higher ASA scores were associated with older age, obesity, higher comorbidity burden, and an increased length of stay. ASA subgroups demonstrated a significant difference in preoperative ODI and VAS back pain scores and improvement in VAS back pain scores at the 12-week and 6-month time points; however, there was no discernible pattern of improvement amongst cohorts. No statistically significant differences were observed with improvements in PROs.

Conclusions:
The study suggests ASA scores are not associated with postoperative recovery in pain and disability after MIS TLIF. Our results indicate that regardless of the preoperative ASA score, patients are likely to achieve similar improvements in PROs through 6 months follow-up. Although using ASA as a risk stratification tool to predict perioperative complications, its utility in predicting improvement in PROs is still uncertain at this time.
Sagittal Balance in Adult Idiopathic Scoliosis
Authors: Nolte Michael T. , Louie Philip K. , Harada Garrett K. , Khan Jannat M. , Ferguson Joseph , Dewald Christopher J. , An Howard S. 
Published: January 2020

Study Design:
A narrative review article study.

Objective:
The objective of this study was to highlight guiding principles and challenges faced with addressing sagittal alignment in patients with adult idiopathic scoliosis (AIS) and to discuss effective surgical strategies based upon our clinical experience.

Summary of Background Data:
Previous research and guidelines for the treatment of AIS have focused on the correction of spinal deformity in the coronal and axial planes. Failure to address sagittal deformity has been associated with numerous adverse clinical outcomes.

Methods:
This is a review of the current body of literature and a description of the rod derotation surgical technique for correction in the sagittal plane.

Results:
Several studies have offered general goals for postoperative radiographic measures in the sagittal plane for patients with AIS. However, these guidelines are evolving as diagnostic and therapeutic modalities continue to improve. The rod derotation surgical technique through differential metal rods is one method to potentially address sagittal balance in AIS.

Conclusions:
Alignment in the sagittal plane is a unique challenge facing surgeons for patients with AIS. Further research with an assessment of functional outcomes and longer follow-up is needed to more precisely guide treatment principles.

Level of Evidence:
Level IV.
Penile Ulcer due to Leukemia Cutis—A Rare Diagnosis Not to Be Missed
Authors: Toh Joseph J.H. , Chia Hui Yi , Heng Yee Kiat 
Published: January 2020

Abstract:
We present a rare case of leukemia cutis presenting with an ulcer on the ventral penis. A 60-year-old Chinese man was referred for a penile ulcer of 10 days. He was diagnosed with acute myelomonocytic leukemia 6 months earlier and had received 2 cycles of venetoclax with azacitidine. He developed a spontaneous penile blister. It ulcerated after the patient pricked it with a needle. This enlarged after traditional medicated ointment was applied. He denied pain, itch, urethral discharge, systemic symptoms, or rashes elsewhere.
PREDICTORS OF RECURRENT EXUDATION IN CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION DURING A TREATMENT-FREE PERIOD
Authors: Hikichi Taiichi , Agarie Mitsuko , Kubo Natsuki , Yamauchi Moe 
Published: January 2020

Purpose:
To investigate predictors of recurrent exudation in choroidal neovascularization (CNV) of age-related macular degeneration on optical coherence tomography angiography (OCTA) images during an anti–vascular endothelium growth factor therapy-free period.

Methods:
Optical coherence tomography angiography images of 41 eyes of 41 patients with more than a 3-year history of anti–vascular endothelial growth factor therapy for neovascular age-related macular degeneration at the study baseline were evaluated retrospectively. The patients thereafter had a treatment-free period exceeding 6 months under an as-needed regimen and could be followed for an additional 6 months.

Results:
The square root of the CNV area in 19 eyes with recurrence during the second 6-month period enlarged significantly (P = 0.036) from 2.31 ± 0.81 (mean ± SD) to 2.86 ± 0.87 mm during the treatment-free period but not in the 22 eyes without a recurrence. The percentages of branching with tiny vessels (42%) and peripheral arcades at the CNV termini (42%) were significantly (P < 0.001, respectively) higher in the recurrence group compared with the group in which the CNV was no longer active (14% and 5%, respectively).

Conclusion:
Choroidal neovascularization enlargement and features may guide treatment timing in eyes with exudative-free periods.
The First Case Report of Septic Arthritis and Osteomyelitis of the Knee Caused by Candida viswanathii
Authors: Wong Hei Man , Sim James Heng Chiak , Zhou Yvonne Peijun , Chien Jaime Mei Fong 
Published: January 2020

Abstract
An elderly lady was diagnosed in 2015 with septic arthritis and osteomyelitis of the knee caused by Candida viswanathii. This is the first report of a nonmeningitic, noncandidemic osteoarticular infection due to this rare Candida since the first 2 isolations in cerebrospinal fluid in 1959 and 1976, respectively. She was successfully treated with 2 repeat arthroscopic washouts and 16 months of susceptible antifungal therapy with full recovery. The contributing factors of this successful treatment include prompt molecular identification of this rare Candida species, adequate source control with arthrotomies, susceptibility directed antifungal therapy, therapeutic drug monitoring of voriconazole, and close follow-up of our patient. To our understanding, this is also the first reported case of invasive C. viswanathii infection with detailed clinical presentation, treatment method, and treatment response described.
Noninvasive optical coherence tomography imaging correlates with anatomic and physiologic end-organ changes in healthy normotensives with systemic blood pressure variability
Authors: Dagel Tuncay , Afsar Baris , Sag Alan A. , Derin Gozde , Kesim Cem , Tas Ayse Y. , Sahin Afsun , Dincer Neris , Kanbay Mehmet 
Published: January 2020

Objective
Blood pressure variability (BPV) is considered as a novel risk factor for cardiovascular disease including left ventricular hypertrophy, vascular stiffness, and renal dysfunction. In this study, we aimed to determine the relationship between ambulatory BPV with subclinical organ damage and vascular stiffness parameters in normotensive healthy subjects.

Methods
A total of 100 healthy subjects over 18 years of age were included in this cross-sectional study. We divided the participants into two groups according to the median value of the SD of mean 24-h blood pressure (BP) (Group 1: SD of mean 24-h BP <10.15 and Group 2: SD of mean 24-h BP >10.15). BPs of these subjects were recorded over a 24-h period using ambulatory BP monitoring. Mobil-O-Graph device was used to estimate the augmentation index (AIx), pulse wave velocity (PWV), and ambulatory BP measurement. The choroidal thickness was measured by using optical coherence tomography device.

Results
The mean age of the patients was 25.4 ± 5.0 years. Choroidal thickness was correlated with PWV, AIx, protein excretion, and SD of systolic and diastolic BP (P < 0.05). Additionally, participants with higher BP variability have lower choroidal thickness and higher AIx.

Conclusion
We showed that even in normotensive subjects, BPV correlates with choroid thickness. Thus, BPV can be an early prognostic parameter for pathologic vascular changes.
Kinetic magnetic resonance imaging analysis of thoracolumbar segmental mobility in patients without significant spondylosis
Authors: Yao Xingwang , Chen Fei , Dong Chuning , Wang Jeffrey , Tan Yanlin 
Published: January 2020

Abstract
To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.
Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10–L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10–T11 to L1–L2 were included for further analysis.
The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10–T11, 1.20 mm at T11–T12, 1.23 mm at T12–L1, and 1.34 mm at L1–L2 (P < .05 for L1–L2 vs T10–T11). The mean angular motion measurements at each level were 3.26° at T10–T11, 3.92° at T11–T12, 4.95° at T12–L1, and 6.85° at L1–L2. The L1–L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1–L2 (36.1%) and least at T10–T11 (17.1%; P < .01).
Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.
Congenital adrenal hyperplasia presenting as pelvic inflammatory disease in a phenotypic male
Authors: Lim Eunsoo , Jeon Ja Young 
Published: January 2020

Abstract

Rationale:
Congenital adrenal hyperplasia (CAH) is caused by various enzyme deficiencies, among which 21-hydroxylase (21-OH) deficiency accounts for more than 90% of cases. Neonatal screening became mandatory only a few decades ago. Many patients who were born before this went undiagnosed and some of the severely virilized females were raised as men.

Patient concerns:
A 58-year old man with a history of excisional surgery in the external genitalia when he was a toddler presented with three days of dysuria and low abdominal pain.

Diagnosis:
The patient's laboratory results showed leukocytosis and elevated C-reactive protein (CRP); thus, the physicians decided to perform a computed tomography (CT) scan. The CT demonstrated pelvic inflammatory disease (PID), left adrenal gland myelolipoma, and a mesenteric mass. Meanwhile, we suspected CAH based on the clinical history and assessed the patient's hormone levels. Seventeen-hydroxyprogesterone (17-OH-PG) was markedly elevated and the patient was diagnosed with classic simple virilizing CAH.

Interventions:
Intravenous antibiotics were administered, and positron emission tomography-CT (PET-CT) was performed to evaluate any metastases.

Outcomes:
After 2 weeks of antibiotic treatment, CRP decreased to 0.12 mg/dL and PID was resolved. The patient opted for resection of the female genitalia along with the mesenteric and adrenal gland tumors in the near future, and was safely discharged.

Lessons:
The adrenal gland myelolipoma was thought to have developed as a result of a longstanding exposure to adrenocorticotropic hormone. There are controversies regarding the management of female genitalia in CAH patients who identify themselves as men. In this case, the physician and patient decided to remove the female genitalia because the surgery for the mesenteric mass was inevitable and there was a possibility of recurrent PID. To our knowledge, this is the first article to report primary mesenteric tumor in a CAH patient to date. In conclusion, patients who were born before neonatal screening for CAH became the mainstay, who are suspected to have CAH from their history, and present with abdominal pain must be diagnosed by performing an imaging study, testing levels of serum 17-OH-PG, and screening for female genitalia and adrenal gland myelolipoma.
Clinical significance of viral–bacterial codetection among young children with respiratory tract infections
Authors: Jung Jiwon , Seo Euri , Yoo Ree Nar , Sung Hungseop , Lee Jina 
Published: January 2020

Abstract
We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.

A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral–bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07–0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13–0.98), respectively.
We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral–bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.
Psychological effects of project-based learning in participants receiving clinical oncology teaching
Authors: Song Ling-Qin , Han Jun-Li , Liu Di , Dai Zhi-Jun , Zhang Shu-Qun , Braun Thomas 
Published: January 2020

Abstract

Background:
This study will assess the effects of the project-based learning (PBL) for participants undergoing clinical oncology teaching (COT).

Methods:
A systematic and comprehensive literature records will be identified from the electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, Springer, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All electronic databases will be searched from their inceptions up to the present. Any relevant randomized controlled trials on the effects of PBL in participants receiving COT will be considered for inclusion. Study quality will be assessed using the Cochrane risk of bias tool. RevMan 5.3 software will be utilized for statistical analysis.

Results:
This study will assess the effects of PBL in participants receiving COT through assessing the primary outcomes of psychological disorders, student satisfaction, and student feedback, and secondary outcomes of examination scores, excellence rates, course examination pass rates, and clinical knowledge or skills.

Conclusion:
The findings of this study will summarize the latest evidence on the effects of PBL in participants receiving in COT.

PROSPERO registration number:
PROSPERO CRD42019150433.