bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Procedure Performance With Practice of Ultrasound Guidance Targeting Tasks
Authors: Nitsche Joshua , Conrad Sarah , Hoopes Sarah , Carrel Meredith , Bebeau Katherine , Brost Brian 
Published: October 2019

PURPOSE:
To determine if repetitive practice of ultrasound guidance targeting tasks improves procedural skill in a simulated setting.

BACKGROUND:
Due to a decrease in ultrasound guided invasive procedures other training methods are required to insure all MFM fellows graduate with sufficient skill to independently perform these procedures.

METHODS:
1st year medical students either practiced the targeting tasks during 4 weekly one hour sessions (training group) or had no training (controls). Afterward all performed a simulated amniocentesis (AC) and chorionic villus sampling (CVS). Procedures were timed and the presence of the following recorded: 1) proper angle of entry, 2) excessive (>0.5 cm) needle movement during aspiration, and 3) critical errors (touching the fetus during AC, touching the opposite uterine wall or amniotic cavity during CVS).

RESULTS:
There were 22 in the training group and 15 controls. AC completion time was 140±28 seconds (sec) vs. 211±62 sec in the training and control groups, respectively (p (0.0%) vs. 1/15 (6.7%), 3/22 (13.6%) vs. 7/15 (46.7%), and 6/22 27.3%) and 8/15 (53.3%) had improper angles, excessive needle movement (p (9.1%) vs. 10/15 (66.7%), 1/22 (4.5%) vs. 8/15 (53.3%), and 3/22 (13.6%) vs. 9/15 (60.0%) had improper angles, excessive needle movement, and critical errors, respectively (all p<0.05).

DISCUSSION:
Repetitive practice of the targeting tasks improved student performance in simulated AC and CVS. There appeared to be greater benefit for CVS performance. Regular practice of the targeting tasks will likely benefit MFM fellow training.
Improved Team Climate and Increased Student Involvement With Interprofessional Learning on Labor and Delivery
Authors: Petruska Sara , Galli Angela , Burns Hadley , Jones Jeffrey 
Published: October 2019

PURPOSE:
To evaluate the impact of an obstetrical interprofessional learning experience for medical students on team climate and medical student clinical involvement.

BACKGROUND:
Students often express difficulty integrating into the obstetrical team and a desire more clinical involvement on the unit. We hypothesized that an obstetrical nurse-shadowing experience for students could increase student understanding of the team’s function and that nurses who worked with students would be more willing to advocate for student involvement in deliveries. We planned to use the Team Climate Inventory to assess students’ inclusion in the team, and to use the percentage of students playing a hands-on role in a vaginal delivery to assess student clinical involvement.

METHODS:
A baseline Team Climate Inventory was administered to students in 2015. The nurse-shadowing day was introduced in 2016-2017 and these students also completed the Team Climate Inventory; student T test used for analysis. The percentages of students assisting in a vaginal delivery before and after the intervention were compared using Fisher’s Exact Test.

RESULTS:
Survey response rates were 38% for control group and 42% for intervention group. Significant improvement (p<0.05) was noted on all axes assessed by the Team Climate Inventory following the intervention with the largest change in Participative Safety. 64.25% of control group students assisted in a vaginal delivery; this increased significantly to 84.65% in the intervention group (p=0.009).

DISCUSSION:
The introduction of an interprofessional learning exercise on Labor and Delivery was associated with improvement in medical student assessment of team climate and with increased involvement of students in vaginal deliveries.
Management of Postoperative Issues in Gynecology and Gynecologic Oncology: A New Method for Teaching Residents
Authors: Rolston Aimee , Brackmann Melissa , Mclean Karen , Reynolds R. , Marzano David , Malone Anita 
Published: October 2019

PURPOSE:
This project sought to develop and assess a curriculum to improve resident knowledge of and comfort in managing common postoperative issues.

BACKGROUND:
Junior obstetrics/gynecology residents enter training with varied experience in post-operative management. They are often the first contact for surgical patients with little formal education on post-operative issues.

METHODS:
Eleven common post-operative issues were identified based on literature review, resident experience and gynecology/gynecologic oncology faculty input. Topic based curriculum included: example case, pathophysiology, differential diagnosis, next steps, and useful resources. It was presented at two educational sessions, involving lectures and small-group simulations. Residents completed a pre and post-assessment questionnaire assessing comfort level in managing (10-point Likert scale) and baseline knowledge about (content-specific questions) the topics.

RESULTS:
Twenty-three residents participated. Seventeen completed one or both pre-assessment surveys (nine junior residents). Ten completed one or both post-assessment surveys (five junior residents). All post-assessment respondents reported improved knowledge of issues covered. Average self-rated comfort level increased for ten of eleven topics amongst junior residents (average increase 1.6 points (range 0.5–3.2; p = 0.02)). Largest increase in score was for hypoxia and low urine output. Average scores maintained or improved for 80% of the content questions (not significant). Residents had no preference for lecture versus small group format.

DISCUSSION:
As a result of directed teaching, resident knowledge of post-operative issues showed measurable improvement. Resident comfort level in management increased significantly for 90% of topics covered, most noticeably amongst junior residents. A systematic, resident-led curriculum on post-operative management can improve resident knowledge and patient care.
Meet You by the Bayou: A Comparison of Resident and Student Views of Resident Teaching Skills on the OB/GYN Clerkship
Authors: Ratan Bani , Johnson Grace , Williams Amanda , Greely Jocelyn , Rutledge Emily , Kilpatrick Charles 
Published: October 2019

PURPOSE:
Compare how OB/GYN residents and medical students view residents as teachers.

BACKGROUND:
The AAMC Medical School Graduation Questionnaire consistently rates OB/GYN residents among the least effective teachers of all the core clerkships. An initial needs-assessment for a resident-as-teacher program was performed to ascertain areas for improvement from both resident and medical student perspectives.

METHODS:
A cross-sectional survey based on the Baker Clinical Educator Self-Assessment using a 1-5 Likert scale was administered to all residents enrolled in an academic OB/GYN Residency in October 2017 and to 37 medical students participating in end-of-clerkship focus groups from October 2017-June 2018. The survey consisted of 13 questions regarding resident teaching skills. Kruskal-Wallis test and two-way ANOVA was used for analysis.

RESULTS:
34 of 48 residents (71% response rate) and all 37 students participating in focus groups completed the survey. Both groups rated residents highest in teaching a skill and lowest in using student learning objectives (p<0.01). Residents’ rating of their own teaching skills was consistently higher than students’ ratings in all except 3 areas: facilitating students’ clinical reasoning, teaching at the bedside, and using questions to teach. Student and resident responses significantly differed only in regards to providing an effective orientation to trainees (2.76 vs 3.71, p<0.01).

DISCUSSION:
A modified Baker Clinical Educator Self-Assessment is useful to evaluate resident and student views of resident teaching. While both agree that OB/GYN residents excel at teaching procedural skills and need improvement in incorporating learning objectives, they significantly differ in views of effectiveness of the student orientation.
The Impact of Interprofessional Education on Attitudes of Medical Students Toward Nurses and Certified Nurse Midwives: A Narrative Review
Authors: Etezadi-Amoli Neda 
Published: October 2019

OBJECTIVE:
To identify how interprofessional education (IPE) may influence attitudes of medical students towards nurses or Certified Nurse Midwives (CNMs).

DATA SOURCES:
PubMed and CINAHL were searched using keywords and MeSH terms from 2007 to present.

METHODS OF STUDY SELECTION:
The search included English-language articles published between 2007 and 2018, subsequent to creation of the Institute for Healthcare Improvement’s Triple Aim which linked interprofessional teams to improved healthcare outcomes. Inclusion criteria for articles was whether IPE activities involving medical students improved attitudes of these students towards other healthcare team members, specifically nurses and/or CNMs.

TABULATION, INTEGRATION AND RESULTS:
40 articles were identified including seven that met inclusion criteria and were reviewed in detail. All seven measured pre- and post- IPE exposure using either scales developed for individual studies or the Jefferson Scale on Attitudes. Types of IPE activities varied from simulations to direct patient care experiences. Participants ranged in number from 54 to 277 medical students. Two, one, three, and one studies included first, second, third and fourth year students, respectively. Six of seven studies noted improvement post-IPE exposure with respect to medical student attitudes towards nursing. There was one study that involved CNMs in the IPE activity, but only included data from nursing, social work and medical students.

CONCLUSION:
Simulated and workplace IPE activities can improve attitudes of medical students toward nursing and other health care providers. No studies have evaluated the optimal timing of IPE activities for medical students for improving team performance in practice.
An Innovative STI Curriculum for Medical Students
Authors: Wiczulis Alicia , Sishtla Haritha , Javlekar Ashwini 
Published: October 2019

PROBLEM:
Student feedback regarding the 50-minute didactic session on sexually transmitted infections (STIs) in the Ob-Gyn Clerkship was poor, and students wanted more interactive instruction methods in our curriculum.

INTERVENTION:
We created a new curriculum for STIs that is more interactive and appropriate for adult learners. Students begin with a self-directed assignment, where they are referred to specific resources and national guidelines to build their fund of knowledge. We replaced the previous didactic lecture with an interactive case-based session that demonstrates clinical application of the material. Small groups of students discuss four clinical vignettes: STI screening, a patient with a genital ulcer, a woman with pelvic inflammatory disease (PID), and a victim of sexual assault. To assess the effectiveness of our method, we will review student feedback on the new curriculum and student performance on the National Board of Medical Examiners subject exam for Obstetrics and Gynecology. We are also conducting a survey for fourth year students that asks how they would manage a patient with PID and a patient requesting STI screening.

CONTEXT:
Screening, diagnosis, and treatment of sexually transmitted infections (STIs) are critical areas of competency for medical students, and interactive teaching methods are increasingly utilized in the modern medical curriculum.

OUTCOME/LESSONS LEARNED:
The current session has been very positively received by students. There has not been a significant change in exam scores. We will conduct our fourth-year survey in the coming academic year to determine whether there is a significant difference in approach to the two vignettes.
Impact of an Opioid Safety Initiative on Patients Undergoing Total Knee Arthroplasty
Authors: Chen Qi , Hsia Hung-Lun , Overman Robert , Bryan William , Pepin Marc , Mariano Edward R. , Mudumbai Seshadri C. , Buchheit Thomas , Krishnamoorthy Vijay , Good Chester B. , Brookhart M. Alan , Raghunathan Karthik 
Published: October 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
The Opioid Safety Initiative decreased high-dose prescriptions across the Veterans Health Administration. This study sought to examine the impact of this intervention (i.e., the Opioid Safety Initiative) on pain scores and opioid prescriptions in patients undergoing total knee arthroplasty.

Methods
This was an ecological study of group-level data among 700 to 850 patients per month over 72 consecutive months (January 2010 to December 2015). The authors examined characteristics of cohorts treated before versus after rollout of the Opioid Safety Initiative (October 2013). Each month, the authors aggregated at the group-level the differences between mean postoperative and preoperative pain scores for each patient (averaged over 6-month periods), and measured proportions of patients (per 1,000) with opioid (and nonopioid) prescriptions for more than 3 months in 6-month periods, preoperatively and postoperatively. The authors compared postintervention trends versus trends forecasted based on preintervention measures.

Results
After the Opioid Safety Initiative, patients were slightly older and sicker, but had lower mortality rates (postintervention n = 28,509 vs. preintervention n = 31,547). Postoperative pain scores were slightly higher and the decrease in opioid use was statistically significant, i.e., 871 (95% CI, 474 to 1,268) fewer patients with chronic postoperative prescriptions. In time series analyses, mean postoperative minus preoperative pain scores had increased from 0.65 to 0.81, by 0.16 points (95% CI, 0.05 to 0.27). Proportions of patients with chronic postoperative and chronic preoperative opioid prescriptions had declined by 20% (n = 3,355 vs. expected n = 4,226) and by 13% (n = 5,861 vs. expected n = 6,724), respectively. Nonopioid analgesia had increased. Sensitivity analyses confirmed all findings.

Conclusions
A system-wide initiative combining guideline dissemination with audit and feedback was effective in significantly decreasing opioid prescriptions in populations undergoing total knee arthroplasty, while minimally impacting pain scores.
Deadliest catch: neutrophil extracellular traps in autoimmunity
Authors: Goel Rishi R. , Kaplan Mariana J. 
Published: October 2019

Purpose of review
To summarize recent evidence on the pathogenic effects of neutrophils and neutrophil extracellular traps (NETs) in autoimmune diseases, including systemic lupus erythematosus and rheumatoid arthritis.

Recent findings
NETs can orchestrate innate and adaptive immune dysregulation through diverse mechanisms. NETs induce potent inflammatory responses and represent sources of many autoantigens, creating a feed-forward loop that may perpetuate disease and lead to organ damage. NETs are also increasingly relevant in atherosclerosis and could contribute to the increased risk of premature cardiovascular disease in patients with autoimmunity.

Summary
NET formation is increased in a variety of autoimmune and autoinflammatory diseases and can have remarkable effects on cell and tissue-specific damage. Novel therapeutics that target NET formation or clearance is a promising strategy for clinical management of autoimmune diseases and may prevent chronic complications associated with these conditions.
A Novel Traction Frame for Femur Fracture Management in Developing Countries: Technique and Outcomes
Authors: Levy David M. , Meadows Molly C. , Gates Dennis J. 
Published: October 2019

Summary:
Fractures of the femur have long been a major cause of morbidity and mortality in developing countries and are most frequently caused by road traffic accidents. Intramedullary nail fixation has become the gold standard of care for diaphyseal fractures of the femur. However, modern techniques require proper implants, access to imaging, and accessible operating room facilities, all of which have limited availability in the developing world. We describe a new technique for assembly of a polyvinyl chloride traction frame for treatment of femur fractures in resource-poor settings. Our report includes a retrospective review of patients treated with polyvinyl chloride traction frames in the Dominican Republic and Haiti.
Clinical Outcome of Magnetically Controlled Growing Rod in Early-onset Scoliosis
Authors: Guan Dawei , Zhang Yuan , Xu Junfang 
Published: October 2019

Study Design:
This was a systematic literature review.

Objective:
To evaluate the efficacy and safety of magnetically controlled growing rod (MCGR) in treating early-onset scoliosis.

Summary of Background Data:
Preliminary studies reported the promising potential of MCGR in deformity correction and spine growth preservation with noninvasive distraction. This study was conducted on the basis of data from published literatures.

Materials and Methods:
A systematic search from multimedical database was conducted for studies of MCGR. Involved studies should provide at least one of the followings: deformity correction, spine growth, and complication. During treatment period, improvement or progression of scoliosis/kyphosis, annual T1–S1/T1–T12 extension, incidence of complication, and unplanned surgery were summarized and the correlations with term of follow-up were investigated.

Results:
In total, 13 studies (n=249) were involved, with an average of 22.2-month follow-up. Scoliosis correction was well maintained, improving from 36.4 degrees at postinitial to 37.1 degrees at last follow-up (P=0.794). Kyphosis progressed from 28.8 degrees at postinitial to 34.4 degrees at last follow-up (P=0.024). Annual T1–S1 and T1–T12 longitudinal extensions were 8.7 and 4.7 mm/year, respectively. As follow-up went on, no significant decline was observed in annual extension of T1–S1 (P=0.4680) or T1–T12 (P=0.8053). The incidences of alignment-related, implant-related, and wound-related complication were 3.5%, 30.1%, and 6.9%, respectively. No significant correlation was observed between occurrence of complication and term of follow-up. The rate of receiving unplanned surgery was 24.3%.

Conclusions:
MCGR is efficient in the maintenance of coronal correction and preservation of spine growth, with loss of sagittal correction and a 24.3% unplanned revision rate.
High cortical delta power correlates with aggravated allodynia by activating anterior cingulate cortex GABAergic neurons in neuropathic pain mice
Authors: Li Ya-Dong , Ge Jing , Luo Yan-Jia , Xu Wei , Wang Juan , Lazarus Michael , Hong Zong-Yuan , Qu Wei-Min , Huang Zhi-Li 
Published: October 2019

Abstract
Patients with chronic pain often report being sensitive to pain at night before falling asleep, a time when the synchronization of cortical activity is initiated. However, how cortical activity relates to pain sensitivity is still unclear. Because sleep is characterized by enhanced cortical delta power, we hypothesized that enhanced cortical delta power may be an indicator of intensified pain. To test this hypothesis, we used pain thresholds tests, EEG/electromyogram recordings, c-Fos staining, and chemogenetic and pharmacological techniques in mice. We found that sleep deprivation or pharmacologic enhancement of EEG delta power by reserpine and scopolamine dramatically decreased mechanical pain thresholds, but not thermal withdrawal latency, in a partial sciatic nerve ligation model of neuropathic pain mice. On the contrary, suppression of EEG delta power using a wake-promoting agent modafinil significantly attenuated mechanical allodynia. Moreover, when EEG delta power was enhanced, c-Fos expression decreased in most regions of the cortex, except the anterior cingulate cortex (ACC), where c-Fos was increased in the somatostatin- and parvalbumin-positive GABAergic neurons. Chemogenetic activation of GABAergic neurons in ACC enhanced EEG delta power and lowered mechanical pain thresholds simultaneously in naive mice. However, chemogenetic inhibition of ACC GABAergic neurons could not block mechanical allodynia. These results provided compelling evidence that elevated EEG delta power is accompanied with aggravated neuropathic pain, whereas decreased delta power attenuated it, suggesting that enhanced delta power can be a specific marker of rising chronic neuropathic pain and that wake-promoting compounds could be used as analgesics in the clinic.
“Shooting pain” in lumbar radiculopathy and trigeminal neuralgia, and ideas concerning its neural substrates
Authors: Defrin Ruth , Brill Silviu , Goor-Arieh Itay , Wood Irene , Devor Marshall 
Published: October 2019

Abstract
Patients with radicular low back pain (radicular LBP, sciatica) frequently describe their pain as “shooting” or “radiating.” The dictionary meaning of these words implies rapid movement, and indeed, many sufferers report feeling pain moving rapidly from the lower back or buttock into the leg. But, others do not. Moreover, the sensation of movement is paradoxical; it is neither predicted nor accounted for by current ideas about the pathophysiology of radicular LBP. We have used a structured questionnaire to evaluate the sensory qualities associated with “shooting” and “radiating” in 155 patients, 98 with radicular LBP and 57 with trigeminal neuralgia, a second chronic pain condition in which shooting/radiating are experienced. Results indicated a spectrum of different sensations in different people. Although many sciatica patients reported rapid downward movement of their pain, even more reported downward expansion of the area of pain, some reported upward movement, and for some, there was no spatial dynamic at all. The velocity of movement or expansion was also variable. By cross-referencing sensations experienced in the sciatica and trigeminal neuralgia cohorts with known signal processing modes in the somatosensory system, we propose testable hypotheses concerning the pathophysiology of the various vectorial sensations reported, their direction and velocity, and the structures in which they are generated. Systematic evaluation of qualitative features of “shooting” and “radiating” pain at the time of diagnosis can shed light on the pain mechanism in the individual patient and perhaps contribute to a better therapeutic outcomes.
Child's food consumption and physical exercise: Results from a Portuguese descriptive study
Authors: Marques Goreti , Festas Constança , Fernandes Carla Sílvia , Simões Daniela , Ferreira Fátima , Pinto Sara , Jorge Áurea , Ferreira Gustavo 
Published: October 2019

Abstract

Aims:
To describe food consumption in Portuguese primary school children, to analyze the influence of food consumption on the body mass index (BMI), and to analyze the relationship between physical exercise and the child's food consumption.

Method:
A quantitative, descriptive, exploratory, and cross-sectional study was conducted in 2 primary schools of the north of Portugal (n = 109 child). The use of a food register for 5 consecutive days and anthropometric evaluation of the children were used.

Results:
The vast majority of children had a normal weight (65.10%). However, 34.90% of the children presented significant changes in their BMI (14.70% with low weight, 11.90% overweight, and 8.30% with obesity). Children who engage in physical activity drink more water and consume less sugary products. However, they also consume less meat, fish, and eggs than those who do not perform regular physical activity.

Conclusions:
The study highlights the emergence of new problems, such as the increasing prevalence of underweight children. The prevention of these problems, overweight, or underweight children, should be addressed among healthcare providers, local authorities, families, and teachers.