bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of an Undergraduate Medical Education Critical Care Content Outline Utilizing the Delphi Method
Authors: Smith Andrew G. , Brainard Jason C. , Campbell Kristine A. 
Published: November 2019

Objectives:No consensus exists on a standardized critical care content outline for medical student education. The aim of this research is to develop a national undergraduate medical education critical care content outline.Design:The authors used a Delphi process to reach expert consensus on a content outline that identified the core critical care knowledge topics and procedural skills that medical students should learn prior to entering residency. Over three iterative rounds, the expert panel reached consensus on a critical care content outline.Setting:An electronic survey of critical care medical educators, residency program directors, and residents in the United States.Subjects:The expert panel included three groups as follows: 1) undergraduate medical education critical care educators, 2) residency program directors representing all core specialties, and 3) residents representing their core specialties.Interventions:None.Measurements and Main Results:The expert panel included 28 members. Experts represented the following medical specialties: anesthesiology, emergency medicine, internal medicine, obstetrics and gynecology, pediatrics, and surgery. Seventeen experts had subspecialty training in critical care. The expert panel identified 19 highly recommended critical care knowledge topics and procedural skills. These topics and procedural skills were grouped into five broad categories as follows: 1) neurologic, 2) respiratory, 3) cardiovascular, 4) renal and electrolytes, and 5) supplemental ICU topics. Bag-mask ventilation was the only procedural skill identified as highly recommended.Conclusions:This study provides a national consensus undergraduate medical education critical care content outline. By including experts from multiple specialties, this content outline is meaningful for medical student education, independent of medical specialty. The content outline represents a first step in the development of a national undergraduate medical education critical care curriculum.
Beyond tissue biopsy: a diagnostic framework to address tumor heterogeneity in lung cancer
Authors: Voigt Wieland , Manegold Christian , Pilz Lothar , Wu Yi-Long , Müllauer Leonard , Pirker Robert , Filipits Martin , Niklinski Jacek , Petruzelka Lubos , Prosch Helmut 
Published: November 2019

Purpose of review
The objective of this review is to discuss the strength and limitations of tissue and liquid biopsy and functional imaging to capture spatial and temporal tumor heterogeneity either alone or as part of a diagnostic framework in non-small cell lung cancer (NSCLC).

Recent findings
NSCLC displays genetic and phenotypic heterogeneity – a detailed knowledge of which is crucial to personalize treatment. Tissue biopsy often lacks spatial and temporal resolution. Thus, NSCLC needs to be characterized by complementary diagnostic methods to resolve heterogeneity. Liquid biopsy offers detection of tumor biomarkers and for example, the classification and monitoring of EGFR mutations in NSCLC. It allows repeated sampling, and therefore, appears promising to address temporal aspects of tumor heterogeneity. Functional imaging methods and emerging image analytic tools, such as radiomics capture temporal and spatial heterogeneity. Further standardization of radiomics is required to allow introduction into clinical routine.

Summary
To augment the potential of precision therapy, improved diagnostic characterization of tumors is pivotal. We suggest a comprehensive diagnostic framework combining tissue and liquid biopsy and functional imaging to address the known aspects of spatial and temporal tumor heterogeneity on the example of NSCLC. We envision how this framework might be implemented in clinical practice.
Invasive Melanoma and Melanoma in Situ Treated With Modified Mohs Micrographic Surgery With En Face Permanent Sectioning: A 10-Year Retrospective Review
Authors: Heath Michael , Woody Meghan , Leitenberger Justin , Latour Emile , Bar Anna 
Published: November 2019

BACKGROUND
Successful surgical treatment of cutaneous melanoma is dependent on margin control.

OBJECTIVE
To determine efficacy of modified Mohs micrographic surgery (mMMS) with en face permanent margins in management of invasive melanoma (IM) and melanoma in situ (MIS).

METHODS
A retrospective cohort study evaluating local recurrence, 5-year recurrence-free survival, and 5-year melanoma-specific survival. Overall, 657 melanomas (128 IM and 529 MIS) from 631 patients were treated using mMMS during a 10-year period. Follow-up information was obtained from medical records and telephone encounters.

RESULTS
The median follow-up time was 5.18 years. Most melanomas were located on the head and neck 93.6% (615/657). Margins required for clearance were 0.77 ± 0.44 cm (mean ± SD). Local recurrence was identified in 1.98% (13/657) of melanomas with no local recurrences in IM. Five-year local recurrence-free and melanoma-specific survival rates were estimated to be 96.9% (95% confidence interval [CI]: 94.6%–98.2%) and 99.0% (95% CI: 97.7%–99.6%). There were 5 melanoma-related deaths.

CONCLUSION
Modified Mohs micrographic surgery is an effective treatment of melanoma as evidenced by low local recurrence rates and high melanoma-specific survival.
Use of Lasers for Iron-Induced Accidental Tattoos: Experience at a Tertiary Referral Center
Authors: Eggenschwiler Corinne D.C. , Dummer Reinhard , Imhof Laurence 
Published: November 2019

BACKGROUND
Awareness of accidental tattoos after iron injections with paravenous leakage is low. No larger patient cohorts have been analyzed. The lesions are a burden to the patients. The only known treatment is laser therapy.

OBJECTIVE
To characterize the clinical appearance and development of iron-induced tattoos and to demonstrate safe and efficient removal with quality-switched (QS) and picosecond lasers.

MATERIALS AND METHODS
The authors conducted a retrospective systematic analysis on patients who presented at the Dermatology Department of the University Hospital of Zurich between Year 2008 and 2017 with accidental hyperpigmentations after iron injections. From 29 collected patients, 13 received laser treatment and were analyzed with reference to the lasers used, including wavelength, fluence, spot size, intervals, number of sessions, and overall success. The authors defined the latter as a complete removal or as patients' satisfaction.

RESULTS
The authors treated 13 patients and completed the treatment in 8 patients, with an average of 5.6 sessions. No complications occurred.

CONCLUSION
Spontaneous regression of iron-induced tattoos is possible within 1 to 2 years, but not guaranteed. Removal with QS ruby, Nd:YAG, and picosecond lasers can be achieved within a mean number of 5.6 sessions. Assuring a valid indication before intravenous iron administration is important.
The Effect and Safety of Aerobic Interval Training According to Exercise Intensity in Acute Coronary Syndrome
Authors: Kim Chul , Choi Hee Eun 
Published: November 2019

Purpose:
To evaluate the effect of increasing the maximal oxygen uptake (

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2max) and the safety of maximal-intensity aerobic interval training (MAIT) compared with high-intensity aerobic interval training (HAIT).

Methods:
Forty-seven patients with first-ever acute coronary syndrome were assigned to MAIT or HAIT. Subjects underwent adaptation period during the first 2 wk of cardiac rehabilitation and then MAIT at 95-100% of the heart rate reserve or HAIT at 85% of the heart rate reserve, 3 d/wk for 4 wk. The primary outcome was

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2max. The secondary outcomes were major cardiovascular complications, hemodynamic responses, myocardial oxygen demand, cardiometabolic health, and echocardiographic findings.

Results:
A total of 670.5 hr of MAIT and HAIT were completed. After 6 wk of aerobic interval training,

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2max was significantly increased in both groups. However, the increment of

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2max was significantly greater in the MAIT group than in the HAIT group (P < .05). The percentage increases for MAIT and HAIT were 31% and 17%, respectively. No major cardiovascular or musculoskeletal complications were noted.

Conclusions:
The results of this study indicate that 6 wk of MAIT resulted in statistically significantly better improvement in

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2max than 6 wk of HAIT at a similar total work in patients with acute coronary syndrome. Moreover, both MAIT and HAIT may be safe to use in the cardiac rehabilitation setting.
Blood pressure dipping and sleep quality in the Wisconsin Sleep Cohort
Authors: Lyu Beini , Hagen Erika W. , Ravelo Laurel A. , Peppard Paul E. 
Published: November 2019

Aims:
Nondipping blood pressure (BP) is associated with higher risk for hypertension and advanced target organ damage. Insomnia is the most common sleep complaint in the general population. We sought to investigate the association between sleep quality and insomnia and BP nondipping cross-sectionally and longitudinally in a large, community-based sample.

Methods:
A subset of the Wisconsin Sleep Cohort (n = 502 for cross-sectional analysis and n = 260 for longitudinal analysis) were enrolled in the analysis. Polysomnography measures were used to evaluate sleep quality. Insomnia symptoms were obtained by questionnaire. BP was measured by 24-h ambulatory BP monitoring. Logistic regression models estimated cross-sectional associations of sleep quality and insomnia with BP nondipping. Poisson regression models estimated longitudinal associations between sleep quality and incident nondipping over a mean 7.4 years of follow-up. Systolic and diastolic nondipping were examined separately.

Results:
In cross-sectional analyses, difficulty falling asleep, longer waking after sleep onset, shorter and longer total sleep time, lower sleep efficiency and lower rapid eye movement stage sleep were associated with higher risk of SBP and DBP nondipping. In longitudinal analyses, the adjusted relative risks (95% confidence interval) of incident systolic nondipping were 2.1 (1.3–3.5) for 1-h longer waking after sleep onset, 2.1 (1.1–5.1) for 7–8 h total sleep time, and 3.7 (1.3–10.7) for at least 8-h total sleep time (compared with total sleep time 6–7 h), and 1.9 (1.1–3.4) for sleep efficiency less than 0.8, respectively.

Conclusion:
Clinical features of insomnia and poor sleep quality are associated with nondipping BP. Our findings suggested nondipping might be one possible mechanism by which poor sleep quality was associated with worse cardiovascular outcomes.
Relationship between heart failure and central serous chorioretinopathy: A cohort study in Taiwan
Authors: Huang Ke-Hao , Chen Yi-Hao , Lee Lung-Chi , Tai Ming-Cheng , Chung Chi-Hsiang , Chen Jiann-Torng , Liang Chang-Min , Chien Wu-Chien , Chen Ching-Long 
Published: November 2019

Background:
Both central serous chorioretinopathy (CSCR) and heart failure (HF) are disorders with a complex pathogenesis, whereas the two diseases might share similar pathogenesis. This study aimed to evaluate whether patients with HF are exposed to potential risk of CSCR by using the National Health Insurance Research Database (NHIRD).

Methods:
Data were collected from the NHIRD over a 14-year period. Variables were analyzed with the Pearson chi-square test and Fisher’s exact test. The risk factors for disease development were examined by adjusted hazard ratio (aHR). Kaplan–Meier analysis was performed to compare the cumulative incidence of CSCR.

Results:
A total of 24 426 patients with HF were enrolled in the study cohort, and there were 24 426 patients without HF in the control cohort. The incidence rate of CSCR was higher in the study cohort than in the control cohort (aHR = 4.572, p < 0.001). CSCR occurred more commonly in males than in females. The overall incidence of CSCR was 30.07 per 100 000 person-years in the study cohort and 23.06 per 100 000 person-years in the control cohort. Besides, subgroup analysis revealed that no matter in gender or age group, HF patients were in an increased risk of CSCR diagnosis (male/female, aHR = 3.268/7.701; 20-59 years/≥60 years, aHR = 3.405/5.501, p < 0.001).

Conclusion:
HF is a significant indicator for CSCR. Patients with HF should stay alert for potential disorder of visual impairment. Further prospective studies to investigate the relationship between HF and CSCR could provide more information.
Naja atra venom-spit ophthalmia in Taiwan: An epidemiological survey from 1990 to 2016
Authors: Tsai Tsung-Han , Lin Chun-Chi , Mao Yan-Chiao , Hung Chia-Lien , Yang Yi-Chiang , Yang Chen-Chang , Jeng Mei-Jy 
Published: November 2019

Background:
Venomous snakebites are common during hot seasons in Taiwan. However, rarely is venom spat directly into the subject’s eyes, causing eye injury. Despite being uncommon, analytical data regarding venom-spit ophthalmia in Taiwan have been lacking. This study thus aimed to conduct an epidemiological survey on Naja atra venom-spit ophthalmia in Taiwan during the past decades to improve future care of such patients.

Methods:
Registered records of cases with snake venom injuries at the Taiwan National Poison Control Center from 1990 to 2016 were retrospectively reviewed, enrolling those with records of cobra venom-spit eye injuries and excluding exotic species. Demographic data, clinical symptoms, snake species, ocular conditions, management, and outcomes were recorded and analyzed.

Results:
A total of 39 cases suffering from Naja atra venom-spit ophthalmia were enrolled. The overall incidence rate was 1.6 cases per million people from 1990 to 2016. Among the included cases, most were unilaterally injured (82%), male (95%), aged 18 to 59 years (90%), injured during catching (51%), and injured in spring and summer (92%). Ocular symptoms occurred in 90% of the cases, majority of which included ocular pain (90%) and redness (85%). Conjunctivitis (67%) and corneal injury (59%) of involved eyes were common. Immediate water irrigations were done in all cases, most of whom received further topical eye drops, including antibiotics, corticosteroids, and vasoconstrictors. Although topical or intravenous antivenoms were administered in 11 cases, no obviously superior outcome was observed. Most cases (77%) were symptom free after the acute stage.

Conclusion:
Although Naja atra venom-spit ophthalmia in Taiwan is uncommon, the risk for transient ocular symptoms and corneal/conjunctival injury does exists. Prompt ocular irrigation and professional ophthalmic care after envenomation help prevent serious ocular sequelae. Moreover, superior outcomes were not achieved with the use of antivenom. Nonetheless, further studies are required to clarify the role antivenoms play in venom-spit ophthalmia.
Exploring HIV-Related Stigma as a Determinant of Engagement in HIV Care by African American Women
Authors: McCoy Katryna , Lipira Lauren , Kemp Christopher G. , Nevin Paul E. , Huh David , M. Turan Janet , Mugavero Michael J. , Cohn Susan E. , Bahk Mieoak , Simoni Jane M. , Andrasik Michele P. , Rao Deepa 
Published: November 2019

Abstract
Engagement in HIV care reduces HIV-related health disparities that persist across racial/ethnic and gender lines; yet, African American (AA) women face multiple challenges to remaining engaged in care, including HIV-related stigma. We analyzed longitudinal data from 239 participants in the Unity Health Study to estimate associations between HIV-related stigma and engagement in care among AA women linked to HIV care. In adjusted Poisson regression analyses, engagement in care was not associated with HIV-related stigma but was associated with older age (incidence rate ratio [IRR] = 1.01, 95% confidence interval [CI] = [1.00–1.01], p = .01), higher levels of education (IRR = 1.18, 95% CI = [1.02–1.35], p = .03), and higher levels of social support (IRR = 1.05, 95% CI = [1.01–1.09], p = .04). Our findings suggest the need for targeted interventions to enhance engagement in care and to incorporate social support into health promotion programming for AA women living with HIV.
Physical Activity and Cognitive Health Among People Living With HIV: An Integrative Review
Authors: Winston Nadia , Swanson Barbara , Capuano Ana W. , Fogg Louis F. , Barnes Lisa L. 
Published: November 2019

Abstract
The purpose of our review was to analyze evidence related to physical activity (PA) and cognitive health in people living with HIV (PLWH), appraise psychometric characteristics of study measures, and calculate effect sizes. A computerized database search of the literature published between 1996 and 2017 was examined for correlational and observational studies that included a sample of PLWH, measured PA, and measured cognitive health. Seven articles met the sampling criteria. Of which, six studies used a cross-sectional design; one used a longitudinal design. All but one found significant positive associations between PA and cognitive health in PLWH. Four studies showed a moderate to high effect for PA on cognitive function (Cohen's d values = 0.45–0.58). None reported sample-specific reliability and validity estimates for PA and cognitive health instruments. PA is a modifiable factor that may delay the onset of cognitive impairment and decline among PLWH.
Direct, Absenteeism, and Disability Cost Burden of Obesity Among Privately Insured Employees
Authors: Ramasamy Abhilasha , Laliberté François , Aktavoukian Shoghag A. , Lejeune Dominique , DerSarkissian Maral , Cavanaugh Cristi , Smolarz B. Gabriel , Ganguly Rahul , Duh Mei Sheng 
Published: November 2019

Objective:
To compare obesity-related costs of employees of the healthcare industry versus other major US industries.

Methods:
Employees with obesity versus without were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Employees working in healthcare with obesity were compared with employees of other industries with obesity for absenteeism/disability and direct cost differences. Multivariate models estimated the association between industries and high costs compared with the healthcare industry.

Results:
Obesity-related absenteeism/disability and direct costs were higher in several US industries compared with the healthcare industry (adjusted cost differences of $–1220 to $5630). Employees of the government/education/religious services industry (GERS) with obesity (BMI of 30 or greater) had significantly higher odds of direct costs at the 80th percentile and above (odds ratio vs healthcare industry = 2.20; P < 0.05).

Conclusions:
Relative to the healthcare industry, employees of other industries, especially GERS, incurred higher obesity-related costs.
Number of Previous Absences Is a Predictor of Sustained Attendance After Return-to-Work in Workers With Absence due to Common Mental Disorders
Authors: Mishima Masayoshi , Adachi Hiroyoshi , Mishima Chieko 
Published: November 2019

Objective:
This study evaluated the relationship of the number of previous episodes due to common mental disorders (CMDs) with long-term outcomes and sustainability of attendance after return-to-work (RTW).

Methods:
Participants were assigned to the following three groups: workers having one (Group 1), two (Group 2), and three or more (Group 3) previous episodes. Outcomes were a recurrent absence and the sustainability rate of attendance after RTW.

Results:
The sustainability rate in Group 1 was significantly higher than that in Group 3 throughout the observation period. The sustainability rates for Group 2 were significantly higher than for Group 3 at 30 and 36 months.

Conclusions:
The number of previous episodes was shown to affect sustainability of attendance after RTW due to CMDs, indicating that repeated previous absences are a significant prognostic factor.
Inappropriate Use of Aztreonam
Authors: Steiner Ryan , King Madeline , Byrne Dana , Rose Lucia 
Published: November 2019

Background:
Aztreonam is not a preferred empiric antibiotic because of variable susceptibilities compared with alternative agents. In addition, it has no Gram-positive activity, necessitating coadministration with vancomycin when used empirically, and is more costly when compared with other Gram-negative active agents. Aztreonam is often given to patients with a reported penicillin allergy without further investigation into the reaction or other relevant allergy information.

Study Question:
How frequently is aztreonam being used inappropriately?

Study Design:
We conducted a retrospective chart review at an academic medical center to assess the appropriateness of our aztreonam use.

Measures and Outcomes:
Our primary outcome was frequency of appropriate aztreonam use, based on a true IgE-mediated allergy reported for each patient. We evaluated whether the patients had tolerated a beta-lactam in the past, and what the reported allergic reaction was.

Results:
We included 165 patients and found that 46.7% of our aztreonam use was inappropriate, based on previous use of a beta-lactam, or no documentation of an IgE-mediated response. Of the patients with a documented beta-lactam allergy, 63 (38.2%) patients had no allergy manifestation listed, and 37 (22.4%) patients had a non–IgE-mediated allergy manifestation. Of the total population, 61 (37%) patients had tolerated a beta-lactam in the past.

Conclusions:
Aztreonam should be avoided, except in the case of a true IgE-mediated allergic reaction. Our goal was to reduce the inappropriate use of aztreonam at our institution by one or more of the following: educating providers, reviewing aztreonam orders, requiring answering of order questions, or requiring an indication for use. Penicillin skin testing and desensitization are options as well.
Direct bilirubin level is an independent risk factor for atrial fibrillation in thyrotoxic patients receiving radioactive iodine therapy
Authors: Sun Danyang , Li Wei , Zheng Wei , Tan Jian , Zhang Guizhi 
Published: November 2019

Objectives
This study aimed to indicate the risk factors of atrial fibrillation (AF) in thyrotoxic patients receiving radioactive iodine (RAI) therapy after antithyroid drug and other medication.

Methods
This study was a retrospective cohort study. Thyrotoxic patients were divided into two groups, with or without AF. Clinical features were retrospectively analyzed. Univariate and multivariate analyses of data from thyrotoxic patients were performed to evaluate the probability of AF.

Results
The following clinical factors were found to be correlated with AF: age, gender, duration of hyperthyroidism, coronary artery disease, hypertension, and levels of platelets, creatinine, uric acid (UA), and certain liver enzymes. According to the multiple logistic regression model, age and levels of UA, direct bilirubin (DBIL), and gamma-glutamyl transpeptidase (GGT) were important risk factors for predicting AF. ROC analysis showed that DBIL levels were predictive of AF, with a specificity of 0.813, a sensitivity of 0.767, and an area under the curve of 0.8515 (P < 0.001).

Conclusion
Older age and levels of UA, DBIL, and GGT influenced the occurrence of AF in thyrotoxic patients receiving RAI. DBIL level was an important factor in predicting AF in patients with hyperthyroidism. Thus, thyrotoxic patients who have the above-mentioned risk factors should undergo routine pulse palpation should be considered for active antithyroid drug therapy.