bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation-based training improves polypectomy skills among practicing endoscopists
Authors: Patel Ronak V. , Barsuk Jeffrey H. , Cohen Elaine R. , Wani Sachin B. , Rastogi Amit , McGaghie William C. , Wayne Diane B. , Keswani Rajesh N. , Komanduri Srinadh 
Published: November 2021

Abstract
Background and study aims Practicing endoscopists have variable polypectomy skills during colonoscopy and limited training opportunities for improvement. Simulation-based training enhances procedural skill, but its impact on polypectomy is unclear. We developed a simulation-based polypectomy intervention to improve polypectomy competency.
Methods All faculty endoscopists at our tertiary care center who perform colonoscopy with polypectomy were recruited for a simulation-based intervention assessing sessile and stalked polypectomy. Endoscopists removed five polyps in a simulation environment at pretest followed by a training intervention including a video, practice, and one-on-one feedback. Within 1–4 weeks, endoscopists removed five new simulated polyps at post-test. We used the Direct Observation of Polypectomy Skills (DOPyS) checklist for assessment, evaluating individual polypectomy skills, and global competency (scale: 1–4). Competency was defined as an average global competency score of ≥ 3.
Results 83 % (29/35) of eligible endoscopists participated and 95 % (276/290) of planned polypectomies were completed. Only 17 % (5/29) of endoscopists had average global competency scores that were competent at pretest compared with 52 % (15/29) at post-test (P = 0.01). Of all completed polypectomies, the competent polypectomy rate significantly improved from pretest to post-test (55 % vs. 71 %; P < 0.01). This improvement was significant for sessile polypectomy (37 % vs. 65 %; P < 0.01) but not for stalked polypectomy (82 % vs. 80 %; P = 0.70).
Conclusions Simulation-based training improved polypectomy skills among practicing endoscopists. Further studies are needed to assess the translation of simulation-based education to clinical practice.
Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey
Authors: Spinzi Giancarlo , Milano Angelo , Brosolo Piero , Da Massa Carrara Paola , Labardi Maurizio , Merighi Alberto , Riccardi Luisa , Torresan Francesco , Capelli Maurizio 
Published: November 2021

AbstractBackground and study aims Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points.Methods In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing.Results As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %).Conclusions Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.
Colon capsule endoscopy in colorectal cancer screening: Interim analyses of randomized controlled trial CareForColon2015
Authors: Deding Ulrik , Bjørsum-Meyer Thomas , Kaalby Lasse , Kobaek-Larsen Morten , Thygesen Marianne Kirstine , Madsen Jeppe Buur , Kroijer Rasmus , Baatrup Gunnar 
Published: November 2021

Abstract
Background and study aims The Danish CareForColon2015 trial, launched in 2020 as part of the Danish Colorectal Cancer Screening program, is the largest randomized controlled trial to date on colon capsule endoscopy (CCE). This paper presents the interim analysis with the objective of ensuring the safety of patients in the intervention group and evaluating the clinical performance of the trial’s predefined clinical parameters.
Patients and methods We evaluated the initial 234 CCEs according to quality, safety, and completion. The participation rates and preference distribution of all individuals invited were analyzed and sample size calculations were adjusted.
Results Fecal immunochemical test and diagnostic participation rates were 62.1 % and 91.1 %, respectively. The completion rate for CCEs was 67.9 % and the rate of conclusive investigations was 80.3 %. The polyp detection rate (PDR) was high (73.5 %), only two (0.85 %) technical failures in 234 videos were observed, and six suspected cancers were identified (2.6 %). No major adverse events were recorded. The required number of invitations had been underestimated due to inaccurate assumptions in sample size calculations.
Conclusions The trial was efficient and safe in terms of CCE quality and time to diagnostic investigation. Participation rates and PDRs were high. The proportion of suspected cancers was lower than expected and will be followed. The completion rate for CCEs was acceptable but lower than expected and the CCE procedure was reviewed for potential improvements and Resolor was added to the regime. The number of invitations for the intervention group of the trial has been adjusted from 62,107 to 185,153.
Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis
Authors: Rodríguez de Santiago Enrique , Sanchez-Vegazo Carlos Teruel , Peñas Beatriz , Shimamura Yuto , Tanabe Mayo , Álvarez-Díaz Noelia , Parejo Sofía , Kazuya Sumi , Marcos-Carrasco Natalia , Vazquez-Sequeiros Enrique , Inoue Haruhiro , Albillos Agustín 
Published: November 2021

Abstract
Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures.
Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data.
Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS.
Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.
Positive white nipple sign on esophageal varices: Not a just bystander; our experience
Authors: Prajhapati Ritesh , Sethia Mohit , Desai Pankaj , Kabrawala Mayank , Mehta Rajiv , Nandwani Subhash , Patel Chintan , Patel Nisharg 
Published: November 2021

Abstract
Background and study aims The goal of this study was to assess whether a white nipple sign on esophageal varices is of no prognostic significance or mandates more attention.
Patients and methods We retrospectively analyzed data from 2601 patients undergoing upper gastrointestinal endoscopy for variceal bleed from January 2008 to January 2020. Intraprocedural events like onset of active spurt while performing endoscopy, active spurt while attempting to band the varix with a nipple, need for rescue glue therapy required to control bleed in cases of failed endoscopic variceal ligation (EVL), slipping of band and rebleed despite successful band application, need for emergency intubation, and pulmonary aspiration-related complications were noted.
Results A total of 2601 patients underwent endoscopy for variceal bleeding. Of them, 631 had a positive white nipple sign. Of that subgroup, 137 (21.7 %) patients developed active spurt during endoscopy. In patients with the white nipple sign, 12.3 % required endotracheal intubation and 6.7 % developed aspiration pneumonia, which were significantly higher than in those without the sign. Rescue glue injection in esophageal varices was needed in 5.6 % as compared to 0.6 % in those without white nipple.
Conclusions The white nipple sign is not only a predictor of recent bleed, but it carries statistically significant increased risk of intraoperative bleeding, need for endotracheal intubation, esophageal glue injections, and aspiration-related complications. Therefore, it is not just a bystander, but rather, a sign of increased danger and a need to be more vigilant with patient management.
Dose estimates of occupational radiation exposure during radioguided surgery of Tc-99m-PSMA-labeled lymph nodes in recurrent prostate cancer
Authors: Schmidt Daniel , Grosse Jirka , Mayr Roman , Burger Maximilian , Hellwig Dirk 
Published: November 2021

Abstract
Aim [99mTc]Tc-PSMA-based radioguided surgery (TPRS) represents a curative approach for localized relapse of prostate cancer. For its simplified regulatory permission, the radiation protection authorities require a 99mTc- activity below the exemption limit of 10 MBq at the time of surgery. Our aim was to determine the optimal amount of radioactivity (OAR) to comply with that limit and to estimate the maximum number of TPRS procedures per year and surgeon without triggering the full monitoring obligations.
Methods In this retrospective study, a dose rate meter was calibrated using measurements on phantoms and from recently injected (1 min p. i.) patients to determine the activity in the patient from measured dose rates. The effective half-life of 99mTc-PSMA-I&S in patients was determined from repeated dose rate measurements to estimate dose parameters of relevance for radiation protection. External exposures of the surgeons were measured with personal dosimeters calibrated in Hp(10). The surgeon’s finger dose Hp(0.07) is estimated from radioactivity measured in resected lymph nodes. Potenzial incorporations were estimated for an activity of 10 MBq.
Results From the first 6 subsequent patients, an effective half-life of 4.15 h was observed. Assuming an operation time 24 h p. i., the OAR was 550 MBq. Operations lasting in average 2 h in a distance of 0.25 m to the patient imply a body dose for surgeons of 4.16 µSv per procedure. Based on these estimates, the surgeon’s Hp(10) is less than 1 mSv per year with up to 241 operations per year. Hp(0.07) and potential incorporation of activity do not lead to further limitations.
Summary All radiation protection regulations are met with adherence to OAR recommended here without triggering the full monitoring obligations from radiation protection regulations.
Die Autonomie von Rehabilitanden in der stationären
medizinischen Rehabilitation – Aspekte der Gefährdung und
Wahrung
Authors: Klemmt Malte , Henking Tanja , Neuderth Silke 
Published: November 2021

Zusammenfassung
Ziel der Studie Ziel der Studie ist die Identifizierung von Aspekten
innerhalb der stationären medizinischen Rehabilitation, die die
Autonomie von Rehabilitanden gefährden bzw. wahren können.
Methodik Durchgeführt wurde ein Scoping Review auf Basis des
aktuellen wissenschaftlichen Erkenntnisstandes. Das methodische Vorgehen
orientierte sich an den Vorgaben des Joanna Briggs Institute. Die Recherche und
Befundgenerierung wurden in Anlehnung an die PRISMA-ScR-Checklist
protokolliert.
Ergebnisse Der finale Studieneinschluss umfasst 39 empirische und
normativ-theoretische Beiträge. Autonomiegefährdende Aspekte
wurden den Bereichen: Rehabilitationssystem, Rehabilitationseinrichtungen,
Einrichtungspersonal, Rehabilitanden und Dritte zugeordnet. Aspekte, die die
Autonomie von Rehabilitanden potenziell wahren können, umfassen die
Bereiche: Rehabilitationseinrichtungen, Einrichtungspersonal, Konzepte und
Ausprägungsformen sowie Instrumente.
Schlussfolgerung Eine Vielzahl von heterogenen Aspekten kann die Autonomie
von Rehabilitanden während des Rehabilitationsaufenthaltes in der
stationären medizinischen Rehabilitation gefährden, aber auch
wahren bzw. fördern. Diese sind im gesamten Verlauf der rehabilitativen
Leistung angesiedelt und betreffen sowohl die strukturelle, organisationale als
auch die personale Ebene. Die Autonomie von Rehabilitanden sollte nicht nur als
Outcome der Rehabilitation, sondern auch als Anforderung an Strukturen und
Akteure während des Rehabilitationsaufenthaltes behandelt werden.
Rehabilitandenzufriedenheit in den sozialen Medien und auf
Online-Bewertungsportalen
Authors: Patzelt Christiane , Kiss Susann , Hopf Felix , Biedermann Irina , Schindler Anja , Emmert Martin , Sander Uwe 
Published: November 2021

Zusammenfassung
Ziel Rehabilitanden äußern sich zu ihrem
Rehabilitationsaufenthalt vermehrt im Internet, bewerten die Leistungserbringer
mit Sterneratings und schreiben Erfahrungsberichte. Bisher liegen keine
Erkenntnisse zur im Internet kommunizierten Rehabilitandenzufriedenheit
für die stationäre medizinische Rehabilitation in Deutschland
vor. Die Studie verfolgte erstmalig das Ziel einer systematischen Analyse der
Rehabilitandenzufriedenheit in den sozialen Medien und auf
Klinikvergleichsportalen.
Methoden Bewertungen zur Rehabilitation auf dem Portal
Klinikbewertungen.de und dem sozialen Netzwerk Facebook wurden für 8
Indikationsgruppen (Orthopädie, Psychosomatik/Psychotherapie,
Onkologie, Kardiologie, Neurologie, Innere Medizin,
Pneumologie/Dermatologie, Gastroenterologie) in einer Vollerhebung
über drei Jahre (10/2014–09/2017) für
federführend belegte Reha-Kliniken der Rentenversicherung
(N=497) erhoben. Zur Bestimmung der Rehabilitandenzufriedenheit wurden
die Sternebewertungen, aggregriert nach Indikationsgruppen, ausgewertet
(Chi-Quadrat-Test nach Pearson, Exakter Test nach Fisher, Phi-Koeffizient).
Ergebnisse Auf Klinikbewertungen.de waren 97,2% der Reha-Kliniken
mit 24 806 Bewertungen vertreten. Die am häufigsten bewerteten
Indikationsgruppen waren die Orthopädie (38,5%) und die
Psychosomatik/Psychotherapie (27,1%). Für Facebook
wurden Bewertungen (N=4127) zu Reha-Kliniken (38,6%) mit jeweils
einer Fachabteilung erfasst, um eine Indikationsgruppenzuordnung
sicherzustellen. Es wurden annährend gleich viele Bewertungen auf
offiziellen (48,7%) wie inoffiziellen Facebookseiten (51,3%)
ermittelt, wobei kein signifikanter Zusammenhang der Seitenverwaltung zur
Gesamtzufriedenheit bestand (p>0,05). Auf den Facebookseiten waren
49,1% der Bewertungen von Frauen (38,5% männlich;
12,4% nicht zuordenbar). Soziodemografische Angaben auf
Klinikbewertungen.de bezogen sich einzig auf den Versichertenstatus
(89,1% gesetzlich Versicherte). Die Bewertungen wurden zu 95,4%
von Rehabilitanden und 4,0% von Angehörigen verfasst.
77,5% der Rehabilitanden gaben eine Weiterempfehlung ab
(Angehörige: 37,2%). Die meisten Rehabilitandenbewertungen waren
positiv. Es zeigten sich Unterschiede in der Gesamtzufriedenheit zwischen den
Indikationsgruppen. Die Rehabilitanden in der Onkologie (77,9%) waren
zufriedener als in der Neurologie (59,0%).
Schlussfolgerung Online-Bewertungen über die stationäre
medizinische Rehabilitation konnten im erheblichen Umfang erhoben werden. Diese
fallen überwiegend positiv aus und sind mit Ergebnissen standardisierter
Befragungen vergleichbar. Trotz Einschränkungen bei der Nutzung von
Daten aus den sozialen Medien weisen die Ergebnisse darauf hin, dass das
öffentlich zugängliche zeitnahe Online-Feedback von
Rehabilitanden nützliche Informationen für das
Qualitätsmanagement der Kliniken sowie für Patienten in der
Wahrnehmung des Wunsch- und Wahlrechts haben kann.
Hypoehoic lesions on Transrectal Ultrasound and its correlation to Gleason grade in the diagnosis of Clinically Significant Prostate Cancer: A Prospective Study
Authors: Sharma Manas , Nerli Rajendra B. , Nutalapati Sree Harsha , Ghagane Shridhar C. 
Published: November 2021

AbstractContext The importance of hypoechoic lesions on transrectal ultrasound (TRUS) merits re-assessment in the present era of widespread prostate-specific antigen (PSA) testing.Aims We aimed to investigate the predictive accuracy of hypoechoic lesions on TRUS of prostate in the diagnosis of prostate cancer and to examine the association of hypoechoic lesions with the aggressiveness of prostate cancer.Settings and Design This prospective study was conducted in a tertiary care center in South India from November 2017 to December 2019.Methods and Material We included 151 patients undergoing TRUS-guided 12-core prostate biopsy in view of raised serum PSA with or without suspicious digital rectal examination (DRE) findings in the study. Age, DRE findings, serum PSA level, TRUS findings, and histopathology reports were documented. These were compared between patients with and without hypoechoic lesions on TRUS.Statistical Analysis Used The statistical analysis for this study was performed using SPSS v20.0 software.Results Among 151 men, prostate cancer was diagnosed in 68 (45.03%) with mean age at presentation 69.81 ± 6.49 years. Fifty-eight cases (38.41%) had hypoechoic lesion on TRUS and the cancer detection rate (68.96%) amongst this group was significantly higher than in those without hypoechoic lesion (p <0.0001). Patients with hypoechoic lesion were more likely to have higher grade cancer. Abnormal DRE findings and hypoechoic lesion on TRUS were independent predictors of a clinically significant cancer (p <0.05).Conclusion Hypoechoic lesion on TRUS can be considered as an indicator of clinically significant prostate cancer.
Epigenetic Approach to PTSD: In the Aspects of Rat Models
Authors: Aykac Asli , Kalkan Rasime 
Published: November 2021

AbstractPosttraumatic stress disorder (PTSD) is a stress-related mental disorder and develops after exposure to life-threatening traumatic experiences. The risk factors of PTSD included genetic factors; alterations in hypothalamic–pituitary–adrenal (HPA) axis; neurotrophic, serotonergic, dopaminergic, and catecholaminergic systems; and a variety of environmental factors, such as war, accident, natural disaster, pandemic, physical, or sexual abuse, that cause stress or trauma in individuals. To be able to understand the molecular background of PTSD, rodent animal models are widely used by researchers. When looking for a solution for PTSD, it is important to consider preexisting genetic risk factors and physiological, molecular, and biochemical processes caused by trauma that may cause susceptibility to this disorder. In studies, it is reported that epigenetic mechanisms play important roles in the biological response affected by environmental factors, as well as the task of programming cell identity. In this article, we provided an overview of the role of epigenetic modifications in understanding the biology of PTSD. We also summarized the data from animal studies and their importance during the investigation of PTSD. This study shed light on the epigenetic background of stress and PTSD.
Hypoalbuminemia Predicts Adverse Events following Unicompartmental Knee Arthroplasty
Authors: Hur Edward S. , Bohl Daniel D. , Della Valle Craig J. , Villalobos Felipe , Gerlinger Tad L. 
Published: November 2021

AbstractHypoalbuminemia is a potentially modifiable risk factor associated with adverse events following total knee arthroplasty. The present study aimed to evaluate whether hypoalbuminemia similarly predisposes to adverse events following unicompartmental knee arthroplasty (UKA). Patients who underwent UKA during 2006–2018 were identified through the American College of Surgeons National Surgical Quality Improvement Program. Only patients with preoperative serum albumin concentration were included. Outcomes were compared between patients with and without hypoalbuminemia (serum albumin concentration < 3.5 g/dL). All associations were adjusted for demographic, comorbidity, and laboratory differences between populations. A total of 11,342 patients were identified, of whom 6,049 (53.3%) had preoperative serum albumin laboratory values available for analysis. After adjustment for potential confounders, patients with hypoalbuminemia had a greater than 2-fold increased probability for occurrence of any complication (7.02% vs. 2.23%, p = 0.009) and a 4-fold increased probability of receiving a blood transfusion (1.81% vs. 0.25%, p = 0.045). Among procedures performed as inpatients, mean postoperative length of stay (LOS) was longer in patients with hypoalbuminemia (2.2 vs. 1.8 days; p = 0.031). Hypoalbuminemia is independently associated with complications and increased LOS following UKA and a marker for patients at higher risk of postoperative complications. Patients should be screened for hypoalbuminemia and nutritional deficiencies addressed prior to UKA.