bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multifaceted Quality Improvement Initiative to Reduce Unnecessary Laboratory Testing on Internal Medicine Inpatient Wards
Authors: Toman Inka , Mathura Pamela , Kassam Narmin 
Published: May 2020

BackgroundThe American and Canadian Choosing Wisely campaigns recommend against routine complete blood count (CBC) and chemistry testing in the face of clinical stability in the inpatient internal medicine setting.
ProblemPatients on internal medicine units commonly have daily lab tests ordered at admission and lab testing is often bundled. Four ‘core’ lab tests (CBC, electrolytes, creatinine, and urea) account for more than half of all lab tests performed.
MethodsThe Model for Improvement and the Donabedian framework was used to define the problem, evaluate the baseline state, and generate targeted improvements. A quality improvement (QI) initiative consisting of education and process change was implemented on one general internal medicine unit and multiple plan-do-study-act cycles were carried out. The outcome measure was the total number of core labs performed, and the process measure was the proportion of patients with tests ordered on a repeating daily basis.
ResultsThe initiative led to an 18.9% decrease in the total number of core labs ordered and an 18.2% absolute decrease in repeating daily lab orders.
ConclusionsA multifaceted QI initiative aimed at reducing unnecessary lab testing was successful at reducing the number of lab tests ordered and changing lab ordering process.
ResumeContexteLes campagnes américaine et canadienne “Choisir judicieusement” recommandent de ne pas effectuer de tests de routine de numération globulaire complète (CBC) et de chimie face à la stabilité clinique des patients hospitalisés en médecine interne.
ProblèmeLes patients des unités de médecine interne doivent généralement passer des examens de laboratoire quotidiens à l’admission et les analyses de laboratoire sont souvent regroupées. Quatre tests de laboratoire “de base” (NFS, électrolytes, créatinine et urée) représentent plus de la moitié de tous les tests de laboratoire effectués.
MéthodesLe modèle d’amélioration et le cadre donabédien ont été utilisés pour définir le problème, évaluer l’état de référence et générer des améliorations ciblées. Une initiative d’amélioration de la qualité (AQ) consistant en un changement d’éducation et de processus a été mise en œuvre dans une unité de médecine interne générale et plusieurs cycles “planifier-faire-étudier-agir” ont été réalisés. La mesure des résultats était le nombre total de laboratoires de base effectués, et la mesure des processus était la proportion de patients dont les tests commandés se répétaient quotidiennement.
RésultatsCette initiative a permis de réduire de 18,9 % le nombre total de laboratoires de base commandés et de 18,2 % en valeur absolue le nombre de commandes quotidiennes répétitives.
ConclusionsUne initiative d’AQ à multiples facettes visant à réduire les tests de laboratoire inutiles a permis de réduire le nombre de tests de laboratoire commandés et de modifier le processus de commande des laboratoires.
Primary Staphylococcus aureus Pericarditis
Authors: Aziz Haya , Bienz Marc , Esmaiel Abdullah , Thanassoulis George 
Published: May 2020

Bacterial pericarditis is a rare but fulminant disease that requires prompt diagnosis and management. It most commonly occurs from direct extension of an adjacent focus of infection or by hematogenous spread to the pericardium from more distant septic foci. Predisposing risk factors include immunosuppression, uremia, collagen vascular disease and thoracic surgery. We present the case of a 77-year-old gentleman with no previous pericardial disease who was diagnosed with primary Staphylococcus aureus pericarditis. The patient was treated with percutaneous pericardial effusion drainage and appropriate antibiotics resulting in complete resolution of his symptoms. This unusual case emphasizes that although it is frequently associated with significant morbidity and mortality, purulent pericarditis can present in a more indolent manner and in the absence of typical predisposing risk factors.
ResumeLa péricardite bactérienne est une maladie rare mais fulgurante qui nécessite un diagnostic et une prise en charge rapides. Elle survient le plus souvent dans le prolongement direct d’un foyer infectieux adjacent ou par propagation hématogène au péricarde à partir de foyers septiques plus éloignés. Les facteurs de risque prédisposants sont l’immunosuppression, l’urémie, les maladies vasculaires du collagène et la chirurgie thoracique. Nous présentons le cas d’un homme de 77 ans, sans antécédents de maladie péricardique, chez qui on a diagnostiqué une péricardite primaire à Staphylococcus aureus. Le patient a été traité par un drainage percutané d’effusion péricardique et des antibiotiques appropriés, ce qui a permis de résoudre complètement ses symptômes. Ce cas inhabituel souligne que, bien qu’elle soit fréquemment associée à une morbidité et une mortalité importantes, la péricardite purulente peut se présenter de manière plus indolente et en l’absence de facteurs de risque prédisposants typiques.
Efficacy of Self-Administration of a Personal Mechanical Eyelid Device for the Treatment of Dry Eye Disease, Blepharitis and Meibomian Gland Disease
Authors: Schanzlin David , Olkowski John , Coble John , Gross Wendy , Dash Michael 
Published: May 2020

PurposeA prospective study to evaluate the safety and efficacy of a novel mechanical eyelid device (NuLidsTM by NuSight Medical, LLC, Rancho Santa Fe, CA) used at home for the treatment of dry eye disease (DED), blepharitis (anterior and posterior) and meibomian gland disease (MGD).
MethodsSeventy-four (74) eyes of thirty-seven (37) patients were self-treated with the NuLidsTM device at home. Inclusion criteria included blepharitis, MGD and/or DED. After an initial training session, each eyelid was treated for 15 seconds (total of 1 minute per treatment session per day). The following tests were collected before the first treatment and after the final treatment: OSDI survey, BCVA, Tear Osmolarity Test (Tear Lab), Tear Break Up Time (TBUT), Meibomian Gland Score (MGS), Meibomian Glands Yielding Liquid Secre-tions (MGYLS), Sicca Ocular Staining Score. Satisfaction with treatment survey was taken after treatment.
ResultsAll measured parameters had a statistically significant improvement. Symptoms improved based on an average decrease in OSDI score from 54.2 ± 19.5 (mean ± SD) to 26.7 ± 18.4 (P < 0.001). Tear osmolarity improved from 315 ± 15.7 to 306 ± 13.9 (P = 0.002). TBUT was noted to improve from pre-treatment of 4.8 ± 1.7 seconds to post-treatment of 7.9 ± 4.1 seconds (P < 0.001). MGS improved from 8.9 ± 5.1 to 7.0 ± 5.9 (P = 0.01). MGYLS improved from 8.7 ± 6.2 to 15.8 ± 6.9 (P = 0.002). Sicca Ocular Staining Score improved from 2.7 ± 2.1 to 1.4 ± 1.5 (P = 0.002).There were no adverse events. No corneal or conjunctival trauma. No patients dropped out of the trial due to discomfort. 91% of participants agreed or strongly agreed that the device was easy and convenient to use. Of those previously using manual lid scrubs, 82% felt the NuLids device was easier and more comfortable to use. 89% described little or no discomfort. 95% were satisfied or very satisfied with the overall treatment.
ConclusionsA mechanical device was safely used by patients at home for 1 minute daily for 30 days to treat DED, blepharitis, and MGD. There was a statistically significant improvement in signs and symptoms of DED as shown by improved OSDI, tear osmolarity, TBUT, MGS, MGYLS, and Ocular Staining Score. High patient satisfaction along with the low risk of adverse events supports the use of this device as a valid tool to treat DED, blepharitis, and MGD.
Chronic Ocular Graft Versus Host Disease: An Update and Review
Authors: Bachman Groth Jane , Conto John , Pasquini Marcelo 
Published: May 2020

An updated comprehensive literature review was completed of chronic ocular graft versus host disease (oGVHD) to identify current and future considerations as to the causes, diagnosis, and treatment of this complication after allogenic hematopoietic cell transplantation (HCT). Graft-versus-host disease involves multiple organ systems, including the eye, and is a leading cause of mortality and morbidity in these patients. This review consisted a comprehensive search of the PubMed, ClinicalTrials.gov and NIH.gov databases.
oGVHD is a debilitating and potentially sight threatening condition. Commonly involved ocular structures include the cornea, conjunctiva, meibomian glands, eyelids, lacrimal gland and tear film. Identifying and treating the ocular complications at the early stages may improve final outcomes and quality of life in these patients. Aggressive lubrication, preservation of tear film and inflammation control, including minimizing surface scarring, are treatment goals. Co-management with HCT and other pertinent health care providers is critical for early diagnosis and to initiate prompt therapy to minimize the ocular damage. Stepped therapy, including the use of emerging systemic treatments can be useful in the management of oGVHD with stable visual function, quality of life and complication management as goals of treatment.
Gangrene of the Bladder
Authors: Britnell William , Hawthorne Rachel , Hadway Paul 
Published: May 2020

Gangrene of the bladder is fortunatley now very rare, with better obstetric care and the advent of the antibioic era. It can present fulminatly with bladder rupture, or less commonly with the sequelae of necrotic urothlium and detrusor causing recurrent episiodes of sepsis, urinary retention or catheter blockages. A high level of morbidity and mortality is associated with the condition. Case History We present a case of a 75 year old male with multiple co-morbidities, including diabetes and vascular disease, who presented to the urology team with recurrent episodes of sepsis and frequent blockage of his long term urethral catheter. After months of no catheter problems, he was admitted to intensive care with severe sepsis following a catheter blockage at home. After discharge he suffered multiple further episodes of urinary sepsis and catheter blockages, requiring almost daily catheter changes. After multiple imaging investigations looking for a source of the recurrent severe infections, a cystoscopy under general anaesthtic revealed a large volume of necrotic tissue in his bladder, which, on biopsy, was found to be sloughed urothelium and detrusor muscle consistent with recent gangrene of the bladder. No problems with the ctaheter were reported after the bladder washout and cystoscopic debridement Discussion The diagnosis of bladder gangrene was delayed becuase of the patients insideous presentation. Had the imaging investigations revelaed an associated bladder rupture when he intially presented to ITU , it is likley that the diagnosis and appropriate debridement would have been perfomed sooner. The patient required muliple readmissions with a blocked catheter before the diagnosis was made, but the eventual cystoscopic debridement was successful. Conclusion Clinicians should keep gangrene of the bladder on the list of differential diagnoses for recurrent catheter blockages, particularly if recognised risk factors have been present. These include a history of catheterisation, vascular disease, diabetes, recent critical illness requiring inotropes and urinary tract infections.
Self-Administered Intravesical Hyaluronic Acid Improves Symptoms and Quality of Life in a Patient-Centred Approach To Bladder Pain Syndrome Management
Authors: Kitchen Mark O. , Thursby Helen , Taylor Monica , Willard Kay , Mistry-Pain Tina 
Published: May 2020

Background and Objectives Bladder pain syndrome (BPS) is an uncommon and potentially debilitating spectrum of chronic pain typically accompanied by lower urinary tract symptoms. Intravesical hyaluronic acid (HA) is a commonly used treatment option, but requires multiple follow-up clinic appointments. We introduced a novel patient-led ‘at-home’ pathway of self-administered HA treatment to reduce the number hospital visits required by patients. We assessed and compared patient-reported outcome measures (PROMS) from patients receiving nurse-administered ‘in-hospital’ and patient-led self-administered ‘at-home’ intravesical HA (Cystistat® and Hyacyst®, respectively). Secondary outcome measures included differences between waiting times for treatment, frequency of treatments, number of clinician and nurse clinic appointments, and estimated financial costs. Patients and Methods Sixty consecutive patients commencing intravesical HA for BPS symptoms between 1st January 2016 and 31st March 2019 were included. O’Leary-Sant Interstitial Cystitis Symptom Index questionnaires were completed prior to, and following, six treatments. Relevant clinical and demographic data were also collected. Results Overall, 76.6% of the patients had improvement in symptoms after HA treatment. Mean O’Leary-Sant questionnaire symptom and problem scores were significantly improved following HA treatment (11.8 (range 6–17) to 8.5 (range 4–13) (p=0.00005) and 11.4 (range 4–16) to 7.9 (range 4–14) (p=0.0002), respectively. There were no significant differences in symptom improvements between patients on either pathway. Mean waiting time for treatment and number of treatments were lower in the patient-led pathway, and number of hospital visits was significantly lower in the patient-led at home pathway. The patient-led pathway could ‘save’ approximately 76 nurse clinic and 11 outpatient clinic appointments per year, and confer cost-savings of more than £1,500 per patient, per year. Conclusions Our case series analyses suggest that patient-led ‘at-home’ intravesical HA administration (Hyacyst®) is acceptable to patients and confers similar symptomatic benefit to ‘in-hospital’ nurse-led HA (Cystistat®). In addition, it appears that BPS sufferers established on the patient-led pathway require fewer HA treatments and fewer hospital visits, and as such, the patient-led pathway may also confer financial cost savings, and relieve some pressures on clinic appointment availability.
Endoluminal and Endoscopic Management of Urethral Stricture
Authors: Mak Martin SY , Tsu James HL , Lam Wayne 
Published: May 2020

Background and Objective Urethral stricture in the male population is one the oldest described urological condition. Significant vari-ability in clinical practice means that standardized management of urethral stricture remains controversial. Since the first description of modern-day direct visual internal urethrotomy (DVIU) by Sachse in 1974, this, alongside with various endoscopic treatment techniques, continues to be by far the most commonly performed procedures for the management of urethral strictures. This article aims to summarise and review the latest literature on endoscopic management of urethral strictures. Material and Methods We conducted a Pubmed and Medline search to identify publications related to endoscopic management of male urethral strictures between 1980 and 2019. Preference was given to recent and larger studies. Original research articles, review articles, abstracts, and opinion articles were included. Keywords used for the search were “male urethral stricture,” “urethrotomy,” “DVIU,” “urethral dilation,” “urethral stent”, “intermittent self-catheterisation”, “mitomycin C”, “steroids”, and “urethroplasty.” Recent Findings The long-term efficacy of endoscopic management of urethral stricture is poor. Recent novel advances with adjunct treatment have yet to demonstrate improvement in long-term treatment success. Repeated endoluminal or endoscopic treatments, especially for long and recurrent urethral strictures, are ineffective. They appear to delay patients from receiving definitive treatments, and potentially increase complexity and decrease the success rate of any future urethral reconstructive treatment. Summary There is overwhelming evidence to suggest limited long-term efficacy of endoluminal or endoscopic treat-ments for urethral stricture. Novel adjunctive therapies showed promising initial results, but none have yet to demonstrate durable efficacy. Endoscopic treatment of urethral stricture disease should only be reserved for patients who are not willing to undergo reconstructive surgery, or not fit for anesthetics.
Improving Written Communication Skills and Mathematical Disposition of Tenth Grade IPS 4 Students by Using Think-Talk-Write (TTW) Learning Strategy at SMAN 50 Jakarta
Authors: . Radiusman , Noornia A. , Ambarwati L. 
Published: May 2020

The aim of this research was to improve mathematical written communication and mathematical disposition of students by using think-talk-write (TTW) learning strategy in tenth grade IPS 4 students at SMAN 50 Jakarta 2017/2018 academic year. The design of this study was a classroom action research. The subject of this research consists of 6 students, 2 students with low written communication skills with moderate disposition skills, 2 students having medium-skilled and medium disposition ability and 2 students who have high disposition ability with medium and high disposition ability. The data collection techniques were consist of 1) Giving mathematics written communication ability test, 2) Spreading mathematic disposition questionnaire, 3) Doing filed notes, 4) Interviewing with the research subjects. The result was based on the end of the third cycle, it was obtained all subject experienced has increase in mathematical written communication ability and 4 out of 6 subjects experienced has increase in mathematical disposition ability. Based on the results, it can be concluded that the TTW learning strategy can increase mathematical written communication and mathematical disposition ability in tenth grade IPS 4 students at SMAN 50 Jakarta 2017/2018 academic year. In this research, an improvement made at the thinking stage was to write answers on the worksheet so that students will be more passionate about thinking of how to solve problems. On the talking stage, students were not only explaining completion but also helping team members who having difficulties. On the write stage, students could write the answer using their own phrase so that they will understand more about the completion based on observations and the results of questionnaires to increase the ability of mathematical disposition it can be seen that students experience increased self-confidence in explaining the ideas obtained, able to solve problems in various ways and have the willingness to solve mathematical problems. Besides, when the teacher asks students to re-examine the result of the work, it can be seen that students check their work while checking if there was a problem-solving problem.
Los conceptos sensibilizadores y el nuevo movimiento metateórico
Authors: Abreu Cláudio 
Published: May 2020

Resumen: La noción de concepto sensibilizador constituye una importante herramienta metateórica para entender el desarrollo del conocimiento sociológico. Empero puede aportar aún más a las discusiones metateóricas. La tesis que motiva este estudio es que la concepción de teoría que sirve de trasfondo para dichas discusiones limita su potencial. El objetivo del artículo es explicitar dicha limitación. La estrategia argumentativa será presentar las ventajas de adoptar una concepción contemporánea de teoría. Una vez expuesta la noción de concepto sensibilizador, serán presentadas las fases de desarrollo de la filosofía de la ciencia; dos concepciones de conceptos científicos, y las ideas básicas de la metateoría estructuralista, de ley fundamental de una teoría y de contrastación de dichas leyes. A partir de esto se realiza el análisis de la noción de concepto sensibilizador. Se concluye que, teniendo por trasfondo la metateoría estructuralista, la noción de concepto sensibilizador puede ser potencializada.
Mucocele of the middle turbinate: A rare entity
Authors: Gupta Nitin , Kalia Madhur , Dass Arjun , Singhal Surinder K 
Published: May 2020

Abstract

BACKGROUND. Mucocele is a benign expansile cyst-like lesion seen in the paranasal sinuses, which has a tendency to expand and erode the surrounding sinus walls. These mucoceles develop as a result of obstruction of the sinus ostium and superadded infection. As such, the frontoethmoidal area is the most common site, followed by the maxillary sinus and the sphenoid sinus. Rarely, mucocele may also develop in abnormally aerated bones, such as middle turbinate (concha bullosa), clinoid process and pterygoid process.

CASE REPORT. We report two infrequent cases of mucocele of concha bullosa, clinically presenting as the cause of nasal obstruction, which were completely removed endoscopically, and patients were symptomatically relieved.

CONCLUSION. Mucocele of the middle turbinate represents a diagnostic challenge to surgeons both in terms of symptoms and risk of complications. Therefore, the condition should be considered as a possible cause of progressive nasal obstruction by otolaryngologists, and careful examination of the nasal cavity is necessary to determine the existence of this rare condition.
WORK SHOP PENYUSUNAN AUTHENTIC ASESSMENT SEKOLAH DASAR BAGI GURU SD
Authors: Cahyono Anang Hadi , Sari Tita Tanjung 
Published: May 2020

Salah satu mandat dari kurikulum 2013 bagi guru adalah pelaksanaan authentic asessment atau penilaian menyeluruh yang mengakut domain kognitif, afektif, dan psikomotor. authentic asessment menilai anak seutuhnya dan menghargai segala kemampuan anak. Salah satu upaya untuk menyelesaikan permasalahan mitra sasaran adalah melalui kegiatan work shop authentic asessment Sekolah Dasar untuk guru SD di SDN Pangarangan III Sumenep.
Work shop authentic asessment Sekolah Dasar untuk guru SD di SDN Pangarangan III Sumenep dilakukan dengan metode praktik langsung oleh guru dibantu mahasiswa yang kebetulan tengah melakukan praktik pengenalan lapangan persekolahan (PLP II) di SD mitra. Melalui kegiatan pengabdian ini, guru di tawarkan cara mudah untuk menentukan indikator dan implementasi langsung di kelas.
Alasan utama mengapa guru banyak yang tidak melakukan authentic asessment adalah karena authentic asessment menuntut guru untuk lebih teliti dalam mengevaluasi kemampuan siswa secara menyeluruh dalam tiga domain kemampuan siswa, yaitu kognitif, afektif, dan psikomotor. Ketiga penilaian tersebut tentu saja memiliki indikator khasnya dan cara menyusunan masing-masing.
Pelaksanaan kegiatan PKM dilakukan dalam empat kali pertemuan, terdiri dari dua tahapan, yaitu tahap pertama adalah penyampaian materi authentic asessment dan tahap kedua praktik langsung penyusunan instrument authentic asessment Sedolah dasar di kelas masing-masing. Sesuai dengan yang telah di sepakati dengan kepala sekolah, bahwa work shop ini di laksanakan dengan terjun langsung ke kelas masing-masing di bantu oleh mahasiswa yang kebetulan melaksanakan praktik PLP II program studi PGSD. Sehingga tidak berupa ceramah, anjuran, dan contoh, tetapi langsung di praktikkan untuk menilai siswa di kelas. Sehinga kedua tahap tersebut dilakukan dalam satu waktu.