bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Teachers’ Perceptions of Their Role in Professional Identity Formation
Authors: Sternszus Robert , Boudreau J. Donald , Cruess Richard L. , Cruess Sylvia R. , Macdonald Mary Ellen , Steinert Yvonne 
Published: April 2020

Purpose
A fundamental goal of medical education is supporting learners in forming a professional identity. While it is known that learners perceive clinical teachers to be critically important in this process, the latter’s perspective is unknown. This study sought to understand how clinical teachers perceive their influence on the professional identity formation of learners.

Method
In 2017, a research assistant conducted 16 semistructured interviews of clinical teachers from 8 specialties at McGill University. The research assistant audiorecorded and subsequently transcribed interviews for analysis. Following principles of qualitative description, the research team developed a coding scheme using both inductive codes (from the words of the participants) and deductive codes (based on the literature and the theory of communities of practice). Through a cross-case analysis, the team then identified salient themes.

Results
Participants struggled to describe their influence on learners’ professional identity without first being prompted to focus on their own identity and its formation. Once prompted, clinical teachers reported viewing their personal and professional identities as integrated and believed that caring for patients was integral to forming their professional identity. They identified explicit role modeling, engaging in difficult conversations, and providing graded autonomy as ways in which they could influence the identity development of learners. However, they had difficulty discerning the magnitude of their influence.

Conclusions
This study was the first to explore professional identity formation from the perspective of clinical teachers. The 2010 Carnegie Foundation report called for an increased focus on professional identity formation. Giving clinical teachers the space and guidance to reflect on this process, helping them make the implicit explicit, and supporting them in using their own experiences as learners to inform their teaching appear to be critical steps in achieving this goal.
Pressure Pain Tolerance Predicts the Success of Emotional Awareness and Expression Therapy in Patients With Fibromyalgia
Authors: Bellomo Tiffany R. , Schrepf Andrew , Kruger Grant H. , Lumley Mark A. , Schubiner Howard , Clauw Daniel J. , Williams David A. , Harte Steven E. 
Published: April 2020

Objectives:
Quantitative sensory testing may help predict treatment responses in individuals with chronic pain. Our objective was to determine whether evoked pain sensitivity at baseline predicted preferential treatment responses to either emotional awareness and expression therapy (EAET) or cognitive behavioral therapy (CBT) in individuals with fibromyalgia (FM).

Methods:
This was a secondary analysis of a previous randomized clinical trial, in which individuals with FM were randomized to EAET, CBT, or Education as a control intervention. Only females who completed baseline and post-treatment assessments were analyzed (n=196). The primary outcome was change in overall clinical pain severity from pretreatment to posttreatment, and the primary predictor of interest was pressure pain tolerance at baseline.

Results:
Among patients with low pain tolerance at baseline (n=154), both EAET and CBT led to small but significant improvements in clinical pain severity (CBT mean=0.66, 95% confidence interval [0.24-1.07]; EAET mean=0.76 [0.34-1.17]). Conversely, in patients with normal pain tolerance (n=42), there was no significant improvement in clinical pain after CBT (0.13 [−0.88 to 1.14]), a small improvement after FM Education (0.81 [0.14-1.48]), but a much larger and statistically significant improvement after EAET (2.14 [1.23-3.04]).

Discussion:
Normal levels of pressure pain tolerance at baseline predicted greater improvement in clinical pain severity after EAET than CBT. Quantitative sensory testing may provide insights about individual responses to psychologically based therapies for individuals with chronic pain.
Comparison of Adductor Canal Block and Femoral Triangle Block for Total Knee Arthroplasty
Authors: Wang Chun-Guang , Ding Yan-Ling , Wang Yuan-Yuan , Liu Jia-Yun , Zhang Qian 
Published: April 2020

Objectives:
Adductor canal block (ACB) could provide effective postoperative pain control for patients after total knee arthroplasty (TKA). However, some authors pointed out that the ACB as originally described may be more similar to a femoral triangle block (FTB). Recent neuroanatomic evidences made the authors conjecture that the “true” ACB would provide superior analgesia compared with FTB. Therefore, the study was designed to determine the hypothesis that postoperative analgesia after TKA could be improved by a “true” ACB compared with FTB.

Materials and Methods:
Patients undergoing unilateral, primary TKA were randomized into the ACB group or FTB group. The primary outcome was postoperative pain during active flexion at 8 hours after surgery measured by the visual analog scale (VAS). In addition, pain scores at other time points, quadriceps strength, morphine consumption, satisfaction of the patient, and side effects of morphine were also evaluated.

Results:
Sixty participants completed the research. The VAS scores were lower in the ACB group than the FTB group at 8 and 24 hours at rest (P<0.05). The VAS scores were lower in the ACB group than the FTB group at 4, 8, 24, and 48 hours during active flexion (P<0.05). The quadriceps strength was superior in the ACB group than the FTB group at 4, 8, and 24 hours (P<0.05). The consumption of morphine was lower in the ACB group than the FTB group (P<0.05). However, there were no significant differences for both patient satisfaction and the incidence of adverse reactions (P>0.05).

Discussion:
ACB can provide superior analgesia and preserve more quadriceps strength than FTB. ACB facilitates functional recovery in the early stages and is compatible with the highly recognized concept of rapid rehabilitation, which should be promoted in the clinic.
Displaced Distal Radius Fracture Treatment: A Survey of POSNA Membership
Authors: Georgiadis Andrew G. , Burgess Jamie K. , Truong Walter H. , Janicki Joseph A. 
Published: April 2020

Background:
Distal radius fractures (DRFs) are the most common pediatric orthopaedic fracture, of which 20% are displaced injuries. Displaced metaphyseal DRFs are often treated with sedated or anesthetized reduction. The necessity of reduction treatment of displaced fractures to achieve good clinical outcomes is unclear. The purpose of this investigation was to determine the treatment preferences for DRFs among pediatric orthopaedic surgeons and to determine whether they were uncertain enough in their decisions to randomize treatment.

Methods:
Twenty-eight DRF scenarios in children aged 3 to 10 years were constructed in an electronic survey to represent a spectrum of age, angulation in sagittal and coronal planes, and displacement. The survey was disseminated to the full membership of the Pediatric Orthopaedic Society of North America (POSNA). Respondents could select either a treatment of (a) attempt anatomic reduction with sedation or (b) nonsedated immobilization. Respondents also denoted whether they would be willing to randomize the treatment of each injury scenario. Patient, fracture, and surgeon characteristics were analyzed to develop predictors of treatment recommendations and willingness to randomize treatment.

Results:
A total of 319 surgeons responded (23% of POSNA membership). Respondents were a characteristic representation of POSNA membership (well distributed by years in practice, 78% academic, 91% whose work is >80% pediatrics, and 84% work with residents). Predictors of sedated reduction were complete displacement [odds ratio (OR), 9.23; 95% confidence interval (CI), 2.27-37.51; P=0.002] and coronal angulation (per 1-degree increase, OR, 1.09; 95% CI, 1.02-1.17; P=0.016), Willingness to randomize was inversely related to larger coronal plane angulation (per 1-degree increase, OR, 0.96; 95% CI, 0.93-0.99; P=0.01). A majority of surgeons were willing to randomize 7 of the 8 scenarios involving complete displacement and shortening, and >64% of surgeons were willing to randomize 5 of these 8 scenarios.

Conclusions:
POSNA members recommend sedated reduction of DRFs primarily based on existence of complete displacement. Although most completely displaced DRFs would undergo reduction, most surgeons would be willing to randomize the treatment of these injuries. This suggests that most POSNA members do not know whether their recommended treatment for displaced DRFs is necessary or correct. This survey establishes the groundwork for a randomized, prospective trial comparing nonsedated immobilization with sedated/anesthetized reduction in the treatment of displaced pediatric DRFs.

Levels of Evidence:
Level II—survey study.
The Association Between Neighborhood Socioeconomic Disadvantage and Readmissions for Patients Hospitalized With Sepsis
Authors: Galiatsatos Panagis , Follin Amber , Alghanim Fahid , Sherry Melissa , Sylvester Carol , Daniel Yamisi , Chanmugam Arjun , Townsend Jennifer , Saria Suchi , Kind Amy J. , Chen Edward 
Published: April 2020

Objectives:
To evaluate associations between a readily availvable composite measurement of neighborhood socioeconomic disadvantage (the area deprivation index) and 30-day readmissions for patients who were previously hospitalized with sepsis.

Design:
A retrospective study.

Setting:
An urban, academic medical institution.

Patients:
The authors conducted a manual audit for adult patients (18 yr old or older) discharged with an International Classification of Diseases, 10th edition code of sepsis during the 2017 fiscal year to confirm that they met SEP-3 criteria.

Interventions:
None.

Measurements and Main Results:
The area deprivation index is a publicly available composite score constructed from socioeconomic components (e.g., income, poverty, education, housing characteristics) based on census block level, where higher scores are associated with more disadvantaged areas (range, 1–100). Using discharge data from the hospital population health database, residential addresses were geocoded and linked to their respective area deprivation index. Patient characteristics, contextual-level variables, and readmissions were compared by t tests for continuous variables and Fisher exact test for categorical variables. The associations between readmissions and area deprivation index were explored using logistic regression models. A total of 647 patients had an International Classification of Diseases, 10th edition diagnosis code of sepsis. Of these 647, 116 (17.9%) either died in hospital or were discharged to hospice and were excluded from our analysis. Of the remaining 531 patients, the mean age was 61.0 years (± 17.6 yr), 281 were females (52.9%), and 164 (30.9%) were active smokers. The mean length of stay was 6.9 days (± 5.6 d) with the mean Sequential Organ Failure Assessment score 4.9 (± 2.5). The mean area deprivation index was 54.2 (± 23.8). The mean area deprivation index of patients who were readmitted was 62.5 (± 27.4), which was significantly larger than the area deprivation index of patients not readmitted (51.8 [± 22.2]) (p < 0.001). In adjusted logistic regression models, a greater area deprivation index was significantly associated with readmissions (β, 0.03; p < 0.001).

Conclusions:
Patients who reside in more disadvantaged neighborhoods have a significantly higher risk for 30-day readmission following a hospitalization for sepsis. The insight provided by neighborhood disadvantage scores, such as the area deprivation index, may help to better understand how contextual-level socioeconomic status affects the burden of sepsis-related morbidity.
Three Types of Nodal Melanocytic Nevi in Sentinel Lymph Nodes of Patients With Melanoma: Pitfalls, Immunohistochemistry, and a Review of the Literature
Authors: Gonzàlez-Farré Mònica , Ronen Shira , Keiser Elizabeth , Prieto Victor G. , Aung Phyu P. 
Published: April 2020

Abstract:
The presence or absence of metastasis in sentinel lymph nodes often drives melanoma staging, prognosis, and treatment. However, distinguishing between metastatic melanoma cells and clusters of benign melanocytic nevus cells is not always straightforward. When morphologic hematoxylin and eosin interpretation alone is not sufficient, additional hematoxylin and eosin sections and immunohistochemical (IHC) studies may be beneficial. This review and small cases series of 3 diagnostically challenging melanocytic sentinel lymph node cases highlights the IHC approach to evaluate intraparenchymal nodal melanocytic nevi, coexistent metastatic melanoma with adjacent melanocytic nevi cells, and nodal blue nevi. In challenging cases, cytological morphology of the melanocytes, location within the lymph node, and IHC studies may assist in diagnosis. If these tools yield conflicting results, expert opinion is recommended.
Longstanding Eccrine Syringofibroadenoma With Evidence of Carcinomatous Transformation
Authors: Pagliuca Francesca , Moscarella Elvira , Argenziano Giuseppe , Ronchi Andrea , Franco Renato 
Published: April 2020

Abstract:
Eccrine syringofibroadenoma (ESFA) is a cutaneous proliferation of eccrine ducts, mainly encountered in association with other dermatoses or skin tumors. Although a benign condition, either considered as a hamartoma or a reactive hyperplasia rather than a real neoplasm, some evidence suggests that longstanding ESFA can undergo malignant change. The recognition of such opportunity could have important therapeutic implications. We present a case of ESFA showing areas of carcinomatous transformation, discussing its morphological and immunohistochemical findings.
Recurrence and Mortality of Melanoma In Situ of the Trunk or Extremities: A Surveillance, Epidemiology, and End Results Analysis
Authors: Daniel Vijaya T. , Crawford Allison , Kiefe Catarina I. , Mahmoud Bassel H. 
Published: April 2020

BACKGROUND
Recent studies demonstrate comparable outcomes of Mohs micrographic surgery (MMS) versus local excision (LE) for melanoma in situ. These studies are limited by their focus on the head and neck.

OBJECTIVE
The primary objective was to compare 5-year overall and melanoma-specific mortality among patients with melanoma in situ of the trunk or extremities who undergo MMS versus LE. The secondary objective was to compare 5-year local recurrence among the same cohort of patients who undergo MMS versus LE.

MATERIALS AND METHODS
The Surveillance, Epidemiology, and End Results (SEER) database (2000–2015) was queried to identify patients who underwent MMS versus LE for melanoma in situ of the trunk, upper extremities, or lower extremities. Outcomes were 5-year recurrence, melanoma-specific mortality, and overall mortality. Multivariable regression analyses were performed.

RESULTS
Thirty three thousand nine hundred eighty-three patients underwent surgical treatment (MMS 3%; LE 97%). In adjusted analyses, there was no difference in local recurrence (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.56–1.78), melanoma-specific mortality (HR 0.89, 95% CI 0.12–6.47), nor overall mortality (HR 1.10, 95% CI 0.82–1.48) between MMS versus LE.

CONCLUSION
There is no difference of 5-year local recurrence, melanoma-specific mortality, nor overall mortality associated with MMS versus LE for melanoma in situ of the trunk or extremities.
Health care professionals’ motivation, their behaviors, and the quality of hospital care: A mixed-methods systematic review
Authors: Veenstra Gepke L. , Dabekaussen Kirsten F. A. A. , Molleman Eric , Heineman Erik , Welker Gera A. 
Published: April 2020

Background
Health care professionals’ work motivation is assumed to be crucial for the quality of hospital care, but it is unclear which type of motivation ought to be stimulated to improve quality. Motivation and similar concepts are aligned along a motivational continuum that ranges from (intrinsic) autonomous motivation to (extrinsic) controlled motivation to provide a framework for this mixed-methods systematic review.

Purpose
This mixed-methods systematic review aims to link various types of health care professionals’ motivation directly and through their work-related behaviors to quality of care.

Methods
Six databases were searched from January 1990 to August 2016. Qualitative and quantitative studies were included if they reported on work motivation in relationship to work behavior and/or quality, and study participants were health care professionals working in hospitals in high-income countries. Study bias was evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. The review protocol was registered in the PROSPERO database (CRD42016043284).

Results
A total of 84 out of 6,525 unique records met the inclusion criteria. Results show that health care professionals’ autonomous motivation improves their quality perceptions and work-related behaviors. Controlled motivation inhibits voicing behavior, but when balanced with autonomous motivation, it stimulates core task and proactive behavior. Proactivity is associated with increased quality of care perceptions.

Practice Implications
To improve quality of care, policy makers and managers need to support health care professionals’ autonomous motivation and recognize and facilitate proactivity as an essential part of health care professionals’ jobs. Incentive-based quality improvements need to be complemented with aspects that stimulate autonomous motivation.
ADAPTIVE OPTICS OPTICAL COHERENCE TOMOGRAPHY IN A CASE OF ACUTE ZONAL OCCULT OUTER RETINOPATHY
Authors: Xu Qinyuan (Alis) , Athwal Arman , Heisler Morgan , Ju Myeong Jin , Vanzan Vinicius , Ferrara Daniela , Sarunic Marinko , Navajas Eduardo V. 
Published: April 2020

Purpose:
To report a case of acute zonal occult outer retinopathy in which adaptive optics (AO) facilitated visualization of abnormal photoreceptors previously thought to be in an area of normal retina on conventional optical coherence tomography (OCT).

Methods:
Case report.

Results:
A 51-year-old woman presents with 11-month history of photopsias and scotoma in the temporal visual field of her left eye. Ocular imaging including fluorescein angiography, fundus autofluorescence and OCT suggested the diagnosis of acute zonal occult outer retinopathy in the left eye. Adaptive optics optical coherence tomography (AO-OCT) revealed photoreceptor abnormalities not previously identified in conventional OCT, in areas apparently normal on multimodal imaging. On enface and cross-sectional AO-OCT, round and evenly spaced hyperreflectivity corresponding to normal cone mosaic (Pattern 1) was adjacent to unevenly and disrupted cone hyperreflectivity (Pattern 2) and areas with hyporeflectivity or no cone reflectivity (Pattern 3). Cross-sectional AO-OCT of Patterns 2 and 3 also revealed attenuation of ellipsoid zone with loss of interdigitation zone.

Conclusion:
Adaptive optics OCT documented cone photoreceptors in finer details than conventional OCT and revealed early changes in a patient with acute zonal occult outer retinopathy, in an area of the retina thought to be normal on conventional multimodal imaging. These findings may provide important insight into pathogenesis and progression of the disease.
Pupil expansion device use and operative outcomes with topical dilation vs intracameral epinephrine in resident-performed cataract surgery
Authors: Wilson Caroline W. , Hock Lauren E. , Oetting Thomas , Kennedy Sean , Terveen Daniel 
Published: April 2020

Purpose:
To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times.

Setting:
Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA.

Design:
Retrospective chart review.

Methods:
Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use.

Results:
In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P < .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P < .0001). Surgical times were on average 7.1 minutes slower with PED use than without PED use. There was a medication savings of $50.44 USD per case in the intracameral group compared with the topical group. Factoring in the $100 to $130 USD per PED used, total surgical costs were $19 267 USD less in the intracameral group over 6 months.

Conclusions:
Intracameral epinephrine with lidocaine decreases the need for PED use during cataract surgery, lowers intraoperative costs, and improves efficiency compared with topical dilation drops alone.
Subjective Loudness Using External Noise Reflects the Loudness and Distress of Tinnitus: A Cross-Sectional Study
Authors: Yamamoto Yuta , Tamagawa Shunji , Tanioka Kensuke , Suzuki Takuya , Hotomi Muneki , Ukai Satoshi , Ueyama Takashi 
Published: April 2020

Objectives:
Subjective tinnitus loudness has been measured using loudness matches, which compare tinnitus loudness with pure tones from an audiometer. When patients compare the sound pressure of certain noises with the tinnitus loudness, however, there may be remarkable differences from the measurements according to loudness matches. Subjective loudness (SubL) is an estimation of the sound pressure of tinnitus loudness by comparison of noises considered to be most similar to tinnitus loudness of patient. We examine whether SubL is inferior to loudness matches in measurement of subjective tinnitus loudness.

Design:
Single-group cross-sectional study.

Patients:
Included in this study were a clinical group of 111 patients with the chief complaint of subjective tinnitus. Seven of the 111 patients were excluded due to missing audiometry or questionnaire data.

Methods:
Patients assessed the tinnitus loudness and related distress using visual analogue scales (VAS-L and VAS-S) and answered the Tinnitus Handicap Inventory (THI). Hearing acuity, tinnitus pitch, and loudness were then measured using an audiometer.

Results:
VAS-L, VAS-S, and THI scores significantly correlated with loudness match using Goodwin's method (SL2) and SubL. Subgroup analysis based on patient ages indicated that all correlations of SL2 with VAS-L, VAS-S, and THI scores were no longer seen in patients more than 60 years of age. Meanwhile, SubL correlated with VAS-L, VAS-S, and THI scores in all subgroups.

Conclusions:
SubL was a good reflection of self-reported loudness and distress of tinnitus. It may therefore be a simple and easy means of assessing tinnitus loudness and associated distress during pre-examination without an audiometer.