bluuebunny/crossref_metadata_2025_split huggingface dataset:
Canadian medical schools’ preclerkship paediatric clinical skills curricula: How can we improve?
Authors: Hudson Alexandra , Mclaughlin Robyn , Miller Stephen , Holland Joanna , Blake Kim 
Published: December 2020

Abstract

Background
Little is known about how Canadian medical schools teach paediatric clinical skills (history and physical exam) to preclerkship students, or its cost to the institutions.

Methods
Clinical skills program directors from all 17 Canadian medical schools were contacted to complete a questionnaire focused on teaching methods, and barriers/strengths of their Preclerkship Paediatric Clinical Skills program.

Results
Seventeen schools (100% response rate) participated. Seven schools (41%) do not introduce paediatric clinical skills until the second year of medicine. Half of the schools (53%) dedicate &lt;10 total hours to preclerkship paediatric clinical skills. Fifty-nine per cent have ≤6 total hours of hands-on paediatric patient interaction (real or simulated). Medical students were least likely to be exposed to the infant age group (age 1 to 24 months). Twelve schools (71%) used simulated parent/child dyads. The most significant barriers identified by programs were limited time for sessions and patient availability. We describe one sample medical school’s simulated parent/paediatric patient program where every student has hands-on learning with paediatric patients of all ages (program cost $938/student).

Discussion
This study is the first to summarize Canadian preclerkship paediatric clinical skills programs, among which there is great variability and commonly experienced barriers. Many students are not being exposed to all age groups of paediatric patients before their clerkship years. Medical schools can use this information to strengthen this important and challenging aspect of the curriculum, while being mindful of its fiscal implications.
Neurobiobehavioral responses to virtual social rejection in females—exploring the influence of oxytocin
Authors: Radke Sina , Jankowiak Kathrin , Tops Sanne , Abel Ted , Habel Ute , Derntl Birgit 
Published: December 2020

AbstractIn recent years, especially adolescents and young adults interact frequently via social media and digital communication. Mimicking an online communication platform where participants could initiate short conversations with two computerized interlocutors, the Verbal Interaction Social Threat Task (VISTTA) was used to induce feelings of social rejection. Motivational and physiological reactions were investigated in 43 healthy young women undergoing functional magnetic resonance imaging (fMRI), of which 22 received 24 international units (IU) intranasal oxytocin and 21 received placebo. Replicating previous findings, social rejection entailed a lower willingness to cooperate with the two peers. Increased activation in the anterior cingulate cortex and bilateral insula/inferior frontal gyrus was observed when receiving negative feedback from others, and in the precuneus when subsequently rating one’s willingness to cooperate with them in the future. Oxytocin did not seem to alter responses to social rejection. The current findings provide validation of the VISTTA for examining consequences of rejection in a virtual social interaction that bears a strong resemblance to online communication platforms.
The Impact of Physical Therapy Following Cervical Spine Surgery for Degenerative Spine Disorders
Authors: Lantz Justin M. , Abedi Aidin , Tran Frances , Cahill Rafael , Kulig Kornelia , Michener Lori A. , Hah Raymond J. , Wang Jeffrey C. , Buser Zorica 
Published: December 2020

Study Design:
Systematic review.

Objective:
To characterize the effects of postoperative physical therapy (PT) after surgery for cervical spondylosis on patient-reported outcomes and impairments. Secondarily, to identify associated complications, adverse effects, and health care costs with postoperative PT, and to describe the content, timing, and duration of the PT.

Summary of Background Data:
Cervical spine surgery is common; however, it is unclear if the addition of postoperative PT leads to improved patient outcomes and decreased health care costs.

Materials and Methods:
PubMed, Embase, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Web of Science were searched until July 2019. All peer-reviewed articles involving cervical spine surgery with postoperative PT for cervical spondylosis were considered for inclusion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. Findings were described narratively, and GRADE approach was used to define the quality of evidence.

Results:
A total of 10,743 studies were screened. Six studies met inclusion criteria; 2 randomized controlled trials and 4 subsequent follow-up studies containing study arms that included postoperative PT after cervical spine surgery. Meta-analysis was not performed due to study heterogeneity and no study compared PT+surgery to surgery alone. PT treatment included exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation. Included studies indicated PT appeared to have positive effects on patient outcomes, however, there were no treatment control groups and the quality of evidence was very low to low. Timing, duration, and content of PT programs varied. No studies reported complications, adverse effects, or cost-effectiveness relating to PT after surgery.

Conclusions:
Current literature prevents a definitive conclusion regarding the impact of postoperative PT, given the lack of treatment control groups. PT treatment was limited to exercise therapy, cognitive behavioral therapy, and optional vestibular rehabilitation in the included studies. PT treatment varied, limiting consistent recommendations for content, timing, and treatment duration. Controlled trials are needed to determine the effectiveness of the addition of postoperative PT following cervical spine surgery for cervical spondylosis.

Level of Evidence:
Level II.
Comparison of Posterior Unilateral Vertebral Column Resection Versus Posterior Vertebral Column Resection for Severe Thoracolumbar Angular Kyphosis as a Revision Surgical Modality
Authors: Xue Rui , Liu Dai , Shen Yong 
Published: December 2020

Objective:
The objective of this study was to determine the safety and efficacy of posterior unilateral vertebral column resection (PUVCR) as revision surgery for severe thoracolumbar angular kyphosis.

Patients and Methods:
This is a retrospective cohort study. Adult patients undergoing revision surgery for severe thoracolumbar angular kyphosis in 2010–2016 with ≥2-year follow-up at our institution were assessed. Perioperative complications and clinical outcomes, including blood loss, operation time, Visual Analog Scale score, Oswestry Disability Index, and preoperative and postoperative kyphotic angles, were analyzed.

Results:
This study included 58 patients who were divided into the PUVCR group and the posterior vertebral column resection (PVCR) group. Age (P=0.810), sex distribution (P=0.500), and vertebrae that underwent surgery (P=0.638) were similar in the 2 groups. Shorter mean operation time was observed in the PUVCR group as compared with the PVCR group (P<0.001). In addition, less blood loss was recorded in the PUVCR group as compared with the PVCR group (P=0.001). There were no significant differences between the 2 groups in a change of Visual Analog Scale scores postoperation versus preoperation (P=0.961), and at postoperative 3 months (P=0.906), 12 months (P=0.752), and 24 months (P=0.811) versus postoperation, respectively. There were no significant differences between the 2 groups in Oswestry Disability Index changes postoperation versus preoperation (P=0.157), and at postoperative 3 months (P=0.899), 12 months (P=0.947), and 24 months (P=0.811) versus postoperation, respectively. PUVCR and PVCR were comparable in deformity correction (P=0.434) and final angle correction (P=0.790). Complication rates in the PUVCR and PVCR groups were 7.1% and 36.7%, respectively.

Conclusion:
PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis, with the advantages of the shorter operation time, less blood loss, and fewer complications.
A Quality Improvement Evaluation of a Primary As-Needed Light Sedation Protocol in Mechanically Ventilated Adults
Authors: Groetzinger Lara M. , Rivosecchi Ryan M. , McVerry Bryan J. , Smithburger Pamela L. , Lamberty Phillip E. , Donahoe Michael P. , Barbash Ian J. 
Published: December 2020

Objectives:
First, to implement successfully a light-sedation protocol, favoring initial as-needed (prioritizing as-needed) boluses over continuous infusion sedation, and second, to evaluate if this protocol was associated with differences in patient-level sedative requirements, clinical outcomes, and unit-level longitudinal changes in pharmacy charges for sedative medications.

Design:
Retrospective review comparing patients who received the prioritizing as-needed sedation protocol to similar patients eligible for the prioritizing as-needed protocol but treated initially with continuous infusion sedation.

Setting:
Thirty-two bed medical ICUs in a large academic medical center.

Patients:
A total of 254 mechanical ventilated patients with a target Riker Sedation-Agitation Scale goal of 3 or 4 were evaluated over a 2-year period. Of the evaluable patients, 114 received the prioritizing as-needed sedation protocol and 140 received a primary continuous infusion approach.

Interventions:
A multidisciplinary leadership team created and implemented a light-sedation protocol, focusing on avoiding initiation of continuous sedative infusions and prioritizing prioritizing as-needed sedation.

Measurements and Main Results: :
Overall, 42% of patients in the prioritizing as-needed group never received continuous infusion sedation. Compared with the continuous infusion sedation group, patients treated with the prioritizing as-needed protocol received significantly less opioid, propofol, and benzodiazepine. Patients in the prioritizing as-needed group experienced less delirium, shorter duration of mechanical ventilation, and shorter ICU length of stay. Adverse events were similar between the two groups. At the unit level, protocol implementation was associated with reductions in the use of continuous infusion sedative medications.

Conclusions:
Implementation and use of a prioritizing as-needed protocol targeting light sedation appear to be safe and effective. These single-ICU retrospective findings require wider, prospective validation.
Arrhythmia Mechanisms in Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes
Authors: Paci Michelangelo , Penttinen Kirsi , Pekkanen-Mattila Mari , Koivumäki Jussi T. 
Published: December 2020

Abstract:
Despite major efforts by clinicians and researchers, cardiac arrhythmia remains a leading cause of morbidity and mortality in the world. Experimental work has relied on combining high-throughput strategies with standard molecular and electrophysiological studies, which are, to a great extent, based on the use of animal models. Because this poses major challenges for translation, the progress in the development of novel antiarrhythmic agents and clinical care has been mostly disappointing. Recently, the advent of human induced pluripotent stem cell–derived cardiomyocytes has opened new avenues for both basic cardiac research and drug discovery; now, there is an unlimited source of cardiomyocytes of human origin, both from healthy individuals and patients with cardiac diseases. Understanding arrhythmic mechanisms is one of the main use cases of human induced pluripotent stem cell–derived cardiomyocytes, in addition to pharmacological cardiotoxicity and efficacy testing, in vitro disease modeling, developing patient-specific models and personalized drugs, and regenerative medicine. Here, we review the advances that the human induced pluripotent stem cell–derived-based modeling systems have brought so far regarding the understanding of both arrhythmogenic triggers and substrates, while also briefly speculating about the possibilities in the future.
Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults
Authors: Knechtle Deborah , Schmid Stefan , Suter Magdalena , Riner Fabienne , Moschini Greta , Senteler Marco , Schweinhardt Petra , Meier Michael L. 
Published: December 2020

Abstract
There is a long-held belief that physical activities such as lifting with a flexed spine is generally harmful for the back and can cause low back pain (LBP), potentially reinforcing fear-avoidance beliefs underlying pain-related fear. In patients with chronic LBP, pain-related fear has been shown to be associated with reduced lumbar range of motion during lifting, suggesting a protective response to pain. However, despite short-term beneficial effects for tissue health, recent evidence suggests that maintaining a protective trunk movement strategy may also pose a risk for (persistent) LBP due to possible pronociceptive consequences of altered spinal motion, potentially leading to increased loading on lumbar tissues. Yet, it is unknown if similar protective movement strategies already exist in pain-free individuals, which would yield potential insights into the role of fear-avoidance beliefs in motor behavior in the absence of pain. Therefore, the aim of this study is to test whether fear-avoidance beliefs influence spinal motion during lifting in a healthy cohort of pain-free adults without a history of chronic pain. The study subjects (N = 57) filled out several pain-related fear questionnaires and were asked to perform a lifting task (5kg-box). High-resolution spinal kinematics were assessed using an optical motion capturing system. Time-sensitive analyses were performed based on statistical parametric mapping. The results demonstrated time-specific and negative relationships between self-report measures of pain-related fear and lumbar spine flexion angles during lifting, indicating potential unfavorable interactions between psychological factors and spinal motion during lifting in pain-free subjects.
Remote management of musculoskeletal pain: a pragmatic approach to the implementation of video and phone consultations in musculoskeletal practice
Authors: Hohenschurz-Schmidt David , Scott Whitney , Park Charlie , Christopoulos Georgios , Vogel Steven , Draper-Rodi Jerry 
Published: December 2020

Abstract

Introduction:
Remote consultations through phone or video are gaining in importance for the treatment of musculoskeletal pain across a range of health care providers. However, there is a plethora of technical options for practitioners to choose from, and there are various challenges in the adaptation of clinical processes as well as several special considerations regarding regulatory context and patient management. Practitioners are faced with a lack of high-quality peer-reviewed resources to guide the planning and practical implementation of remote consultations.

Objectives:
This Clinical Update seeks to provide practical guidance for the planning and implementation of remote consultations for the management and treatment of people with musculoskeletal pain.

Methods:
Recommendations are based on a brief overview of the relevant research regarding phone and video consultations for musculoskeletal practice and derived from the literature, relevant guidelines, and practical experience.

Results:
The technical feasibility of remote consultations for musculoskeletal complaints is good, patient satisfaction is high, and a growing body of evidence supports its comparative effectiveness to in-person consultations in some circumstances for improving pain and functioning. We consider in detail practical aspects such as the choosing of hardware and software, we touch on the legal and regulatory context, and we focus on the adaptation of clinical processes and communication.

Conclusion:
This Clinical Update draws together best-practice evidence in a practically applicable format, enabling therapists who are working with people with pain to directly apply this knowledge to their individual clinical settings and the requirements of their patients.
Characteristics of Sexual Partnerships Among Men With Diagnosed HIV Who Have Sex With Men, United States and Puerto Rico—2015–2019
Authors: Dasgupta Sharoda , Tie Yunfeng , Bradley Heather , Beer Linda , Rosenberg Eli S. , Holtgrave David , Fagan Jennifer , Green Shana , Shouse Roy L. 
Published: December 2020

Background:
Understanding sexual partnerships of HIV-positive persons, particularly at the dyad level, can help in quantifying HIV transmission risk. We described sexual partnerships among HIV-positive men who have sex with men (MSM), including partnerships with a high risk for sexual HIV transmission.

Setting:
The Medical Monitoring Project is an annual, cross-sectional study that reports representative estimates on U.S. HIV-positive adults.

Methods:
During 2015–2019, we assessed sexual behaviors by interview, and viral load results from medical records. Among sexually active HIV-positive MSM (n = 4923), we described prevalence of high-risk sex, defined as: (1) not having sustained viral suppression, and (2) having condomless sex with an HIV-negative partner not known to be taking pre-exposure prophylaxis or an HIV-unknown partner. We described sexual partnerships among HIV-positive MSM (n = 13,024 partnerships among 4923 MSM). For HIV-discordant partnerships (n = 7768), we reported the proportion involved in high-risk sex, and associations with high-risk sex using prevalence ratios with predicted marginal means, controlling for age of the HIV-positive partner (P < 0.05).

Results:
More than half (66%) of sexually active HIV-positive MSM had condomless sex; 11% had high-risk sex. Blacks were more likely to have detectable viral loads, but less likely to have condomless sex, making prevalence of high-risk sex comparable between racial/ethnic groups. Dyad-level analyses among HIV-discordant partnerships indicated that prevalence of high-risk sex was higher among partnerships with HIV-positive white MSM, which was not observed using person-level data alone.

Conclusions:
In the context of ending the HIV epidemic, behavioral and clinical surveillance data can help monitor HIV transmission risk and target prevention efforts to reduce transmission among populations at disproportionate risk.
Rituximab for Inflammatory Myopathies in a Colombian Cohort
Authors: Santos Víctor A. , Aragón Cristian C. , Posso-Osorio Iván , Naranjo-Escobar Juan , Milisenda J.C. , Obando María Alejandra , Barrera Tatiana , Zamorano Laura , Hormaza-Jaramillo Andrés 
Published: December 2020

Introduction/Objectives
Rituximab (RTX) is a treatment for refractory inflammatory myopathies, such as dermatomyositis (DM) and polymyositis (PM). This study describes the characteristics of patients receiving RTX for myositis in our institution to evaluate its efficacy.

Method
We collected demographic data from all patients diagnosed with DM or PM who received RTX between 2011 and 2018. Clinical and serological variables (including creatine phosphokinase [CPK] levels) were analyzed. Remission of disease was defined as no evidence of disease activity (active myositis) for longer than a 6-month continuous period while undergoing myositis therapy or no medication.

Results
Eighteen patients who had received first-line immunosuppressants were included. Fifteen (83%) had DM, 2 (11%) had PM, 1 had juvenile dermatomyositis, and 14 (77%) were women. All patients received glucocorticoids. Three patients (16.6%) were treated with RTX as monotherapy, and 15 (83.3%) were treated with RTX combined with other immunosuppressants. On average, there were 2 RTX treatment cycles. Improved muscular weakness was found in 13 cases (72%), and improved serum CPK levels were found in 15 cases (83%). Twelve patients (66%) achieved remission.

Conclusions
Most patients experienced an objective improvement, as reflected in their serum CPK values and degree of muscular weakness. This suggests that RTX could be helpful in treating refractory myositis.
Systolic and Diastolic Cardiac Functions in Juvenile Spondyloarthropathies
Authors: Yildiz Mehmet , Dedeoglu Reyhan , Akdeniz Beste , Adrovic Amra , Haslak Fatih , Karagozlu Fatih , Koker Oya , Ulug Nujin , Sahin Sezgin , Barut Kenan , Oztunc Funda , Kasapcopur Ozgur 
Published: December 2020

Background/Objective
Juvenile spondyloarthropathies (JSpAs) are a group of inflammatory diseases characterized by asymmetric peripheral arthritis (especially in lower extremities), axial skeleton involvement, and enthesitis. Although cardiovascular findings of inflammatory diseases such as juvenile systemic lupus erythematosus (SLE) and juvenile scleroderma (SD) are well documented, there are only a few studies assessing the cardiovascular consequences of JSpA in the literature.

Methods
Forty patients with JSpA and 20 healthy controls were included into this cross-sectional study. Cardiac functions of the participants were evaluated by conventional echocardiography and pulse-wave (PW) tissue Doppler.

Results
The patients with JSpA had higher mitral lateral S (p = 0.005) and E’ wave (p < 0.001), tricuspid A’ wave (p = 0.03), ejection fraction (p = 0.03) and shortening fraction (p = 0.01) than the control patients. In contrast, the patients with JSpA had lower left ventricle MPI (p = 0.01) and the ratio of tricuspid E’/A’ waves (p = 0.05). Patients with enthesitis detected on magnetic resonance imaging had lower ejection fraction (p = 0.05), the ratio of E/A waves (p = 0.03) and had higher Mitral lateral A’ wave (p = 0.01) than those without. There was a significant inverse correlation between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and PW transmitral A velocity (r = −0.256, p = 0.03), the BASDAI score and tricuspid annular plane systolic excursion (r = −0.301, p = 0.04), the BASDAI score and the ratio of E/E' waves (r = −0.276, p = 0.02), and the Juvenile Spondyloarthritis Disease Activity Index and PW transmitral A velocity (r = −0.246, p = 0.04).

Conclusions
In this study, we report the possible early signs of RV diastolic dysfunction and possible association between magnetic resonance imaging–confirmed enthesitis and lower LV systolic functions. Early identification of cardiac dysfunctions can help with prevention of long-term cardiovascular complications.
Skin Manifestation Associated With Multicentric Reticulohistiocytosis
Authors: Yamamoto Toshiyuki 
Published: December 2020

Abstract
Multicentric reticulohistiocytosis (MRH) is a rare multisystem disorder, primarily affecting the skin and joints. As severe joint damage is a possible symptom, early diagnosis and therapeutic intervention are required. Cutaneous lesions present with characteristic features such as discrete reddish nodules, especially on acral locations. Additionally, the face, scalp, trunk and extremities are also affected. Xanthomatous plaques are also seen on the face. The cutaneous manifestations of MRH are various, which therefore should be differentiated from several diseases. In particular, MRH has been reported to assume clinical appearances resembling Gottron papules, periungual erythema, V-neck erythema, shawl sign, and poikiloderma associated with dermatomyositis. Histopathologic features show proliferation of multinucleated giant cells with abundant eosinophilic granular ground glass–like cytoplasm in the dermis. Multicentric reticulohistiocytosis is occasionally paraneoplastic and is associated with internal malignancies. The appropriate therapies are still challenging, and oral prednisolone, immunosuppressants, and recent biologics are used. In this article, cutaneous lesions, histopathology, and pathogenesis of MRH are mainly discussed from a dermatological perspective. It is important, not only for dermatologists but also for rheumatologists and orthopedists, to be able to distinguish between the various types of skin lesions brought on by MRH. Cutaneous signs are important diagnostic clues and assessment tools for therapeutic efficacy.