bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metachronous neoplasms in patients with laterally spreading tumours during surveillance
Authors: Bogie Roel M. M. , Winkens Bjorn , Retra Sean J. J. , le Clercq Chantal M. C. , Bouwens Mariëlle W. , Rondagh Eveline J. A. , Chang Li‐Chun , de Ridder Rogier , Hoge Chantal , Straathof Jan‐Willem , Goudkade Danny , Sanduleanu‐Dascalescu Silvia , Masclee Ad A. M. 
Published: November 2020

AbstractBackgroundLaterally spreading tumours represent a major challenge for endoscopic detection and resection.ObjectiveTo examine synchronous and metachronous neoplasms in patients with laterally spreading tumours.MethodsWe prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years' follow‐up. Post‐resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared.ResultsBetween 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, p < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, p = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, p < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8–4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients.ConclusionPatients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.
Perceived impact on efficiency and safety of experienced American physician assistants/associates in acute hospital care in England: findings from a multi-site case organisational study
Authors: Drennan Vari M , Calestani Melania , Taylor Francesca , Halter Mary , Levenson Ros 
Published: November 2020

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.
Implementation of Modified Cardiovascular Health Awareness Program for Canadian Adults on a Waiting List for a Family Physician
Authors: Kaczorowski Janusz , Lussier Marie-Thérèse , Girard Magali , Beaulieu-Carbonneau Audrey 
Published: November 2020

Introduction The Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular diseases (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary care. Centralized waiting lists and prioritization based on urgency of medical need were created to address this problem. We aimed to assess the acceptability, CVD risk profile, and potential benefits of offering a modified version of CHAP to adults on the waiting list. Methods The implementation was conducted in Laval (Canada) between March and June 2016, targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centers. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured. They also received targeted healthy lifestyle and patient education materials and were referred to local programs including a medical follow-up, when required. Results A total of 1976 invitation letters were sent resulting in 281 (14.2%) participants. The average age of attendees was 58.1 (SD = 8.2) and a majority were female (58%, n = 163). A third of participants (34.2%, n = 96) had BP ≥140/90 and 11.4% (n = 32) were classified as having a very high risk for developing diabetes. Almost half (41.6%, n = 117) of participants were referred either to health promotion programs offered by local health authorities, to family physicians (4.6%, n = 13) or emergency departments (1.8%, n = 5) for short-term medical assistance. Conclusion Despite low participation rate, many adults on a waiting list had elevated risk for CVD and would greatly benefit from having a regular source of primary care.
Use of a Feedback Survey as a Part of a Wellness Champions Program to Improve Academic Faculty Satisfaction and Burnout: Implications for Burnout in Academic Health Centers
Authors: Locke Amy Beth , Fortenberry Katherine T , Sullivan Erika , Ose Dominik , Tingey Ben , Qeadan Fares , Henson Autumn , Van Hala Sonja 
Published: November 2020

Background Faculty and trainee well-being at academic medical centers is a nationwide concern. In response, the University of Utah Health created a system-wide provider wellness program that used individual faculty champions who were empowered to 1) examine the unique needs of their department or division using a lens of quality improvement, 2) design projects to address well-being, and 3) measure impact of projects addressing well-being. One team used a feedback tool to attempt to improve the well-being of Family Medicine faculty by better understanding challenges and developing a roadmap for action. Objective Evaluate the effectiveness of an anonymous feedback tool on faculty well-being. Methods The Division of Family Medicine developed and implemented a quarterly anonymous faculty survey to facilitate an ongoing improvement process for faculty wellness in 2016. The faculty survey identified thematic concerns, which were used to develop constructive solutions and systemic changes. Results A closed loop feedback structure provided rich faculty input into impacts on burnout and professional well-being. Sense of control (good to optimal) over workload among faculty increased significantly (p = 0.011) from 10% to 42% over one year exhibiting a large effect size (Cohen’s h = 0.751). Faculty burnout, using a single item emotional exhaustion question validated to the Maslach Burnout Inventory, was reduced from 48% to 25% showing a medium effect size (Cohen’s h = 0.490 with p = 0.097). Work related stress was reduced from 72% to 50% demonstrating clinical significance (Cohen’s h = 0.465) but not statistical significance (p = 0.154)—an effect which was more noticeable when comparing means between years (Cohen's d=0.451with p = 0.068). Response rate was 100% in 2016 (29/29) and 92% (23/25) in 2017. Conclusion This faculty survey, which has since been adopted by other groups at the University of Utah, could help improve well-being in a variety of health care professions.
Advancing Malaria Prevention and Control in Africa Through the Peace Corps-US President’s Malaria Initiative Partnership
Authors: Henderson Susan J , Belemvire Allison , Nelson Roman , Linn Anne , Moriarty Leah F , Brofsky Emma , Diaw Mamadou , Gittelman David 
Published: November 2020

Background Peace Corps is a US government volunteer service agency which provides trained Volunteers to assist host countries in addressing critical development challenges at the community level. The US President’s Malaria Initiative provides technical expertise and financial resources to reduce malaria morbidity and mortality in focus countries in sub-Saharan Africa. Objective We aim to describe the nature of the collaboration between Peace Corps and President’s Malaria Initiative (PMI) and highlight examples of the partnership in select countries. Methods We conducted an analysis of retrospective data obtained from Peace Corps and PMI for the years 2014–2019. Results Volunteers were able to learn about and work on malaria prevention and control with PMI in three key ways: a malaria-specific training program for staff and Volunteers; malaria-focused small grants; and extension of Volunteer assignments for a third year to support malaria projects. Successful Peace Corps projects supported by PMI, at the community level, were highlighted, with a focus on Rwanda, Benin, Zambia, Madagascar, and Senegal. In Fiscal Year 2019, 1408 Volunteers contributed to malaria prevention activities in 18 Peace Corps programs across Africa, of which 15 were PMI focus countries. While the majority of documented work by Volunteers has involved social and behavior change, there were many other ways to partner with PMI staff. Conclusion Each of the proven interventions that PMI supports for malaria prevention and control may have a role for Volunteer involvement. Combined with the technical expertise and the relationships that PMI staff have with national-level counterparts in PMI focus countries, the continued collaboration between Peace Corps and PMI can accelerate the fight against malaria.
Pandemics Past and Present: A Guided Inquiry Approach
Authors: Willey Joanne M , Olvet Doreen M , Bird Jeffrey B , Brenner Judith M 
Published: November 2020

Background: COVID-19 exposed undergraduate medical education curricular gaps in exploring historical pandemics, how to critically consume scientific literature and square it with the lay press, and how to grapple with emerging ethical issues. In addition, as medical students were dismissed from clinical environments, their capacity to build community and promote professional identity formation was compromised. Methods: A synchronous, online course entitled Life Cycle of a Pandemic was developed using a modified guided inquiry approach. Students met daily for 2 weeks in groups of 15 to 18 with a process facilitator. During the first week, students reported on lessons learned from past pandemics; in the second week, students discussed ethical concerns surrounding COVID-19 clinical trials, heard from physicians who provided patient care in the HIV and COVID-19 pandemics, and concluded with an opportunity for reflection. Following the course, students were asked to complete an anonymous, voluntary survey to assess their perceptions of the course. Results: With a response rate of 69%, an overwhelming majority of students agreed or strongly agreed that learning about historical pandemics helped them understand COVID-19 (72, 99%). The course successfully helped students understand current and potential COVID-19 management strategies as 66 (90%) agreed or strongly agreed they developed a better understanding of nonpharmacological interventions and new pharmacological treatments. Students also gained insight into the experiences of healthcare providers who cared for patients with HIV and COVID-19. Qualitative analysis of the open-ended comments yielded 5 main themes: critical appraisal of resources, responsibility of the physician, humanism, knowledge related to pandemics, and learning from history. Conclusions: The onset of the COVID-19 crisis illustrated curricular gaps that could be remedied by introducing the history and biology of pandemics earlier in the curriculum. It was also apparent that learners need more practice in critically reviewing literature and comparing scientific literature with lay press. The flexible format of the course promotes the development of future iterations that could cover evolving topics related to COVID-19. The course could also be repurposed for a graduate or continuing medical education audience.
A nomogram to predict unfavourable outcome in patients receiving oral anticoagulants for atrial fibrillation after stroke
Authors: Cappellari Manuel , Seiffge David J , Koga Masatoshi , Paciaroni Maurizio , Forlivesi Stefano , Turcato Gianni , Bovi Paolo , Yoshimura Sohei , Tanaka Kanta , Shiozawa Masayuki , Yoshimoto Takeshi , Miwa Kaori , Takagi Masahito , Inoue Manabu , Yamagami Hiroshi , Caso Valeria , Tsivgoulis Georgios , Venti Michele , Acciarresi Monica , Alberti Andrea , Toni Danilo , Polymeris Alexandros , Bonetti Bruno , Agnelli Giancarlo , Toyoda Kazunori , Engelter Stefan T , De Marchis GM ,   on behalf of the SAMURAI-NVAF, RAF-NOAC, NOACISP LONG-TERM, and Verona Study Groups
Published: November 2020

Introduction It is unknown whether the type of treatment (direct oral anticoagulant versus vitamin K antagonist) and the time of treatment introduction (early versus late) may affect the functional outcome in stroke patients with atrial fibrillation. We aimed to develop and validate a nomogram model including direct oral anticoagulant/vitamin K antagonist and early/late oral anticoagulant introduction for predicting the probability of unfavourable outcome after stroke in atrial fibrillation-patients. Patients and Methods We conducted an individual patient data analysis of four prospective studies. Unfavourable functional outcome was defined as three-month modified Rankin Scale score 3 -6. To generate the nomogram, five independent predictors including age (<65 years, reference; 65--79; or 80), National Institutes of Health Stroke Scale score (0--5 points, reference; 6--15; 16--25; or >25), acute revascularisation treatments (yes, reference, or no), direct oral anticoagulant (reference) or vitamin K antagonist, and early (7 days, reference) or late (8--30) anticoagulant introduction entered into a final logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve. Results A total of 2102 patients with complete data for generating the nomogram was randomly dichotomised into training ( n = 1553) and test ( n = 549) sets. The area under the receiver operating characteristic curve was 0.822 (95% confidence interval, CI: 0.800--0.844) in the training set and 0.803 (95% CI: 0.764--0.842) in the test set. The model was adequately calibrated (9.852; p = 0.276 for the Hosmer--Lemeshow test). Discussion and Conclusion Our nomogram is the first model including type of oral anticoagulant and time of treatment introduction to predict the probability of three-month unfavourable outcome in a large multicentre cohort of stroke patients with atrial fibrillation.
Stress Generated in Customized Versus Non-Customized Rigid Fixation Plates in a Simulation of Mandibular Advancement
Authors: Pinto Leonardo Augustus Peral Ferreira , Ramos Viviane Ferreira , Basting Roberta Tarkany 
Published: November 2020

Study design: A finite element method used to virtually analyze the distribution of stresses in human mandible. Objective: The aim of this study was to evaluate the distribution of stresses in 1 customized and 2 non-customized plates used in simulated procedures of mandibular advancement and rigid fixation after bilateral sagittal split osteotomy of the mandibular ramus. Methods: The model used was obtained from a tomograph of an 18-year-old patient, and the simulation involved advancing the mandibular body by 4.75 mm. The plates used were Osteomed, double-row medium; Stryker, standard straight; and Traumec, custom-machined double straight. Virtual models of the mandible and the installed plates were generated and submitted to finite element analysis. Two 100-N loads, 1 anterior and 1 posterior, were applied perpendicular to the occlusal plane. Results: In the Osteomed and Traumec plate models, the stress peaks occurred near the separation zone of the mandible, adjacent to the connections. In the Stryker plate model, the stress peak occurred in the region between the screws. Conclusions: The Stryker plate was associated with the lowest risk of compromising bone repair, followed by the Traumec and Osteomed plates. Stress concentration was related to plate length and to the existence of a connection between the upper and lower portions of the fixation used.
Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis
Authors: Cicchinelli Luke D. , Štalc Jurij , Richter Martinus , Miller Stuart 
Published: November 2020

Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.
A ten-year report of microbial keratitis in pediatric population under five years in a tertiary eye center
Authors: Soleimani Mohammad , Tabatabaei Seyed Ali , Mohammadi S. Saeed , Valipour Niloufar , Mirzaei Arash 
Published: November 2020

AbstractPurposeTo report characteristics of microbial keratitis in pediatric patients under five years.MethodsPatients with infectious keratitis under the age of 5 years were included in this retrospective cross-sectional study for ten years. All patients were admitted and corneal scraping was performed in 81 children. Fortified empiric antibiotic eye drops including cefazolin (50 mg/cc) and amikacin (20 mg/cc) were started and the antibiotic regimen was continued or changed according to culture results. In the case of fungal keratitis, topical voriconazole (10 mg/cc) or natamycin (50 mg/cc) and topical chloramphenicol (5 mg/cc) were started. A tectonic procedure was done when corneal thinning or perforation was present.ResultsNinety-Three Patients between 1 to 60 months with a mean age of 33 ± 18 months old with corneal ulcer were included in the study. The most common risk factor was trauma (40.9%) followed by contact lens use (8.6%). Cultures were negative for microbial growth in 28 (30.1%) patients. The most common pathogens wereS. epidermidis(10.8%) andP. aeruginosa(10.8%). Fluoroquinolone antibiotics (ciprofloxacin; 93.8% sensitivity) were the most potent antibiotic against bacterial pathogens. Forty-one patients underwent tectonic procedures, which the most common ones were cyanoacrylate glue 18.3% followed by keratoplasty 16.1%.ConclusionThis study emphasizes the role of trauma as the primary cause andS. epidermidisas the most frequent microorganism in pediatric keratitis; according to antibiogram results and poor cooperation of patients under five years, monotherapy with fluoroquinolones could be a good regimen in small non-central lesions without thinning.
HOme-based Longitudinal Investigation of the multidiSciplinary Team Integrated Care (HOLISTIC): protocol of a prospective nationwide cohort study
Authors: Liao Jung-Yu , Chen Ping-Jen , Wu Yu-Lin , Cheng Ching-Hsia , Yu Sang-Ju , Huang Chi-Hsien , Li Chia-Ming , Wang Ying-Wei , Zhang Kai-Ping , Liu I-Te , Umegaki Hiroyuki , Hamano Jun , Mori Masanori , Petersen Irene , Sampson Elizabeth L. , Hsiung Chao A. 
Published: November 2020

Abstract
Background
The use of home health care (HHC) is increasing worldwide. This may have an impact not only on patients and their caregivers’ health but on care resource utilization and costs. We lack information on the impact of HHC on the broader dimensions of health status and care resource utilization. More understanding of the longitudinal HHC impact on HHC patients and caregivers is also needed. Moreover, we know little about the synergy between HHC and social care. Therefore, the present study aims to observe longitudinal changes in health, care resource utilization and costs and caregiving burden among HHC recipients and their caregivers in Taiwan.

Methods
A prospective cohort study “Home-based Longitudinal Investigation of the Multidisciplinary Team Integrated Care (HOLISTIC)” will be conducted and 600 eligible patient-caregiver dyads will be recruited and followed with comprehensive quantitative assessments during six home investigations over two years. The measurements include physical function, psychological health, cognitive function, wellbeing, shared decision making and advance care planning, palliative care and quality of dying, caregiving burden, continuity and coordination of care, care resource utilization, and costs.

Discussion
The HOLISTIC study offers the opportunity to comprehensively understand longitudinal changes in health conditions, care resource utilization and costs and caregiving burden among HHC patients and caregivers. It will provide new insights for clinical practitioners and policymakers.

Trial registration
ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.